Open Access Method Article

Mapping an HIV Treatment Program to Identify Barriers to Linkage in HIV Care in Resource Limited Settings

Katherine McQuade Billingsley, Loice Achieng, Edwin Ombegoh, Helen Musangi, Caroline Mwangi, Jonathan Mwiindi, Philip Keiser

International Journal of TROPICAL DISEASE & Health, Page 973-983
DOI: 10.9734/IJTDH/2014/9758

Aims: To develop a practical method to evaluate and address failures to linkage to care for HIV treatment so as to achieve better access to antiretroviral therapy in resource limited settings.
Study Design: A mixed methods analysis to identify and quantify failure to linkage to care involving intensive program mapping, retrospective quantification of retention data, and statistical analysis.
Place and Duration of Study: AIC Kijabe Hospital, Kijabe Kenya. Data were collected from January 1 to December 31, 2011. Data collection and analysis was conducted in February 2012.
Methodology: First a series of successive interviews of all levels of care providers was used to create a program map and identify linkage points. Following this, data registries were identified and cases at each linkage point were quantified. Simple statistical analysis of retention data were then completed and trends analyzed by Kaplan-Meier survival analysis.
Results: Less than 20% of eligible cases testing positive for HIV were enrolled in the treatment program. Most cases enrolled received CD4 testing (78.9%). Most eligible enrolled patients were initiated on ART (82.2%). Patients referred from VCT (voluntary testing) were more likely to be enrolled, receive CD4 testing, and be initiated on therapy. Cases enrolled in the program within 7 days of HIV diagnosis had improved time to initiation of therapy (43 days vs 79 days, p<.001). Cases who received a CD4 test within seven days of diagnosis also had improved time to initiation of therapy (47 vs 77 days, p=.01).
Conclusion: This method proved effective to identify, prioritize, and problem solve to improve linkages to care in our setting. Further evaluation should include prospective studies to identify facilitators to linkage and test interventions.

Open Access Original Research Article

A New Focus of Pleuro-Pulmonary Paragonimiasis in Manjo Health District, Littoral Region of Cameroon

Roger Moyou-Somo, Hervé Blaise Mfouapong-Ewane, Therese Nkoa, Blanche Etaluka-Mungo, Walter Kum-Kan, Charles Kefie-Arrey

International Journal of TROPICAL DISEASE & Health, Page 963-972
DOI: 10.9734/IJTDH/2014/11252




Background: Paragonimiasis is a food-borne parasitic disease caused by lung flukes of the genus Paragonimus. Cameroon has five known foci of paragonimiasis. Recently, 2 children from the Manjo health district were diagnosed of paragonimiasis at the near-by Ndoungué hospital. The aim of the present study was to determine whether Manjo district is endemic for paragonimiasis.
Materials and Methods: The study was conducted in Manjo health district, Littoral Region of Cameroon. A stool and a sputum samples obtained from each participant were examined in search of paragonimus eggs. Crabs from local streams were dissected in search of paragonimus metacercariae.
Results: Two hundred and fourteen participants were recruited (49.1% males and 50.1% females with an age range from 3-75 years and a mean of 15.73±10.72 years. 1.9% of subjects had eggs of paragonimus in their stools and/or sputum. Eight out of twenty crabs dissected (40%) were positive for metacercariae.
Conclusion: Manjo health district is endemic for paragonimiasis and should be considered as the 6th focus of the disease in Cameroon.

Open Access Original Research Article

Seroprevalence of Human Cytomegalovirus and Rubella Virus Antibodies among Anti-retroviral Naive HIV Patients in Lagos

O. Akintunde Olajumoke, I. Ayolabi Christianah, I. Opara Morrison, A. Akanmu Sulaimon, S. Bamiro Babajide, A. Adeleye Isaac, O. Adeoye Grace, T. Seriki Abiodun

International Journal of TROPICAL DISEASE & Health, Page 984-992
DOI: 10.9734/IJTDH/2014/10465




Background/Aims: Opportunistic infections such as Cytomegalovirus (CMV) and Rubella virus that pose no threat to healthy individuals can be life threatening in those with impaired immune systems. The aim of this study was to determine the sero-prevalence of human Cytomegalovirus (CMV) and Rubella Immunoglobulin M and G (IgM and IgG) antibodies among anti-retroviral naive patients in Lagos.
Study Design: This is a cross sectional study.
Place and Duration of Study: AIDS Prevention Initiative in Nigeria (APIN) clinic in Lagos University Teaching Hospital (LUTH) between April 2011 and May 2012.
Methodology: The study was carried out among 80 (28 males and 52 females) HIV infected adults attending the AIDS Prevention Initiative in Nigeria (APIN) clinic in Lagos University Teaching Hospital and the patients were aged between 18 and 60 years. IgG and IgM assay were performed using ELISA reagents (produced by Biotec laboratories, United Kingdom). Also, CD4+ cell counts were evaluated. Pearson’s Chi-squared test was used for the analytic assessment.
Results: From our findings, twenty (25%) patients were positive for CMV IgM and sixty (75%) patients were positive for CMV IgG. Also, 59 (73.75%) patients were positive for Rubella IgG and only one (1.25%) patient was positive for rubella IgM. There was no significant statistical difference in seroprevalences of CMV-IgM, CMV- IgG, and rubella IgG with respect to sex, age, and CD4+ cell counts.
Conclusion: This study showed that the sero-prevalence of CMV and Rubella virus is high among anti-retroviral naive HIV patients in Lagos, Nigeria.

