Factors associated with strongylida infections in sheep on farms in peri-urban Nairobi, Kenya.

Gastrointestinal parasite infections are among the major limitations to production in sheep in many parts of the world. It is important to continually assess their levels of infection in order to institute control measures and reduce the impact. This study determined the factors associated with the strongylida egg counts in sheep on selected farms in peri-urban Nairobi, Kenya. This was a cross-sectional study in which farm and animal-level data, including faecal samples, were collected from 1640 sheep from 30 purposively selected farms in Ruai, and Kamulu wards in Kasarani sub-county and Utawala and Mihango wards in Embakasi East Sub-County, in Nairobi County Kenya. The faecal samples were subjected to coprological examination using a modified McMaster technique to determine counts of strongylida eggs and coccidia oocysts with a detection level of 100 egg or oocyst per gram (EPG or OPG) of faeces. The positive faecal samples for strongylida eggs were pooled per farm and cultured for morphological identification of larval stage three. Descriptive statistics and multilevel mixed-effect logistic regression analyses were used to determine factors associated with strongylida egg count ≥600 EPG (p < 0.05). The receiver operating characteristics curve was used to assess the overall diagnostic performance in the final model. Strongylida eggs were detected in 45.5% (746/1640) of the sheep, and the mean EPG was 486.0± 858.9 with a median of 200 and a range of 0-16,700. The coccidia oocysts were detected in 49.4% (810/1640) of the sheep with a mean OPG was 341.7± 1782.4, a median of 0 and a range of 0-60,000. In the coprocultures, the nematode genera identified (% differential count of L3) were Haemonchus (90%), Trichostrongylus (5%) and Oesophagostomum (5%). In the final multivariable regression model, the odds of detecting EPG ≥ 600 was 1.44 times higher for sheep shedding coccidia oocysts than those that did not. The odds for detecting EPG ≥ 600 was 4.01 times for sheep in Ruai ward compared with those in the combined Kamulu, Utawala and Mihango wards. The receiver operating characteristic curve area was 73.1%, suggestive of good model performance. The results suggest that gastrointestinal strongylida and coccidia infections are common in sheep and farmers should be educated on the importance of appropriate control measures.

Association of mother's handwashing practices and pediatric diarrhea: evidence from a multi-country study on community oriented interventions.

INTRODUCTION: Improved hand hygiene in contexts with high levels of diarrheal diseases has shown to reduce diarrheal episodes in children under five years. A quasi-experimental multi-country study with matched comparisons was conducted in four rural districts/sub districts in Cambodia, Guatemala, Kenya and Zambia. METHODS: Community oriented interventions including health promotion for appropriate hand washing was implemented in the intervention sites, through community health workers (CHW) and social accountability mechanisms. Community councils were strengthened/established in all study sites. Using household surveys, information on mother's handwashing practices and diarrhea incidence of children 2 weeks preceding the study was obtained. RESULTS AND CONCLUSION: Access to safe drinking water was reportedly higher for communities in Guatemala and Zambia (> 80%), than those in Cambodia and Kenya (< 63%), with significantly higher levels in intervention sites for Guatemala and Kenya. Improved sanitation was low (< 10%), for Kenya and Zambia, compared to Cambodia and Guatemala (> 40%); intervention sites reporting significantly higher levels, except for Zambia. Hand washing index; hand washing before food preparation, after defecation, attending to a child after defecation, and before feeding children was significantly higher for intervention sites in Cambodia, Guatemala and Kenya (Cambodia, 2.4 vs 2.2, p < 0.001, Guatemala, 3.0 vs 2.5, p < 0.001, Kenya, 2.6 vs 2.3, p < 0.001). Factors significantly associated with lower odds of diarrhea were; mother's marital status, higher educational status, one or more handwashing practices, wealthier quintiles, older (> 24 m), and female children. The findings suggest that caretaker handwashing with soap or ash has a protective effect on prevalence of diarrhea in children.

Infection dynamics of gastrointestinal helminths in sympatric non-human primates, livestock and wild ruminants in Kenya.

