Open Access Short Communication

Profile of Patients Attending an Animal Bite Management Clinic in Rural Pondicherry, India

S. V. Nikhil, S. A. Rizwan, Vinoth G. Chellaiyan, V. Kavita, Ravi P. Upadhyay, C. Palanivel

International Journal of TROPICAL DISEASE & Health, Page 306-310
DOI: 10.9734/IJTDH/2014/5683

Aims: In India, annual incidence of animal bite is estimated as 1.7 per 100 population and that of human rabies as 1.7 per 1,00,000 population. Since rabies is universally fatal it requires prevention through timely management by wound care, Anti-Rabies Vaccine (ARV) and rabies immunoglobulin.
Study Design: Retrospective record review.
Place and Duration of Study: Animal Bite Management (ABM) clinic of a Primary Health Centre in rural Pondicherry, south India, between January and December, 2011.
Methodology: This study is a secondary analysis of data collected at an Animal Bite Management (ABM) clinic in a primary health centre in rural Pondicherry. The study population was mainly rural and agrarian. All victims of animal bite, who sought treatment from the ABM clinic between January and December, 2011 were included. Wound washing and administration of ARV through intramuscular route was provided for all victims. Data on factors like age, gender, place of residence, biting animal was collected. Means and proportions were calculated. Chi square test for categorical and t-test for continuous variables were applied.
Results: A total of 767 victims sought treatment from ABM clinic. The mean age was 29 years (1 to 84 years). Mean distance of travel to ABM clinic was 2.1 km. About a third of all cases occurred during summer (March to May). Majority of victims were bitten by dog (85%) followed by cat (9%) and monkey (6%). Only 61.7%, 32.2%, 0.8% and 0% turned up for day 3, day 7, day 14 and day 28 doses of ARV schedule. Of those who came, only 70% came on due day. There was no statistically significant difference in treatment seeking based on gender and distance from ABM clinic.
Conclusion: The high dropout rate for Day 3 and subsequent doses of the ARV and the delayed administration of Day 3 and Day 7 are worrying facts because only a full and timely ARV course will provide complete protection against rabies.

Open Access Original Research Article

Predictors of Postgraduate Dental Specialty Training Choice: The Nigerian Experience

Gerald Isiekwe, Modupeoluwa Ashiwaju, Olubukola Olatosi, Solomon Olusegun Nwhator

International Journal of TROPICAL DISEASE & Health, Page 272-283
DOI: 10.9734/IJTDH/2014/6670

Objectives: The objectives of this study are three-fold. First, to highlight areas of shortage in postgraduate dental education in Nigeria, secondly to propose the introduction of dental advisors into our postgraduate dental training and thirdly, to propose a model that could aid such dental advisors in predicting postgraduate dental training choice among Nigerian dental graduates. It is hoped that such a model would have enough predictive powers to aid would-be dental advisors in guiding fresh dental graduates aright in their choice of postgraduate dental training.
Methods: Participants were dentists attending compulsory continuing professional development events at different centres across Nigeria. Graded Likert responses of 16 potential predictors of dental postgraduate training choice were obtained through self-administered questionnaires filled by 112 Nigerian dentists (mean age of 35.21 years ± 8.21). Data were analyzed after necessary recodes to allow for meaningful statistical analysis. The predictive power of each factor was determined by inter-specialty and intra-specialty comparisons.
Results: A total of 51 males and 61 females participated in the study with predictors rated from 2.29 ± 1.23 to 4.09 ± 1.04.
Diagnostic challenge strongly predicted a choice of Oral and maxillofacial surgery. Affluence and income jointly predicted choices of orthodontics and restorative dentistry while the female gender predicted a choice of pediatric dentistry. (P=<0.001). Work-life balance influenced a choice of preventive dentistry-related specialties in combination with other factors. Periodontology had several unique predictors.
Conclusions: Income, work hours, private practice opportunity and affluence were stronger predictors than skills and course content in this study. There's a gradual shift from an oral surgery predilection to restorative dentistry. A female predilection for pediatric dentistry and male predilection for oral surgery persist.
Endangered specialties like periodontics, prosthodontics justify a call office of postgraduate dental advisors in Nigerian postgraduate dental training to avert the looming dental training manpower crisis

