Probiotic yeast Saccharomyces cerevisiae Az-12 isolated from pomegranate juice presented inhibitory effects against pathogenic bacteria.

The potential probiotic yeast was isolated from the Kyzyl Anor pomegranate variety growing in the Turkestan region (Kazakhstan). The yeast strain was identified as Saccharomyces cerevisiae Az-12. Molecular genetic identification was carried out using the Sanger sequencing method. The degree of homology of the S. cerevisiae Az-12 strain with the strain MH608341.1 Saccharomyces cerevisiae isolate extr03 was 99.65%. Antagonistic effect of the yeast against pathogenic bacteria was confirmed according inhibition zones for Staphylococcus aureus 13.5 ± 0.05 mm; the inhibition zones for Escherichia coli 12.8 ± 0.05 mm; and 10.7 ± 0.05 mm for Pseudomonas aeruginosa. Scanning microscopy of S. cerevisiae Az-12 and S. aureus confirmed the adhesive ability of the yeast cell surface to S. aureus. S. cerevisiae Az-12 were chosen as the most promising, as they are able to quickly ferment juices. Functional drinks containing pomegranate juice and yeast with a probiotic effect can be considered as a useful synbiotic product formulation.

Potential of phenolic compounds from pomegranate (Punica granatum L.) by-product with significant antioxidant and therapeutic effects: A narrative review.

The wealth of epidemiological evidence in the scientific world underscores the possibility that a plant-based diet can reduce the prevalence of common diseases such as diabetes, cardiovascular disease, cancer, and stroke. The therapeutic effects of plant sources are partly explained by phenolic secondary metabolites or polyphenolic compounds. Therefore, polyphenolic compounds, which are widely distributed in plants, are of great interest for the development of effective specific drugs with antioxidant and anti-inflammatory effects. Moreover, polyphenol compounds have no harmful effects due to their natural biocompatibility and safety. Numerous studies have highlighted the potential of some industrial food wastes from plant material processing, including apple peels and mashed potatoes, grape skins, tomato and carrot peels, pomegranate peels and seeds, and many others. These byproducts are considered low-cost sources of natural biological compounds, including antioxidants, which have beneficial effects on human health. The polyphenol complex of pomegranate peel (Punica granatum L.), which makes up half of the pomegranate fruit, has more pronounced antioxidant and anti-inflammatory properties than other parts. And the most important active components of pomegranate peel, which are found only in this plant, are punicalagin, followed by ellagic acid and gallic acid. It is known that these polyphenolic compounds of pomegranate peel have the most pronounced therapeutic effect. Several studies have shown the protective effect of ellagic acid, punicalagin, against oxidative stress damage caused by free radicals. The potential of pomegranate peel as an antioxidant and therapeutic component in various biological systems is high, according to scientific sources. However, despite extensive research in recent years, a review of sources has shown that there is insufficient evidence to support the therapeutic effects of polyphenolic compounds from pomegranate peels. The role of pomegranate peel polyphenolic compounds, including flavonoids, as antioxidants in various biological systems also requires further research. Of particular importance are the mechanisms by which antioxidants influence the cellular response against oxidative stress. The purpose of this review was to report our current knowledge of plant polyphenolic compounds and their classification, and to evaluate the potential of phenolic compounds from pomegranate peels with significant antioxidant and therapeutic effects.

Induction of 8-hydroxydeoxyguanosine and ultrastructure alterations by silver nanoparticles attributing to placental transfer in pregnant rats and fetuses.

A quantitative assessment of the genotoxicity of silver nanoparticles (AgNPs) ascribed to its transplacental transfer and tissue distribution in pregnant rats was carried out in this study. A single intravenous (i.v.) injection of AgNPs with a size range from 4.0 to 17.0 nm was administered to pregnant rats at a dose of 2 mg/kg b.w. on the 19th day of gestation. Five groups beside control, each of the five rats were euthanized after 10 min, 1, 6, 12, or 24 h, respectively. The accumulation of nanoparticles (NPs) in mother and fetal tissues was quantified by inductively coupled plasma optical emission spectroscopy, where the highest accumulation level was recorded in maternal blood (0.523 µg/ml) after 24 h of administration. AgNPs induced accumulation in spleen tissue higher than placenta and fetal tissue homogenates. The data showed significantly detected levels of 8-hydroxydeoxyguanosine in all collected samples from administered animals compared with untreated individuals. Level of 8-OHdG in amniotic fluid exhibited the greatest values followed by maternal spleen, kidneys, and liver, respectively. Investigation by transmission electron microscope showed that the transfer of AgNPs through placental wall caused indentation of nuclei, clumped chromatin, pyknotic nuclei, and focal necrotic areas, while AgNPs appeared mainly accumulated in the macrophages of the spleen. Therefore, the data assume that the genotoxicity studies of AgNPs must be recommended during a comprehensive assessment of the safety of novel types of NPs and nanomaterials. Additionally, exposure to AgNPs must be prevented or minimized during pregnancy or prenatal periods.

