Deriving an optimal threshold of waist circumference for detecting cardiometabolic risk in sub-Saharan Africa.

BACKGROUND: Waist circumference (WC) thresholds derived from western populations continue to be used in sub-Saharan Africa (SSA) despite increasing evidence of ethnic variation in the association between adiposity and cardiometabolic disease and availability of data from African populations. We aimed to derive a SSA-specific optimal WC cut-point for identifying individuals at increased cardiometabolic risk. METHODS: We used individual level cross-sectional data on 24 181 participants aged ⩾15 years from 17 studies conducted between 1990 and 2014 in eight countries in SSA. Receiver operating characteristic curves were used to derive optimal WC cut-points for detecting the presence of at least two components of metabolic syndrome (MS), excluding WC. RESULTS: The optimal WC cut-point was 81.2 cm (95% CI 78.5-83.8 cm) and 81.0 cm (95% CI 79.2-82.8 cm) for men and women, respectively, with comparable accuracy in men and women. Sensitivity was higher in women (64%, 95% CI 63-65) than in men (53%, 95% CI 51-55), and increased with the prevalence of obesity. Having WC above the derived cut-point was associated with a twofold probability of having at least two components of MS (age-adjusted odds ratio 2.6, 95% CI 2.4-2.9, for men and 2.2, 95% CI 2.0-2.3, for women). CONCLUSION: The optimal WC cut-point for identifying men at increased cardiometabolic risk is lower (⩾81.2 cm) than current guidelines (⩾94.0 cm) recommend, and similar to that in women in SSA. Prospective studies are needed to confirm these cut-points based on cardiometabolic outcomes.International Journal of Obesity advance online publication, 31 October 2017; doi:10.1038/ijo.2017.240.

Re-assessing community-directed treatment: evidence from Mazabuka District, Zambia.

Cross-sectional surveys with carers, health workers, community drug distributors (CDDs) and neighbourhood health committees were conducted to identify factors associated with utilization of community-directed treatment (ComDT) of soil-transmitted helminths in children aged 12-59 months in Mazabuka district, Zambia. The surveys took place in December 2006 and December 2007. In addition child treatment records were reviewed. The factors that were found to be significantly associated (p < 0.05) with treatment of children by the CDDs were: (1) the perception of soil-transmitted helminth infections as having significant health importance, (2) the community-based decision to launch and subsequently implement ComDT, (3) the use of the door-to-door method of drug distribution, (4) CDDs being visited by a supervisor, (5) CDDs receiving assistance in mobilizing community members for treatment, (6) CDDs having access to a bicycle and (7) CDDs having received assistance in collecting drugs from the health centre. Despite the effectiveness of ComDT in raising treatment coverage there are factors in the implementation process that will still affect whether children and their carers utilize the ComDT approach. Identification and understanding of these factors is paramount to achieving the desired levels of utilization of such interventions.

Socio-demographic factors associated with treatment against soil-transmitted helminth infections in children aged 12-59 months using the health facility approach alone or combined with a community-directed approach in a rural area of Zambia.

A health facility-based (HF) approach to delivering anthelminthic drugs to children aged 12-59 months in Zambia was compared with an approach where community-directed treatment (ComDT) was added to the HF approach (HF+ComDT). This paper reports on the socio-demographic factors associated with treatment coverage in the HF+ComDT and HF areas after 18 months of implementation. Data were collected by interviewing 288 and 378 caretakers of children aged 12-59 months in the HF+ComDT and HF areas, respectively. Bivariate and multivariate logistic regression analyses were used for data analysis. Statistically significant predictors of a child being treated were: a child coming from the HF+ComDT area, being 12-36 months old, the family having lived in the area for >20 years, coming from a household with only one under-five child and living ≤3 km from the health facility. It is concluded that socio-demographic factors are of public health relevance and affect treatment coverage in both the HF+ComDT and the HF approaches. The implementation and strengthening of interventions like ComDT that bring treatment closer to households will enable more children to have access to treatment.

Exposure to occupational health hazards among Zambian workers.