Open Access Original Research Article

Comparison of Rifampicin Resistance in Mycobacterium tuberculosis Isolates by Multiplex Allele Specific PCR (MAS-PCR) with Enzyme Linked Immunosorbent Assay (PCR-ELISA)

Ali Akbar Velayati, Maryam- Fatemeh Sheikholeslami, Parissa Farnia

International Journal of TROPICAL DISEASE & Health, Page 284-294
DOI: 10.9734/IJTDH/2014/6726

Aims: Detection of drug resistance M. tuberculosis isolates is one of the most important strategies to control the disease. Nowadays, with advances in molecular technology, various methods are available to detect drug resistant M. tuberculosis strains such as those based on capture specific probes. In this study, we aimed to investigate the frequency of mutation in the M. tuberculosis -rpoB gene by Polymerase Chain Reaction based on Enzyme Linked Immuno Sorbent Assay (PCR-ELISA) detection.
Methodology: Thirty-three culture positive isolates were randomly selected for this study. All the isolates were subjected to a drug Susceptibility Test (DST) using the proportion method. Then the ability and the efficiency of Multiplex Allele Specific PCR (MAS-PCR) and PCR-ELISA to detect Rif resistant (Rifr) M. tuberculosis isolates was compared and evaluated.
Results: Mutation of rpoB gene was detected in 19/33 isolates (57.6%) by PCR-ELISA. Hybridization with the specific mutant probes 516 and 526 codon occurred in 1/33 isolates each (3% respectively). Hybridization with the specific mutant probe 531 occurred in 13/33 isolates (39.4%). Three isolates (9.2%) showed simultaneous mutation in codons 516 and 531. The sensitivity and specificity of MAS-PCR in comparison to the Proportional Method was 100%. On the other hand, PCR-ELISA showed 75% sensitivity and 69.2% specificity. The positive predictive value for the PCR-ELISA method was 78.9% and the negative predictive value was 64.3%.The general efficacy of test was 72.7%.
Conclusion: The study showed that the sensitivity and specificity of PCR-ELISA to detect mutations in the rpoB gene in Drug Resistant strains was low. Furthermore, this proved to be a complex, time consuming and expensive test. Therefore, this test is not recommended for determining Rifampicin resistance in M. tuberculosis strains.

Open Access Original Research Article

Patterns of Plasmodium falciparum among Settled Fulani Pastoralists in Rivers State, Nigeria

Eze N. Chinwe, Sidney O. Nzeako, Florence O. Nduka

International Journal of TROPICAL DISEASE & Health, Page 295-305
DOI: 10.9734/IJTDH/2014/6962

Aims: To establish the current status and control management of malaria infection among Fulani Pastoralists in their various bush encampments in Rivers State, Nigeria.
Study Design: Cross –sectional, descriptive study.
Place and Duration of Study: Six bush encampments in Rivers State, Nigeria, between November 2009 and January 2011.
Methodology: Thick and thin blood films were made and stained using parasitological standard procedures to identify malaria parasites. Packed cell volume estimation was determined with the use of hematocrit centrifuge and microhematocrit reader. Malaria control measures and personal data were collected through questionnaires. Data was analyzed statistically using ANOVA to test for significance and a P- value less than 0.05 was considered statistically significant.
Results: Plasmodium falciparum was the only species of malaria parasite identified in the sampled group. Overall prevalence showed that 464 (78.2%) of the sampled Fulani Pastoralists were infected with malaria infection. Male herdsmen were more infected 79.9% than females 75.4% (p<0.05). prevalence rates of 79.2%, 80.2%, 81.8% and 79.8% were observed among the age group 1-10,11-20, 21-30 and 31-40 respectively (P>0.05). A total of 216 (46.6%) of the infected pastoralists had moderate parasite density and was higher among males. Low Packed cell volume (PCV) in the population was 18.4% and was higher among the age group 21-30 years. Data revealed that 10.5% of the examined used insecticide treated nets however, the use of mosquito coil and burning of medicinal leaves were the major preventive measures in the sampled population.
Conclusion: Educating the herdsmen on malaria infection, prevention and control through environmental management as well as ensuring access to basic health care such as free anti-malaria drugs and long lasting Insecticide Treated Nets (IITN) which is the goal of malaria control programme will help to alleviate malaria infection among this group.

