Population-based analysis of ocular Chlamydia trachomatis in trachoma-endemic West African communities identifies genomic markers of disease severity.

BACKGROUND: Chlamydia trachomatis (Ct) is the most common infectious cause of blindness and bacterial sexually transmitted infection worldwide. Ct strain-specific differences in clinical trachoma suggest that genetic polymorphisms in Ct may contribute to the observed variability in severity of clinical disease. METHODS: Using Ct whole genome sequences obtained directly from conjunctival swabs, we studied Ct genomic diversity and associations between Ct genetic polymorphisms with ocular localization and disease severity in a treatment-naïve trachoma-endemic population in Guinea-Bissau, West Africa. RESULTS: All Ct sequences fall within the T2 ocular clade phylogenetically. This is consistent with the presence of the characteristic deletion in trpA resulting in a truncated non-functional protein and the ocular tyrosine repeat regions present in tarP associated with ocular tissue localization. We have identified 21 Ct non-synonymous single nucleotide polymorphisms (SNPs) associated with ocular localization, including SNPs within pmpD (odds ratio, OR = 4.07, p* = 0.001) and tarP (OR = 0.34, p* = 0.009). Eight synonymous SNPs associated with disease severity were found in yjfH (rlmB) (OR = 0.13, p* = 0.037), CTA0273 (OR = 0.12, p* = 0.027), trmD (OR = 0.12, p* = 0.032), CTA0744 (OR = 0.12, p* = 0.041), glgA (OR = 0.10, p* = 0.026), alaS (OR = 0.10, p* = 0.032), pmpE (OR = 0.08, p* = 0.001) and the intergenic region CTA0744-CTA0745 (OR = 0.13, p* = 0.043). CONCLUSIONS: This study demonstrates the extent of genomic diversity within a naturally circulating population of ocular Ct and is the first to describe novel genomic associations with disease severity. These findings direct investigation of host-pathogen interactions that may be important in ocular Ct pathogenesis and disease transmission.

Diagnostic splenectomy for visceral leishmaniasis.

A 57-year-old-man with a history of malaise, fever, night sweats and shortness of breath presented a diagnostic challenge to his medical team. He was pancytopaenic and had splenomegaly on admission but other investigations, including bone marrow aspiration, proved inconclusive. After the patient deteriorated clinically, the general surgical team was requested to perform a diagnostic splenectomy. The histology of this showed infection with visceral leishmaniasis. He recovered completely with Amphotericin treatment. Although this is a rare condition, particularly for the general surgeon, this case highlights the difficult position surgeons are often put in when performing major surgery diagnostically.

Crossing the public-private sector divide with reproductive health in Cambodia: out-patient services in a local NGO and the national MCH clinic.

Set within the context of recent literature on the private-public divide in the health sector of developing countries generally and Asia specifically, this study considers the major government and the major indigenous non-government clinics offering out-patient reproductive health services in Phnom Penh, Cambodia. Reproductive health is of critical importance in Cambodia, which has one of the highest levels of unmet need for family planning in the developing world and suffers from what is arguably the most severe STD and HIV/AIDS problem in Asia. The study is unusual in that it examines and compares aspects of service delivery and pricing along with the socio-economic profile and health-seeking behaviour of clients self-selecting services in the two settings. The socio-economic status of clients was much higher than the norm in Cambodia but did not differ significantly between the two clinics. A few service indicators suggested that the quality of care was better in the NGO clinic. Underlying variables--such as the broader mandate of the public sector institution and the significant discrepancy between public and private sector salaries--offer an obvious explanation for these differences. The Ministry of Health in Cambodia has been developing policies related to the NGO sector, which has expanded rapidly in Cambodia during the 1990s, and it is struggling to increase staff remuneration within the public sector.

Regional lung deposition of a technetium 99m-labeled formulation of mometasone furoate administered by hydrofluoroalkane 227 metered-dose inhaler.