Genital ulcers and transmission of HIV among couples in Zimbabwe.

Seventy-five married men found to be positive for HIV-1 in Harare, Zimbabwe, were interviewed in order to define behaviours associated with acquisition of infection and to determine factors associated with transmission of infection to their wives. The majority of infected men reported sexual intercourse with multiple heterosexual partners and female prostitutes, and gave a history of sexually transmitted diseases (STDs). All subjects denied homosexual activity and parenteral drug abuse. Serological testing of the wives of seropositive men showed that 45 (60%) were HIV-antibody-positive. Wives of men with AIDS and AIDS-related complex (ARC) and wives of men who gave a history of genital ulcer disease were more likely to be seropositive. The study demonstrates that HIV-1 infection in Zimbabwe occurs through heterosexual intercourse and is associated with other STDs. In addition, the study shows that male to female transmission of HIV-1 is facilitated by the presence of genital ulcers in infected men.

PIP: As part of a prospective cohort study of Zimbabweans seropositive for human immunodeficiency virus (HIV) infection, the factors associated with HIV transmission from husband to wife were analyzed in 75 couples. The mean age of the infected men was 32.1 years; all had been married for at least 1 year and 53 had at least 1 child. None of the men acknowledged a history of homosexual practices or intravenous drug use. All 75 had received injections, but only at reputable health care facilities, and none had been blood transfusion recipients. 4 men (5%) were asymptomatic, 40 (53%) had persistent generalized lymphadenopathy, 24 (32%) had acquired immunodeficiency syndrome (AIDS)-related complex (ARC), and 7 (9%) had full-blown AIDS. Of the 75 wives tested, 45 (60%) were seropositive for HIV-1 infection. Seropositivity was significantly more common among women married to men with ARC (71% infection rate) and AIDS (86% infection rate). Comparison of concordant (both seropositive) and discordant (husband only seropositive) couples indicated no significant differences in terms of age, duration of marriage, number of children, oral contraceptive use by the wife, husband's contact with prostitutes, or sexual activity on the part of the husband with multiple partners in the preceding 3 years. In addition, there was no significant difference between groups in terms of history of sexually transmitted diseases. However, men who reported a history of genital ulcer disease were significantly more likely to have a wife who was seropositive (relative risk, 1.94; 95% confidence interval, 1.62-15.13). This difference persisted even when the male's stage of disease was controlled. Thus, it appears that HIV-1 infected men with genital ulcers are likely to transmit the infection through vaginal intercourse.

Neurocysticercosis and human immunodeficiency virus infection. A possible association.

We present four patients with active neurocysticercosis and human immunodeficiency virus type 1 infection. In three patients, symptoms of neurocysticercosis brought the patient to medical attention and led to the diagnosis of human immunodeficiency virus infection. Neurocysticercosis should be considered in human immunodeficiency virus-infected persons who have been in areas where cysticercosis is endemic.

Sexual behavior and risk factors for HIV infection in a group of male factory workers who donated blood in Harare, Zimbabwe.

Zimbabwe has experienced a rapid rise in HIV seroprevalence in recent years. As many as 1 million people (10% of the population) are predicted to become seropositive by 2000. We examined social and behavioral factors associated with HIV infection in a case-control study among male factory workers who donated blood before the launching of the AIDS Awareness Campaign. There were 188 subjects: 69 were HIV-positive and 119 were HIV-negative. High-risk behavior was common in both groups. Among seronegative men, 73.1% reported a sexually transmitted disease (STD), 55.5% reported cash payment for sex, and 73.1% had outside girlfriends. Nonetheless, HIV-positive men were more likely to report a history of STD (OR = 3.9; 95% CI = 1.5-11.9), particularly genital ulcers (OR = 2.4; 95% CI = 1.2-4.8), and extramarital partners (OR = 2.8; 95% CI = 1.1-7.1). HIV-positive men reported more lifetime partners (16.5 vs. 12; p less than 0.05) and were less likely to live with their wives (OR = 0.51; 95% CI = 0.23-1.15). Our findings support the importance of genital ulcer as a risk factor and suggest widespread high-risk sexual behavior among urban working-class men.

