PREVALENCE AND INCIDENCE OF FOUR COMMON BEAN ROOT ROTS IN UGANDA.

Root rots are one of the main biotic constraints to common bean (Phaseolus vulgaris L.) production, causing losses estimated at 221 000 metric tons a year in sub-Saharan Africa. Until recently, root rots in Ugandan common bean agroecologies were mostly caused by Pythium and Fusarium spp., especially in high altitude areas. But now, severe root rots are observed in low and medium altitude agroecologies characterized by dry and warm conditions. The objective of our study was therefore to ascertain the current prevalence and incidence of common bean root rot diseases in Ugandan common bean agroecologies. Our results show that root rots were present in all seven agroecologies surveyed. Overall, the most rampant root rot was southern blight caused by Sclerotium rolfsii Sacc., followed by root rots caused by Fusarium spp., Pythium spp. and Rhizoctonia solani, respectively. Our study clearly showed the influence of environmental conditions on the prevalence and incidence of common bean root rots. While Fusarium and Pythium root rots are favoured under low air temperature and high air humidity in highland areas, high incidence of southern blight is favoured by warm and moist conditions of lowland areas. The prevalence and incidence of common bean root rots was mapped, providing a reliable baseline for future studies. Similarly, hotspots identified for common bean root rots will be a very useful resource for evaluation of germplasm and breeding lines for resistance to root rots.

Clinical and laboratory characteristics of hospitalised patients with neurological manifestations of HIV/AIDS at the Nairobi hospital.

OBJECTIVE: To determine the profile of clinical and laboratory characteristics of hospitalised HIV positive patients with neurological complications at a private hospital in Nairobi, Kenya from January 2000 to June 2005. DESIGN: Retrospective observational study. SETTING: The Nairobi Hospital, Nairobi, Kenya. SUBJECTS: One hundred and fifty hospitalised patients. RESULTS: Records of 708 HIV positive hospitalised patients were reviewed, 150 patients had neurological complications; giving a six-year point prevalence of 21.2%. Males were 86 (57.3%) and females 64 (42.7%) M:F ratio = 1.3:1. Mean age was 38.84 years. The five commonest neurological complications were; cryptococcal meningitis 33 (22%), encephalitis 28 (18.7%), cerebral toxoplasmosis 19 (12.7%), stroke 19 (12.7%) and tuberculous meningitis 16 (10.7%). Overall, 72 patients (63%) had CD4+ counts done. Cryptococcal meningitis patients' CD4+ count, (mean 60, median 17, range 1-273/cmm). Encephalitis patients' CD4+count, (mean 82, median 54, range 3-495/cmm). Cerebral toxoplasmosis patients' CD4+count, (mean 59, median 58, range 11-120/cmm). Stroke patients' CD4+ count, (mean 120, median 30, range 15-394/cmm) and Tuberculous meningitis patients' CD4+ count, (mean 67, median 62 and range 12-154/cmm). The other rare neurological manifestations included peripheral neuropathy, HIV associated dementia (HAD), myelopathy and myopathy amongst others. One hundred and eight (72%) patients were on anti-retroviral therapy. The commonest drugs used in various regimen combinations included efavirenz and combivir. Fourteen (9.3%) patients died while in hospital; eight of them were among those with the top five neurological complications. CONCLUSION: The findings show that patients come to hospital when severely immune compromised and hence have overwhelming opportunistic infections. The profile of opportunistic infection is comparable to that observed in studies elsewhere. Some of the facts observed here may not reflect the situation in public health institutions where resources are scarce. RECOMMENDATION: To do a multi-centre prospective study of neurological manifestations of HIV/AIDS.

Dystonia: case series of twenty two patients.

OBJECTIVE: Dystonia is a rare neurological disorder characterised by sustained muscle contraction with resultant bizarre muscle movements and hence bizarre posturing. The pathophysiology is not well understood but it is believed there is dysfunction of the cortico-striatal-thalamo-cortical circuitry and projections. There is very scanty literature in sub-Saharan Africa. DESIGN: Retrospective descriptive case series. SETTING: Outpatient clinics of the authors, the Nairobi Hospital and the Mater Hospital, Nairobi, Kenya. SUBJECTS: A cohort of twenty two consecutive patients of indigenous Kenyan origin, seen by the authors between 1996 and January 2005 were described. This study was carried out to describe characteristics of 22 patients. RESULTS: Males comprised of 15 (68.2%) of the cases. Late onset dystonia was found in 12 (54.5%) cases. Over half of the patients had focal dystonia and only 13.6% had generalized dystonia, all of whom were of early onset variety. There was significant delay in diagnosis of dystonia with 68.2% of patients being diagnosed after 12 months of onset of symptoms. CONCLUSION: Dystonia is rare; however, multi-centre studies are required to map out prevalence rates of the disease in the country. There is need to highlight the presentation of the disease amongst clinicians and patients as this would improve diagnosis rate, early intervention and appropriate management. Genetic studies need to be done.

Implementation of a comprehensive AIDS education programme for schools in Masaka District, Uganda.

As part of a large IEC (Information, Education and Communication)/STD intervention trial, a 19-lesson, comprehensive school-based AIDS education programme was implemented and evaluated in 50 primary and 16 secondary schools in 12 parishes of Masaka District, Uganda. A series of three teacher-training and evaluation workshops spread over a year was held in each parish, between which teachers implemented the programme in the classroom. One hundred and forty-eight teachers were trained and about 3,500 students were subsequently exposed to the programme. Both teachers and students responded positively, which suggests that this type of programme has much to offer young people who attend school. However, some problems were encountered: language, programme content, community resistance to teaching about condoms, and several practical issues. Proposed solutions include flexibility with the English language policy, alternative approaches to role play activities, targeting influential individuals with information about the need for young people to learn about safer sex, and a parallel community-based IEC programme to facilitate community acceptance of the need for the programme. In addition, implementation may be incomplete unless comprehensive AIDS education is fully incorporated into the curriculum, and properly examined. These findings are placed in the context of other life skills/AIDS education programmes being introduced both in Uganda and elsewhere in Africa.

PIP: This paper presents a comprehensive teacher-based AIDS education program that was implemented in 50 primary and 16 secondary schools in Masaka District, Uganda. An education program produced by WHO/UN Educational, Scientific and Cultural Organization was used which contained 53 English language student activities and related teachers' guides. 19 activities were chosen for the Masaka trial that would cover 15-20 hours of classroom time. A total of 148 teachers were trained and about 3500 students (85% fell within the target age range of 12-16 years) were exposed to the program. The program received positive response from both teachers and students. However, there were some problems encountered which included language difficulties, program content, and community resistance to teaching about condoms. There was a limited discussion of condoms in class because parents, religious sectors opposed it, and by teachers themselves who believe that condoms promote promiscuity. In addition, practical problems were also experienced such as time constraints, teacher attrition, sexual harassment of schoolgirls by some male teachers, and limited transportation and communication. The proposed solutions included flexibility with the English language policy, targeting influential individuals with information about the need for young people to learn about safer sex and a parallel community-based program to facilitate community acceptance of the need for the program. Finally, the benefits of this program range from reduction of HIV transmission and unwanted pregnancies, to improved communication between sexual partners that is accompanied by an enhanced mental well-being.