Open Access Original Research Article

Epidemiological Profile of Tuberculosis in the Provinces of Laayoune and Tarfaya, Morocco (2006-2012)

N. Ait Ouaaziz, A. Arfaoui, M. El Bakkali, A. Sbayi, A. Khadmaoui, A. Soulaymani, A. Quyou

International Journal of TROPICAL DISEASE & Health, Page 993-1000
DOI: 10.9734/IJTDH/2014/12456

Aims: Tuberculosis is considered as one of the major causes of mortality worldwide after AIDS in the recent years. The present work aims to bring out the epidemiological profile of tuberculosis in the provinces of Laayoune and Tarfaya so as to contribute to the improvement of the application WHO Anti- Tuberculosis Program and to the increase of success rates of treatment in these regions.
Methodology: This is a retrospective study based on 1331 cases of tuberculosis, all forms combined, reported to the Centre for Diagnosis and Treatment of Respiratory Diseases of Laayoune during the period between 2006 and 2012.
Results: The results show that the average age of patients is 34.97±15.47 years old while median age is 32 years. The highest incidence is observed in patients who are between 20 and 50 years old. The sex-ratio men to women, which is 1.73, is highly significant (X²=95.2, P<.001). Moreover, the number of cases is significantly higher during the winter and spring, compared to autumn and summer (X² =16.07, P<.001).
The repartition of patients according to the type of tuberculosis shows that respiratory tuberculosis represents three-quarters of cases. As for the patients' evolution, we noticed a disappearance of the symptoms as well as a general improvement for 37% of the cases that have finished their treatment. 25% of the patients healed with a negative bacillus copy. 34 deaths were registered during the study’s period. It should be mentioned that the evolution remains unknown for 14% of the cases because of their disappearance during the treatment.
Finally, we noticed a constant and remarkable increase of the annual success rate, which rose from 48% in 2006 to reach 69% in 2012.
Conclusion: In conclusion, it should be pointed out that health authorities should make more efforts for a better implementation of the national anti-tuberculosis strategy in these regions.

Open Access Original Research Article

Ownership of Bed Nets and Use by Children below 5 Years in Sagamu Local Government Area of Ogun State, Nigeria

I. Runsewe-Abiodun Tamramat, D. Alabi Adekunle

International Journal of TROPICAL DISEASE & Health,
DOI: 10.9734/IJTDH/2014/12143

Aim: To document the level of ITNs ownership and utilization for children within the Sagamu Local Government Area in Ogun State three years after the commencement of major distribution exercise of this simple tool.
Study Design: A descriptive cross -sectional community based study.
Place and Duration of Study: Sagamu Local Government area in Nigeria. May 2009.
Methodology: Study involved one hundred and thirty one (131) children within the Local Government with fever or a 2 day history of fever prior to the day of the meeting following a 3 day community campaign. They were enrolled into the study using a systematic random sampling method. Pretested semi-structured questionnaire was administered by research assistants/investigators to obtain data on ownership of ITNs by the caregiver and their utilization by the index child. Factors that may affect ownership and utilization were also documented.
Frequency tables were generated for all the categorical variables and association between them tested using the chi-square test and logistic regression. Level of significance was set at p value <0.05.
Result: The mean age of the study population was 47.3±50.6 months for the children and 28.8±5.9 years for the mothers. Among the 128 respondents, ITNs ownership was 9.2%, utilization was 4.6%.
House-types and mothers’ occupation were positive predictors of use (r=0.97). There was a strong positive correlation between mother’s educational level and ownership (r=0.96). Ownership was however limited by a combination of lack of awareness and knowledge of access point as well as cost.
Conclusion: While improving the awareness of the populace through radio jingles and social marketing as well as use of private health facilities as access points will aid in better ownership of ITNs, subsidizing the cost of ITNs rather than making it out rightly free may ensure better utilization.