BACKGROUND: A new inhaled suspension formulation of mometasone furoate (MF), a potent corticosteroid with minimal systemic availability, has been developed for the treatment of asthma. This formulation is delivered by metered-dose inhaler (MDI) using the nonchlorofluorocarbon propellant hydrofluoroalkane 227 (HFA-227). OBJECTIVE: The primary goal of this study was to determine the respiratory tract deposition of this formulation of MF. A secondary objective was to measure plasma concentrations of MF and a putative metabolite, 6-X-OH MF, to determine the systemic exposure to corticosteroid. METHODS: This was a single-dose, open-label study in which 200 microg of technetium 99m (99mTc)-radiolabeled MF was administered to patients with asthma. Gamma scintigraphy was used to quantify lung, oropharyngeal, stomach, and MDI mouthpiece deposition patterns of MF. RESULTS: Eleven patients, aged 21 to 47 years, with a history of asthma were enrolled in and completed the study. The mean (+/- SD) whole lung deposition of MF was 13.9%+/-5.7% of the metered (ex-valve) dose. The central lung zone received 5.3%+/-2.8% of the dose; the intermediate zone received 4.7%+/-1.9%; and peripheral lung deposition was 4.0%+/-1.5%. The mean (+/- SD) ratio of peripheral to central lung deposition was 0.8+/-0.2. Oropharyngeal deposition was 79.1%+/-8.7% of the ex-valve dose, with 6.3%+/-7.8% deposited on the MDI mouthpiece and 0.7%+/-0.5% exhaled. The majority of plasma samples taken for analysis of MF and 6-13-OH MF concentrations were below the limit of quantification (50 pg/mL) in all patients after inhalation of 200 microg 99mTc-labeled ME CONCLUSION: The lung deposition of MF when administered via HFA-227 MDI is comparable to the 10 to 20% lung deposition seen with other corticosteroid suspension for- mulations administered by MDI that have demonstrated effectiveness in the treatment of asthma.

Determinants of attendance and patient satisfaction at eye clinics in south-western Uganda.

PURPOSE: To identify the reasons for subjects deciding to attend or not attend local and referral ophthalmology clinics in south-west Uganda, and to establish the levels of satisfaction of clinic attenders with the services they received. METHODS: A population survey identified subjects with ocular conditions who were referred to the local clinic or the district hospital. All non-attenders and a group of attenders were interviewed at home. RESULTS: 31% of those referred did not attend the local clinic. The most common reasons were 'too busy' (29%) or 'unwilling to buy spectacles' (17%). Less than half of attenders were satisfied, mainly because of no perceived clinical improvement or having to buy spectacles. Only 13% of those referred to the district hospital clinic attended. The main reasons for non-attendance were high transport cost and fear of the clinic. CONCLUSION: Attendance and satisfaction with the community ophthalmology service could be improved by more intensive motivation and explanation for patients, and assistance with spectacle and transport costs. The use of aphakic motivators should be tested in this context.

Molecular epidemiological analysis of HIV in sexual networks in Uganda.

OBJECTIVE: To investigate the suitability of HIV sequence analysis, based on the p17 region of the gag gene, to characterize the sexual networks in and around a trading town in south-west Uganda. METHODS: Blood samples were obtained from 54 HIV-seropositive members of three distinct sexual networks and phylogenetic analysis carried out on proviral DNA sequences obtained from the p17 region of gag from 53 individuals. RESULTS: Despite documented evidence of very little sexual mixing between residents of the trading town, fishing village and surrounding rural area, there was no evidence of clustering of sequences associated with place of residence. More strikingly, known sexual partners failed to show significantly related sequences, and the two pairs of sequences that did show significant similarity came from individuals who had no known social or sexual contact. CONCLUSIONS: Sequence analyses such as those described here have proved effective in confirming or identifying epidemiological links not only following single transmission events but also within risk groups. However, the results from Uganda contrast markedly with those from Europe and the United States. The length of time that the community has been infected, the number of occasions when the virus has been introduced and the high degree of partner change may contribute to the lack of supportive evidence for sociological studies of sexual networks in Uganda.

Sexual networks in Uganda: mixing patterns between a trading town, its rural hinterland and a nearby fishing village.

