An outbreak of Rift Valley Fever, eastern Africa, 1997-1998.
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Adolescent↗
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Results for “AFRICA, EASTERN”
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[Features of the course and treatment of several eye diseases in Eastern Africa].
Ophthalmologist with a 4-year history (1993-1997) of practice at the Russian Red Cross Hospital in Addis Ababa (Ethiopia) shares his experience. More than 30,000 patients were examined and treated. Interesting cases are described: cytomegalovirus retinitis in the presence of AIDS, AIDS-associated involvement of the eyes (uveitis, keratitis, Kaposi's sarcoma), herpes zoster involvement of the eyes, phlyctenar keratoconjunctivitis, vernal conjunctivitis, trachoma, diseases of the eyes concomitant with syphilis, a case with Vogt-Koyanagi-Harada. Clinical course and therapy of these diseases under local conditions are described.
Acquired Immunodeficiency Syndrome↗
Evidence for extensive genetic differentiation among populations of the malaria vector Anopheles arabiensis in Eastern Africa.
We describe the geographical population structure of the malaria vector Anopheles arabiensis in Eastern Africa. Allelic variation at eight microsatellite loci was scored in samples from nine localities along a 4500 km transect from Sudan to Mozambique. Highly significant differences in genotype frequencies were found between all populations separated by more than 200 km. Populations within Malawi separated by 191 km were indistinguishable, as were those within Sudan separated by 134 km. FST and rhoST gave significant estimates of isolation by distance. These data, lead us to conclude that there are extensive barriers to gene flow in this region. The high estimates of Nm (9.4 from FST and 5.2 from rhoST) indicate recent range expansion in this species rather than extensive contemporary gene flow.
Africa, Eastern↗
Surgical operations in eastern Africa: a review with conclusions regarding the need for further research.
This review of surgical ouput in eastern Africa and other developing countries, is based mainly on published, and to a small extent, on unpublished sources, such as hospital annual reports. It is noted that poorly standardized classification of surgical operations is a problem in recording and reporting, and that one internationally agreed classification would be useful in comparative studies. Rates of major surgical operations in sub-Saharan Africa are 70-500 per 100,000 population per year with inguinal hernia repair, caesarean section, hydrocele operation and surgical management of injuries as the most common major operations. There are large variations between hospitals. Corresponding figures in high-income industrialized countries are 5,000-9,000. Data on minor surgery at hospitals are scarce, but figures from a few African hospitals are presented. Almost nothing is known about minor surgery performed at health centres and dispensaries or about surgical cases referred to hospital, and population-based rates of minor surgery cannot therefore be calculated. Resources are scarce, but can be more effectively utilized. Further research should include: (a) population-based output of major and minor operations in different countries and regions; (b) outcome after a few selected operations, preferably selected in consultation with researchers studying medical care outcome in other countries; (c) availability and use of surgery-related resources such as manpower, equipment and supplies; and (d) assessment of needs for surgery using household health survey methods.
Africa, Eastern↗
Status of polio eradication in the seven countries of the Eastern Africa Epidemiological Block.
The progress that Burundi, Eritrea, Kenya, Rwanda, Tanzania, Uganda, and Zambia, the seven countries of the Eastern Africa Epidemiological Block (EAEB), have made toward polio eradication is summarized. Despite low per capita gross national product, poor infrastructure (especially for communication and transportation), and civil unrest, the EAEB has made significant progress toward polio eradication. Five of the seven countries have achieved high levels of routine coverage with at least three doses of oral polio vaccine. Virologic surveillance is established in Tanzania, Uganda, Zambia, and Kenya; will be established in Eritrea in 1997; and will be resumed in Rwanda as soon as civil unrest abates. Political support for polio eradication is strong in the region, and all of the EAEB countries, except Burundi, held either national or subnational immunization days in 1996.
Adolescent↗
Chloroplast DNA variation and the recent radiation of the giant senecios (Asteraceae) on the tall mountains of eastern Africa.