BACKGROUND: Data on occupational safety and health in Southern Africa are scant. Hence the negative impact of poor working conditions is unknown and the scientific basis for interventions and policy formulation is lacking. AIMS: To determine the prevalence of, and factors associated with, exposure to occupational health hazards in Zambia. METHODS: We used data collected in the 2009 National Labour Force Survey. Unadjusted and adjusted odds ratios and their 95% confidence intervals were used to measure magnitudes of associations. RESULTS: Exposure to occupational hazards among the 64 119 respondents (response rate = 78%) included vibration from hand tools or machinery (3%), temperatures that make one perspire even when not working (4%), low temperatures whether indoors or outdoors (4%), smoke, fume, powder or dust inhalation (13%), pesticides (3%), noise so loud that voice had to be raised to talk to people (4%), chemical handling or skin contact (3%) and exposure to heavy object lifting, frequent bending of the back or rapid movement of limbs causing body pain (30%). In multivariate analysis, exposure to occupational health hazards was associated with older age, male sex, low educational level, being married/cohabiting and not being self-employed. CONCLUSIONS: Results from this study indicate that Zambian workers are exposed to a broad range of occupational health hazards. This could be useful for the formulation of a multi-sector approach aimed at the prevention and control of hazard exposure.

District specific correlates for hypertension in Kaoma and Kasama rural districts of Zambia.

INTRODUCTION: Hypertension a major risk factor for cardiovascular disease and is the most widely recognized modifiable risk factor for this disease. There is little information on the prevalence and risk factors for hypertension in Zambia, and in particular in rural areas of the country. In order to contribute to the existing global literature on hypertension, particularly in rural Zambia, this study was conducted to determine the prevalence of hypertension and its correlates in two rural districts of Zambia, namely Kaoma and Kasama. METHODS: A cross-sectional study using a modified World Health Organization (WHO) global non communicable diseases (NCD) surveillance initiative NCD-STEPwise approach was used. Proportions were compared using the Yates' corrected χ2 test, and a result yielding a p-value of less than 5% was considered significant. Bivariate and multivariate logistic regression analyses were conducted. Factors that were significantly associated with the outcome in bivariate analyses were considered in a multivariate logistic regression analysis using a backward variable selection method. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were reported. RESULTS: In total, 895 participants from Kaoma and 1198 participants from Kasama took part in the surveys. Overall, 25.8% participants (27.5% male, 24.6% female; p=0.373) in Kaoma and 30.3% (31.3% male, 29.5% female; p=0.531) in Kasama were hypertensive. In Kaoma, age and BMI were independently associated with hypertension. Compared with participants aged 45 years or older, participants aged 25-34 years were 60% (AOR=0.40, 95% CI [0.21, 0.56]) less likely to be hypertensive. Participants with BMI <18.5 and 18.5-24.9 were 54% (AOR=0.46, 95% CI [0.30, 0.69]) and 31% (AOR=0.69, 95% CI [0.49, 0.98]) less likely to be hypertensive compared with participants with BMI ≥30. In Kasama, age, smoking and heart rate were significantly associated with hypertension in multivariate analysis. Participants 25-34 years were 49% (AOR=0.51, 95% CI [0.41, 0.65]) less likely to be hypertensive compared with participants 45 years or older. Compared with participants who were non-smokers, smokers were 21% (AOR=1.21, 95% CI [1.02, 1.45]) more likely to be hypertensive. Participants who had heart rate >90 beats/min were 59% (AOR=1.59, 95% CI [1.17, 2.16]) more likely to be hypertensive compared with participants who had heart rate 60-90 beats/min. CONCLUSIONS: The findings reveal that hypertension is prevalent among rural residents in Kaoma and Kasama, Zambia. The disease is highly associated with age, BMI, smoking and heart rate. Efficient preventive strategies are needed to halt the growing trend of non-communicable diseases through the control of risk factors highlighted in this study.

Predictors of mortality in acute hospitalised COVID-19 pneumonia patients: A retrospective cohort study at two tertiary-level hospitals in Zambia.

