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PubMed2003

The emergence of Taenia solium cysticercosis in Eastern and Southern Africa as a serious agricultural problem and public health risk.

Pig production has increased significantly in the Eastern and Southern Africa (ESA) region during the past decade, especially in rural, resource-poor, smallholder communities. Concurrent with the increase in smallholder pig keeping and pork consumption, there have been increasing reports of porcine cysticercosis in the ESA region. This article reviews the findings concerning the presence and impact of porcine cysticercosis in seven of the ESA countries. Most of the reported findings are based on surveys utilising lingual palpation and post-mortem examination, however, some also used serological assays. In Tanzania, community-based studies on porcine cysticercosis indicate a prevalence of 17.4% in the northern highlands district of Mbulu and a prevalence range of 5.1-16.9% in the southern highlands. In Kenya recent surveys in the southwestern part of the country where smallholder pig keeping is popular indicate that 10-14% of pigs are positive for cysticercosis by lingual examination. Uganda has the most pigs in Eastern Africa, most of which are kept under smallholder conditions. Preliminary surveys in 1998 and 1999 at slaughterhouses in Kampala indicated a prevalence of porcine cysticercosis between 0.12 and 1.2%, however, a rural survey in northern Uganda in 1999 indicated 34-45% of pigs slaughtered in selected villages were infected. Additionally, a new survey of 297 pigs slaughtered in Kampala in 2002 indicated that pigs from the central region of the country were negative for cysticercosis while 33.7% of the pigs coming from the rural Lira district in the north were positive. Interestingly 8 piglet foetuses removed from an infected slaughtered sow coming from Lira district were all found to harbour cysts of T. solium providing evidence of congenital transmission of porcine cysticercosis. In Mozambique, abattoir records indicate that porcine cysticercosis is present in all provinces of the country. A serological survey on pigs in rural Tete Province found 15% of pigs positive. In Zimbabwe, a retrospective study in official abattoirs around the country from 1994 to 2001 reported a mean prevalence of 0.34% which is in contrast to a post-mortem survey in 1999, which showed that the prevalence of porcine cysticercosis in rural west Zimbabwe where smallholder pig keeping is popular was 28.6%. In Zambia, abattoir records reported porcine cysticercosis in six of the nine provinces. Routine meat inspection of 1316 pigs at a slaughter slab in Lusaka showed that 20.6% of the pigs had cysticercosis whereas serological testing of 874 pigs at the same abattoir indicated that 56.6% were found to have circulating antigens of Taenia solium. Field surveys based on lingual palpation in Southern and Eastern Provinces of Zambia revealed prevalences of 8.2-28.4 and 5.2%, respectively. South Africa has the largest number of pigs in Southern Africa and cysticercosis has been recognised as a problem in the country for many decades. There is strong evidence supporting the high prevalence of neurocysticercosis infecting humans from resource-poor areas of the country where pigs are being raised under smallholder conditions. In spite of this community-based surveys on porcine cysticercosis have never been conducted in South Africa and the last slaughterhouse survey was conducted nearly 40 years ago. The prevalences of porcine cysticercosis found in these ESA countries rank among the highest in the world and the disease is emerging as an important constraint for the nutritional and economic well being of resource-poor smallholder farming communities. The current findings suggest the widespread presence of human tapeworm carriers and thus a high risk of human cysticercosis in both rural areas and urban centres in the ESA region. More research is required in the region to assess the extent and public health and economic impact of T. solium infection in order to determine whether and what prevention and control efforts are needed.

Abattoirs↗

PubMed1993

Dog ecology in eastern and southern Africa: implications for rabies control.

With an apparent decline in rabies vaccination coverage in dog populations in many parts of eastern and southern Africa, consideration should be given to more effective targeting of rabies vaccination to protect those sectors of the dog population with the greatest capacity to transmit rabies. This paper discusses the potential contributions that dog ecology studies may make to the improved delivery of rabies control measures and the targeting of vaccination programmes in the region. Data requirements on dog population size and structure are discussed, methods for collection of such data are summarized, and the studies on dog ecology carried out to date within the region are reviewed.