BACKGROUND: Gastrointestinal parasites are neglected infections, yet they cause significant burden to animal and human health globally. To date, most studies of gastrointestinal parasites focus on host-parasite systems that involve either a single parasite or a host species. However, when hosts share habitat and resources, they may also cross-transmit generalist gastrointestinal parasites. Here we explore multi-host-parasite interactions in a single ecosystem to understand the infection patterns, especially those linked to livestock-wildlife interfaces and zoonotic risk. METHODS: We used both coprological methods (flotation and sedimentation; N = 1,138 fecal samples) and molecular identification techniques (rDNA and mtDNA; N = 18 larvae) to identify gastrointestinal parasites in nine sympatric host species (cattle, sheep, goats, wildebeest, Grant's gazelles, Thomson's gazelles, impala, vervet monkeys and baboons) in the Amboseli ecosystem, Kenya. RESULTS: We found that the host community harbored a diverse community of gastrointestinal helminths, including 22 species and/or morphotypes that were heterogeneously distributed across the hosts. Six zoonotic gastrointestinal helminths were identified: Trichuris spp., Trichostrongylus colubriformis, Enterobius spp. Oesophagostomum bifurcum, Strongyloides stercoralis and Strongyloides fuelleborni. The dominant parasite was Trichuris spp, whose ova occurred in two morphological types. Baboons were co-infected with Strongyloides fuelleborni and S. stercoralis. CONCLUSIONS: We found that the interface zone shared by wild ungulates, livestock and non-human primates is rich in diversity of gastrointestinal helminths, of which some are extensively shared across the host species. Closely related host species were most likely to be infected by the same parasite species. Several parasites showed genetic sub-structuring according to either geography or host species. Of significance and contrary to expectation, we found that livestock had a higher parasite richness than wild bovids, which is a health risk for both conservation and livestock production. The zoonotic parasites are of public health risk, especially to pastoralist communities living in areas contiguous to wildlife areas. These results expand information on the epidemiology of these parasites and highlights potential zoonotic risk in East African savanna habitats.

Laboratory and field evaluation of entomopathogenic fungi for the control of amitraz-resistant and susceptible strains of Rhipicephalus decoloratus.

Rhipicephalus decoloratus causes serious economic losses in cattle industry every year in East Africa. Biological control using entomopathogenic fungi is seen as a promising alternative to chemical acaricides being used for their control. The pathogenicity of Metarhizium anisopliae and of Beauveria bassiana isolates was tested in the laboratory against amitraz-resistant and amitraz-susceptible strains of R. decoloratus. Unfed larvae were sprayed with conidial suspensions of 1×10(9) conidia ml(-1). Fungal isolates were pathogenic to R. decoloratus larvae, causing mortality of between 10.0 and 100% and between 12.1 and 100% of amitraz-susceptible and amitraz-resistant strains, respectively. The LT50 values of selected fungal isolates varied between 2.6-4.2days in amitraz-susceptible strain and between 2.8-3.9days in amitraz-resistant strain. The LC50 values varied between 0.4±0.1 and 200.0±60×10(3) conidia ml(-1) and between 0.1±0.1 and 200.0±31.0×10(3) conidia ml(-1) in amitraz-susceptible and amitraz-resistant strains, respectively. Metarhizium anisopliae isolate ICIPE 7 outperformed the other isolates and was selected for compatibility study with amitraz and field trial. ICIPE 7 was compatible with amitraz. In the field, four treatments including control, ICIPE 7 alone, amitraz alone and ICIPE 7/amitraz were applied on cattle. All the treatments significantly reduced the number of ticks on all the sampling dates: day 7 (F3,8=3.917; P=0.0284), day 14 (F3,8=9.090; P=0.0275), day 21 (F3,8=37.971; P=0.0001) and day 28 (F3,8=8.170; P=0.0016) compared to the control. Results of the present study indicate that ICIPE 7 can be used for the management of amitraz-resistant strain of R. decoloratus.

Interpreting sexual behaviour data: validity issues in the multicentre study on factors determining the differential spread of HIV in four African cities.

