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PubMed2000

Global malnutrition.

The four most important forms of malnutrition worldwide (protein-energy malnutrition, iron deficiency and anaemias (IDA), vitamin A deficiency (VAD), and iodine deficiency disorders (IDD)) are examined below in terms of their global and regional prevalences, the age and gender groups most affected, their clinical and public health consequences, and, especially, the recent progress in country and regional quantitation and control. Zinc deficiency, with its accompanying diminished host resistance and increased susceptibility to infections, is also reviewed. WHO estimates that malnutrition (underweight) was associated with over half of all child deaths in developing countries in 1995. The prevalence of stunting in developing countries is expected to decline from 36% in 1995 to 32.5% in 2000; the numbers of children affected (excluding China) are expected to decrease from 196.59 millions to 181.92 millions. Stunting affects 48% of children in South Central Asia, 48% in Eastern Africa, 38% in South Eastern Asia, and 13-24% in Latin America. IDA affects about 43% of women and 34% of men in developing countries and usually is most serious in pregnant women and children, though non-pregnant women, the elderly, and men in hookworm-endemic areas also comprise groups at risk. Clinical VAD affects at least 2.80 million preschool children in over 60 countries, and subclinical VAD is considered a problem for at least 251 millions; school-age children and pregnant women are also affected. Globally about 740 million people are affected by goitre, and over two billions are considered at risk of IDD. However, mandatory salt iodisation in the last decade in many regions has decreased dramatically the percentage of the population at risk. Two recent major advances in understanding the global importance of malnutrition are (1) the data of 53 countries that links protein-energy malnutrition (assessed by underweight) directly to increased child mortality rates, and (2) the outcome in 6 of 8 large vitamin A supplementation trials showing decreases of 20-50% in child mortality.

Adolescent↗
PubMed2001

The duality of sleeping sickness: focusing on sleep.

Sleeping sickness, once under control, is a re-emergent endemic parasitic disease in intertropical Africa. Its originality resides in its duality. Two trypanosome groups (Trypanososma brucei gambiense vs.rhodesiense ) are transmitted to humans by tsetse flies from two geographical areas (Western and Central Africa humid forest vs. Eastern Africa arboreous savannah), provoking a slowly or a rapidly evolutive disease. The two stage (haemolymphatic vs. neurological invasion) pathogenic evolution leads to the duality of the immune response, depending on the host-parasite inter-relation differences in the blood and the brain. In the blood, the immune processes involved are both specific (anti-variant surface glycoprotein (VSG) antibodies) and non-specific (complement-mediated lysis, opsonification-facilitated phagocytosis and antibody dependent cell-mediated cytotoxicity). Although macrophages are activated in the blood and infiltrate the brain, nitric oxide decreases in the blood and increases in the brain, with a breakage in the blood-brain barrier, leading to brain lesions through the production of deleterious molecules. Prophylactic means are affected by the duality of pathogenic processes. This finally leads to a two stage disease (haemolymphatic vs. neurological) with two different therapeutic strategies. The sleep-wake cycle and other biological rhythms are also marked by the disappearance of circadian rhythmicity demasking basic ultradian activities and relationships, such as the interdependence of endocrine profiles and the sleep-wake alternation. 2001 Harcourt Publishers Ltd

Journal Article↗
PubMed1999

High amounts of genetic differentiation between populations of the malaria vector Anopheles arabiensis from West Africa and eastern outer islands.

Polymorphism at nine microsatellite loci was examined to assess the level of genetic differentiation between four Anopheles arabiensis populations from Senegal, the high plateau of Madagascar, and Reunion and Mauritius islands. Eight of nine loci showed great polymorphism (2-16 alleles/locus) and significant genetic differentiation was revealed between all four populations by F- and R-statistics, with Fst estimates ranging from 0.080 to 0.215 and equivalent Rst values ranging between 0.022 and 0.300. These high amounts of genetic differentiation are discussed in relation to geographic distance including large bodies of water, and history of mosquito settlement, and insecticide use on the islands. The results suggest that historical events of drift rather than mutation are probably the forces generating genetic divergence between these populations, with homogenization of the gene pool by migration being drastically restricted across the ocean.

