Body composition of HIV-positive patients with pulmonary tuberculosis: a cross-sectional study in Mwanza, Tanzania.

To estimate the weight deficit and body composition of cases of pulmonary TB (PTB), and assess the roles of HIV and the acute-phase response, a cross-sectional study was carried out in Tanzania. Weight, body mass index (BMI), arm muscle area (AMA), arm fat area (AFA) and the serum concentration of the acute-phase protein alpha(1)-antichymotrypsin (serum ACT) were evaluated for each of 532 cases of PTB and 150 'non-TB' controls. On average, the female cases of PTB not only weighed 7.8 kg less but also had BMI that were 3.1-kg/m(2) lower, AMA that were 14.8-cm(2) lower, and AFA that were 7.6-cm(2) lower than those seen in the female subjects without TB. Similarly, on average, the male cases of PTB weighed 7.1 kg less and had BMI that were 2.5-kg/m(2) lower, AMA that were 18.8-cm(2) lower and AFA that were 1.6-cm(2) lower than those seen in the male subjects without TB. Although HIV infection was associated with a 1.7-kg lower weight and a 0.6-kg/m(2) lower BMI (with deficits in both AMA and AFA) among males, it was not associated with any such deficits among the female subjects. Elevated serum ACT was found to be a negative predictor of BMI, AMA and AFA, partially explaining the effects of the PTB but not those of the HIV. There is need for a better understanding of the determinants and effects of loss of fat and lean body mass in HIV-positive tuberculosis.

Community knowledge, attitude and practice towards sexually transmitted diseases and HIV infection in Biharamulo and Muleba districts in Kagera Region, Tanzania.

The study was conducted to determine knowledge, attitude and practice towards Sexually Transmitted Diseases and HIV infections among communities in Biharamulo and Muleba districts, Kagera Tanzania. A total of 915 study participants were recruited and most of them (96.3%) knew that there are diseases which could be transmitted through sexual contact. Seventy one percent of participants thought STDs could be acquired through sharing a towel while fifty percent thought HIV could be transmitted through insect bites. Eighty five percent of school pupils who participated in the study reported to have been taught about AIDS and less than 30% on sex and pregnancy. Sixty three percent of study participants were of the opinion that a girl or woman should not refuse to have sex after being given a gift, and having sex with an elder partner was thought to be acceptable by almost fifty percent of participants. Over 50% percent of interviewees thought a girl or woman should not refuse to have sex with their friends. Although 99% of interviewees reported to have ever heard about condoms, only 28% reported to have ever used them irrespective of been affordable. Most schoolboys and about 50% of schoolgirls reported to have experienced sex by the time of the study. Thirty eight percent of girls reported to have first sex at the age of 14 years. Nine percent of the participants who reported to have experienced sex were forced to do so. Knowledge regarding STDs and HIV/AIDS was high among participants, but a sizeable proportion report misconception on transmission of STDs/HIV such as through sharing a towel and insect bites. Therefore it is recommended that S&RH intervention programme should address these misconceptions in order to match knowledge and practice, and achieve the intended objectives.

Antimicrobial susceptibility of Shigella flexneri and S. dysenteriae isolated from stool specimens of patients with bloody diarrhoea in Mwanza, Tanzania.

This study was conducted to determine frequency and pattern of antimicrobial susceptibility of Shigella species isolated from stool specimens collected from patients presenting with bloody diarrhoea in Mwanza City, Tanzania. The study was carried out from October 2004 to October 2005 and involved patients attending Sekou Toure Regional Hospital and Butimba Health Centre. Bacteriological cultures were done at the National Institute for Medical Research laboratory. A total of 489 patients (median age = 20 years) participated in the study and were able to provide stool specimens. Shigella species were isolated from 14% (69/489) of the stool specimens collected. Of the sixty nine strains of Shigella spp isolated, 62 (90%) were S. flexneri and 7 (10%) were S. dysenteriae. All Shigella strains isolated showed high resistance to ampicillin, tetracycline, trimethoprim-sulphamethoxazole and chloramphenicol, drugs commonly used for management of shigellosis in Tanzania. However all isolates were fully susceptible to ciprofloxacin, nalidixic acid, erythromycin, cefuroxime and gentamycin. S. flexneri showed resistance to amoxy-clavulanic_acid and azithromycin in 5% and 2% of isolates, respectively. None of the S. dysenteriae isolates were resistant to these two drugs. Entamoeba histolytica, Giardia lamblia and Schistosoma mansoni were microscopically detected in 16.5%, 4.4% and 5.3% of patients, respectively. These findings suggest that there is a need to carry out extensive susceptibility studies in different parts of the country with view of re-appraising the current guidelines for management of bloody diarrhoea in Tanzania.

Assessment of quality assurance in HIV testing in health facilities in Lake Victoria zone, Tanzania.

Tanzania is currently implementing the antiretroviral treatment programme, and has a target of putting about 400,000 eligible HIV infected individuals on treatment by 2008. This will involve screening a large number of people, which will require non-laboratory personnel to be involved in doing HIV testing. In order to guarantee reliable and quality HIV test results, there is a need to ensure that quality assurance (QA) procedures are followed from specimen collection, testing and reporting of results. In light of the above a survey was conducted to assess QA in HIV testing in health facilities in Lake Victoria zone, Tanzania. A total of 89 health facilities (29 hospitals, 34 health centres, 9 dispensaries and 17 voluntary and counselling testing centres) were surveyed. Only three (10.3%) health facilities reported performing Uniform II ELISA for HIV diagnosis. All other health facilities reported to be using HIV rapid tests Capillus and Determine. Five (5.6%) of health facility laboratories performed CD4 counts. Internal quality control (IQC) were performed in 21 (63.6%) of the hospitals. Kits for HIV testing were reported to be readily available by 54 (60.7%) of the facilities. Only 16 (18%) of the health facilities had standard operating procedures in place. Systems of equipment calibration were reported by 13 (14.6%) of the health facilities. Counselling services were available in all health facilities and all counsellors had received the 6-week mandatory training course. These findings show that most of health facilities in the Lake Victoria zone do not adhere to QA procedures in HIV testing. There is therefore, a need to establish a monitoring system to laboratories performing HIV testing for the purpose of ensuring QA procedures are done. Personnel doing HIV testing should be re-trained at a regular basis to cope with new techniques and ensure QA procedures are followed.

HIV and parasitic co-infections in tuberculosis patients: a cross-sectional study in Mwanza, Tanzania.

A cross-sectional study was conducted in Mwanza, Tanzania, to determine the burden of HIV and parasitic co-infections among patients who were confirmed or suspected cases of pulmonary tuberculosis (PTB). Of the 655 patients investigated, 532 (81.2%) had been confirmed as PTB cases, by microscopy and/or culture (PTB+), whereas the other 123 (18.8%) were only suspected cases, on the basis of other clinical criteria (PTB-). Hookworm and Schistosoma mansoni infections were common in the patients, with prevalences of 18% and 34%, respectively. Malarial, Ascaris lumbricoides, Trichuris trichiura and Strongyloides stercoralis infections were less common, each recorded at a prevalence of <5%. The PTB+ patients were less likely to be HIV-positive than the PTB- patients (43.6% v. 62.6%; P<0.0001). Among the PTB+ patients, the HIV-positive had a significantly lower prevalence (12.1% v. 25%; P<0.0001) and mean intensity (49 v. 123 eggs/g; P=0.003) of hookworm infection than the HIV-negative. The PTB patients in the study area were, however, still frequently co-infected with HIV and with parasitic infections that may increase morbidity and accelerate the progression of HIV disease.