BACKGROUND: The main conclusion of the multicentre study on factors determining the differential spread of HIV in four African cities was that differences in sexual behaviour could not, by themselves, explain the differences in HIV prevalence between the four cities. The present paper examines three potential sources of bias that could invalidate this conclusion: (1) changes in sexual behaviour since the start of the HIV epidemics; (2) bias due to the low response rates of men; and (3) bias in reported sexual behaviour. METHODS: To assess whether there have been any changes in sexual behaviour over time, selected parameters of sexual behaviour were compared between different age groups in the four cities. The maximum likely extent of bias due to non-participation of men in Yaoundé, Kisumu and Ndola was assessed with a simulation exercise, in which records of non-participants were replaced with records of 'low activity men' in Yaoundé and 'high activity men' in Kisumu and Ndola. To assess the validity of the sexual behaviour data, internal validity checks were carried out: comparing biological data on sexually transmitted infections with reports; comparing reports of spouses; and comparing numbers of sex partners reported by men and women. A fourth method consisted of comparing the findings of the multicentre study with an external source, Demographic and Health Surveys (DHS). RESULTS: There were differences in sexual behaviour between the younger and the older age groups in all four cities but there was no evidence of a shift towards safer sexual behaviour in the high HIV prevalence cities. After simulating results for male non-participants in Yaoundé, Kisumu and Ndola, the median lifetime number of sex partners was similar in Yaoundé, Kisumu and Ndola. By testing for various sexually transmitted infections among men and women aged 15-24 years who reported that they had never had sexual intercourse, we could establish that, in all four cities, at least 1-9% of men and 6-18% of women had misreported their sexual activity. The number of non-spousal partners in the past 12 months reported by men was two to three times higher than the number reported by women, as has been found in other studies. The most consistent differences between our survey and the DHS were found in the numbers of non-spousal partners in the past 12 months reported by never-married men and women. In all four cities, participants reported more non-spousal partners in the DHS than in our survey. CONCLUSIONS: In all four cities, we found evidence that men as well as women misreported their sexual behaviour, but overall it seems that under-reporting of sexual activity was not more common or more serious in the two high HIV prevalence cities than in the two low HIV prevalence cities. We believe that the main conclusions of the multicentre study still hold.

Male circumcision and HIV infection in four cities in sub-Saharan Africa.

OBJECTIVES: To explore the role of male circumcision in the spread of HIV infection in four urban populations in sub-Saharan Africa. DESIGN AND METHODS: A cross-sectional population based study was conducted in four cities in sub-Saharan Africa with different levels of HIV infection. HIV prevalence among adults was relatively low in Cotonou (Benin) and in Yaoundé (Cameroon), and exceeded 25% in Kisumu (Kenya) and in Ndola (Zambia). In each city, a random sample was taken of men and women aged 15-49 years from the general population. Consenting study participants were interviewed about their sociodemographic characteristics and their sexual behaviour, and were tested for HIV, herpes simplex virus type 2, syphilis, gonorrhoea and chlamydial infection. Men underwent a genital examination. RESULTS: In Cotonou and in Yaoundé, the two low HIV prevalence cities, 99% of men were circumcised. In Kisumu 27.5% of men were circumcised, and in Ndola this proportion was 9%. In Kisumu, the prevalence of HIV infection was 9.9% among circumcised men and 26.6% among uncircumcised men. After controlling for socio-demographic characteristics, sexual behaviour and other sexually transmitted infections, the protective effect of male circumcision remained with an adjusted odds ratio of 0.26 (95% confidence interval = 0.12-0.56). In Ndola, the prevalence of HIV infection was 25.0% in circumcised men and 26.0% in uncircumcised men. The power was insufficient to adjust for any differences in sexual behaviour. CONCLUSIONS: The differences in epidemic spread of HIV are likely to be due to differences in the probability of transmission of HIV during sexual exposure as well as differences in sexual behaviour. Male circumcision is one of the factors influencing the transmission of HIV during sexual intercourse, and this study confirms the population level association between HIV and lack of male circumcision, as well as a strong individual level association in Kisumu, the only city with sufficient power to analyze this association.

Comparison of key parameters of sexual behaviour in four African urban populations with different levels of HIV infection.