The study was based in south-west Uganda where significant differences in HIV prevalence have been found between urban and rural areas. Longitudinal data collected in a diary format was used to determine the extent to which high-risk men and women living in a truck stop/trading town had sexual contact with people from surrounding rural areas and a nearby fishing village. Study participants were 143 men, 75 of whom were resident in the town, 40 in a fishing village and 28 in rural areas, and 81 women, of whom 47 were resident in the town, 25 in the fishing village and 9 in a rural area. During 1687 man weeks the 143 men made 3149 trips and had 5189 sexual contacts. Ninety-two per cent of these sexual contacts occurred in the man's current place of residence and 21% were with a new partner. The 81 women participated for 1280 women weeks during which they recorded 6378 sexual contacts. Women who lived in the fishing village and the rural area had around 90% of their contacts with local men while those who lived in the town fell into 3 categories: women who charged a relatively high price for commercial sex had only 11% of contacts with men living in the town, while those who charged a tenth of the price had 71% of contacts with town men. The small number of women who fell into an intermediate category, in terms of price, had sexual contact with a wide variety of men. These findings show that there is little scope for HIV infection to spread between different residential or occupational groups. This may help to explain how large differences in HIV seropositivity between neighbouring localities can be maintained for long periods, despite considerable social and economic mixing between groups and high levels of sexual partner change within groups.

PIP: In southwest Uganda, there is concern that sexual mixing between rural areas with low HIV prevalence and urban areas with high HIV prevalence will produce uniformly high rates of HIV. To determine the extent of such mixing, a prospective study was conducted in a trading town on the trans-African highway with a steady flow of male truckers, an agricultural hinterland to the west, and a fishing village to the east. A total of 143 men recruited largely from bars and 81 women reported to be sexually promiscuous kept records of their sexual contacts over a 6-month period. During 1687 man-weeks of observation, the men made 3149 road trips and had 5189 sexual contacts; 92% of these contacts occurred in the men's place of residence and 21% involved a new partner. 59% of town men's sexual contacts, 61% reported by men in the fishing village, and 52% of those in rural areas involved casual partners. An additional 6378 sexual encounters were recorded during 1280 woman-weeks. Close to 90% of women's sexual contacts in the 2 rural areas involved local men. Among the highest-paid town commercial sex workers, only 11% of sexual contacts involved men from the town; in contrast, 71% of sexual encounters among town women who charged only 10% the price of their more expensive counterparts were with local men. Serologic testing of a subset of 75 men and 52 women yielded HIV prevalences of 28% and 52%, respectively. The distinct sexual networks identified in this study suggest it is unlikely that rates of HIV infection in the rural areas will reach those in nearby trading towns.

Sexual networks in Uganda: casual and commercial sex in a trading town.

A longitudinal study of the sexual behaviour of high-risk men and women living in a trading town on the trans-Africa highway showed that distinct sexual networks operated within the town. Forty-eight prostitutes kept daily records for 6 months of all their sexual contacts including the occupation and place of residence of each client and the price paid. Details of 4573 sexual contacts of the women were recorded. Three classes of women were identified: (1) 20 "high-class' women who charged a mean price of over US $4/- per contact. The majority of their clients were from large urban areas of Uganda (55%) or neighbouring countries (32%)-70% were truck-drivers or their mates; (2) 18 "low-class' women, charging an average of US $0.4 per contact, who were patronized predominantly by men resident in the town (71%) who were unskilled casual workers (58%); (3) 10 women fell into an intermediate category in terms of price and the residence of their clients. Thirty-eight male potential clients were recruited in low-cost bars where some of the women worked. They provided similar details of their daily sexual contacts. All were resident in the town and 22 had occupations which were classified as unskilled. Of the 1621 sexual contacts recorded by the men 25% were with new partners.