Chloroplast DNA restriction-site variation was surveyed among 40 accessions representing all 11 species of giant senecios (Dendrosenecio, Asteraceae) at all but one known location, plus three outgroup species. Remarkably little variation (only 9 variable sites out of roughly 1000 sites examined) was found among the 40 giant senecio accessions, yet as a group they differ significantly (at 18 sites) from Cineraria deltoidea, the closest known relative. This pattern indicates that the giant senecios underwent a recent dramatic radiation in eastern Africa and evolved from a relatively isolated lineage within the Senecioneae. Biogeographic interpretation of the molecular phylogeny suggests that the giant senecios originated high on Mt. Kilimanjaro, with subsequent dispersion to the Aberdares, Mt. Kenya, and the Cherangani Hills, followed by dispersion westward to the Ruwenzori Mountains, and then south to the Virunga Mountains, Mt. Kahuzi, and Mt. Muhi, but with dispersion back to Mt. Elgon. Geographic radiation was an important antecedent to the diversification in eastern Africa, which primarily involved repeated altitudinal radiation, both up and down the mountains, leading to morphological parallelism in both directions. In general, the plants on a given mountain are more closely related to each other than they are to plants on other mountains, and plants on nearby mountains are more closely related to each other than they are to plants on more distant mountains. The individual steps of the geographic radiation have occurred at various altitudes, some clearly the result of intermountain dispersal. The molecular evidence suggests that two species are extant ancestors to other species on the same or nearby mountains.
Africa, Eastern↗
Coastal aquaculture development in eastern Africa and the Western Indian Ocean: prospects and problems for food security and local economies.
This paper reviews the experience and status of coastal aquaculture of seaweeds, mollusks, fish and crustaceans in eastern Africa and the islands of the western Indian Ocean. In many respects, coastal aquaculture is still in its infancy in the region, and there is a pressing need to formulate development strategies aimed at improving the income and assuring the availability of affordable protein to coastal communities. This paper also draws from positive and negative experiences in other parts of the world. The requirements of feed and fry, and the conversion of mangroves are used to illustrate how some aquaculture activities constitute a net loss to global seafood production. The paper presents both general and specific sustainability guidelines based on the acknowledgement of aquaculture as an ecological process. It is concluded that without clear recognition of its dependence on natural ecosystems, the aquaculture industry is unlikely to develop to its full potential in the region.
Africa, Eastern↗
Community health in eastern Africa--and the East African Medical Journal's contribution over seventy years.
The East African Medical Journal which started in 1923 has now reached its 70th year. To what extent has the journal focused the attention of policy and decision makers on the most relevant problems of and solutions for Community Health in Eastern Africa? To answer this question this paper surveys the Journal's publications on Community Health in four eras into which the 70 years can be subdivided. It then tries to match these publications with what has been happening in the political field and in the development of health services related to community health. The conclusion is that the journal has, in this geographical region, been keeping pace with important trends and has been a stimulus to the development of improved and more relevant services for communities. Although the predominant focus has often been on publications based on clinical research in hospital settings, it is hoped that the journal will step up even further its publication of papers related to community health and Primary Health Care. By doing so it can make an even greater contribution to the health and well being of the populations of Eastern Africa and not just to the care of individuals who gain access to medical institutions.
Community Medicine↗
Progress toward poliomyelitis eradication--Eastern Africa, 1988-1995.
In 1988, the World Health Assembly established the goal of eradicating poliomyelitis by the year 2000. Commitment to this goal and to the strategies that have proven effective in other regions was reaffirmed in 1995 by the African Regional Health Committee and in 1996 by heads of state attending the Organization of African Unity Summit. These strategies include 1) achieving and maintaining high vaccination coverage among children aged < 1 year with at least three doses of oral poliovirus vaccine (OPV) through routine vaccination services; 2) establishing effective epidemiologic and laboratory surveillance systems, with examination of stool specimens from suspected cases of polio; and 3) providing supplemental vaccination through National Immunization Days (NIDs) to interrupt wild poliovirus transmission. This report summarizes progress toward polio eradication since 1988 in the seven countries (Burundi, Eritrea, Kenya, Rwanda, Tanzania, Uganda, and Zambia) of the Eastern Africa Epidemiological Block (EAEB) of the African Region (AFR) of the World Health Organization (WHO) (Figure 1). Implementation of these polio-eradication strategies is proceeding rapidly; however, overall surveillance capacity in the EAEB is not yet adequate and requires strengthening.
Africa, Eastern↗
Antibiotic resistance pattern of Vibrio cholerae and Shigella causing diarrhoea outbreaks in the eastern Africa region: 1994-1996.