OBJECTIVE: To explore whether differences in sexual behaviour could explain differences in the rate of spread of HIV in four urban populations in Africa. METHODS: A cross-sectional, population-based study was conducted in two cities where the prevalence of HIV among adults exceeded 20% (Kisumu, Kenya and Ndola, Zambia) and two cities with a much lower HIV prevalence among adults (Cotonou, Benin and Yaoundé, Cameroon). In each of these cities, approximately 1000 men and 1000 women, aged 15-49 years, were randomly selected from the general population. Consenting men and women were interviewed about their sociodemographic characteristics and sexual behaviour, including characteristics of spouses and of non-spousal partners. Key parameters of sexual behaviour were compared between the four cities. RESULTS: On average, women in the high HIV prevalence cities had their sexual debut earlier than in the other cities. Men and women in Kisumu and Ndola got married earlier than men and women in Cotonou and Yaoundé. High rates of partner change, contacts with sex workers, concurrent partnerships and large age differences between partners were no more common in the two high HIV prevalence cities than in the two low HIV prevalence cities. CONCLUSIONS: In these four African populations, differences in reported sexual behaviour could not explain the differences in rate of spread of HIV. In all four cities, high-risk sexual behaviour patterns were identified.

Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, Zambia.

OBJECTIVE: To examine the factors responsible for the disparity in HIV prevalence between young men and women in two urban populations in Africa with high HIV prevalence. DESIGN: Cross-sectional survey, aiming to include 1000 men and 1000 women aged 15-49 years in Kisumu, Kenya and Ndola, Zambia. METHODS: Participants were interviewed and tested for HIV and other sexually transmitted infections. Analyses compared the marital and non-marital partnership patterns in young men and women, and estimated the likelihood of having an HIV-infected partner. RESULTS: Overall, 26% of individuals in Kisumu and 28% in Ndola were HIV-positive. In both sites, HIV prevalence in women was six times that in men among sexually active 1 5-19 year olds, three times that in men among 20-24 year olds, and equal to that in men among 25-49 year olds. Age at sexual debut was similar in men and women, and men had more partners than women. Women married younger than men and marriage was a risk factor for HIV, but the disparity in HIV prevalence was present in both married and unmarried individuals. Women often had older partners, and men rarely had partners much older than themselves. Nevertheless, the estimated prevalence of HIV in the partners of unmarried men aged under 20 was as high as that for unmarried women. HIV prevalence was very high even among women reporting one lifetime partner and few episodes of sexual intercourse. CONCLUSIONS: Behavioural factors could not fully explain the discrepancy in HIV prevalence between men and women. Despite the tendency for women to have older partners, young men were at least as likely to encounter an HIV-infected partner as young women. It is likely that the greater susceptibility of women to HIV infection is an important factor both in explaining the male-female discrepancy in HIV prevalence and in driving the epidemic. Herpes simplex virus type 2 infection, which is more prevalent in young women than in young men, is probably one of the factors that increases women's susceptibility to HIV infection.

Commercial sex and the spread of HIV in four cities in sub-Saharan Africa.

OBJECTIVE: To examine whether commercial sex transactions were more common and/or transmission between sex workers and clients more efficient in two African cities with high HIV prevalence (Kisumu, Kenya and Ndola, Zambia) compared with two with relatively low HIV prevalence (Cotonou, Benin and Yaoundé, Cameroon). METHODS: Data on sexual behaviour, HIV and sexually transmitted infections were collected from representative samples of around 300 female sex workers in each city. Sexual behaviour data from a population-based study of around 1000 men aged 15-49 in each city were used to estimate the extent of contact with sex workers. RESULTS: The number of sex workers per 1000 males was highest in Kisumu and Ndola, but other estimates of the extent or characteristics of sex work contact showed no consistent differences between high or low prevalence cities. HIV prevalence among sex workers was 75% in Kisumu, 69% in Ndola, 55% in Cotonou and 34% in Yaoundé. The prevalence of genital ulceration and trichomoniasis was higher among sex workers in Kisumu and Ndola but no clear pattern was seen for the other sexually transmitted infections. Around 70% of sex workers in Cotonou reported use of a condom with the last client, markedly higher than in the other cities. CONCLUSIONS: Although sex work is likely to have played an important role in the spread of HIV in all four cities, differences in present patterns of sex work do not appear to explain the differential spread of HIV. However, high levels of condom use among sex workers may have slowed the spread from sex workers to the general population in Cotonou, highlighting the importance of interventions among sex workers and their clients.

