The effects of genital schistosoma haematobium on human papillomavirus and the development of cervical neoplasia after five years in a Zimbabwean population.

BACKGROUND: High-risk human papillomavirus (HPV) is responsible for cervical cancer and genital Schistosoma haematobium infection has been hypothesized to be an additional co-factor or even an independent risk factor for cervical neoplasia. The present study aimed to investigate the impact of schistosomiasis on HPV persistence and development of cell atypia in a group of rural Zimbabwean women with confirmed high-risk HPV. METHODS: A five-year follow-up was done among women previously included in a study on genital schistosomiasis. Women who had high-risk HPV at baseline were invited after 5 years for examination of cell atypia, genital schistosomiasis, and high-risk HPV. Both vaginal lavage samples (low-cost) and cervix brush samples (high-cost) were obtained for further analysis. RESULTS: Thirty-seven women were re-examined. Genital Schistosoma haematobium of a minimum of five years' duration was associated with the development high-grade squamous intraepithelial neoplasia, but not with persistent high-risk HPV. There was a high concordance between the brush and vaginal lavage (96.3% agreement, kappa 0.93); however, the number of beta-globin negative vaginal lavage samples was unacceptably high. CONCLUSIONS: Findings warrant an exploration in a larger longitudinal study where a vaginal swab should be explored.

Downregulation of MIP-1alpha/CCL3 with praziquantel treatment in Schistosoma haematobium and HIV-1 co-infected individuals in a rural community in Zimbabwe.

BACKGROUND: Chemokines have been reported to play an important role in granulomatous inflammation during Schistosoma mansoni infection. However there is less information on their role in Schistosoma haematobium infection, or on the effect of concurrent HIV-1 infection, as a potential modifying influence. METHODS: To determine levels of MIP-1alpha/CCL3 chemokine in plasma of S. haematobium and HIV-1 co-infected and uninfected individuals in a rural black Zimbabwean community.A cohort was established of HIV-1 and schistosomiasis infection and co-infection comprising 379 participants. Outcome measures consisted of HIV-1 and schistosomiasis status and levels of MIP-1alpha/CCL3 in plasma at baseline and three months post treatment. An association was established between MIP-1alpha/CCL3 plasma levels with HIV-1 and S. haematobium infections. RESULTS: A total of 379 adults formed the established cohort comprising 76 (20%) men and 303 (80%) women. Mean age was 33.25, range 17 - 62 years. The median MIP-1alpha/CCL3 plasma concentration was significantly higher in S. haematobium infected compared with uninfected individuals (p = 0.029). In contrast, there was no difference in the median MIP-1alpha/CCL3 levels between HIV-1 positive and negative individuals (p = 0.631). MIP-1alpha/CCL3 concentration in plasma was significantly reduced at three months after treatment with praziquantel (p = 000). CONCLUSION: The results of our study show that the MIP-1alpha/CCL3 levels were positively associated with S. haematobium egg counts at baseline but not with HIV-1 infection status. MIP-1alpha/CCL3 levels were significantly reduced at three months post treatment with praziquantel. We therefore conclude that MIP-1alpha/CCL3 is produced during infection with S haematobium. S. haematobium infection is associated with increased MIP-1alpha/CCL3 levels in an egg intensity-dependent manner and treatment of S. haematobium is associated with a reduction in MIP-1alpha/CCL3.

Intimate partner violence among HIV-serodiscordant couples in Durban, South Africa.

BACKGROUND: South Africa (SA) has a high prevalence rate of intimate partner violence (IPV) and HIV, both of which can be exacerbated further by HIV serodiscordancy in the couple dyad. Further exploration of the discordancy sidedness in known mediating factors, such as alcohol abuse risk and post-traumatic stress (PTS), is required. OBJECTIVES: To investigate the extent of and gender differences in IPV, alcohol abuse risk and PTS symptoms among HIV-serodiscordant couples in Durban, SA, and to analyse these further with regard to female HIV serostatus. METHODS: A cross-sectional analysis of data on 30 serodiscordant couples was conducted at the point of enrolment into a pilot study of an HIV risk reduction intervention. The statistical procedure for a dependent small sample was applied to examine gender differences in IPV, alcohol use and PTS symptoms among HIV-serodiscordant couples. RESULTS: The woman was HIV-positive in 18 (60.0%) of the 30 serodiscordant couples enrolled. Exposure to IPV differed significantly between men (28.6%) and women (89.3%) (proportional difference -0.61, 95% confidence interval (CI) -0.82 - -0.39). The Wilcoxon signed-rank test showed that PTS symptom scores differed significantly between men (median 22, interquartile range (IQR) 23) and women (median 44, IQR 28) (p=0.03). When the above analysis was stratified by female HIV serostatus, significant gender differences were found in IPV and PTS in the couples where the woman was HIV-positive. There were no significant gender differences for alcohol abuse risk. CONCLUSIONS: The findings demonstrated high levels of IPV in HIV-serodiscordant couples and a significant gender difference in mental health risk such as PTS in such relationships, particularly where the woman was HIV-positive. HIV intervention programmes should address gender-based violence and inequity among heterosexual couples.