Open Access Original Research Article

Assessing the Performance Characteristics of the “CareStartTM Malaria HRP2 pf (CAT NO: G0141, ACCESSBIO)” Rapid Diagnostic Test for Asymptomatic Malaria in Mutengene, Cameroon

Judith Lum Ndamukong-Nyanga, Helen K. Kimbi, Irene Ule Ngole Sumbele, Lum Emmaculate, Malaika Nain Nweboh, Yannick Nana, Sunjo Cyrilla Bertek, Kenneth J. N. Ndamukong

International Journal of TROPICAL DISEASE & Health, Page 1011-1023
DOI: 10.9734/IJTDH/2014/10778




Aim: The aim of this study was to determine the prevalence and density of malaria parasites in asymptomatic school children in Mutengene and evaluate the performance characteristics of the ‘CareStartTM Malaria HRP2 pf (CAT NO: G0141, ACCESSBIO)’ rapid diagnostic test (RDT) using light microscopy as a gold standard.
Study Design: The study was a cross-sectional survey.
Place and Duration of Study: The study was carried out in Mutengene, from February to March, 2013.
Methodology: A total of 406 pupils were studied. Demographic data was taken for each child and capillary blood was collected. Blood films were prepared for the assessment of parasite density and speciation. A drop of blood was used on the RDT to determine the malaria status.
Results: The mean age at 95% confidence interval (CI) was 8 ± 2 years (range = 4 -15 years) and the overall prevalence of malaria was 39.9% (162) by microscopy. The geometric mean parasite density (GMPD) was 2332.7 parasites/µL (range: 218 - 16000). Only 386 pupils were examined by both methods. More pupils were positive by microscopy (40.9%, CI = 36.1 - 45.9) than by RDT (27.9%, CI = 23.7 - 32.7) and the difference was statistically significant (χ2 = 16.1, P <0.0001). The majority of those detected had high infection (≥ 5000 parasite/µL). Less than 50% of those with low (25.0%, CI = 12.0 - 44.9), moderate (40.7%, CI = 32.24-49.70) and high parasitaemia (75%, CI = 5.00-89.82) were positive by RDT and the difference was significant (χ2 = 10.09, P = 0.006). The RDT showed a low sensitivity of 48.5% (CI = 40.3 – 56.9%) and specificity of 84.0% (CI = 80.0- 88.2%).
Conclusion: More research needs to be done on the RDT to improve on its performance characteristics before it could be used in mass surveillance programmes.

Open Access Original Research Article

Survey of the Iron Status of Patients with Type 2 Diabetes Mellitus Attending Hospitals in Jos

P. O. Okonkwo, Z. S. C Okoye

International Journal of TROPICAL DISEASE & Health, Page 1024-1037
DOI: 10.9734/IJTDH/2014/10899

Background and Objective: Epidemiological studies have shown that high body iron stores are associated with insulin resistance and type 2 diabetes. The aim of this study was to evaluate iron status of patients with type 2 diabetes mellitus (T2DM). Blood samples were collected from participants after overnight fast.
Materials and Methods: Two hundred (200) subjects comprising 130 type 2 diabetics attending Hospitals in Jos and 70 normal subjects as controls were involved in the survey. Questionnaires were used in the recruitment of participants. Serum ferritin (SF) was assayed by ELISA method, while other parameters were determined colorimetrically.
Results: Diabetics presented with higher mean age, BMI, and blood pressure than non diabetics. Also, diabetics had elevated serum ferritin, SI, TIBC, total cholesterol (TC), triglycerides, and TC/HDL ratio, lower serum HDL; elevated serum aminotransferases and creatinine than non diabetic subjects. There was a strong and significant positive correlation between serumn ferritin levels and each of six diabetes mellitus risk factors: systolic blood pressure, diastolic blood pressure, serum total cholesterol (TC), serum triglyceride (TG), HDL and TC/HDL.
Conclusion: This work has shown that type 2 diabetic subjects exhibited strong positive diagnostic features for the indices of iron status, dyslipidaemia, liver damage and kidney dysfunction compared to non diabetic subjects.

Open Access Original Research Article

Clinical Profile of Patients with Scorpion Sting

B. S. Pandey, L. Venugopal, V. Dharma Rao, N. Ganesh

International Journal of TROPICAL DISEASE & Health, Page 1038-1043
DOI: 10.9734/IJTDH/2014/12303




Introduction: Scorpion sting is a major public health problem in developing countries, especially in villagers. Manifestations include vomiting, profuse sweating, piloerection, diarrhoea, loss of appetite, loss of sphincter control and priapism. Stimulation of Alpha receptor results in hypertension, tachycardia, myocardial dysfunction, pulmonary edema and cool extremities.
Aims: The study is undertaken to know the clinical profile of the patients with scorpion sting.
Methods and Materials: prospective study was conducted from October 2011 to September 2013 at Mamata General Hospital, khammam in adult patients 18yrs and above with history of scorpion sting. Detailed physical examination and grading of envenomation was done.
Results: Eighty two patients fulfilled the inclusion criteria for the time period studied. Fifty two patients (62.25%) were male and thirty (37.50%) were female. Mean age of patients with scorpion sting was 31.23±7.23 years. Pain (87.50%),Sweating (81.25%) tingling & numbness (77.50%) were the most common presenting symptoms
Conclusion: The present study shows that scorpion bite is more common in males. Local pain and signs of sympathetic over activity were the commonest features.