Clinical and laboratory characteristics of HIV-1 infection in Zimbabwe.

To define the impact of human immunodeficiency virus (HIV) infection in Africa, clinical and laboratory investigations were conducted on 265 HIV-seropositive outpatients in Zimbabwe. Twenty-four of the study subjects were asymptomatic (ASX), 124 had persistent generalized lymphadenopathy (PGL), and 117 had AIDS-related complex (ARC). HIV infection was assessed by commercial ELISA, Western blots, synthetic peptide ELISA, and measurement of p24 antigen. Serum immunoglobulins, lymphocyte mitogen responses, and CD4+ cell numbers were obtained in 54 sequential patients. Compared to seronegative subjects, mean CD4+ cell numbers were decreased and serum immunoglobulins, particularly IgM and IgG, were increased in all groups of seropositive subjects. Lymphocyte proliferative responses to phytohemagglutinin and concanavalin A decreased progressively in ASX, PGL, and ARC patients and were significantly lower in PGL and ARC patients compared to seronegative controls. Generalized lymphadenopathy was present in 234/265 (88%) of patients. Lymph node biopsies in 100 patients demonstrated follicular hyperplasia in 97 and Mycobacterium tuberculosis in 3. Of 165 patients followed for a median of 6 months, 5 developed the acquired immune deficiency syndrome (AIDS). Symptoms of ARC, low CD4+ cell number, and p24 antigen were predictive of the development of AIDS in Zimbabwe.

Guillain-Barré syndrome associated with human immunodeficiency virus infection in Zimbabwe.

We studied the clinical features and human immunodeficiency virus (HIV) serology of 32 consecutive adults with inflammatory demyelinating polyneuropathy (IDP) admitted to the teaching hospitals in Harare, Zimbabwe. Twenty-nine of the IDP patients had Guillain-Barré syndrome (GBS), and the other three had chronic IDP. Sixteen of 29 (55%) GBS patients were HIV-seropositive, a higher frequency of HIV infection than in blood donors drawn from the population served by these hospitals. All three chronic IDP patients were HIV-seronegative. In all HIV-seropositive patients, GBS was the initial illness that brought the patient to medical attention and led to the diagnosis of HIV infection. Compared with seronegative patients, the HIV-seropositive GBS patients were more likely to have generalized lymphadenopathy, CSF pleocytosis, coexistent CNS disturbance, and prior sexually transmitted disease. GBS in this region of Africa is frequently associated with HIV infection.

Antimicrobial susceptibility patterns amongst group B streptococci from women in Harare, Zimbabwe.

As part of a larger study of vaginal pathogens in women in Harare, we have examined the antimicrobial susceptibility patterns of 130 isolates of group B streptococci (GBS). These organisms are important because of their association with preterm labour, premature rupture of membranes and neonatal sepsis. All of the isolates in Harare were fully sensitive to beta-lactams, with an MIC(90) for ampicillin of 0.38 mg/l, but five isolates were resistant in vitro to erythromycin, and each of these had an MIC >4 mg/l. Seven isolates showed resistance to clindamycin. Some isolates showed an intermediate sensitivity to gentamicin, but the great majority were resistant to this antibiotic. Studies in developed countries have shown that an intervention strategy, using intrapartum chemoprophylaxis, is effective in reducing the incidence of complications of GBS colonization in pregnant women. Our data suggest that ampicillin would be a suitable antibiotic for use in an intervention programme of intrapartum chemoprophylaxis in Harare.

Antimicrobial resistance in gonococci isolated from patients and from commercial sex workers in Harare, Zimbabwe.