Prevalence of urinary schistosomiasis and HIV in females living in a rural community of Zimbabwe: does age matter?

A cross-sectional study was conducted on 544 women living in Mupfure rural area of Zimbabwe to determine whether infection with urinary schistosomiasis is associated with HIV infection. Schistosoma haematobium infection was examined in urine samples and HIV infection was determined in sera. The prevalence of S. haematobium infection was highest (60%) in women below 20 years of age and declined to 29% in the oldest age group (test for trends, P<0.001). Overall, women infected with urinary schistosomiasis had an HIV prevalence of 33.3%, whilst women without urinary schistosomiasis had an HIV prevalence of 25.6% (chi(2), P=0.053). Women above the age of 35 years and infected with urinary schistosomiasis had a significantly higher HIV prevalence (37.5%) than those without urinary schistosomiasis (16.8%; chi(2), P<0.001).

Stool Xpert® MTB/RIF test for the diagnosis of childhood pulmonary tuberculosis at primary clinics in Zimbabwe.

OBJECTIVE: To evaluate the diagnostic performance of Xpert® MTB/RIF on stool samples from children with clinical suspicion of pulmonary tuberculosis (PTB) at primary care clinics. DESIGN: A cross-sectional diagnostic evaluation enrolling 5-16 year olds from whom one induced sputum (IS) sample was tested for microbiological TB confirmation. Results of a single stool sample tested using Xpert were compared against microbiologically confirmed TB, defined as a positive result on sputum microscopy and/or culture and/or IS Xpert. RESULTS: Of 222 children enrolled, 218 had complete microbiological results. The median age was 10.6 years (interquartile range 8-13). TB was microbiologically confirmed in 19/218 (8.7%) children. Of these, respectively 5 (26%), 9 (47%) and 15 (79%) were smear-, culture- and IS Xpert-positive. Stool Xpert was positive in 13/19 (68%) microbiologically confirmed cases and 4/199 (2%) microbiologically negative cases. Stool Xpert detected 76.9% (10/13) of human immunodeficiency virus (HIV) infected and 50% (3/6) of non-HIV-infected children with microbiologically confirmed TB (P = 0.241). CONCLUSION: Stool Xpert is a potential alternative screening test for children with suspected TB if sputum is unavailable. Strategies to optimise the diagnostic yield of stool Xpert assay need further study.

HIV and other predictors of serum beta-carotene and retinol in pregnancy: a cross-sectional study in Zimbabwe.