PIP: A longitudinal study of the sexual behavior of men and women living in a trading town on the trans-Africa highway (100 km south-west of Kampala, Uganda) revealed the presence of distinct networks of casual and commercial sex. 48 commercial sex workers recruited from bars and hotels on or away from the main road and 38 potential male clients located in bars away from the road were followed for a mean period of 16 and 13 weeks, respectively. Among women, a total of 4573 sexual contacts were recorded over 787 woman-weeks of observation, for an average of 5.8 contacts per week; 472 contacts (10%) were with regular partners. Condoms were reportedly used in 99% of casual and 59% of regular contacts. Clients of high-class prostitutes (charging over US$4/contact) were generally drivers from other urban areas or neighboring countries, while those of middle-class sex workers (US$2/contact) tended to be from fishing villages and those of low-class sex workers (under US$0.50/contact) were predominantly local unskilled workers. Among male respondents, 1621 sexual contacts were reported during 516 man-weeks of observation, for an average of 3.1 contacts per week; 584 contacts (36%) were with regular partners and 406 (24%) were with new partners. Men reported condom use in 3% of regular contacts and 87% of casual contacts. In-depth interviews with a convenience sample of six men revealed a total of 32 sexual contacts in the previous 2 weeks, of which eight involved wives or regular partners, 11 were with a sex worker encountered in discos or on the road, and 13 were with a woman known for 2-3 days. The condom use rates reported by respondents for casual partners are considered inflated, especially in light of the drunkenness that usually accompanies sexual encounters initiated in lower-class bars.

Sexual behaviour in a fishing community on Lake Victoria, Uganda.

This study describes the sexual behaviour of men and women in a fishing village on the shores of Lake Victoria in southwest Uganda. The village is near a well known trading town-truckstop on the main trans-Africa highway with a high recorded prevalence of HIV infection. Data were obtained on the daily travel and sexual activities of 26 women and 54 men with particular attention paid to the rate of partner change and the proportion of sexual contacts with people outside the village. During a total of 587 person weeks the men made 1086 trips, mostly returning home the same day. They had a total of 1226 sexual contacts, most of which occurred either in their own village (83%) or a neighbouring fishing village (11%); 17 per cent of sexual contacts were with new partners. Fifteen of the women described themselves as married; 42 per cent of their sexual contacts were casual, paying partners. Of the eleven women who were single, between 80 and 100 per cent of contacts were with paying partners. Most of the women's partners were resident in the village. These data show a very high rate of sexual mixing within the village. Such communities should be targeted in future STD control programs.

PIP: The first cases of AIDS in Uganda were identified in fishing villages on the shores of Lake Victoria in 1985. This paper describes the sexual behavior of men and women in one such village. The village is located 5 kilometers from a well-known trading town on the main transAfrica highway with an HIV prevalence of 40% in 1991, and is home to an adult population of approximately 250. Many residents make frequent trips to the town by foot or bicycle. Data were obtained over a 6-month period on the daily travel and sexual activities of 26 women and 54 men with focus upon the rate of partner change and the proportion of sexual contacts with people outside of the village. Over 587 person-weeks, the men made 1086 trips, mostly returning home the same day. They reported a total of 1226 sexual contacts, 83% of which occurred in their own village and 11% in a neighboring fishing village. 17% of sexual contacts were with new partners. Although 15 of the women reported being married, 42% of their sex contacts were with casual, paying partners. Of the 11 women who were single, 80-100% of contacts were with paying partners. Most of the women's partners were resident in the village. A high rate of sexual mixing therefore exists in the village, but with little contact with people from outside. Such communities should be targeted in future sexually transmitted disease control programs.

Melatonin receptor pharmacology: toward subtype specificity.

The recent cloning of three distinct melatonin receptor subtypes (Mel1a, Mel1b and Mel1c) which are part of a new family of G-protein coupled receptors, and probably mediate the physiological actions of the hormone, has spurred interest in the design of analogues with subtype selectivity. The 5-methoxyl and N-acetyl groups of melatonin are important for binding to and activation of the receptor. The indole nucleus serves to hold these two groups at the correct distance from one another and allows them to adopt the required orientation for interaction with the receptor binding pocket. We have investigated the subtype selectivity of a number of analogues of melatonin in which the structure has systematically been modified in order to probe the similarities and differences in the interaction of ligand and receptor subtype. At all three subtypes 5-methoxyl and N-acetyl groups of melatonin are important for high affinity binding. However, replacing the 5-methoxyl group (eg with 5-H, 5-OH, 5-Me or 5-BzO) reduces affinity much less at the Mel1b receptor subtype than at either Mel1a or Mel1c cloned subtypes. This suggests differences between the Mel1b and Mel1a/1c subtypes in the size and shape of the binding pocket or in the manner in which melatonin interacts with the receptor at this position. Further studies have revealed that analogues with longer N-acyl carbon chains behave similarly at each subtype. These observations suggest that the 'pocket' into which the N-acetyl group fits is very similar for each subtype. Substitutions at the 2-position on the indole ring improved affinity at each receptor subtype but did not give selective analogues. The systematic 'mapping' of the requirements for binding at each receptor subtype should allow the design of more selective agonists and antagonists, which will be valuable tools for the characterization and classification of functional melatonin receptors.