The objective is to compare antibiotic resistance amongst gonococci isolated from different patient groups in Harare, Zimbabwe. Antimicrobial susceptibilities of Neisseria. gonorrhoeae were determined by disc sensitivity tests. The MICs for penicillin, kanamycin, ceftriaxone, norfloxacin and ciprofloxacin were determined using E-test strips. There were 147 isolates from symptomatic men, 47 isolates from symptomatic women, 29 isolates from asymptomatic women and 41 isolates from female commercial sex workers. A total of 119 (45%) isolates were PPNG and 23 (16%) non-PPNG isolates had a penicillin MIC > 0.64 mg/l. Over 90% of isolates were resistant to TMP/SMX and 16% were resistant to tetracycline. Resistance was uncommon against kanamycin (6%), erythromycin (2%) or ceftriaxone ( < 1%). For kanamycin, the MIC90 was 32 mg/l, for ceftriaxone the MIC90 was < 0.032 mg/l for non-PPNG and < 0.064 mg/l for PPNG. For norfloxacin and ciprofloxacin the MIC90 was < 0.064 mg/l for both PPNG and non-PPNG. Isolates from the commercial sex workers showed a significantly increased prevalence of PPNG, of penicillin-tolerant non-PPNG and of tetracycline resistance. Four of the 41 isolates from sex workers showed multiple resistance (to penicillin, TMP/SMX, tetracycline and kanamycin) compared to 1/223 isolates from other groups (OR = 24.0). Antimicrobial resistance is common amongst gonococci in Harare, especially with isolates from commercial sex workers. In order for STD treatment to be implemented as an effective strategy in HIV control, continued monitoring of resistance patterns is essential.

Clinicopathological features of cutaneous histoplasmosis in human immunodeficiency virus-infected patients in Zimbabwe.

Reports of disseminated Histoplasma infection in African AIDS patients are scanty. In Zimbabwe, 12 patients presented in 1994-2000 with facial nodular/papular cutaneous lesions, which became umbilicated and finally ulcerated. Histology revealed non-granulomatous inflammation and macrophages stuffed with Histoplasma. Recognition of these clinical features may lead to more rapid diagnosis of disseminated histoplasmosis in Africa.

The aetiology of acute hepatitis in Zimbabwe.

The cause of acute viral hepatitis in 141 patients admitted to both Infectious Diseases Hospitals in Harare (Zimbabwe) was hepatitis A in 44, hepatitis B in 86 and hepatitis Non-A Non-B in 11. The wide distribution of hepatitis A and B viruses and early exposure to both in Zimbabwe are shown by the high positivity rate for anti-HAV antibody in patients under 10 years old (87.5%) and for anti-HBs antibody in patients over 20 (60%). Among the 86 hepatitis B cases, e and delta systems were also investigated: 66 patients (76.5%) were HBeAg positive, six (7%) anti-HBe positive and 14 (16.5%) negative for both; only one was anti-delta positive. Two cases of fulminant liver failure (both occurring in HBsAg and anti-HBc IgM positive, but delta-markers negative patients) and five cases of hepatoma (only one of whom was negative for all HBV markers) are described.

Pulmonary diseases in patients infected with the human immunodeficiency virus in Zimbabwe, Central Africa.

During the 11 month period up to 30 September 1987, 37 patients (26 male, 11 female, mean age 27 years) with respiratory symptoms who were human immunodeficiency virus (HIV) positive, were studied prospectively on 40 occasions to determine the cause of any pulmonary complications. HIV was heterosexually transmitted. Predominant symptoms were cough (89%), fever (89%), weight loss (83%), and dyspnoea (60%). Transnasal fibre-optic bronchoscopy (with bronchoalveolar lavage, bronchial brushings and transbronchial lung biopsies) was performed on 35 patients, twice on 3 patients. 'Tru-cut' lung biopsies were obtained from 2 patients who died before bronchoscopy. Pulmonary tuberculosis was the commonest disease, being found in one-third of the patients (12 of 37). Mycobacterium tuberculosis was cultured from 4; the remainder of the plates were contaminated. Pneumocystis carinii was present in 8 patients: as the sole pathogen in 3, with Streptococcus pneumoniae in 4, Staphylococcus aureus in 2, and one also had tuberculous lymphadenitis. Endobronchial Kaposi's sarcoma was seen in 6 of 7 patients with skin nodules. Bacterial pathogens isolated included Staph. aureus (5), S. pneumoniae (5), Klebsiella pneumoniae (2), Haemophilus influenzae (2), H. parainfluenzae (1) and Pseudomonas aeruginosa (1). Invading Aspergillus fumigatus was diagnosed by lung biopsy in one. No diagnosis was reached for 8 patients. It is concluded that in Central Africa pulmonary complications in AIDS patients are similar to those in Europe and North America but the incidence of different pathogens depends on the prevalence of pathogens in the community. M. tuberculosis is probably the commonest pathogen. This study has confirmed that P. carinii pneumonia does occur, but occurs less frequently.