Animals↗
PubMed1964

ANOPHELES GAMBIAE, A COMPLEX OF SPECIES.

The author reports on some 200 laboratory crossings of 36 strains of Anopheles gambiae from many different parts of Africa which show the existence of five mating-types in what was until recently considered a single species. Three of these mating-types are freshwater forms and have been provisionally called A, B and C. Two are saltwater forms: A. melas, confined to West Africa, and the East African A. merus. Hybrid male sterility is universal when any two of these five forms are crossed, and from some of the crosses grossly abnormal sex-ratios result. From an evolutionary standpoint these five mating-types are probably species or semi-species in view of the fact that they can be found to co-exist sympatrically and still retain their identities. From a practical point of view it may be necessary for the field worker to be able to identify the exact species with which he is dealing before the most efficient means of controlling it can be found.

Africa↗
PubMed1996

Manifestation and epidemiology of contagious bovine pleuropneumonia in Africa.

Contagious bovine pleuropneumonia (CBPP) is one of the major threats to cattle health and production in Africa. This article reviews the clinical manifestations, lesions and epidemiology of the disease. The clinical manifestations and lesions are typical and are no different in Africa from those seen in other countries. CBPP is a respiratory disease characterised by pneumonia and serofibrinous pleurisy. The usual form of this disease is acute but chronic forms are frequent, particularly in endemic regions. Hyperacute forms, with a high mortality rate, can be seen at the beginning of outbreaks in newly infected regions. The epidemiology of the disease in Africa is dominated by four factors, namely: cattle are the only species affected, there is no reservoir in wild animals, clinical cases or chronic carriers are the usual sources of infection, through direct contact, and cattle movements play a very important role in the maintenance and extension of the disease. CBPP is widespread in Africa and, according to the Office International des Epizooties and to various reports in 1995, the disease is present in 24 countries of tropical Africa. In western Africa, CBPP is mainly enzootic or sporadic but in some countries the incidence is increasing. The situation in Central Africa is not very alarming. However, in eastern and south-eastern Africa, CBPP has become a major issue, placing southern Africa under direct threat. An evaluation of economic losses due to the disease and the cost-benefit ratio of control programmes is indispensable, since such economic assessments are needed before policy-makers decide on programmes of control or eradication. This is an area which needs to be addressed immediately, as the launching of new campaigns, particularly in eastern and southern Africa, is urgently needed.

Africa↗
PubMed1997

Determination of iron content in different parts of herbs used traditionally for anaemia treatment in East Africa.

The iron content in different parts of eight plants traditionally used to treat anaemia in Eastern Africa was determined using atomic absorption spectrophotometry. Extracts were made of plant samples using both wet and dry oxidation procedures. Results obtained from both procedures agree significantly and the average of both methods was taken as the iron content in each plant part. In most cases, the values obtained for the rootbark had a higher total iron content than the corresponding leaves and stembark. The prominent iron contents of 35.69 and 35.21 mg/100 g were found in the rootbark of Bridelia cathartica and Lannea stuhlmannii, respectively. The iron content of the decoctions prepared in the traditional way was low. However, the therapeutic potential of the herbs cannot be established on the basis of available iron content alone as other factors play a role in the absorption of iron in the body.

Africa, Eastern↗
PubMed2002

Identification of a hepatitis B virus genome in wild chimpanzees (Pan troglodytes schweinfurthi) from East Africa indicates a wide geographical dispersion among equatorial African primates.

DNAs from four wild chimpanzees (Pan troglodytes schweinfurthi) from eastern Africa were screened for 14 DNA viruses and retroviruses. Between two and three viruses were found in each animal. An entire hepatitis B virus (HBV) genome was amplified and sequenced from samples taken from one animal. This indicates that HBV is distributed across the entire range of chimpanzee habitats.