A three-year follow-up survey of demographic changes in a Ugandan town on the trans-African highway with high HIV-1 seroprevalence.

A 1991 serosurvey in a Ugandan trading town on the trans-African highway reported a 40 per cent HIV-1 prevalence in adults. Three years later in a repeat survey of the 531 adults resident in 1991, 279 (53%) were still present, 196 (37%) had left and 56 (11%) had died. There were 138 new residents and 46 children had become adults, making a total of 463 adults in 1994, 13 per cent less than 1991. Most immigrants (91%) came from the surrounding rural district whereas 38 per cent of emigrants went to an urban area. A significant inverse association between wealth and seropositivity was found for women but not men. Of the original residents 157 were known to be HIV-1 positive in 1991; 31 (20%) had died compared to 10 (4%) of the 232 known to be seronegative, representing an HIV-1 attributable mortality fraction of 60 per cent.

PIP: A 1991 serosurvey was conducted in 1991 in a small trading town-truck stop on the trans-African highway in Masaka district, Uganda, to assess the level of HIV-1 seroprevalence among residents. 531 adults aged 13 years or older living in 154 randomly selected households were censused and a clear HIV-1 test result obtained for 389. 157 were HIV-1 positive and 232 seronegative. A higher number of lifetime sex partners, being married, and being a woman aged 20-34 years or a man aged 35-44 years were positively associated with being HIV-infected. A repeat survey of the 531 adults resident in 1991 was conducted in 1994 to find that 279 were still present, 196 had left, and 56 had died. Of the original residents, 31 known to be HIV-1-positive had died, compared to 10 of the 232 known seronegative. There were 138 new residents and 46 children had become adults, for a total 463 adults in 1994. 91% of immigrants came from the surrounding rural district, while 38% of emigrants moved to an urban area. A significant inverse association between wealth and seropositivity was found for women but not men.

Social aspects of AIDS-related stigma in rural Uganda.

In the process of collecting sexual behaviour data through in-depth interviews, 24 respondents offered information on stigma related to HIV-1 infection. Observations of social relations in public places and families of infected individuals were made. The findings suggest that although HIV/AIDS-related stigma has had adverse effects on treatment seeking behaviour of PWAs and coping mechanisms of their families, a more tolerant attitude is starting to emerge in this area. Probably, due to improvements in counselling services and home care schemes for those with AIDS. This supports the call for increased investments in counselling and community development aimed at caring for people with AIDS (PWAs).

Sexual networks in Uganda: Casual and Commercial sex in a trading town

"A longitudinal study of the sexual behavior of high-risk men and women living in a trading town on the trans-Africa highway showed that distinct sexual networks operated within the town. Forty-eight prostitutes kept daily records for 6 months of all their sexual contacts including the occupation and place of residence of each client and the price paid. Details of 4573 sexual contacts of the women were recorded. Three classes of women were identified: (1) 20 ""high-class' women who charged a mean price of over US$4/- per contact. The majority of their clients were from large urban areas of Uganda (55) or neighbouring countries (32) - 70were truck-drivers or their mates; (2) 18 ""low-class' women; charging an average of US$0.4 per contanct; who were unskilled casual workers (58); (3) 10 women fell into an intermediate category in terms of price and the residence of their clients. Thirty-eight male potential clients were recruited in low-costs bars where some of the women worked. They provided similar details of their daily sexual contacts. All were resident in the toown and 22 had occupations which were classified as unskilled. Of the 1621 sexual contacts recorded by the men 25were with new partnets."

Women's groups and individual entrepreneurs: a Ugandan case study.