Between March 1994 and December 1996, 1797 rectal swabs were transported to the AMREF laboratory from sites in six countries in the eastern Africa region: 1749 were cultured for Vibrio cholerae and 48 for Shigella/Salmonella. Culture, isolation, identification and antibiotic susceptibility testing were performed using standardized techniques. The isolates were categorized as sensitive or resistant based on standardized zones of inhibition. The rate of isolation of V. cholerae from rectal swabs increased progressively from less than 20% to more than 45% between 1994 and 1996, 80-100% of isolates of V. cholerae from Kenya and south Sudan, and 65-90% from Somalia were sensitive to tetracycline, although in 1995 isolates from Mogadishu showed only 44% sensitivity. All isolates from Tanzania and Rwanda were 100% resistant to tetracycline. In Kenya and Somalia, the percentage of isolates sensitive to chloramphenicol and cotrimoxazole reduced markedly from 85% in 1994 to < 10% in 1996. 100% of isolates from Rwanda and Tanzania were resistant to chloramphenicol and cotrimoxazole while in south Sudan > 70% of isolates were sensitive. Nalidixic acid and erythromycin retained > 75% sensitivity in all areas. Shigella dysenteriae and Shigella flexneri were recovered from dysentery specimens in northern Kenya. Both species showed similar antibiotic sensitivity patterns and were sensitive only to nalidixic acid and furazolidone. Due to variations of resistance patterns within countries in the region, antibiotic sensitivity testing should be performed at the start of an outbreak, and antibiotic use should be restricted to severe cases of V. cholerae and Shigella infection.
Africa↗
Tectonic uplift and Eastern Africa aridification.
The history of Eastern African hominids has been linked to a progressive increase of open grassland during the past 8 million years. This trend was explained by global climatic processes, which do not account for the massive uplift of eastern African topography that occurred during this period. Atmosphere and biosphere simulations quantify the role played by these tectonic events. The reduced topographic barrier before 8 million years ago permitted a zonal circulation with associated moisture transport and strong precipitation. Our results suggest that the uplift itself led to a drastic reorganization of atmospheric circulation, engendering the strong aridification and paleoenvironmental changes suggested by the data.
Journal Article↗
A PCR system for detection of species and genotypes of the Echinococcus granulosus-complex, with reference to the epidemiological situation in eastern Africa.
We describe the development of a specific and sensitive PCR/semi-nested PCR system for the rapid diagnosis of Echinococcus granulosus genotype G1, E. granulosus genotype G6/7, and Echinococcus ortleppi (G5). Diagnosis of G1 and the group G5/6/7 is performed by a simple PCR, while discrimination between E. ortleppi (G5) and G6/7 involves a subsequent semi-nested PCR step. The target sequence for amplification is part of the mitochondrial 12S rRNA gene. Specificity of the PCRs was 100% when evaluated with isolates of 16 species of cestodes, including Echinococcus multilocularis, Echinococcus equinus, E. ortleppi and three strains of E. granulosus (G1, G6 and G7). Sensitivity threshold was 0.25pg of DNA. This new approach was compared with published protocols of restriction fragment length polymorphism-PCR and sequencing of mitochondrial cytochrome c oxidase subunit 1 and NADH dehydrogenase 1 genes using Echinococcus isolates of human, sheep, goat, camel, cattle and pig origin from Kenya and Sudan. Additionally, two internal DNA probes were developed, one hybridising only with G1, the other with G5, G6 and G7 amplification products. Preliminary epidemiological results obtained with this PCR approach include the detection of a camel strain (G6) infection for the first time in a human patient from eastern Africa, and the first reports of E. ortleppi (G5) in livestock from Kenya and the Sudan.
Animals↗
Methods for diagnosing tuberculosis among in-patients in eastern Africa whose sputum smears are negative.
SETTING: Two University hospitals in Eastern African capital cities where large prospective studies had been carried out on hospitalized patients to determine the cause of their respiratory diseases. OBJECTIVE: To identify features that differentiated between tuberculosis (TB) and non-tuberculous respiratory disease (non-TB) in hospitalized patients from Bujumbura, Burundi (n = 111) and Dar es Salaam, Tanzania (n = 71) whose sputum smears were negative on microscopic examination for acid-fast bacilli (AFB). DESIGN: Review of clinical findings, radiologic abnormalities, and laboratory test results from 182 patients, first by univariate and then by multivariate (stepwise logistic regression) analysis to assess the contribution of each factor to the final diagnosis. RESULTS: Of the 182 patients with two or more negative AFB smears, 41 had TB and 141 had non-TB. Stepwise regression analysis revealed four easily ascertained symptoms were associated with TB: 1) cough > 21 days; 2) chest pain > 15 days; 3) absence of expectoration; and 4) absence of shortness of breath. Any two of the four diagnosed TB with 85% sensitivity and 67% specificity; any three of the four with 49% sensitivity and 86% specificity. Multivariate analysis showed that adding lymphadenopathy and hematocrit < 30% improved discrimination. CONCLUSION: This methodological approach provides a means for diagnosing TB among all AFB smear-negative hospitalized patients. In this setting, simple clinical symptoms alone are helpful. Similar studies are needed to develop a system for out-patient TB suspects.