BACKGROUND: The global COVID-19 pandemic has resulted in increased acute hospitalisations, a high demand for intensive care and high in-hospital mortality, placing a huge burden on healthcare systems. OBJECTIVES: To assess in-hospital mortality outcomes and associated factors in acute hospitalised COVID-19 pneumonia patients in Zambia. METHODS: We performed a retrospective cohort review of patients admitted to two tertiary-level hospitals in Zambia from 1 March 2020 to 28 February 2021. We examined the factors (demographic, clinical and laboratory) that were associated with in-hospital mortality using multivariate logistic analysis. Adjusted odds ratios with their 95% confidence intervals (CIs) are reported. RESULTS: Of 350 patients, 59.4% were aged ≥55 years and 52.6% were male. The commonest comorbidities were hypertension, diabetes mellitus (DM), HIV/AIDS and chronic kidney disease (49.6%, 28.5%, 22.0% and 8.1%, respectively). The overall in-hospital mortality rate was 42.6%, and mortality was significantly increased in patients aged ≥55 years (52.0% v. 48.0%) and in those with DM (52.1% v. 47.9%), cardiac disease (68.0% v. 32.0%), a Quick Sequential (Sepsis-Related) Organ Failure Assessment (q-SOFA) score ≥2 (75.4% v. 24.6%), and admission blood glucose levels ≥7.0 mmol/L (66.3% v. 33.7%). Compared with patients who survived, who spent a median (interquartile range) of 6 (3 - 10) days in hospital, the median time between admission and death in those who died was 2.5 (1 - 6) days. In multivariate logistic analysis, age ≥55 years, a q-SOFA score ≥2 and a random blood sugar level ≥7.0 mmol/L were predictors of in-hospital mortality, with adjusted odds ratios of 1.54 (95% CI 1.09 - 2.17), 2.17 (95% CI 1.40 - 3.38) and 1.65 (95% CI 1.18 - 2.30), respectively. Raised serum creatinine was not associated with in-hospital COVID-19 mortality after adjusting for other confounders. CONCLUSIONS: This study highlights that high in-hospital COVID-19 mortality was associated with a high q-SOFA score, hyperglycaemia on admission and older age. The study reinforces the need to invest in emergency healthcare services for optimal management of COVID-19 patients presenting with high q-SOFA scores in resource-limited countries.

Factors associated with secular trends in mortality attributed to measles in Gweru, Zimbabwe, in 1967-89.

A retrospective study conducted in Gweru, Zimbabwe, investigated the trend and its associated factors in measles mortality between 1967 and 1989. Measles and malnutrition surveillance data were analysed in SPSS version 8.0 using the Forward Stepwise Linear Regression method. Measles case fatality rates ranged from zero to 48.2% (median: 4.2, Q(1) = 1.2, Q(3) = 12.9) and they significantly linearly declined [slope = -1.686; 95% confidence interval (CI) -2.327, -1.044; R(2) = 59%]. Rates of mortality among complicated measles cases (slope = 0.546, 95% CI = 0.133-0.345) and rates of mortality from malnutrition among children aged <5 years (slope = 0.459, 95% CI = 0.031-0.099) independently predicted (R(2) = 87%) measles case fatality rates. It was concluded that decline in rates of mortality among complicated measles cases, probably due to good management of such cases, and decline in rates of malnutrition among children aged <5 years may have contributed to the decline in measles case fatality rates.

Prevalence and correlates of current cigarette smoking among adolescents in East Timor-Leste.

OBJECTIVES: To determine the prevalence and correlates for current cigarette smoking. DESIGN: Secondary analysis of the East Timor-Leste Global Youth Tobacco Survey conducted in 2006. SETTING: Public and private schools registered with the Ministry of Education. PARTICIPANTS: A two-stage cluster sample of 1790 students in Grades 7 to 9. Schools were selected with probability proportional to enrolment size, and classes were randomly selected in each school. All students in selected classes were eligible to participate in the survey. The school and student response rates were 96.0% and 84.5%, respectively. MAIN OUTCOME MEASURE: Prevalence of current cigarette smoking. RESULTS: Out of 1790 adolescents, 52.1% were of ages less than 15 years, 51.8% were males, 42.8% reported having some pocket money in a month, and 72.7% had at least a parent who was a smoker. Prevalence of current cigarette smoking was 40.3%. Current smokers also reported having bought cigarettes from peddlers (32.4%), someone bought for them (16.7%), got from someone older (13.7%), borrowed (13.3%), and stole (3.4%). Males were more likely to be smokers than females (59.0% versus 19.3%). Factors positively associated with current smoking were: parental smoking; closest friend smoking; amount of pocket money; and exposure to anti-tobacco messages. CONCLUSIONS: East Timor has one of the highest prevalence of cigarette smoking among adolescents. The fact that exposure to anti-tobacco messages was associated with being a smoker may be evidence suggesting that anti-tobacco messages, especially from tobacco-related industry, may have unintended consequences.