PIP: This study is based on interviews conducted among 8 women's income-generating groups and 12 individual women entrepreneurs in 15 villages in Masaka district, Uganda. The Baganda are the main tribe in the study villages. The study evaluates the economic achievement, objectives, and social characteristics of the groups. Groups ranged in size from 9-20 members. All had functioned for 3-5 years. A regular membership fee was paid through the sale of agricultural produce. Groups met at least every 2 weeks. This study revealed that the individual goals were to increase individual wealth, while the stated group goals were to invest in the community. Members considered the groups as useful in providing an easy way to raise capital. Most members considered financial status as a criterion for group membership. Elderly women tended to join social and handicraft groups. The women's group members tended to be friends before the establishment of the group and tended to be currently married to men residing in the area. Of the 12 women entrepreneurs, only 5 were currently married. All 12 women entrepreneurs had considerable initiative. The 12 women and the women's group members derived income from two or more sources: agricultural projects, animal husbandry, craft production, alcohol production and sale, or other activities. Study findings indicate that decisions were often delayed or avoided in order to preserve social cohesion. In a market-oriented enterprise, quick response time is needed and the bureaucratic dynamics would hinder some agricultural ventures. The poorest women experienced barriers to group membership. Women entrepreneurs were more successful than group women.^ieng

Analogues of diverse structure are unable to differentiate native melatonin receptors in the chicken retina, sheep pars tuberalis and Xenopus melanophores.

1. The pineal hormone melatonin exerts its biological effects through specific, high affinity G-protein coupled receptors. Recently, three melatonin receptor subtypes (Mel1a, Mel1b and Mel1c) have been cloned. Neither the cloned subtypes, nor the native receptors have yet been compared in a detailed pharmacological analysis. 2. The present study examined the structure-activity relationships of a series of 21 melatonin analogues, by comparing their potency on the pigment aggregation response in Xenopus laevis melanophores with their affinity in radioligand binding competition studies in chicken retina and sheep pars tuberalis (PT), two tissues in which melatonin is known to mediate a biological response. 3. All but four of the analogues were full melatonin receptor agonists producing a concentration-related redistribution of pigment granules in cultured Xenopus melanophores. The remaining analogues produced little pigment aggregation at 10 microM. 4. Saturation studies with 2-[125I]-iodomelatonin identified a single binding site in the chicken retina and sheep PT membranes, with a KD of 36.6 +/- 2.8 and 37.3 +/- 4.3 pM, and a maximal number of binding sites (Bmax) of 16.6 +/- 0.5, and 40.1 +/- 1.7 fmol mg-1 protein, respectively. 5. Comparison of the potency/affinity of the analogues for the binding sites gave a highly significant correlation in each case, retina/melanophore, r = 0.97 (P < 0.001, n = 17), PT/melanophore, r = 0.97 (P < 0.001, n = 17) and PT/retina, r = 0.98 (P < 0.001, n = 21). 6. Despite their large range in affinity and structural diversity these melatonin agonists were unable to distinguish between melatonin receptors in the chicken retina, sheep pars tuberalis and Xenopus melanophores.

Sexual mixing patterns in Uganda: small-time urban/rural traders.

OBJECTIVE: To document the extent to which rural and urban-based male traders have sexual contacts away from their place of residence. METHODS: Fifty-one traders (46 who travel by bicycle and five others) kept daily diaries of all their journeys and sexual contacts for a total of 584 person-weeks. Twenty-five were resident in a trading town where HIV prevalence was about 40% and 26 lived up to 25 km away in rural areas where HIV prevalence was approximately 8%. RESULTS: A total of 2147 return trips were made (mean, 3.7 per week). Eighty per cent were between the trading town and the surrounding rural area. A total of 1377 sexual contacts were recorded (mean, 2.3 per week); 95% of the contacts of urban-based men occurred in the town, 3% in other urban areas and 2% in a rural area. For rural-based men 82% of sexual contacts took place in their home village, 14% in a neighbouring village, 2% in the trading town and 3% in other urban centres. CONCLUSION: Despite considerable economic interaction there is very little sexual mixing between the town and surrounding rural areas. This may explain why the high HIV prevalence found in some trading towns in Africa has not diffused out to rural areas.