Condom use and its association with HIV/sexually transmitted diseases in four urban communities of sub-Saharan Africa.

OBJECTIVES: To estimate rates of condom use in four urban populations in sub-Saharan Africa and to assess their association with levels of HIV infection and other sexually transmitted diseases (STDs). METHODS: Data were obtained from a multicentre study of factors that determine the differences in rate of spread of HIV in four African cities. Consenting participants were interviewed on sexual behaviour, and also provided blood and urine samples for testing for HIV infection and other STDs. Data on sexual behaviour included information on condom use during all reported spousal and non-spousal partnerships in the past 12 months. RESULTS: A total of 2116 adults aged 15-49 years were interviewed in Cotonou (Benin), 2089 in Yaoundé (Cameroon), 1889 in Kisumu (Kenya) and 1730 in Ndola (Zambia). Prevalence rates of HIV infection were 3.4% in Cotonou, 5.9% in Yaoundé, 25.9% in Kisumu and 28.4% in Ndola. Reported condom use was low, with the proportions of men and women who reported frequent condom use with all non-spousal partners being 21-25%, for men and 11-24% for women. A higher level of condom use by city was not associated with lower aggregate level of HIV infection. The proportions of men reporting genital pain or discharge during the past 12 months were significantly lower among those reporting frequent condom use in all sites except Yaoundé: in Cotonou, adjusted odds ratio (OR) = 0.28, 95% confidence interval (CI) = 0.09-0.94; in Kisumu, adjusted OR = 0.34, 95% CI = 0.14-0.83; and in Ndola, adjusted OR = 0.33, 95% CI = 0.12-0.90. The same association was found for reported genital ulcers in two sites only: in Cotonou, adjusted OR = 0.14, 95% CI = 0.02-1.02; and in Kisumu, adjusted OR = 0.18, 95% CI = 0.04-0.75. There were few statistically significant associations between condom use and biological indicators of HIV infection or other STDs in any of the cities. CONCLUSION: Similar levels of condom use were found in all four populations, and aggregate levels of condom use by city could not discriminate between cities with high and low level of HIV infection. It seems that rates of condom use may not have been high enough to have a strong impact on HIV/STD levels in the four cities. At an individual level, only a male history of reported STD symptoms was found to be consistently associated with lower rates of reported condom use.

Concurrent sexual partnerships and HIV prevalence in five urban communities of sub-Saharan Africa.

OBJECTIVE: To estimate parameters of concurrent sexual partnerships in five urban populations in sub-Saharan Africa and to assess their association with levels of HIV infection and other sexually transmitted infections (STI). METHODS: Data were obtained from a multicentre study of factors which determine the differences in rate of spread of HIV in five African cities. Consenting participants were interviewed on sexual behaviour and at four of the five sites also provided a blood and a urine sample for testing for HIV and other STI. Data on sexual behaviour included the number of partnerships in the 12 months preceding the interview as well as the dates of the start and end of each partnership. Summary indices of concurrent sexual partnerships -- some of which were taken from the literature, while others were newly developed -- were computed for each city and compared to HIV and STI prevalence rates. RESULTS: A total of 1819 adults aged 15--49 years were interviewed in Dakar (Senegal), 2116 in Cotonou (Benin), 2089 in Yaoundé (Cameroon), 1889 in Kisumu (Kenya) and 1730 in Ndola (Zambia). Prevalence rates of HIV infection were 3.4% for Cotonou, 5.9% for Yaoundé, 25.9% for Kisumu and 28.4% for Ndola, and around 1% for Dakar. The estimated fraction of sexual partnerships that were concurrent at the time of interview (index k) was relatively high in Yaoundé (0.98), intermediate in Kisumu (0.44) and Cotonou (0.33) and low in Ndola (0.26) and in Dakar (0.18). An individual indicator of concurrency (iic) was developed which depends neither on the number of partners nor on the length of the partnerships and estimates the individual propensity to keep (positive values) or to dissolve (negative values) on-going partnership before engaging in another one. This measure iic did not discriminate between cities with high HIV infection levels and cities with low HIV infection levels. In addition, iic did not differ significantly between HIV-infected and uninfected people in the four cities where data on HIV status were collected. CONCLUSION: We could not find evidence that concurrent sexual partnerships were a major determinant of the rate of spread of HIV in five cities in sub-Saharan Africa. HIV epidemics are the result of many factors, behavioural as well as biological, of which concurrent sexual partnerships are only one.