BACKGROUND: Vitamin A status during pregnancy is important to maternal and infant health. OBJECTIVE: Our goal was to identify predictors of serum beta-carotene and retinol. DESIGN: This was a cross-sectional study of 1669 women (22-35 wk of gestation) in Harare, Zimbabwe, who were receiving prenatal care. The statistical effects of age, season, gestational age, gravidity, HIV-1 infection, malaria parasitemia, and serum alpha1-antichymotrypsin (ACT) on serum beta-carotene (log10 transformed) and retinol were estimated by using multiple linear regression analyses. RESULTS: HIV infection was found in 31.5% of the women; 0.4% had malaria. Serum beta-carotene concentrations (geometric x: 0.19 micromol/L) were lower in HIV-infected women than in uninfected women (10beta = 0.78; 95% CI: 0.72, 0.84) and increased with age (10beta = 1.05; 1.02, 1.07) in gravida 1 but not in gravida > or =2 (P for interaction = 0.00002). Serum retinol (x: 0.92 micromol/L) increased with age (beta = 0.004; 0.0001, 0.008) in uninfected women but not in HIV-infected women (P for interaction = 0.02) and was 0.05-micromol/L (0.02, 0.09) lower in HIV-infected women than in uninfected women at 24 y of age. Furthermore, gestational age, season, use of prenatal supplements, and malaria were predictors of serum beta-carotene. Serum retinol was lower in women carrying male (beta = -0.04; -0.08, -0.00005) and multiple (beta = -0.21; -0.35, -0.08) fetuses. Serum ACT concentrations of 0.3-0.4, 0.4-0.5, and >0.5 g/L were associated with 3%, 11%, and 44% lower serum beta-carotene and 0.04-, 0.15-, and 0.41-micromol/L lower serum retinol. Serum ACT (g/L) was higher in women with malaria than in those without (beta = 0.10; 0.03, 0.16) and in gravida 1 than in gravida > or =2 (beta = 0.012; 0.003, 0.021), but was not higher in HIV-infected women than in uninfected women (beta = 0.001; -0.008, 0.011). CONCLUSIONS: HIV infection, malaria, gravidity, and gestational age were predictors of serum beta-carotene and retinol. Serum ACT was an important predictor of both and was associated with gravidity and gestational age.

HIV and other predictors of serum folate, serum ferritin, and hemoglobin in pregnancy: a cross-sectional study in Zimbabwe.

BACKGROUND: Folate and iron status and hemoglobin concentrations are important to maternal and infant health. OBJECTIVE: Our goal was to identify predictors of serum folate, serum ferritin, and hemoglobin. DESIGN: This was a cross-sectional study of 1669 pregnant women (22-35 wk of gestation) in Harare, Zimbabwe, who were receiving prenatal care. The statistical effects of age, season, gestational age, gravidity, HIV-1 infection, malaria parasitemia, and serum alpha1-antichymotrypsin (ACT) on serum folate, serum ferritin (log10 transformed), and hemoglobin were estimated by using multiple linear regression analyses. RESULTS: Serum folate (x: 11.4 micromol/L) was 0.52-nmol/L (95% CI: 0.04, 1.0) lower in HIV-infected women than in uninfected women and 0.65-nmol/L (0.014, 1.28) lower in weeks 25-35 than in weeks 22-25. Serum ferritin (geometric x: 11.6 microg/L) was 0.93 times (0.86, 0.99) lower in HIV-infected women and 2.25 times (1.41, 3.61) higher in women with malaria parasitemia than in uninfected women. Similarly, serum ferritin was 0.71 times (0.63, 0.79) higher in weeks 32-35 than in weeks 22-25 and 1.21 times (1.12, 1.29) higher in gravida > or =3 than in gravida 1. Elevated serum ACT was a strong predictor of serum folate, serum ferritin, and hemoglobin. HIV infection was associated with a 12.9-g/L (8.9, 16.8) lower hemoglobin concentration in women with nondepleted iron stores but low serum retinol and a 7-8-g/L lower hemoglobin concentration in women with other combinations of serum ferritin and retinol (P for interaction = 0.038). Season, age, gestational age, and gravidity were not significant predictors of hemoglobin. Low serum folate, ferritin, and retinol were associated with low hemoglobin. CONCLUSIONS: HIV was associated with lower serum folate, serum ferritin, and hemoglobin. HIV infection was also associated with lower hemoglobin, particularly in women with stored iron and low serum retinol. Low serum folate, ferritin, and retinol were associated with low hemoglobin.

Schistosomiasis infection in relation to the ABO blood groups among school children in Zimbabwe.