Risk factors associated with porcine cysticercosis in selected districts of Eastern and Southern provinces of Zambia.

To determine the risk factors associated with Taenia solium transmission in humans and pigs in the rural areas of Eastern and Southern provinces of Zambia, a questionnaire was administered in 788 households from 155 villages. Pigs were examined from 800 households. Tongue examination and enzyme-linked immunosorbent assay (Ag-ELISA) for the detection of circulating antigens of T. solium cysticerci were used to measure infection in pigs. A snowballing technique was utilised to select households with pigs. Prevalence of households with pigs infected with T. solium on tongue examination by district ranged from 12.7% to 32.1% with Ag-ELISA having a range of 30.0-51.7%. Of the total number of households visited, 18.8% and 37.6% had at least one pig positive for porcine cysticercosis on tongue examination and Ag-ELISA, respectively. Risk factors associated with T. solium infection were lack of pork inspection at slaughter (96.7%), consumption of pork with cysts (20.1%), selling of pork infected with T. solium cysticerci (18.3%), free-range husbandry system (83.2%) and absence of latrines (58.0). Free-range husbandry system (OR=1.68; 95% CI=1.36-2.07) was a significant risk factor for porcine cysticercosis in the surveyed areas. The result that pigs were mostly kept on free-range and semi-intensive husbandry systems may have permitted them to have access to eating human faeces that could be contaminated with tapeworm eggs. This study has shown that T. solium infection poses a high public health risk in the study areas and urban areas as well. We recommend that a human survey be conducted to verify the human exposure to taeniasis and/or cysticercosis in Zambia.

Predictors of cigarette smoking among adolescents in rural Zambia: results from a cross sectional study from Chongwe [corrected] district.

INTRODUCTION: Cigarette smoking is a leading cause of morbidity and mortality globally. There are limited data on the prevalence of and factors associated with smoking among in-school adolescents in developing countries. OBJECTIVES: To estimate prevalence of those who have smoked cigarettes and to identify associated socio-demographic factors among adolescents in Chongwe district, Chongwe [corrected] Province, Zambia. METHODS: Data used was from the Zambia Global Youth Tobacco Survey, which was conducted using standardized methodology among in-school adolescents in 2002. Data were analyzed to assess if selected socio-demographic variables were associated with having smoked cigarettes. Bivariate and multivariate logistic regression analysis was used to assess the associations. RESULTS: A history of having smoked cigarettes ranged from 20.5% among 15 year olds to 37.2% among males younger than 12 years old. In females, 20.7% of 13 year olds and 37.7% of those less than 12 years old had smoked. Parental smoking, friends smoking, a lack of perception that smoking was harmful, and exposure to pro-tobacco advertisements were associated with having smoked cigarettes. Adolescents who had smoked cigarettes were more likely to allow others smoke in their presence. CONCLUSIONS: Many adolescents in rural Chongwe[corrected], Zambia had tried cigarette smoking. The identification of predictors for smoking should guide the design and implementation of programs aimed to prevent initiation and maintenance of tobacco use among adolescents.

Prevalence of sexual intercourse among school-going adolescents in Coast Province, Kenya.

A study was carried out to estimate the prevalence and associated factors of sexual intercourse among school adolescents in Coast Province, Kenya. Data were obtained through the Kenya Global School-Based Health Survey. Overall the prevalence of sexual intercourse within the last 12 months was 14.9% (22.2% in males and 5.0% in females). Among males, the protective factors against having sex were being of age < 15 years (OR = 0.60, 95% CI 0.58, 0.62) and ever been drunk (OR = 0.63, 95% CI 0.59, 0.67). The risk factors for having sex among males were ever smoked (OR = 2.05, 95% CI 1.92, 2.19), having close friends (OR = 1.68, 95% CI 1.56, 1.81), currently drinking alcohol (OR = 1.13, 95% CI 1.06, 1.20), ever used drugs (OR = 2.36, 95% CI 2.24, 2.49) and parental supervision (OR = 1.30, 95% CI 1.25, 1.34). Meanwhile among female respondents, parental supervision was protective (OR = 0.88, 95% CI 0.81, 0.94) and the only risk factor was ever used drugs (OR = 2.85, 95% CI 2.57, 3.15). It is suggested that public health interventions aimed to promote adolescent sexual health should be designed with the appreciation of the factors associated with sexual activity in due consideration.