Ecological and individual level analysis of risk factors for HIV infection in four urban populations in sub-Saharan Africa with different levels of HIV infection.

OBJECTIVE: To identify factors that could explain differences in rate of spread of HIV between different regions in sub-Saharan Africa. DESIGN: Cross-sectional study. METHODS: The study took place in two cities with a relatively low HIV prevalence (Cotonou, Benin and Yaoundé, Cameroon), and two cities with a high HIV prevalence (Kisumu, Kenya and Ndola, Zambia). In each of these cities, a representative sample was taken of about 1000 men and 1000 women aged 15-49 years. Consenting men and women were interviewed about their socio-demographic background and sexual behaviour; and were tested for HIV, herpes simplex virus type 2 (HSV-2), syphilis, Chlamydia trachomatis and Neisseria gonorrhoea infection, and (women only) Trichomonas vaginalis. Analysis of risk factors for HIV infection was carried out for each city and each sex separately. Adjusted odds ratios (aOR) were obtained by multivariate logistic regression. RESULTS: The prevalence of HIV infection in sexually active men was 3.9% in Cotonou, 4.4% in Yaoundé, 21.1% in Kisumu, and 25.4% in Ndola. For women, the corresponding figures were 4.0, 8.4, 31.6 and 35.1%. High-risk sexual behaviour was not more common in the high HIV prevalence cities than in the low HIV prevalence cities, but HSV-2 infection and lack of circumcision were consistently more prevalent in the high HIV prevalence cities than in the low HIV prevalence cities. In multivariate analysis, the association between HIV infection and sexual behavioural factors was variable across the four cities. Syphilis was associated with HIV infection in Ndola in men [aOR = 2.7, 95% confidence interval (CI) = 1.5-4.91 and in women (aOR = 1.7, 95% CI = 1.1-2.6). HSV-2 infection was strongly associated with HIV infection in all four cities and in both sexes (aOR ranging between 4.4 and 8.0). Circumcision had a strong protective effect against the acquisition of HIV by men in Kisumu (aOR = 0.25, 95% CI = 0.12-0.52). In Ndola, no association was found between circumcision and HIV infection but sample sizes were too small to fully adjust for confounding. CONCLUSION: The strong association between HIV and HSV-2 and male circumcision, and the distribution of the risk factors, led us to conclude that differences in efficiency of HIV transmission as mediated by biological factors outweigh differences in sexual behaviour in explaining the variation in rate of spread of HIV between the four cities.

Multicentre study on factors determining differences in rate of spread of HIV in sub-Saharan Africa: methods and prevalence of HIV infection.

OBJECTIVE: The objective of this study was to explore whether the differences in rate of spread of HIV in different regions in sub-Saharan Africa could be explained by differences in sexual behaviour and/or factors influencing the probability of HIV transmission during sexual intercourse. METHODS: A cross-sectional, population-based study was conducted in two cities with a high HIV prevalence (Kisumu in Kenya and Ndola in Zambia) and two cities with a relatively low HIV prevalence (Cotonou in Benin and Yaoundé in Cameroon). In each of these cities, approximately 1000 men and 1000 women, aged 15-49 years, were randomly selected from the general population. Consenting men and women were interviewed and were tested for HIV, syphilis, herpes simplex virus type 2 (HSV-2), gonorrhoea, chlamydial infection and trichomoniasis (the latter for women only). In addition, a survey was conducted on a random sample of 300 sex workers in each city. The research instruments, including the questionnaires and the laboratory procedures, were standardized to permit comparison of results. RESULTS: The numbers of men interviewed were 1021 in Cotonou, 973 in Yaoundé, 829 in Kisumu, and 720 in Ndola. The corresponding figures for women were 1095, 1116, 1060 and 1130. In Yaoundé, Kisumu and Ndola, the response rates for men were lower than for women due to failure to make contact with eligible men. The proportion of eligible women who were interviewed was 86% in Yaoundé, and 89% in Kisumu and Ndola. In Yaoundé, 76% of eligible men were interviewed, along with 82% in Kisumu and 75% in Ndola. The prevalence of HIV infection in men was 3.3% in Cotonou, 4.1% in Yaoundé, 19.8% in Kisumu and 23.2% in Ndola. For women, the respective figures were 3.4, 7.8, 30.1 and 31.9%. The prevalence of HIV infection among women aged 15-19 years was 23.0% in Kisumu and 15.4% in Ndola. Among women in Kisumu who had their sexual debut 5 years before the interview, the prevalence of HIV infection was 46%; in Ndola, it was 59%. Among sex workers, the prevalence of HIV infection was 57.5% in Cotonou, 34.4% in Yaoundé, 74.7% in Kisumu and 68.7% in Ndola. CONCLUSIONS: The HIV prevalence rates in the general population confirmed our preliminary assessment of the level of HIV infection in the four cities, which was based on estimates of HIV prevalence from sentinel surveillance among pregnant women. The very high prevalence of HIV infection among young women in Kisumu and Ndola calls for urgent intervention.