The study aimed to establish if there was any relationship between the blood group of the human host and schistosomiasis prevalence, intensity, incidence and related organ pathology. Urine and stool specimens were collected from the 735 school children attending a rural school in Zimbabwe to determine the Schistosoma haematobium and S. mansoni infection status of the children. The parasitology results were used to calculate prevalence and intensity of schistosomiasis infection. All the children, irrespective of infection status, were examined for signs of organ damage using ultrasonography before those that were infected were treated using a single dose of praziquantel. A blood specimen was taken from each child for blood group determination. Exactly 1 year later, parasitology was repeated to allow calculation of annual incidence of schistosomiasis infection. Of the children studied, 212 (28.8%) were of blood group 'A', 156 (21.2%) were of blood group 'B' while 367 (49.9%) belonged to blood group 'O'. The prevalence of S. haematobium was 59.6% (n = 438) while that of S. mansoni was 15.60% (n = 115). S. haematobium infection was detected among 129 (60.8%) children belonging to blood group 'A': 225 (61.30%) of blood group 'O' and 84 (53. 80%) of those belonging to blood group 'B'. S. mansoni infection was detected among 65 (30.70%) blood group 'A' children while 37 (10.10%) blood group 'O' and 13 (8.30%) blood group 'B' children were infected. Intensity, annual incidence of S. haematobium infection and related organ pathology was significantly higher among children of blood group 'A' and lowest among blood group 'O' children (P < 0.01, F-value = 6.13). Similarly, S. Mansoni intensity and incidence of infection and related liver lesions were highest among children of blood group 'A' (P < 0.005, F-value = 11.45).

Validation of a simple and cheap gelatin particle agglutination test for human immunodeficiency virus using dried blood spot samples.

OBJECTIVES: To validate a Gelatin Particle Agglutination (GPA) test for HIV using dried blood spots with a view to applying the test in large epidemiological studies. DESIGN: A method comparison study with standard enzyme linked immunosorbent assay (ELISA) using the Recombigen HIV-1/2 kit as the gold standard. SETTING: Blair Research Laboratory, Harare, Zimbabwe. SUBJECTS: Sera and dried blood spots samples were available from 379 women from Mbare, Harare and Mupfure, Shamva District, Zimbabwe who had participated in HIV studies conducted by Blair Research Laboratory. MAIN OUTCOME MEASURES: Results of the GPA and Recombigen HIV-1/2 ELISA using serum and dried blood spots. RESULTS: With the Recombigen HIV-1/2 ELISA as the gold standard, sensitivity and specificity of the GPA were 100% and 99.2% respectively using serum. With dried blood spots sensitivity and specificity of the GPA test were 100%. The cost of analysing one sample, based on cost of reagents and accessory materials only, was Z$300 for GPA compared to Z$1,200 for ELISA. Furthermore, hands-on time was significantly reduced with the GPA compared to ELISA. CONCLUSION: The GPA method is simple, less labour intensive and much cheaper, yet is equally sensitive when compared to standard ELISA. The high sensitivity with blood spots makes the test ideal for large-scale epidemiological studies in remote rural areas with no infrastructure for advanced diagnostic methods.

In vitro activity of several antimicrobial agents against Neisseria gonorrhoeae and comparison of cost of treatment.

During a cross sectional study on the prevalence and incidence of gonorrhoea, Neisseria gonorrhoeae was isolated from 185 people aged between 16 and 60 years. In vitro activity of six antimicrobial antibacterial agents, penicillin, erythromycin, tetracycline, cotrimoxazole, ceftriaxone and norfloxacin on the isolated N. gonorrhoeae were carried out. The results obtained showed that, of all 111 isolates, 48 (43.2 pc) were penicillinase producing N. gonorrhoeae (PPNG) and 63 (56.8 pc) were non PPNGs. Over 90 pc of both PPNG and non PPNG isolates were sensitive to tetracyline and erythromycin. Seventy five pc of the PPNG and 45 pc non-PPNG were not sensitive to two units of penicillin. Both PPNG and non-PPNG were less sensitive to cotrimoxazole 25 micrograms. Norfloxacin and ceftriaxone were over 70 pc effective but were extremely expensive for most people who got infected.

A cross-sectional study on the prevalence and intensity of schistosomiasis among sugar cane cutters in Zimbabwe.

A schistosomiasis prevalence and intensity survey was carried out among sugar cane cutters of Hippo Valley and Triangle, the two largest irrigated sugar estates in Zimbabwe. Urine and stool specimens were collected for determination of schistosomiasis infection from 1995 cane cutters. A total of 315 (15.8pc) cutters were found to be infected with Schistosoma mansoni while 163 (8.2pc) were found to be positive for S. haematobium. The arithmetic mean egg count (AMEC) and geometric mean egg count (GMEC) for the different age groups into which the cane cutters were divided was calculated. The prevalence and intensity of S. mansoni increased with age while the opposite was true for S. haematobium. The factors contributing to this observation are discussed.

