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PubMed1989

The dilemma of essential drugs in primary health care.

This article describes the evolution of essential drug programmes in eastern Africa from national donor assisted programmes to community-based drug programmes. Problems of the transition towards cost recovery are discussed and greater dialogue between government, donors and communities will be required if real community management is to be commenced.

Africa, Eastern↗
PubMed2004

Driving under the influence of khat--alkaloid concentrations and observations in forensic cases.

The use of the herbal stimulant khat (Catha edulis FORSK) is maintained by immigrants from countries where it is part of their cultural life (Arabian Peninsula and eastern Africa). In western countries the drug and its effects are largely unknown and no experience in evaluating impairment symptoms due to the khat-alkaloids, e.g. cathinone, cathine and norephedrine exists. Blood and urine samples from khat users involved in 19 cases of suspected driving under the influence of drugs were analysed and correlated with the results of medical examination and police officer reports. In 3 cases impaired driving and in 10 cases marked impairment of psychophysical functions was observed such as effects on the nervous system (slow pupil reaction to light, dry mouth, increased heart-rate), trembling, restlessness/nervousness, daze/apathy/dullness, impairment of attention, walking and standing on one leg. However, the alkaloid concentrations assayed in blood did not correlate with the impairment symptoms. Apart from an acute phase of indirect sympathomimetic action the development of habituation and withdrawal symptoms must also be considered in explaining the diversity of effects observed. From these results it can be concluded that chewing khat may severely impair driving ability, but may also be without noticeable effects.

Adult↗
PubMed2006

Dental metric comparisons of Morotopithecus and Afropithecus: implications for the validity of the genus Morotopithecus.

Morotopithecus bishopi and Afropithecus turkanensis are two large-bodied hominoid primates from early Miocene deposits of eastern Africa. Researchers have used both cranial and postcranial characters to distinguish these two species. Unfortunately, of the fossil material attributed to each, only the face, palate, and upper dentition are preserved well enough in both species for direct comparisons. There are currently no known directly comparable postcranial elements. In this study, we reevaluated dental characters argued to distinguish the type specimens of Morotopithecus from Afropithecus: relative size of the upper premolars and M3. Exact randomization methods were used to address two questions. First, is it possible to find the degree of dental-size difference observed between Morotopithecus (UMP 62-11) and Afropithecus (KNM-WK 16999) within extant African hominoids? Second, what is the probability of observing the levels of difference found between the fossils among pairs of extant individuals? Metric differences in relative premolar and M3 size were calculated between all possible pairs within the extant sample and the observed difference of the fossil pair was then compared to the resulting distribution of extant pairs. The observed size differences for all comparisons in the fossil teeth were well within the variation observed in the extant African hominoid samples (p>0.05). In light of these results and other currently available cranial evidence, we suggest that the type specimens of Morotopithecus and Afropithecus are not different enough to support taxonomic distinction.

Africa, Eastern↗
PubMed1999

Epidemiological uses of a population model for the tick Rhipicephalus appendiculatus.

The spatial and temporal risk of tick-borne disease depends fundamentally on the distribution, abundance and seasonal dynamics of the vector ticks. The latter factor exerts a major quantitative influence on the transmission dynamics of tick-borne parasites. The population model for Rhipicephalus appendiculatus applies throughout the range of this tick in eastern Africa, and predicts all three fundamental risk factors on the basis of the local temperature and rainfall conditions. Satellite imagery can provide more detailed, real-time measures of environmental conditions over extensive areas than climatic data. There is preliminary evidence to suggest that the population model could be driven by satellite-derived surrogates of its climatic predictors, thus providing wide-scale predictive risk maps of theileriosis.

Africa, Eastern↗
PubMed2003

Divergent selection during speciation of Lake Malawi cichlid fishes inferred from parallel radiations in nuptial coloration.