Sexual mixing patterns in Uganda: small-time urban/rural traders

OBJECTIVE: To document the extent to which rural and urban-based male traders have sexual contacts away from their place of residence. METHODS: Fifty-one traders (46 who travel by bicycle and five others) kept daily diaries of all their journeys and sexual contacts for a total of 584 person-weeks. Twenty-five were resident in a trading town where HIV prevalence was about 40and 26 lived up to 25 km away in rural areas where HIV prevalence was approximately 8. RESULTS: A total of 2147 return trips were made (mean; 3.7 perweek). Eighty per cent were between the trading town and the surrounding rural area. A total of 1377 sexual contacts were recorded (mean; 2.3 per week); 95of the contacts of urban-based men occurred in the town; 3in other urban areas and 2in a rural area. For rural-based men 82of sexual contacts took place in their home village; 14in a neighbouring village; 2in the trading town and 3in other urban centres. CONCLUSION: Despite considerable economic interaction there is very little sexual mixing between the town and surrounding rural areas. This may explain why the high HIV prevalence found in some trading towns in Africa has not diffused out to rural areas

Prevalence and demographic factors of stimulant use.

The use of stimulants for recreation purposes has increased considerably during the 20th century. Cocaine was first considered to be a drug of potential abuse during the First World War but was only perceived as a serious threat when it became widely used in socially and economically deprived urban areas of the USA in the 1980s. Use of amphetamines was common among certain occupational groups as a means of remaining alert until the 1950s, when they were seen to be abused by a small minority of recreational users. Controls were then introduced in most developed countries. The public health issue of stimulant use is that of finding a balance between the prevention of serious social or personal harm caused by abuse of these drugs while not impeding their beneficial use.

Attitudes to malaria, traditional practices and bednets (mosquito nets) as vector control measures: a comparative study in five west African countries.

Five West African communities were visited to assess the knowledge of the cause of malaria and to document traditional ways of treating and preventing the infection. Knowledge of the cause of malaria was low in the five communities visited. People were more concerned about mosquitoes being a nuisance than a cause of the infection. Various herbs were used as mosquito repellents. Malaria was treated by a number of traditional practices, including herbal remedies. Bednets were used to a varying extent, from 44% Ghana to 86% Gambia, in each community to protect against mosquito bites but also for other purposes such as privacy, decoration and protection from roof debris dropping on the bed.

PIP: A previous study among Gambian children aged 1-4 years found that overall mortality was reduced by 63% after use of insecticide-treated bednets. In this study, the aim was to determine the degree to which bednets were used and the factors affecting their use in Farafenni, The Gambia; Navrongo in eastern Ghana; suburban Bandim outside Bissau Town, Guinea-Bissau; Niakhar in Senegal; and a rural village around Bo in Sierra Leone. Bednets were known and used to protect children from mosquito bites in the 5 West African countries; bednets were also used for privacy and to protect from falling roof debris. A structured questionnaire was administered. Background information had been collected prior to the survey administration on local terminology for symptoms of malaria, the extent of health education campaigns, availability of Western and traditional treatment regimens, use of bednets, and constraints to use. Each of the study areas was described in terms of the social and demographic characteristics of the population. The findings indicated that about 50% of people in Ghana Guinea-Bissau, and Sierra Leone were aware that mosquitoes caused malaria. Only about 25% were aware in The Gambia. Heavy rains and the cold weather that followed were also linked with malaria causes in Ghana and Guinea-Bissau. Stepping in goat urine was viewed as a cause of malaria in Senegal. In The Gambia, other causes indicated were eating of seasonally foods excessively, and an act of God. Fever was the most common symptom associated with malaria. Some differentiated in subtle ways between malaria fever and other fevers. Treatment was viewed in all countries as herbal, which was available from markets or traditional healers. About 50% of the 996 Ghana respondents used some form of traditional treatment for malaria. 86% used bednets in The Gambia and Guinea-Bissau. Only about 33% used them in Senegal, and very few used bednets in Sierra Leone and Ghana. Most were concerned about the irritation to sleep from mosquitoes. In all countries, cost of bednets was a constraint to use. Public health programs should stress the cost effectiveness and advantages of insecticide treated bednets, and information on malaria causes. Where Ghanians sleep on roofs, a new bednet design is needed.