Africa, Eastern↗

PubMed1997

The variable incidence of psoriasis in sub-Saharan Africa.

BACKGROUND: Surveys of skin disorders have previously provided information about the prevalence and incidence of psoriasis in sub-Saharan Africa; however, the geographic and ethnic trends which may be drawn from these surveys have not been fully described in previous studies, which considered only a fraction of the available data. METHODS: A critical review of clinic-based surveys of psoriasis incidence and population-based studies of psoriasis prevalence is presented. The incidence of psoriasis is adjusted, wherever possible, to factor out the widely variable incidence of infectious skin conditions seen in African skin clinics. To distinguish between genetic and environmental factors that may be responsible for the variability of psoriasis incidence, attention is drawn to climate, human leukocyte antigen (HLA) frequencies, and language groups across the regions surveyed in sub-Saharan Africa. RESULTS: Higher psoriasis incidence rates are consistently observed in eastern Africa than in western Africa, consistent with more limited data on the prevalence of psoriasis in western Africa. Neither rainfall/humidity levels nor HLA frequencies can simply account for these differences; however, the ethnicities of sub-Saharan African peoples may be observed to parallel roughly the trend in psoriasis incidence. Western African countries, such as Nigeria, Mali, Senegal, and Sierra Leone, where lower rates of psoriasis incidence have been reported (less than 1.0% of skin disorders), are populated mainly by non-Bantu-speaking ethnic groups. Bantu-speaking peoples constitute a majority in the populations of most countries in eastern and southern sub-Saharan Africa, where the incidence of psoriasis varies widely. African Americans, whose largely non-Bantu-speaking African ancestry is shared with modern western Africans, also have relatively low psoriasis incidence rates by comparison with North American Caucasians. CONCLUSIONS: Ethnic correlations both within Africa and between North America and Africa suggest that unidentified genetic factors, which differ between eastern and western sub-Saharan Africans, may govern the differential incidence of psoriasis.

Africa South of the Sahara↗

PubMed1992

Knowledge of AIDS and HIV infection displayed by Tanzanian operating dental staff in 1988 and 1989: a follow-up study.

In many urban areas of Central and Eastern Africa 20-30 per cent of the sexually active population has been infected with HIV. It can be assumed that every member of the operating dental staff in Tanzania frequently treats HIV-positive patients. The knowledge of AIDS and HIV infection was investigated by Tanzanian dental teams in 1988 and 1989. In both years almost one quarter of the dental officers and half the other operating team members chose incorrect information about the methods of transmission of HIV. Several respondents named health care workers as belonging to a high risk group. Fever and loss of weight were known to be early symptoms of AIDS. In 1989, when asked to identify oral manifestations of HIV, one quarter of all the dental staff could not mention any of them. The findings of the study emphasise the need for urgent further education of dental teams in Tanzania.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Relationship between household access to food and malnutrition in eastern and southern Africa.

This review paper gives an overview of the relationship between household access to food and malnutrition using national level data in the Eastern and Southern Africa Region. The overall prevalence of malnutrition amongst the under-five population have not changed significantly over the decade and, in some cases, have deteriorated. The situation of household access to food differs between economies and production systems, but most households (average of 80%) in the region do not have access to adequate food. A preliminary analysis of the determinants of malnutrition at country level pointed to the importance of: financial access to food (an indicator of household access to food) and; access to safe water (an indicator of household healthy environment), as the most significant variables predicting rates of malnutrition. Several areas for action by governments in the region and for further study within the subject of household access to food are delineated. These are: more clear determination of the relative contribution of household access to food, to the nutritional status of women and children and, improved analysis of indicators of household access to food.

Africa, Eastern↗

PubMed1981