Retrospective study on the criteria for diagnosis of HIV infection in adults in Zimbabwe.

OBJECTIVE: To review the criteria for diagnosis of HIV infection in adults in order to improve upon the Zimbabwe Adult AIDS case definition. DESIGN: A descriptive study which involved the analysis of "Request fo r HIV Antibody Test" forms which had been submitted by clinicians to Masvingo Public Health Laboratory, between June 1990 and December 1992. SETTING: Masvingo Public Health Laboratory, Zimbabwe. SUBJECTS: 627 adult patients. MAIN OUTCOME MEASURES: HIV seroprevalence; specific, sensitivity and positive predictive values of the Adult AIDS case definition. RESULTS: The HIV seroprevalence in 627 adult patients whose forms had been submitted to Masvingo Public Health Laboratory was 79pc. The criterion for the diagnosis of HIV infection had a very high specificity value of 93pc but low sensitivity of 53pc. The positive predictive value of the case definition was very high (97pc). The positive predictive values of individual symptoms were calculated and only weight loss and persistent generalized lymphodenopathy had high values of 99pc and 72pc respectively. CONCLUSIONS: This study has shown that the criterion used in the diagnosis of HIV infection in Zimbabwe is highly specific but relatively insensitive at identifying seropositive patients. This shows the ability of clinicians to identify HIV positive patients irrespective of the stage of the disease (i.e. HIV related symptoms, AIDS related complex or full blown AIDS). There is also a need for constant monitoring of the clinical manifestations of AIDS patients to keep abreast with newer disease manifestations.

PIP: In Zimbabwe, researchers analyzed data on blood samples collected from 627 adult patients at least 14 years old at all hospitals in the 7 districts of Masvingo Province during June 1990-December 1992 to reexamine the criteria for diagnosis of HIV infection in hopes of improving the Zimbabwe Adult AIDS case definition. This case definition is: an illness characterized by at least 2 major signs and 1 minor sign provided serologic tests for HIV are positive (major signs: weight loss 10% of body weight, chronic diarrhea for 1 month, and fever for 1 month; minor signs: cough 1 month, general pruritic dermatitis, recurrent Herpes zoster, oropharyngeal candidates, chronic progressive and disseminated Herpes simplex infection, and generalized lymphadenopathy). 79.1% tested positive for HIV infection. 271 of all adult patients had signs and symptoms that met the criterion for diagnosis of HIV infection. 97.1% of them actually had HIV infection. The specificity for this criterion was 93.9%, but its sensitivity was 53%, suggesting a high ability of clinicians to identify HIV positive patients but low ability to correctly exclude HIV infection. The positive predictive value was higher than that in Uganda (97% vs. 74%). The symptom with the highest positive predictive value and the highest sensitivity value was weight loss greater than 10% of body weight (98.9% vs. 2-71.9% and 74.6% vs. 1.5-57.4%, respectively). Candidiasis and chronic diarrhea had the highest specificity values (86.3% and 85.4%, respectively, vs. 26.4-80.9%). In conclusion, the criterion for diagnosis of HIV infection in Zimbabwe is very specific but rather insensitive at identifying HIV positive patients.

An investigation of the schistosomiasis transmission status in Harare.

A schistosomiasis prevalence and intensity survey was carried out among school children in selected residential suburbs of Harare. Urine and stool specimens were collected for determination of schistosomiasis infection from 2,552 children aged between five and 15 years. A total of 351 (13.7 pc) school children were found to be infected with Schistosoma haematobium while 172 (6.7 pc) pupils were found to be positive for S. mansoni. The arithmetic mean egg count (AMEC) for S. haematobium was 16 while that for S. mansoni was 7.6 figures much lower than those found among school children in rural areas. Malacological studies revealed the presence of infected intermediate hosts of schistosomiasis in some water bodies in and around Harare signifying the potential for transmission. The factors contributing to this observation are discussed. Prevalence and annual incidence of schistosomiasis was highest among children of high density suburbs on the outskirts of Harare where children had access to unprotected and untreated water usually outside the city boundaries. The lack of recreational facilities in these areas was found to be a major contributing factor towards the transmission of schistosomiasis as children were sometimes forced to use water bodies outside the City of Harare boundaries for such activities. The possible contribution of religious activities is also discussed.