Open Access Original Research Article

Stigma and HIV/AIDS in South Africa: Exploring Respect and Treatment Adherence

John Eyles, Olivia Lee, Stephen Birch

International Journal of TROPICAL DISEASE & Health, Page 311-329
DOI: 10.9734/IJTDH/2014/6468

Aims: The purpose of this study is to contribute to the study of the relationships between stigma and HIV/AIDS treatment adherence in South Africa.
Study Design: A mixed method investigation employed cross-sectional exit surveys in four sites in South Africa (N=1200) and in-depth interviews with 15 patients from 2 sites, one urban and one rural.
Place and Duration of Study: This paper is part of a 5 year long study on three forms of treatment for conditions with adverse outcomes, TB, maternal delivery and HIV/AIDS. It took place between 2008 and 2012 in four sites in South Africa, two urban – Soweto and Mitchell’s Plain and two rural – Bushbuckridge and Hlabisa.
Methodology: The mixed method design used clinic-based exit interviews in multiple sites in the four study areas, selection being based on a stratified approach to include clinics with such characteristics as size, patient flow, geographical accessibility. Patients exiting those clinics were randomly selected for inclusion in the study. All participants were required to be 18 years old or over. Qualitative research took place in Soweto and Bushbuckridge only because of resource constraints. A total of 15 people 4 men, 11 women, between the ages of 27 and 59) were interviewed, some twice on the trajectories of their illnesses. Standard analytic packages of SPSS and Atlas-TI were used for analysis.
Results: The interviews established the importance of various forms of stigma in these populations as well as the importance of social and family support. Gaps were identified in the social support system yet there remained a degree of hope and optimism among the patients. In the quantitative analyses, reports of associations are laid out because of the problematic relationship between stigma and adherence noted in the literature. All associations (except for respect from health care providers are significant at 0.05 with wealth associations being highly significant (0.000, 0.003) as are community support measures (0.000, 0.002). The logistic regression results show few significant relationships with only social support (0.000) being significant for missing taking ARV tablets.
Conclusion: The research presented in this paper is largely supportive of other work on stigma as well as on adherence. It puts forward some suggestions, based on associative analyses, on the still perplexing relationship between stigma and adherence.

Open Access Original Research Article

Seroincidence of Human Herpes Virus 2 Among Ante-natal Clinic Attendees in Benin, Nigeria

E. I. Kalu, K. Akubuo, F. E. Agwu, E. O. Yusuf, C. K. Ojide, V. U. Nwadike

International Journal of TROPICAL DISEASE & Health, Page 330-343
DOI: 10.9734/IJTDH/2014/7020

Background: Human Herpes Virus 2 (HSV-2) infection has been shown to be significantly associated with several obstetric complications, especially if the infection occurred during the pregnancy. Advocacy for policy formulation and the design of interventions requires local data on the risk factors for incident HSV-2 infection.
The aim of this study is to assess HSV-2 sero-incidence among pregnant women in Benin and the effect of socio-demographic factors, HIV status, and HSV-1 status.
Study Location, Design and Duration: Pregnant women attending ante-natal clinic in University of Benin Teaching Hospital and Central Hospital, Benin were prospectively recruited. A cross-sectional study was done and baseline data, obtained. The HSV-2 seronegative participants were followed up till the last clinic appointments [the closest appointment to their expected delivery dates (EDD)]. The study took place between November 2011 and December 2012.
Methods: On recruitment a structured self-administered questionnaire was used to capture their socio-demographic data. Obstetric data was obtained from the patients’ case notes. Their HSV-1 and HSV-2 serostatuses were determined using an HSV glycoprotein G-based type-specific ELISA technique. Their HIV statuses were also determined. All those who were seronegative for HSV-2 were retested for HSV-2 six months later and/or on their last clinic appointment before the EDD. Incidence rates were calculated per person-years. Data analysis utilized SPSS version 16 software.
Results: Out of the 674 participants, 315(46.8%) were HSV-2 seropositive while 359 (53.2%) were seronegative. 15.9% (57) of the HSV-2 sero-negative ones were lost to follow-up, giving a response rate of 84.1%. Seroincidence rate was found to be 17.9 per 100 person-years. There was significant association of seroincidence with younger reproductive age groups, unmarried status, and education below secondary level. Relative Risk (RR) and Incidence rate ratio (IRR) of HSV-2 infection among the HIV-infected cohort were 55.15 [95%CI:17.0-179.1] and 72.37 [95% CI:71.11-73.63] respectively. The RR and IRR among the HSV-1-seronegative cohort were 1.43 [95%CI:0.64-3.17] and 11.62 [95%CI:9.60-13.64] respectively.
Conclusion: Seroincidence rate of HSV-2 infection among pregnant women in Benin was found to be 17.9 per 100 person-years. Positive HIV status, young age, unmarried status, and low education level were indicators of increased risk of incident HSV-2 infection.