Suicidal ideation and associated factors among in-school adolescents in Zambia.

A cross sectional study was conducted to estimate the prevalence and correlates of suicidal ideation among in-school adolescents in Zambia. Backward logistic regression analysis was conducted to assess the association between relevant predictor variables and suicidal ideation within the last 12 months. A total of 1970 in-school adolescents who participated in the Zambia Global School-Based Health Survey in 2004 responded to the question on suicidal ideation. Overall, 54.0% were males, 40.8% were current drinkers, and 35.9% ever smoked marijuana (cannabis). Altogether 31.3% reported suicidal ideation in the past 12 months (males = 31.1%; females = 31.4%). Being male (OR = 1.05; 95%CI 1.03, 1.05): being <14 years old (OR = 1.21; 95%CI 1.19, 1.23), having been drunk (OR = 1.28; 95%CI 1.27, 1.29). worried (OR= 1.05; 95%CI 1.04, 1.06), sad or hopeless in the past 12 months (OR = 1.02; 95%CI 1.01, 1.03) and ever used marijuana (OR = 1.18; 95%CI 1.17, 1.19) were positively associated with suicidal ideation. Loneliness appeared to be protective (OR = 0.92; 95%CI 0.91, 0.92). All the results, except for ever smoked marijuana and ever been drunk, may have been biased due to non-response to the question on suicidal ideation. A series of cross sectional studies should be conducted to monitor changes in behavioural factors among others ever smoked marijuana and ever been drunk in order to broaden our understanding of factors that may be causing adolescents to seriously consider committing suicide.

Sex differences in prevalence rates and predictors of cigarette smoking among in-school adolescents in Kilimanjaro, Tanzania.

An analysis of the Global Youth Tobacco Survey for Kilimanjaro, Tanzania was carried out to assess sex differences in the prevalence rates and predictors of current cigarette smoking among in-school adolescents. A total of 2323 adolescents participated in the study of whom 53% were females and 47% males. The prevalence of current cigarette smoking was 3.0% and 1.4% among males and females, respectively. The common factors that were significantly positively associated with cigarette smoking between sexes were: having more pocket money, closest friend smoked cigarettes, seeing actors smoke on TV, videos or movies, and seeing advertisements for cigarettes at social gatherings. Seeing anti-smoking messages at social gatherings were negatively associated with smoking among both sexes. While having had something such as a t-shirt or pen with a cigarette brand logo on it was positively associated with cigarette smoking among males, it was negatively associated with cigarette smoking among females. Male adolescents older than 15 years, those in their 9th year of schooling, and those who had seen cigarette brand names on TV were more likely to smoke. Meanwhile, male respondents who were in their 8th year of schooling, had seen anti-smoking media messages, and advertisements for cigarettes in newspapers or magazines were less likely to smoke. Among female adolescents, those who had parents who smoked, and surprisingly those who perceived that cigarette smoking as harmful were more likely to smoke. Interestingly, seeing advertisement for cigarettes on billboards was negatively associated with smoking among female adolescents. Interventions aimed to reduce adolescent smoking need to be designed and implemented with due consideration of sex differences in these associated factors.

Seasonal pattern of bovine fasciolosis in the Kafue and Zambezi catchment areas of Zambia.