Risk factors for HIV infection in a rural cohort in Zimbabwe: a pilot study.

OBJECTIVE: To identify demographic, sexual behavioural and cultural risk factors for human immunodeficiency virus (HIV) infection in a rural community in Zimbabwe. DESIGN: Prospective study. SETTING: Rural area in Zimbabwe. SUBJECTS: 207 subjects (81 males, 126 females) mean age 31.6 years (SD 15.3), range 12 to 76 years living in the area. MAIN OUTCOME MEASURES: HIV seropositivity and seroconversion, exposure or no exposure to risk factor. RESULTS: Prevalence of HIV was 7.7% and was associated with being divorced or widowed [Odds ratio (OR) 4.26, 95% confidence interval (CI) 1.17 to 14.97] and past history of sexually transmitted diseases (STDs) [(OR 3.54, 95% CI 1.31 to 9.89)]. Seroconversion rate was 3.6% per year and was associated with history of STD [Relative Risk (RR) 13.22, 95% CI 1.15 to 156.1)] during the follow up period. Individuals over 20 years of age, those reporting one or more sexual partners, those reporting irregular use of condoms and those scarified were at greater risk than their counterparts. Individuals who reported being circumcised were at slightly lesser risk than those who did not report circumcision. CONCLUSION: STDs were major determinants of HIV transmission in the study area. In addition being divorced or widowed was a risk factor for HIV infection. Scarification, tattooing and circumcision require further investigations.

Enumeration of CD4 and CD8 T-cells in HIV infection in Zimbabwe using a manual immunocytochemical method.

OBJECTIVES: To enumerate CD4 and CD8 T-cells using the simple and cheap immuno-alkaline phosphatase (IA) method and to compare it with flow cytometry (FC); and to study the effects of duration of sample storage on the IA method results. DESIGN: Method comparison study. SETTING: Blair Research Laboratory, Harare, Zimbabwe. SUBJECTS: 41 HIV positive and 11 HIV negative men and women from Harare participating in HIV studies at Blair Research Laboratory, Zimbabwe. MAIN OUTCOME MEASURES: CD4 and CD8 T-cell counts by FC and the IA method. RESULTS: The IA method and FC were highly correlated for CD4 counts (Spearman rs = 0.91), CD4 percentage (rs = 0.84), CD8 count (rs = 0.83), CD8 percentage (rs = 0.96) and CD4/CD8 ratio (rs = 0.89). However, CD4 cell counts and percentage measured by the IA method were (mean difference +/- SE) 133 +/- 24 cells/microL [corrected] and 6.7 +/- 1.1% higher than those measured by the FC method (p < 0.0001) respectively. CD8 counts and percentages by the IA method were lower than those by the FC method (p < 0.01). Accordingly, the IA method gave a higher CD4/CD8 ratio (p < 0.01). IA method CD4 counts < 300/mL best predicted FC CD4 counts < 200/mL while IA CD4% < 25 best predicted FC CD4% < 14%. IA method CD4/CD8 ratio < 0.8 best predicted FC CD4/CD8 ratio < 0.5. Smears stored for up to 18 months gave results similar to fresh smears. CONCLUSION: The IA method correlates well with but gives CD4 counts and percentages that are higher than those determined by FC. On the contrary, the IA method gives CD8 counts and percentage that are lower than FC values. The method is a cheap and reliable alternative to FC and allows storage of samples for extended periods before analysis, making it an appropriate technology for resource poor countries.

Predictors and reference values of CD4 and CD8 T lymphocyte counts in pregnancy: a cross sectional study among HIV negative women in Zimbabwe.