Africa, Eastern↗
PubMed2000

Is malnutrition declining? An analysis of changes in levels of child malnutrition since 1980.

Nutritional status is the best global indicator of well-being in children. Although many surveys of children have been conducted since the 1970s, lack of comparability between them has made it difficult to monitor trends in child malnutrition. Cross-sectional data from 241 nationally representative surveys were analysed in a standard way to produce comparable results of low height-for-age (stunting). Multilevel modelling was applied to estimate regional and global trends from 1980 to 2005. The prevalence of stunting has fallen in developing countries from 47% in 1980 to 33% in 2000 (i.e. by 40 million), although progress has been uneven according to regions. Stunting has increased in Eastern Africa, but decreased in South-eastern Asia, South-central Asia and South America; Northern Africa and the Caribbean show modest improvement; and Western Africa and Central America present very little progress. Despite an overall decrease of stunting in developing countries, child malnutrition still remains a major public health problem in these countries. In some countries rates of stunting are rising, while in many others they remain disturbingly high. The data we have presented provide a baseline for assessing progress and help identify countries and regions in need of populationwide interventions. Approaches to lower child malnutrition should be based on successful nutrition programmes and policies.

Child↗
PubMed1984

Incidence and estimated need of caesarean section, inguinal hernia repair, and operation for strangulated hernia in rural Africa.

Numbers of caesarean sections, inguinal hernia repairs, and operations for strangulated hernia performed in 1979-81 at 10 rural hospitals in eastern Africa were matched against estimated populations in the respective catchment areas. Annual rates of each operation varied considerably between hospitals, the averages being: for caesarean sections 25 per 100 000 per year; for inguinal hernia repairs 25 per 100 000 per year; and for operations for strangulated hernia four per 100 000 per year. The estimated minimum needs for these operations, based on available data for morbidity were 225, 175, and 30 per 100 000 per year, respectively. Numerous deaths and cases of permanent disability occur in remote rural villages because common conditions requiring urgent surgery are neither prevented nor properly cared for. A balanced improvement of both primary and secondary care in rural Africa is needed.

Africa, Eastern↗
PubMed1999

An ethnobotanical study of plants used for the treatment of wounds in the Eastern Cape, South Africa.

The people of the Eastern Cape Province, South Africa, still depend, to a large extent, on traditional herbal medicine for the treatment of various diseases and ailments. This includes the use of plants for the treatment of wounds. Information collected from the traditional healers, the Sangomas, has revealed 38 plant species that are used for the treatment of wounds in the Province. The plants belong to 26 families of which Asteraceae, Asphodelaceae and Solanaceae are the most represented. The use of plant leaves as a poultice and infusions are the commonest categories of herbal preparations. In all cases, the treatment of wounds involved the external application of the herbal medicine.

Humans↗
PubMed1993

Sentinel surveillance for HIV-1 among pregnant women in a developing country: 3 years' experience and comparison with a population serosurvey.

OBJECTIVES: To establish unlinked, anonymous sentinel surveillance for HIV-1 among pregnant women attending an antenatal clinic, to determine age-specific seroprevalences, to monitor trends and to compare seroprevalence with that detected by a population serosurvey. To establish the sustainability and costs of surveillance. DESIGN: Sentinel surveillance for HIV through serial collection of unlinked, anonymous seroprevalence data from antenatal care; comparison of sentinel data with those from a population serosurvey; financial and general audit of the sentinel surveillance. SETTING: A community antenatal clinic in a large urban centre, Mwanza Municipality, Tanzania, eastern Africa, between October 1988 and September 1991. PATIENTS: Pregnant women attending for antenatal care. MAIN OUTCOME MEASURE: Age-specific HIV-1 seroprevalences, trends over time, difference from age-specific population seroprevalences, sustainability and costs. RESULTS: Overall HIV-1 seroprevalence was 11.5% (95% confidence interval, 10.5-12.4); differences in age-specific prevalences were not significant. There was no clear evidence of change in seroprevalence over the study period in any age group, although there was some indication of a rise in some age groups in 1988-1989. Sentinel surveillance among pregnant women may have significantly underestimated population HIV-1 seroprevalence for women under the age of 35 years. HIV-1 surveillance proved feasible and sustainable. Additional recurrent costs were US$1.7 per specimen for unlinked anonymous testing and US$0.57 per woman for syphilis screening. CONCLUSIONS: HIV-1 seroprevalence did not change significantly over 3 years, probably implying a substantial incidence of HIV-1 infection. In this setting seroprevalence in pregnant women may have underestimated population seroprevalence in women aged under 35 years. With modest inputs and good organization unlinked anonymous HIV-1 sentinel surveillance of pregnant women can be introduced and sustained in an African setting. This may usefully be carried out in conjunction with syphilis screening.