In order to establish seasonality of bovine fasciolosis in the Southern province of Zambia, 288 cattle were examined at slaughter at Turnpike slaughter slab for 1 year. The examination involved liver inspection and coprological examination. Liver condemnation rates were relatively high at the beginning of both the cold dry season and the rainy season (May/June and December, respectively). All cattle, regardless of age, had higher fluke abundances in the post-rainy season (39.1% young and 42.1% adult) while the lowest rates were in the hot dry season (13.3% young and 14.3% adult). On coprological examination, the highest abundance was in the post-rainy season (45.0%) and the lowest in the cold dry season (24.9%). From November (end of dry season) to February/March (end of rains), more fluke eggs were found than in any other period. The distribution of fluke eggs was significantly different (p<0.001) among the four seasons. Identified associations were: egg counts were highest in post-rainy (mean abundance=146) and lowest in cold dry season (mean abundance=118) at 95% confidence (CI 0.64-1.25). Differences in abundance observed according to origin, sex and age of cattle were not significant on both methods. Based on these results, it may be concluded that Fasciola gigantica was present throughout the year in cattle in Zambia but the abundance was highest in the post-rainy season and lowest in the cold dry season.

Myocardial dysfunction in human immunodeficiency virus infection: an echocardiographic study of 157 patients in hospital in Zimbabwe.

OBJECTIVE: To determine the prevalence and characteristics of myocardial dysfunction and other cardiac manifestations in acutely ill hospital patients infected with human immunodeficiency virus (HIV) in Zimbabwe. DESIGN: A prospective echocardiographic survey of acutely ill HIV seropositive patients. SETTING: General medical ward, Harare Central Hospital, Zimbabwe. PATIENTS: One hundred and fifty seven HIV seropositive patients admitted with various acute medical conditions over a 12 month period, January to December 1994. MAIN OUTCOME MEASURES: Detection of myocardial dysfunction and other cardiac abnormalities by cross sectional echocardiography. RESULTS: Eighty (51%) men and 77 women were studied (mean (SD) age 34.4 (8.5), range 15-60 years for males and 31.6 (9.0), range 16-65 years for females). They were all heterosexual. None was haemophiliac or an intravenous drug user. Echocardiographic abnormalities were found in 79 (50%) patients: 14/151 (9%) had dilated cardiomyopathy, 33/151 (22%) left ventricular dysfunction, 9/151 isolated right ventricular dilatation, and 30/157 (19%) pericardial disease (28 with effusions, three having tamponade). There were two cases of constrictive pericarditis and one of ascending aortic aneurysm. CONCLUSIONS: There is a high prevalence of echocardiographically detected myocardial and pericardial disease in this group of acutely ill HIV infected patients. Left ventricular dysfunction without dilatation was common, but its significance was not ascertained.

The role of some risk factors of exposure to malaria in determining the outcome of the immunofluorescent antibody test in an urban population.

Data obtained previously were analysed to assess the relative importance of variables which relate to the risk of exposure to malaria in explaining the level of indirect fluorescent antibody (IFAT) reactions observed among the urban study population. In the analysis specific activities, notably travelling out of the main towns, season when out of the main towns, length of period since having been out of the main towns, and history of having had malaria in the last year, were of help in predicting the level of IFAT reaction. Sensitivity and specificity values of history of malaria, history of having been out of the main towns, and serological results were higher in older people in both periods and were highest in the March-April 1985 survey period.

Importance of schistosomiasis in the Isoka district of Zambia: a prerequisite for its control using community participation.

The opinion has long been held that only by treating cases individually could diseases be controlled or eradicated. This view has been adopted from time immemorial and has failed miserably in, for instance, the control of schistosomiasis. This paper presents views of the head teachers on the prominence of schistosomiasis in the Isoka district, Zambia, as a step towards their involvement in a community mediated programme for the control of schistosomiasis. Information was sought on the importance of schistosomiasis in the district by means of two questionnaires, one distributed to head teachers, and the other to school children. Lack of clean water was considered to be the leading factor by 71 (82.6%) teachers. Generally, schistosomiasis was not considered to be a prominent disease in the district. Nevertheless, teachers from highly infected areas ranked schistosomiasis as a health problem higher than those teachers from schools with lower prevalences (P = 0.002). The implications of these results to implementing a district wide schistosomiasis control programme covering both infected and uninfected areas are discussed.

Echocardiographic assessment of left ventricular hypertrophy diastolic dysfunction and pericardial disease in patients on maintenance haemodialysis.