The relative bioavailability of salbutamol to the lung using urinary excretion following inhalation from a novel dry powder inhaler: the effect of inhalation rate and formulation.

Each dry powder inhaler has a different resistance so that a respirable dose can be generated from the formulation by the patient's inspiratory effort. It is important to recognize that this effect is achievable. The inspiratory flow characteristics of asthmatics inhaling through a Clickhaler were determined. In a separate study 10 volunteers inhaled separate 2 x 100 microg salbutamol doses from a Clickhaler (ML Laboratories plc U.K.). Two different formulations (one with a high and one with a low respirable fraction) were each inhaled using an inspiratory flow of 30 and 60 l min(-1). A urine sample was collected 30 min post inhalation and then pooled for the next 24 h. The mean (SD) inhalation rate of 24 asthmatics when they inhaled from a Clickhaler was 37.3 (14.6) l min(-1). The mean (SD) urinary salbutamol excretion during the first 30 min, by the volunteers, using the high respirable dose formulation at 30 and 60 l min(-1) was 5.59 (1.87) and 4.62 (1.49) microg respectively (P<0.01). Similar values using the low respirable dose formulation were 4.84 (1.58) and 3.86 (2.14) microg. There was no significant difference between the amounts excreted in the 24 h post-dose. The different 30-min urinary excretions following inhalation of the two formulations suggest a link between the relative bioavailability of salbutamol to the lung and the respirable dose, and that a slow inhalation rate should be used when using a Clickhaler. The patient study shows that this rate is achieved by most asthmatics without further training.

Volumatic usage: some generic salbutamol metered dose inhalers can be used.

BACKGROUND: The 30 minute and 24 hour post-inhalation urinary excretion of salbutamol represents the relative amount of drug deposited in the lungs and total systemic absorption, respectively. Using this method two metered dose inhalers used with a Volumatic (Allen and Hanburys Ltd, UK) large volume spacer have been compared. METHOD: Eleven healthy volunteers inhaled 4 x 100 micrograms salbutamol from either a generic salbutamol (Baker Norton, UK) or Ventolin (Allen and Hanburys Ltd, UK) metered dose inhaler with a Volumatic. The order of administration was randomised with a seven day washout period. Urine samples were collected for 0-30 minutes and then pooled up to 24 hours after inhalation. RESULTS: The mean (SD) urinary salbutamol excretion 30 minutes after inhalation with the metered dose inhalers used with the Volumatic was 22.22 (4.63) and 21.30 (5.91) micrograms for the Baker Norton and Ventolin respectively, with a mean difference (95% confidence interval (CI)) of 0.92 (-0.65 to 2.49) micrograms. Similar amounts were excreted up to 24 hours after the dose with a mean (SD) urinary excretion of 116.1 (24.3) micrograms and 114.8 (22.3) micrograms, respectively, and a mean difference (95% CI) of 1.22 (-20.39 to 22.84) micrograms. CONCLUSION: Inhalations from generic salbutamol (Baker Norton) and Ventolin metered dose inhalers with a Volumatic inhalation aid deliver similar amounts of drug to the lungs and the total systemic absorption from the two products is the same.