AIDS Serodiagnosis↗
PubMed1996

Purity, pollution and the invisible snake in southern Africa.

There exists in parts of southern and eastern Africa an apparently widespread belief in the existence of an invisible, internal "snake," often described as a power or force of some kind that dwells in the stomach but that can move throughout the upper body. Although some anthropologists have described this snake as related to witchcraft, findings from diverse parts of Mozambique, South Africa and elsewhere suggest that it may (also) be thought of as a symbolic expression of the need to respect the human body, specifically to protect it against the introduction of impurity. Belief in nyoka, as Tsonga- and Shona-speakers call the invisible snake, suggests the importance of purity and pollution beliefs as they relate to health in a particular society; the presence of nyoka belief may even be taken as an empirical measure of their importance. Going beyond nyoka, it is argued that pollution beliefs are more central in southern African ethnomedicine than the literature suggests, perhaps more so than witchcraft and sorcery beliefs. It is hypothesized that pollution-related illnesses tend to be roughly coterminous with diseases biomedically classified as contagious. Apart from ethnographic and theoretical significance, establishing the nature and centrality of pollution beliefs, aided by analysis of cultural metaphors such as the invisible snake, can point to culturally appropriate ways of presenting health education messages in societies where pollution beliefs are important. Pollution beliefs may be characterized as quasi-naturalistic and they in fact represent an area of potential interface between indigenous and cosmopolitan medicine-far more than witchcraft beliefs.

Africa↗
PubMed2005

Working with girls living on the streets in East Africa: professionals' experiences.

AIM: This paper reports a study elucidating the meaning of caring for girls of the street, as experienced by female staff members working with street children in Eastern Africa. BACKGROUND: The phenomenon of children living on the streets is a global and escalating problem, and girls are presumed to be especially vulnerable. In East Africa, the traditional extended family system is rapidly breaking down and traditional gender values seem to remain. This was the context for investigating female carers' experience of caring for girls. METHOD: Interviews were conducted with 37 project staff members working with children living on the streets in the framework of non-governmental organizations in Kenya, Uganda and Tanzania between 1997 and 1998. Transcribed text from female interviewees (n = 13) working with girls of the street was analysed using a phenomenological-hermeneutic approach. FINDINGS: The meaning of caring for girls of the street for female professional carers in East Africa was comprehensively understood as counselling the girls to integrate the past of their adverse life stories with their present identity. Counselling meant conveying visions for a possible re-direction of the life stories, from being a girl of the street into being an accepted family girl. Caring in this context meant being squeezed between ethical demands and gender values. Experiencing frustration and powerlessness was related to gender structures in society, having to fight the grip of street culture, and a lack of professional tools. Hope and satisfaction were related to success in changing the course of life stories of girls and to seeing possibilities for contributing to empowerment of girls and community members. CONCLUSIONS: Gender issues are critical to care provided to girls of the street. Carers felt that they lacked relevant knowledge and support. Ethical aspects and gender issues in relation to professional care for vulnerable girls ought to be addressed in nursing education and practice, not only for developing countries, but also as a matter of global interest.

Adaptation, Psychological↗