Echocardiographic study of sixty patients on maintenance haemodialysis (MHD) was undertaken to determine the prevalence and factors associated with left ventricular (LV) hypertrophy (LVH), LV diastolic dysfunction and pericardial disease. The mean age was 34.4 (standard deviation 13.0), range 14-66 years with 31 (51.7%) men. LVH was found in 41 (68%) patients. Of the factors analysed, serum calcium and calcium-phosphate product were significantly associated with LVH (t = 2.01, df = 58, p = 0.046; t = 2.18, df = 58, p = 0.032 respectively). Hypertension in this study was not significantly associated with LVH (p = 0.169). LV diastolic dysfunction was found in 23/41 (56%) patients with LVH, and in 9/19 (47%) patients without LVH (difference is not statistically significant, X2 = 0.12, df = 1, p = 0.725). Small pericardial effusions were detected in 4/60 (7%) patients and two patients had pericardial thickening. We conclude that in our MHD patients LVH, is very common and that diastolic dysfunction is observed equally in patients with and without LVH. However, haemodynamically significant pericardial effusions are rare in patients who have been on dialysis for at least six months.

HIV infection in malnourished children in Harare, Zimbabwe.

A descriptive study was undertaken to compare the pattern of socio-demographic features, nutritional profile and presenting features of HIV infected and uninfected children with malnutrition. A total of 140 children aged above 15 months admitted to the paediatric wards, Harare Hospital from December 1993 to February 1994 were studied. Sixty eight (48.6%) children were found to be HIV seropositive and 72 negative. The socio-demographic features were similar in both groups. Marasmus and marasmic kwashiorkor were predominant in the HIV infected children, whilst the majority (64%) of the children in the HIV uninfected group had kwashiorkor (p = 0.001). Pneumonia, lymphadenopathy, chronic discharging ears and oral thrush were significantly more frequent in the HIV infected than in the non HIV infected children (p < 0.01). Factors predictive of HIV infection were marasmus (OR 2.72, 95% CI 1.04-8.10), generalised lymphadenopathy (OR 2.77, 95% CI 1.16-6.64), oral thrush (OR 2.72, 95% CI 1.16-6.37) and discharging ears (OR 6.05, 95% CI 1.89-19.42) with a sensitivity of 57.6% (95% CI 45.7%-69.5%), specificity of 71.4% (95% CI 60.8% 82.0%). The high prevalence of HIV infection among the malnourished children emphasises the impact of the HIV epidemic on childhood nutritional morbidity.

PIP: The HIV epidemic in Zimbabwe has increased the prevalence of child malnutrition. This descriptive study compared sociodemographic features, the nutritional profile, and clinical features of 140 HIV-positive and HIV-negative children 15 months of age and older with malnutrition admitted to Harare Hospital in 1993-94. 68 children (48.6%) were HIV-infected. There were no significant differences between infected and non-infected children in terms of sociodemographic factors such as area of residence, maternal education, caretaker, and breast feeding status. HIV-infected children were most likely to have marasmus and marasmic kwashiorkor; 64% of children in the HIV-negative group had kwashiorkor. Pneumonia, lymphadenopathy, chronic ear discharge, and oral thrush were significantly more prevalent among HIV-infected children. Four factors were predictive of HIV infection: marasmus (odds ratio (OR), 2.72; 95% confidence interval (CI), 1.04-8.10), generalized lymphadenopathy (OR, 2.77; 95% CI, 1.16-6.64), oral thrush (OR, 2.72; 95% CI, 1.16-6.37), and ear discharge (OR, 6.05; 95% CI, 1.89-19.42). 32 children (22.8%) died during their hospitalization. Mortality was significantly greater among children less than 60% of expected weight (severe malnutrition), but was not significantly related to HIV status.

Study of psychiatric consequences of closed head injury at the Kenyatta National Hospital.

This was a study to compare the psychiatric consequences of closed head injury (CHI) in 37 patients with 39 demographically similar patients with fractured lower limb injury (FLLI), aged 16-55 years. The outcome measures were the Clinical Interview Schedule-Revised, the Bender Gestalt Test and the WHO AUDIT Core for alcohol abuse. The final diagnoses were made according to DSM-III-R diagnostic criteria. The findings indicated that CHI patients suffered more psychiatric consequences than FLLI controls (OR = 4.07; 95% CI = 1.30:13.14; p = 0.013). Depression and anxiety disorders were the most common problems encountered in these subjects.