OBJECTIVE: To identify predictors and define reference values for T lymphocyte subsets in HIV negative pregnant black women. DESIGN: Cross sectional study. SETTING: Edith Opperman Martenity Hospital, Harare, Zimbabwe. STUDY POPULATION: 1113 HIV negative women 22 to 35 weeks pregnant registering for routine antenatal care. METHODS: A questionnaire was used to collect demographic and obstetric data. CD4 and CD8 T lymphocyte counts were determined by manual immunocytochemistry. Concentrations in serum, of retinol, beta-carotene, ferritin, folate and 1-antichymotrypsin were also measured. Multiple linear regression analysis was employed to identify and estimate effects of potential predictors. MAIN OUTCOME MEASURES: CD4 and CD8 T lymphocyte levels, demographic, obstetric data and micronutrient status. RESULTS: Predictors of CD4 counts were gestational age, serum retinol and season. CD4 counts declined by 25 (95% confidence interval [CI]; 11 to 40; p = 0.001) cells/L for each week's increase in gestation among women with low serum retinol, while low serum retinol was independently associated with lower CD4 counts (-127; 95% CI, -233 to 20 cells/L; p = 0.02) at 35 weeks gestation. The late rainy season was associated with higher CD4 counts (137; 95% CI, 67 to 207 cells/L; p < 0.001). CD8 counts were higher in women with low serum folate (87; 95% CI, 6 to 166 cells/L; p = 0.036) and were slightly higher in gravida 4+ compared to gravida one to three. Reference values of CD4 but not CD8 count and percentage markedly differed from flow cytometry values of pregnant and non-pregnant women in developed and developing countries reported in the literature, even after controlling for the differences in methods of T lymphocyte subset immunophenotyping. CONCLUSION: Gestational age, gravidity, micronutrient status and season influence T lymphocyte subset levels and need to be considered when designing clinical management and intervention strategies for pregnant women. The data underscores the need for local reference values.

Prevalence of gonorrhoea and knowledge of sexually transmitted infections in a farming community in Zimbabwe.

OBJECTIVE: To determine the prevalence of gonorrhoea and knowledge about sexually transmitted infections in a farming community. DESIGN: Cross sectional study. SETTING: Commercial farming area, Zimbabwe. SUBJECTS: 1,005 individuals aged between 15 and 60 years. MAIN OUTCOME MEASURES: Prevalence rates, knowledge of gonorrhoea and other sexually transmitted infections (STIs) by age and sex. RESULTS: Knowledge of gonorrhoea and other STIs was higher while knowledge of AIDS was lower among males than females. Frequency of past history of STIs in five years was significantly higher among males than females (OR 3.22; 95% CI 2.45 to 4.25). Physical examination revealed that 14% of males and 22% of females had other STIs besides gonorrhoea. The prevalence of gonorrhea was 18.4% (95% CI 16.0 to 20.8) and was higher among females than males (OR 2.77; 95% CI 1.97 to 3.90). Thirty one percent of the gonorrhoea infections were due to penicillinase producing Neisseria gonorrhoeae. CONCLUSIONS: Our findings emphasize the disparity between knowledge and practices with regards to STIs, and the importance of STIs as potential targets for and indices in the fight against human immunodeficiency virus (HIV) infection.

PIP: A cross-sectional study of 1005 males and females 15-60 years of age from a commercial farming community (Hippo Valley Sugar Estates) in Zimbabwe investigated knowledge and prevalence rates of gonorrhea and other sexually transmitted infections (STIs). Although over 70% of respondents were aware of gonorrhea, only 45.5% were knowledgeable about AIDS. Males had higher knowledge of gonorrhea and other STIs than females, but lower knowledge of HIV/AIDS. 47% of subjects had a history of an STI in the 5 years preceding the study. The frequency of such a history was significantly higher among males compared to females (odds ratio (OR), 3.22; 95% confidence interval (CI), 2.45-4.25). Physical examination indicated that 20.5% of males and 37.9% of females had signs of STIs. The majority of STI cases affected men in the 20-29 year age group and women 30-39 years of age. Gonorrhea prevalence was 18.4% and significantly higher among females than males (OR, 2.77; 95% CI, 1.97-3.90). 31% of gonorrhea infections were associated with penicillinase-producing Neisseria gonorrhoeae. Since STIs have been associated with increased transmission of HIV, these infections should be targeted for campaigns aimed at reducing the disparity between knowledge and practices. Moreover, examination of the prevalence of STIs such as gonorrhea is a quick way of assessing the impact of HIV control measures in a community.

Quality of life evaluation in patients with HIV-I infection: the impact of traditional medicine in Zimbabwe.