Repeated evolution of the same phenotypic difference during independent episodes of speciation is strong evidence for selection during speciation. More than 1,000 species of cichlids, >10% of the world's freshwater fish species, have arisen within the past million years in Lakes Malawi and Victoria in eastern Africa. Many pairs of closely related sympatric species differ in their nuptial coloration in very similar ways. Nuptial coloration is important in their mate choice, and speciation by sexual selection on genetically or ecologically constrained variation in nuptial coloration had been proposed, which would repeatedly produce similar nuptial types in different populations, a prediction that was difficult to test in the absence of population-level phylogenies. We measured genetic similarity between individuals within and between populations, species, and lake regions by typing 59 individuals at >2,000 polymorphic genetic loci. From these data, we reconstructed, to our knowledge, the first larger species level phylogeny for the most diverse group of Lake Malawi cichlids. We used the genetic and phylogenetic data to test the divergent selection scenario against colonization, character displacement, and hybridization scenarios that could also explain diverse communities. Diversity has arisen by replicated radiations into the same color types, resulting in phenotypically very different, yet closely related, species within and phenotypically highly similar yet unrelated sets of species between regions, which is consistent with divergent selection during speciation and is inconsistent with colonization and character displacement models.

Africa, Eastern↗
PubMed2002

Minimising antibiotic resistance to Staphylococcus aureus in developing countries.

OBJECTIVE: To assess the role of rational drug use and laboratory service in preventing the emergence of multiple antibiotic resistant Staphylococcus aureus in developing countries. DATA SOURCE: Literature search on compact disk-read only memory (CD-ROM) Medline and Internet using the key words: Staphylococcus and antibiotic resistance. A few articles were manually reviewed. STUDY SELECTION: Relevant studies or articles on antibiotic resistance with special reference to Eastern Africa, region are included in the review. DATA EXTRACTION: From individual studies or articles. DATA SYNTHESIS: Evidence for the spread of S. aureus multiple antibiotic resistance is synchronized under the headings: Introduction, current situation, antibiotic resistance control strategies, are outlined. CONCLUSION: There is need for concerted efforts between different groups to monitor changes in the epidemiology and antibiotic resistance of S. aureus. Strategies aimed at preventing transmission of resistant strains are remarkably effective when strictly enforced. Necessary attention should be given on the subject so that meaningful control measures preventing the expansion of antimicrobial resistance can be formulated, thereby ensuring the future successful treatment of Staphylococcal infections.

Africa, Eastern↗
PubMed1998

Mortality impact of the AIDS epidemic: evidence from community studies in less developed countries.

BACKGROUND: The AIDS epidemic is now more than a decade old and direct evidence of mortality impact has become measurable, as indicated by an increasing number of publications presenting empirical data from less developed countries. METHODS: This review focuses on the evidence of mortality impact among adults and children in community studies. The majority of these studies are located in Africa, particularly eastern Africa, where the AIDS epidemic is conjectured to be older than in other less developed countries. RESULTS: Community studies show a two- to threefold increase in total adult mortality with an even larger increase in mortality among young adults in communities with adult HIV prevalence levels below 10%. Mortality amongst HIV-infected adults ranges from 5 to 11% per year, and more than half of all adult deaths can be attributed to HIV. HIV-infected women die at an earlier age than men and thereby lose significantly more productive years of life. Follow-up studies of incident cases are few, but population-based data indicate that the median survival time is substantially longer than originally thought on the basis of mortality amongst HIV-infected commercial sex workers. Tuberculosis incidence is on the increase, but evidence of additional impact on mortality is hitherto limited. Infant and early child mortality among children of HIV-infected mothers is two to five times higher than among children of HIV-negative mothers in follow-up studies of maternity-based and community samples. CONCLUSION: There is now empirical evidence of the mortality impact of HIV/AIDS from several community studies. The large increase in adult mortality and moderate increase in child mortality lead to dramatic falls in life expectancy. For instance, in a rural area of Uganda, which has an HIV prevalence of 8%, life expectancy has dropped from just under 60 years to 42.5 years.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Contemporary African food habits and their nutritional and health implications.

Food is fundamental to human survival, in more than just one way. First, food is basic for averting hunger and maintaining health for every human being. Secondly, food satisfies our palate and makes us happy and emotionally and socially content. Third, food constitutes a form of cultural expression. The food we eat should be safe, palatable, affordable, and of the quality that can maintain mental, emotional, physiologic and physical health. Even with globalization that has seen food movements to and from different parts of the world, for most populations in Africa, food is still very locale-specific, especially in the rural farming areas where it is produced. Many locally produced foods have both nutritional and intrinsic value. The types of foods produced in Western Africa are very different from those produced in Eastern Africa. The staple foods, vegetables and the drinks that go with these foods are different. The way food is prepared is also very different in the two parts of Africa. Cultural specificity appears to be more pronounced in Western Africa, involving more secondary processing in the home and more spicing. Data linking food to health, as something that is understood by traditional communities is not easily available. This paper will collate information that discusses people's perceptions in both Western and Eastern Africa, and try to draw comparisons between the two. The paper presents a community picture of food, nutrition and health.