Open Access Original Research Article

Effect of Combined Quinine and Ciprofloxacin Therapy in Experimental Murine Plasmodiasis

Udobi Chinweizu Ejikeme, M. E. Ubulom Peace, Onwubiko Chinaza

International Journal of TROPICAL DISEASE & Health, Page 344-351
DOI: 10.9734/IJTDH/2014/6788

The increasing spread of drug-resistant malaria parasite has necessitated the continuous search for even more effective malaria treatment including the combination of drugs known to have significant anti malarial potentials. Effort in this study was therefore, devoted to evaluating in vivo, anti plasmodial activity of combination of varying doses (4.3, 8.6, 12.9 mg/kg body weight) of quinine (a known anti malarial gradually loosing relevance) with varying doses (5.0, 10.0, 15.0 mg/kg body weight) of ciprofloxacin (a fluoroquinolone commonly used to treat bacterial infections and has been shown to possess significant anti malarial activity both in vitro and in vivo) in Plasmodium berghei infected mice. Parasitological activity and survival of the animal were assessed over 21 days. Parasitemia in non-treated control mice peaked at 75% on day 9 and none survived by day 11. The lower dosages of quinine (4.3 and 8.6 mg/kg body weight) and ciprofloxacin (5.0 and 10.0 mg/kg body weight) were not efficient. However, the combination of 12.9 mg/kg body weight of quinine with 15 mg/kg body weight of ciprofloxacin achieved 87% reduction in parasitemia level and significantly reduced mortality in the infected animals compared with other treatment groups. The results from this study support the potential use of ciprofloxacin in combination with quinine for the treatment of resistant malaria.

Open Access Original Research Article

Living with Obstetric Fistula: Perceived Causes, Challenges and Coping Strategies among Women Attending the Fistula Clinic at Mulago Hospital, Uganda

Joan Kabayambi, Justus Kafunjo Barageine, Joseph K. B. Matovu, Jolly Beyeza, Elizabeth Ekirapa, Rhoda K. Wanyenze

International Journal of TROPICAL DISEASE & Health, Page 352-361
DOI: 10.9734/IJTDH/2014/7505

Aims: To determine perceived causes, challenges and coping mechanisms of women living with obstetric fistula (OF) in Uganda.
Study Design: Cross-sectional study.
Place and Duration of the Study: Mulago National Referral Hospital Uganda – January to July 2009.
Methodology: Thirty women with OF were interviewed on challenges, coping mechanisms and perceived causes of OF using semi-structured questionnaires. Two focus group discussions were held with 10 caretakers of the women with OF and key informant interviews with 10 health care providers.
Results: Majority of the women (21; 70%) were young (<25 years) had primary education (20; 67%) and had lived with OF for 2-9 years (20; 67%). The main perceived causes of OF were injury by surgeon (8; 27%), delivery of a big baby (7; 23%) and prolonged labor (4; 13%). Nearly all women with OF (27; 90%) reported that OF had detrimentally affected their health and well being; 26 women (87%) lost their children at birth or within the neonatal period. Families were affected by high cost of treatment (13; 43%); provision of basic items (10; 32%), and suffered stress (17; 55%). Women coped with OF by hiding from the general public (27; 90%), maintaining strict hygiene (25; 83%), ignoring people’s comments (23; 75%) or resorting to prayer (18; 57%).
Conclusion: Women with OF experienced physical, emotional and socio-economic challenges and coped with OF through non-effective social measures. There is need to strengthen strategies to prevent OF and enhance OF rehabilitation services for affected women and their families.