Pneumocystis carinii pneumonia in patients with AIDS in Central Africa.

Over a period of 11 months, 37 patients infected with the Human Immunodeficiency Virus (HIV) presenting with symptoms of bronchopulmonary disease were investigated. Patients presented with cough, weight loss, fever and dyspnoea. Investigations included fibreoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy. In eight patients (22%) Pneumocystis carinii was found. Pulmonary infiltrates were found on chest radiographs of six patients, while in the remaining two patients chest radiographs showed clear lung fields. P. carinii was found in two patients with pulmonary Kaposi's sarcoma. Infection with P. carinii often occurred with other pathogens: Streptococcus pneumoniae was found in four patients, Staphylococcus aureus in two and tuberculosis in two. P. carinii pneumonia does occur in patients with HIV infection in Africa and the diagnosis is relatively simple to make provided that transbronchial biopsy and bronchoalveolar lavage are carried out through a fibreoptic bronchoscope and specimens examined after appropriate staining. However, the prevalence of P. carinii in patients with HIV infection in Africa appears to be lower than that found in patients with HIV infection in Europe and North America.

Syndromic management of sexually transmitted diseases. Part 4--The management of lower abdominal pain in women.

The symptom of lower abdominal pain in women is extremely common and does not always indicate the presence of serious illness. However, women with certain serious conditions such as pelvic inflammatory disease (PID), acute appendicitis, ectopic pregnancy and other complications of pregnancy may present initially with this symptom. Therefore, in managing women with lower abdominal pain care should be taken to exclude any serious condition before dismissing the patient. PID is a condition in which there is infection of the reproductive tract of women above the internal os of the cervix. This usually occurs as a result of an ascending cervical infection caused by Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic bacteria. The immediate and long term effects of PID include salpingitis, pelvic abscess, peritonitis, infertility and predisposition to tubal ectopic pregnancy. Women with lower abdominal pain should be assessed carefully and if PID is the cause they should be treated for gonococcal, chlamydial and anaerobic bacterial infection. Other gynaecological and surgical causes of lower abdominal pain and the immediate complications of PID require urgent referral to a specialist. PID is associated with significant morbidity and mortality.

Syndromic management of sexually transmitted diseases. Part 2--The management of genital discharge.

In men urethral discharge is commonly caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Both organisms cause an acute anterior urethritis and infected men usually present with symptoms of urethritis. A proportion of men with urethral infection may remain asymptomatic. Amongst women the common cause of vaginal discharge is vaginitis caused by Trichomonas vaginalis, Candida albicans and anaerobic bacterial infection (bacterial vaginosis). However, cervicitis caused by N. gonorrhoeae and C. trachomatis also causes vaginal discharge. Cervicitis is the more serious cause of vaginal discharge as the aetiologic agents may lead to infection ascending above the internal os of the cervix resulting in pelvic inflammatory disease and other complications.

Risk factors for gonococcal and chlamydial cervical infection in pregnant and non-pregnant women in Zimbabwe.