Adolescent↗
Transmission of extended spectrum β-lactamase-producing Escherichia coli and antimicrobial resistance gene flow across One Health compartments in eastern Africa: a whole-genome sequence analysis from a prospective cohort study.
BACKGROUND: The One Health paradigm considers interdependence of human, animal, and environmental health. However, there is little evidence from high-income countries to support the importance of a One Health approach to addressing spread of antimicrobial resistance (AMR). Given AMR is a global threat, understanding how the close interactions of humans with animals and the environment in low-income settings affect the spread of AMR is important. We aimed to investigate diversity and transmission of extended spectrum β-lactamase (ESBL)-producing Escherichia coli across household-linked One Health compartments using genomic data. METHODS: We sequenced whole genomes of ESBL-producing E coli isolates from humans, animals, and the environment from a prospective, longitudinal cohort study conducted in Malawi (April 29, 2019, to Dec 3, 2020) and Uganda (July 16, 2020, to Aug 6, 2021). In the cohort study, 259 households were enrolled at baseline in Malawi and 92 in Uganda from a mix of urban, peri-urban, and rural areas. Households were followed up at months 1, 3, and 6 in Malawi and at months 1, 2, and 4 in Uganda. Samples collected at each visit included human and animal stool, environmental samples from hand-contact areas, food, and water, and broader environmental samples such as river water. Samples were cultured in buffered peptone water and then ESBL chromogenic agar to isolate ESBL-producing E coli. ESBL-producing E coli isolates underwent whole-genome sequencing. We performed phylogenetic analyses, and in-silico multi-locus sequence typing, characterised AMR determinants and linked genotypes with sample location, ecological source, and other covariates. We performed fine-scale single nucleotide polymorphism (SNP) and network analysis to infer strain and plasmid transmission across ecological compartments. The primary outcome was colonisation with ESBL-producing E coli. Secondary outcomes were genomic clusters and ESBL genomic determinants within and between One Health compartments. FINDINGS: We found high diversity of ESBL-producing E coli, with 170 sequence types and 166 genomic clusters identified from 2344 genomes, including 1814 genomes from Malawi (907 human, 221 animal, and 686 environmental) and 530 genomes from Uganda (380 human, 147 animal, and three environmental). Sequence type (ST)131 dominated in Malawi (209 [11·5%] of 1814 genomes), and ST10 dominated in Uganda (45 [8·5%] of 530 genomes). Common ESBL genes blaCTX-M-15 (1604 [68·4%] of 2344 genomes) and blaCTX-M-27 (336 [14·3%] of 2344 genomes) were carried on a complex network of 55 and 30 different plasmids. This diversity of plasmids presented multiple pathways for dissemination and revealed high force of selection. Phylogenetic analyses revealed common intermixing of isolates between humans, animals, and the environment. SNP transmission analysis revealed ecologically overlapping clusters, suggesting ESBL-producing E coli co-circulation both within and between compartments with frequent spillover events. Applying a five-SNP threshold, we inferred 463 human-environment transmission events, 146 human-animal events, and 142 animal-environment events. INTERPRETATION: Our work suggests that a One Health approach is crucial to addressing AMR in eastern Africa. Improving water, sanitation, and hygiene systems will create a safer environment, reduce spillovers of AMR bacteria between compartments, and eventually reduce AMR reservoirs in the environment and in animals. FUNDING: Medical Research Council, National Institute for Health and Care Research, and Wellcome Trust.
Humans↗
Postneonatal and child mortality among twins in Southern and Eastern Africa.