Open Access Original Research Article

Hepcidin: A New Noninvasive Biomarker for Histological Cirrhosis in Hepatitis C Virus Patients

Hanan El-Bassat, Lobna Aboali, Hanan Alshenawy, Atif Taha, Rasha A. Alm El-Din

International Journal of TROPICAL DISEASE & Health, Page 362-373
DOI: 10.9734/IJTDH/2014/5922

Aim: To investigate the potential role of serum hepcidin as a biomarker for histological cirrhosis in hepatitis C virus patients.
Methods: Serum hepcidin was measured in 80 patients with hepatitis C virus and 15 age and sex matched healthy subjects as control. Liver biopsy was available for 50 patients only. All subjects were divided as follows:
Group I: 50 patients with chronic HCV waiting for treatment decision. They were subdivided according to liver fibrosis stage into:
Group I (a): 39 patients with fibrosis stage F1, F2 and F3.
Group I (b): 11 patients with histological cirrhosis F4.
Group II: 30 HCV cirrhotic patients.
Group III: 15 age- and sex-matched healthy subjects as control.
Results: Serum hepcidin concentration was significantly lower in patients with chronic HCV, histological cirrhosis and cirrhotic patients than healthy control and was lowest in those with cirrhosis (PË‚0.001). Serum hepcidin level was significantly positively correlated with serum ferritin, transferrin saturation, ALT, AST, hemoglobin level, albumin and hepatic iron but negatively correlated with serum bilirubin. Serum hepcidin decrease with progression of liver fibrosis and was lowest in those with histological cirrhosis and clinically proven cirrhosis. In contrast, serum ferritin increased progressively with increasing stages of fibrosis and was highest in those with histological cirrhosis and cirrhotic patients.
Conclusions: Increasing hepatic fibrosis is associated with decreased hepcidin serum level. This indicates that hepcidin may serve as a potential biomarker for fibrosis and cirrhosis. Hepcidin is positively correlated with hepatic iron and liver enzymes but negatively correlated with the stage of fibrosis.

Open Access Original Research Article

Prevalence and Risk Factors for Placental Malaria in Nnewi, South East Nigeria

V. E. Okolie, N. J. Obiechina, Z. C. Okechukwu, C. F. Oguejiofor, L. Okor, A. O. Onyegbule, O. I. Udegbunam, L. S. A. Nwajiaku, C. Ogbuokiri, R. Egeonu

International Journal of TROPICAL DISEASE & Health, Page 374-383
DOI: 10.9734/IJTDH/2014/8365

Background: Placental malaria is one of the complications of malaria in pregnancy and is associated with poor pregnancy outcome. Demonstration of its prevalence and risk factors will help in modifying the measures in the prevention of malaria in pregnancy and strengthens the effective pre-existing preventive measures in our community. More so, there is paucity of studies of placental malaria in our environment using histology which is the gold standard.
Aim: To determine the prevalence and the risk factors for placental malaria.
Study Design and Setting: This is a cross sectional study carried out at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South East, Nigeria between 1st August, 2012 and 31st January, 2013.
Materials and Methods: A cross section of pregnant women who delivered in the labour ward was recruited for the study. The following data were obtained from those who met the inclusion criteria: age, parity, gestational age, the booking status, educational level and husband’s occupation. The history of Intermittent preventive therapy (IPT), Insecticide treated net (ITN), HIV status, Blood group and Haemoglobin genotype were also obtained. Descriptive analysis of the results was done using the statistical package for social sciences (SPSS) version 16. Univariate analysis and logistic regression were used and the results expressed in Odd ratios (OR) and Confidence interval (C.I). P-value <0.05 was taken as significant level.
Result: Out of 200 placentae analyzed, 141 were positive for malaria, giving a prevalence of 70.5%. The commonest form of parasitisation was chronic infection (68.09%) followed by past infection (19.14%) and acute infection (12.77%). Using univariate analysis, the potential risk factors were young age, primigrividity, unbooked status and non use of IPT, non use of ITN, low social class, HIV positivity and haemoglobin genotype AA. However when these were subjected to logistic regression, the independent risk factors identified were young age, primigrividity, unbooked status, non use of IPT and non use of ITN.
Conclusion: This study highlighted high prevalence of placental malaria in our environment. The independent risk factors noted were young age, primigrividity, unbooked status, non use of IPT and non use of ITN.