OBJECTIVE: To identify demographic, behavioural and clinical characteristics of symptomatic and asymptomatic women with gonococcal and/or chlamydial cervicitis a study was conducted among women attending antenatal clinics and primary care clinics in Harare, Zimbabwe. DESIGN: Cross sectional study. SETTING: Primary care clinics and antenatal clinics in Harare. SUBJECTS: 467 women with vaginal discharge and 1,189 asymptomatic pregnant women. MAIN OUTCOME MEASURES: Behavioural and clinical correlates of gonococcal and chlamydial cervical infection. RESULTS: The mean age of symptomatic women was 26.11 +/- 6.84 years (range: 15 to 52 years) and that of asymptomatic pregnant women was 24.67 +/- 5.43 years (range: 15 to 45 years). Gonococcal and/or chlamydial cervical infection was found in 69 of 1,189 (5.8%) pregnant women and in 77 of 467 (16.5%) non-pregnant women. Logistic regression analysis identified the following predictors of gonococcal or chlamydial infection in women with vaginal discharge: being separated from the partner for a month or more (p = 0.002), having had sex with a new partner in the last three months (p = 0.002), current use of condoms (p = 0.011), and the finding on examination of a purulent vaginal discharge (p = 0.004). Amongst these women an increasing educational level was inversely associated with cervical infection (p = 0.007). Amongst asymptomatic pregnant women the following were identified as predictors of cervical infection: the patient admitting to having a vaginal discharge on direct questioning (p = 0.004), and the finding of a purulent vaginal discharge on examination (p = 0.001). CONCLUSIONS: Amongst symptomatic and asymptomatic women certain behavioural factors and some clinical findings are associated with cervical gonococcal or chlamydial infection. Women with multiple partners and with partners who are currently using condoms with them and those women with a purulent vaginal discharge are likely to be infected. The age and marital status of subjects was not associated with cervical infection. These findings are useful in providing appropriate care for women with overt or minimal symptoms.

Impact of HIV counselling and testing on HIV seroconversion and reported STD incidence among male factory workers in Harare, Zimbabwe.

OBJECTIVES: To assess the impact of HIV counselling and testing on HIV seroconversion and incidence of reported sexually transmitted diseases (STDs) among male factory workers in Harare, Zimbabwe. DESIGN: Prospective, observational study among men recruited to participate in a future workplace based AIDS prevention intervention. METHODS: Participants provided STD histories and blood for HIV antibody testing at enrolment and six month intervals during visits to factories. Participants received HIV test results, post test counselling, and free STD services at the project clinic. RESULTS: Between March 1993 and June 1995, 2,414 men were enrolled with 85% follow up. Overall HIV sero-incidence was 2.60 per 100 person-years; the incidence of reported STDs was 10.19 per 100 person-years. Men who obtained their HIV test results had significantly higher HIV sero-incidence and incidence of reported STDs compared to men who did not obtain their results (IRRs: 1.87, 3.47, respectively). Among men who obtained their HIV test results, a non-significant 40% decrease in HIV sero-incidence was observed after obtaining test results compared to before obtaining results (p = 0.18). The incidence of reported STDs, however, increased by 30% after obtaining HIV test results (p = 0.10). CONCLUSIONS: Decreased HIV sero-incidence in the face of increased reported STD incidence suggests that timely treatment of STDs may decrease the risk of acquiring HIV even in the absence of behaviour change. In populations with high rates of HIV and STDs, the greatest benefit of HIV counselling and testing may be achieved by simultaneously offering STD screening and treatment services.

Immunization status of children living in Harare, Zimbabwe.

PIP: Surveys to ascertain the immunization status of children living in Harare, the capital of Zimbabwe (population 658,364 as of the 1982 census) were carried out over a period of 10 days in May/June 1982 and a period of 6 weeks in October/November 1983, using World Health Organization prescribed cluster sampling methods. 206 children were examined in 1982 and 234 in 1983. 82.5% of children were found to have record cards in the 1982 survey, 88.5% in 1983. 47.6% were considered fully immunized in 1982, 55.6% in 1983. In 1982, 74.0% of children were recorded as having BCG scars, 79.4% in 1983. 64.6% and 71.4% had measles innoculations respectively. DPT (dyptheria, pertussis, tetanus) injections had been given to 69.9% in 1982 and 76.5% in 1983. Figures for 2nd and 3rd DPT boosters were 65.5% and 58.7% for 1982 and 76.5 and 75.6% for 1983. Figures for 1st innoculations with OPV (polio) were 69.9 and 76.5% for 1982 and 1983 respectively. 2nd and 3rd polio booster figures were 66.0 and 57.8% for 1982 and 76.5 and 74.8% for 1983. The study was part of an evaluation of immunization integrated with maternal and child health services in the city, administered by nursing personnel, health visitors, and medical assistants in various clinics. Dropout rates for 1st to 2nd dose and 1st to 3rd dose for DPT and OPV improved markedly. Increased usage of immunization probably reflects publicity generated by the 1982 program launching. The extent of infection by these 6 diseases in Zimbabwe is not known, although most are frequently encountered. Survey studies will be required to ascertain reasons for nonimmunization, in order to attain total immunization by 1990.^ieng

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.