Africa, Eastern↗
PubMed1976

[World health-related indicators].

Many of the statistics given in this report are estimates based on tentative data and on that extent are not reliable in a strict sense. But the picture they present of gross differences in demographic and social characteristics, in vital statistics, and in resources of medical manpower and hospital beds between major areas of the world is real. More than half of the people of the world live in South Asia and East Asia; population density is highest in Western Europe; and highest rates of population growth are in Middle America and Tropical South America. In Europe less than one-third of the population are aged under 20 years, whereas more than half the population are aged under 20 im Middle and Tropical South America and the Carribbean, in Africa and in South Asia. Urbanization is high in Temperate South America, Northern America, Northern and Western Europe, and Oceania. The daily dietary energy supply per person is 50% higher in Northern America, Europe, USSR, and Ocenia than in Africa (excluding Southern Africa, South and East Asia. The Gross National Product in Northern America is 10 times higher than in Tropical South America and 30 to 40 times higher than in Western Middle and Eastern Africa and in Middle South and South East Asia. Crude birth rates are close to three times higher in Africa, Middle America and South Asia than in Europe, North America and USSR. Differences in crude death rates are less--rates in Western, Middle and Eastern Africa are double these of America Europe, USSR and Oceania. The Expectation of Life is over 70 years for Northern America, Europe, USSR and Oceania. It is under 50 years for Western, Middle and Eastern Africa. In all areas the expectation of life at birth has increased--by up to 10 years--in the past quarter century. Infant mortality is less than 20 per 1 000 in Northern and Western Europe and Northern America. It is over 100 in Africa and South Asia. Number of physicians range from 25 per 10 000 population in USSR to less than 1 per 10 000 in Western, Middle and Eastern Africa. There are over 100 hospital beds per 10 000 population in USSR and in Northern and Western Europe, less than 10 per 10 000 in Western Africa, Middle South Asia and South East Asia.

Age Factors↗
PubMed1999

Plague epidemiology and control in eastern and southern Africa during the period 1978 to 1997.

Human plague is one of the important re-emerging zoonotic diseases threatening public health in some African, Asian and South American countries. During the period 1978 to 1997, Africa reported the largest numbers of plague cases and deaths in the world. During the decade 1978 to 1987, 19 countries reported 10 537 cases. Ten of the countries and 41.9% of the reported cases were in Africa. At least 14.5% of the cases reported in Africa died. Similarly, during the decade 1988 to 1997, 22 countries, 12 of which were in Africa, reported a total of 17,674 cases and 1,465 deaths. Of these, 11,711 cases of which 9.6% died, were reported from Africa.

Africa, Eastern↗
PubMed2006

Whole-mtDNA genome sequence analysis of ancient African lineages.

Studies of human mitochondrial (mt) DNA genomes demonstrate that the root of the human phylogenetic tree occurs in Africa. Although 2 mtDNA lineages with an African origin (haplogroups M and N) were the progenitors of all non-African haplogroups, macrohaplogroup L (including haplogroups L0-L6) is limited to sub-Saharan Africa. Several L haplogroup lineages occur most frequently in eastern Africa (e.g., L0a, L0f, L5, and L3g), but some are specific to certain ethnic groups, such as haplogroup lineages L0d and L0k that previously have been found nearly exclusively among southern African "click" speakers. Few studies have included multiple mtDNA genome samples belonging to haplogroups that occur in eastern and southern Africa but are rare or absent elsewhere. This lack of sampling in eastern Africa makes it difficult to infer relationships among mtDNA haplogroups or to examine events that occurred early in human history. We sequenced 62 complete mtDNA genomes of ethnically diverse Tanzanians, southern African Khoisan speakers, and Bakola Pygmies and compared them with a global pool of 226 mtDNA genomes. From these, we infer phylogenetic relationships amongst mtDNA haplogroups and estimate the time to most recent common ancestor (TMRCA) for haplogroup lineages. These data suggest that Tanzanians have high genetic diversity and possess ancient mtDNA haplogroups, some of which are either rare (L0d and L5) or absent (L0f) in other regions of Africa. We propose that a large and diverse human population has persisted in eastern Africa and that eastern Africa may have been an ancient source of dispersion of modern humans both within and outside of Africa.

Base Sequence↗