OBJECTIVES: To evaluate the impact of phytotherapy (traditional medicine) in persons with HIV infection and to assess the quality of life of those persons with respect to HIV disease progression, including sociodemographic characteristics. DESIGN: A community based open label non-intervention and uncontrolled cohort study. SETTING: Blair Research Institute Clinic. SUBJECTS: A total of 105 HIV infected persons at various stages of HIV infection. Seventy-nine percent were on phytotherapy (PT) and 21% on conventional medical care (CMC). MAIN OUTCOME MEASURES: (a) Assessment of quality of life of HIV infected persons on phytotherapy using the WHOQol instrument, and (b) assessment of quality of life of those persons in relation to the HIV disease progression using CD4 cell counts and viral load as measure of disease progression. METHODS: We interviewed 105 patients with various stages of HIV-I infection in a community based cohort study from June 1996 to May 1998, in Harare. The 96 (91.4%) asymptomatic and six (8.6%) symptomatic patients underwent regular physical examinations and had blood drawn for laboratory tests at the baseline afterwards at three month intervals over a period of two years. RESULTS: The mean (s.d.) age was 34.9 (7.3) years; 64.4% were women and 60.3% were married. In multi variate analyses, age was significantly correlated with the level of independence domains (p = 0.032), whereas, gender was significantly correlated with social relationships' domains (p = 0.034). The type of treatment received was significantly correlated with spiritual domains (p = 0.045). Proportions of scores on five domains measuring different aspects of quality of life for patients on phytotherapy were much lower than those on conventional therapy (p < 0.0001, for all variables). CONCLUSION: Our data support the role of phytotherapy in improving the quality of life of HIV-I infected patients, yet its pharmacological basis is unknown. The WHOQol instrument is a good measure of quality of life for patients with HIV infection.

Alcohol consumption in HIV-I infected persons: a study of immunological markers, Harare, Zimbabwe.

OBJECTIVE: To examine the effect of alcohol use in relation to the age, gender and plasma levels of HIV-I RNA and CD4 cells count in HIV-I infected persons as a prognostic indicator for the disease progression to AIDS. DESIGN: A community based cohort study. SETTING: The study was conducted at the Blair Research Institute Clinic from June 1996 to May 1998. SUBJECT: We interviewed 105 volunteers, at a baseline and then followed them up on a three monthly basis. They underwent physical examinations and had blood drawn for laboratory tests. AUDIT Core was used to gain an indication of how much dependence there was on alcohol by patients in relation to demographic and immunological variables. MAIN OUTCOME MEASURES: Frequency of alcohol use and HIV-I disease progression to AIDS using viral loads and CD4 cells counts as measures of immune impairment. RESULTS: The volunteers had a mean (s d) age of 34.9 (7.3) years. Prevalence of alcohol use was 30.5% (n = 34.95% CI = 21.7 to 39.3). Most of the patients with CD4 cells count less than 200 mm3 did not use alcohol (p = 0.023) by the six months follow ups. There were no significant mean differences between users and nonusers of alcohol regarding the levels of both plasma viremia and CD4 cells count. CONCLUSION: Our finding is consistent with previous findings that found no relationship between alcohol use in persons with HIV-I infection and progression of disease to AIDS.

The physical fitness and work performance of agricultural workers infected with Schistosoma mansoni in Zimbabwe.

Stool specimens were collected from 1995 sugarcane cutters on the Hippo Valley and Triangle sugar estates, Zimbabwe, in order to determine the prevalence and intensity of Schistosoma mansoni infection. Pathological changes normally ascribed to S. mansoni infection were assessed in the infected cutters, by ultrasonography before treatment. The height, weight, age, haemoglobin levels, blood pressure and body fat of the infected and uninfected control study subjects, standardized by age, were determined. Those with elevated blood pressure were excluded from the study. Physical fitness and work performances were assessed in 287 infected and 210 uninfected cane cutters aged (mean +/- S.D.) 36.5 +/- 7.5 years. Despite the finding that all the subjects were of good nutritional status and generally physically fit, a t-test showed a significant improvement (P < 0.01) in the performance of the infected cutters following treatment; age-related physical performance, measured by the Harvard Step Test, increased by 4.3% and work output, measured as the amount of cane cut in a given time, rose by 16.6%. Although the physical and work performances of the uninfected control subjects also increased over the same period, this trend, attributed to occupational physical exercise, was not statistically significant (P > 0.05). Significant correlations were found between both infection intensity-related pre-treatment physical fitness (P < 0.05) and work performance (P < 0.01) and prevalence of Symmers' peri-portal fibrosis.