BACKGROUND: Few studies have evaluated the difference in mortality between twins and singleton children during the postneonatal and childhood period in sub-Saharan Africa. The aim of this study was to quantify the excess mortality of twins during the postneonatal and childhood period and to identify factors that contribute to the excess mortality among twins. The different use made of health care services was hypothesized to contribute to the increased mortality. METHODS: The Demographic and Health Survey data on Malawi, Tanzania and Zambia were pooled. Logistic regression was used to estimate twin/singleton differences for the combined postneonatal and child mortality and to study the role of intermediate factors and effect modifiers. RESULTS: The study was based on 18 214 singleton children and 706 twins. The twin/ singleton odds ratio (OR) of the combined postneonatal and child mortality was 2.33 (95% CI : 1.85-2.93). This excess mortality was largest during the first year of life. Control for intermediate factors (preventive health care and breastfeeding) did not sizeably diminish the mortality difference. Effect modifiers that were associated with increased twin/singleton OR were male sex, unwanted child, short birth interval and low socioeconomic status. CONCLUSIONS: The excess mortality of twins compared to singletons is considerable. A difference in use of preventive health care or in breastfeeding cannot explain the increased mortality. Males, unwanted children, those born after a short birth interval and the socioeconomically disadvantaged are at special risk. The generally good attendance at under-5 clinics gives health care providers the opportunity for increased surveillance of these high-risk groups.
Adolescent↗
NAUDE versus Whittle in the Supreme Court of South Africa (Eastern Districts Local Division).
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Humans↗
mtDNA sequences of Chadic-speaking populations from northern Cameroon suggest their affinities with eastern Africa.
BACKGROUND: No mitochondrial DNA (mtDNA) sequences from Chadic-speaking peoples have yet been reported, even though these populations inhabit a vast territory from eastern Nigeria to central Chad. This paper deals with the mtDNA sequences of four Central Chadic populations (Hide, Kotoko, Mafa and Masa) from northern Cameroon, biological samples from which were collected during anthropological research in the area of their homeland. OBJECTIVE: The main goals of this article are to report new mtDNA sequences of Chadic-speaking populations, to analyse their genetic diversity and to establish their relationships within the peri-Saharan area in respect of geography and languages. SUBJECT AND METHODS: The analyses are based on 104 mtDNA haplotypes, which can be localized into four different areas of northern Cameroon. Data collection was based on a strict geographical sampling strategy; the ethnonyms are retained here only for comparative purposes. RESULTS: None of the examined Chadic populations displays a departure from the normal mismatch distribution pattern, and the null hypothesis of the expansion event cannot be rejected. Analyses of molecular variance and F(ST) genetic distances revealed that the Chadic-speaking groups of northern Cameroon share more similarities with the populations of the Upper and Middle Nile Valley and East Africa than with populations from Central Africa. The results show geographical clustering to be more important than the correlation of linguistic affiliations with molecular genetic data. CONCLUSION: The observation that the Chadic group reveals some affinities to East Africans is extremely surprising giving the present-day geographical distance (around 2000 km) between them. These observations complement recent linguistic and archaeological findings, which consider the Chadic branch in the Afro-Asiatic phylum to be of eastern origin. A continuous, well-defined, geographic sampling strategy of the different genetic polymorphisms of the native populations of sub-Saharan Africa is further needed as the only way of understanding the differentiation of the mtDNA sequences at a micro-regional scale.
Africa↗
Genetic diversity and evolution of Mycoplasma capricolum subsp. capripneumoniae strains from eastern Africa assessed by 16S rDNA sequence analysis.
Mycoplasma capricolum subsp. capripneumoniae (M. capripneumoniae), the causal agent of contagious caprine pleuropneumonia (CCPP), is a member of the so-called Mycoplasma mycoides cluster. These mycoplasmas have two rRNA operons in which intraspecific variations have been demonstrated. The sequences of the 16S rRNA genes of both operons from 13 field strains of M. capripneumoniae from three neighbouring African countries (Kenya, Ethiopia, and Tanzania) were determined. Four new and unique polymorphism patterns reflecting the intraspecific variations were found. Two of these patterns included length differences between the rrnA and rrnB operons. The length difference in one of the patterns was caused by a two-nucleotide insert (TG) in the rrnB operon and the length difference in the other pattern was due to a three-nucleotide deletion, also in the rrnB operon. Another pattern was characterised by a polymorphic position caused by a mutation that is known to cause streptomycin resistance in other bacterial species. The strain with this pattern was also found to be resistant to streptomycin. Streptomycin resistant clones were selected from four M. capripneumoniae strains to further investigate the correlation of this mutation to streptomycin resistance. Mutations in the 16S rRNA genes had occurred in two of these strains. The fourth pattern included a new polymorphism in position 1059. The results show that polymorphisms in M. capripneumoniae strains can be used as epidemiological markers for CCPP in smaller geographical areas and to study the molecular evolution of this species.
Animals↗