T. E. Nyirenda

Accuracy of chest radiograph diagnosis for smear-negative pulmonary tuberculosis suspects by hospital clinical staff in Malawi.

Sana’a city, Republic of Yemen: prevalence among C, and D virus markers in Yemeni patients with chronic pregnant women and materno-fetal transmission. J Egypt liver disease. J Med Virol 1993;40:330-3 Public Health Assoc 1991;66:491-503 30 Scott DA, Constantine NT, Callahan J, et al. The El Guneid AM, Gunaid AA, O’Neill AM, Zureikat NI, epidemiology of hepatitis C virus antibody in Yemen. Coleman JC, Murrya-Lyon IM. Prevalence of hepatitis B, Am J Trop Med Hyg 1992;46:63-8 29

Tuberculosis control in the face of the HIV epidemic

S transmission. A similar study took place in Cameroon where ivermectin was used in a dose of 150 pg/kg. Six months after treatment average microfilarial counts were reduced by more than 73% and about a third became amicrofilaraemic. In the first study 56% had side effects in the 24 h following treatment which included an exacerbation of pruritus in about half, cutaneous rash in about 8% and arthralgia in about 3%. The incidence of side effects was not commented On in the Cameroon Continued from p . 237 Epilepsy ~ ~ i i ~ ~ ~ ~ and onc~ocerciasis A high prevalence of epilepsy was observed in an area hyperendemic for onchocerciasis in Burundi and onchocerciasis was more frequent in epileptics than in controls from the same households. Other possible infective causes, for instance cysticercosis were infrequent. Nine epileptics with growth retardation were seen showing the characteristics of Nakalanga syndrome and all nine were suffering from onchocerciasis. These findings provide increasing evidence of an association between onchocerciasis and epilepsy. NEWELL ED, VYUNGIMANA F, BRADELY JE. Epilepsy, retarded growth and onchocerciasis, in two areas of different endemicity of onchcerciasis in Burundi. Trans R Soc Trop Med Hyg 1997;91:525-7 Ivermectin Onchocerciasis and reproductive health in South America Onchocerciasis has been associated with an increased risk of epilepsy and microfilaria have also been detected in the female reproductive system and in the umbilical cords of new born infants. A retrospective study in Ecuador compared the number of spontaneous abortions in a hyper endemic area for onchocerciasis before and after ivermectin treatment. In the endemic area a significantly greater rate of spontaneous abortions was seen before ivermectin distribution compared to that after the start of ivermectin treatments every 6 months, whereas no change was seen in the spontaneous abortion rate in the non endemic area. lvermectin may improve reproductive health in endemic populations as well as other benefits. GUDERIAN RH, LOVATO R, ANSELMI M, et al. Onchocerciasis and reproductive health in Ecuador. Trans R Soc Trop Med H.vg 1997:91:3 15-1 7 Effect of ivermectin in Loa loa Although ivermectin may have considerable dangers in patients with heavy infections, in more lightly infected patients ivermectin appears to have a significant beneficial effect. The action of a single dose of ivermectin 200 pg/kg was assessed in 71 Ganonese patients with Loa loa microfilia and 10-12 months after treatment 43 patients had no circulating microfilaria and geometric mean peripheral blood microfilaria count had decreased by nearly 90%. The authors comment that a DUONG TH, KOMBILA MA, FERRER A, et al. Reduced Loa loa microfilaria count ten to twelve months after a single dose of ivermectin. Trans R Soc Trop Med Hyg 1997;91:592-3 GARDON J, KAMCNO J, FOLEFACK G, et al. Marked decrease in Loa loa microfilaraemia six and twelve months after a single dose of ivermectin. Trans R Soc Trop Med Hyg l997;91:5934 Severe reactions with ivermectin in combined onchocerciasis and Loa loa. Nineteen African countries are currently involved in the World Bank programme for onchocerciasis control involving community based ivermectin treatment. Several cases of encephalopathy have been reported after ivermectin in people heavily infected with microfilariae of the Loa loa group. In Cameroon ivermectin was given to nearly 18 000 people and day time capillary blood was examined in all adults aged over 15 years. Of these 0.1 1 % developed serious reactions without neurological signs with a functional impairment lasting more than a week and two patients were in coma for 2-3 days associated with the presence of Loa loa microfilariae in cerebrospinal fluid. The occurrence of serious reactions was related to the intensity of pre-treatment Loa loa microfilariaemia, and the relative risk of developing marked or serious reactions was significantly higher when the Loa loa load exceeded 8000 microfilariae/mL. The odds ratio for severe reactions was very high (> 1000) for microfilarial load greater than 50 000 microfilariae/mL. An accompanying editorial suggests that ivermectin mass distribution should be provided only where potential long-term benefits outweigh the risks of serious reactions. Surveillance systems need to be strengthened and follow up times after treatment extended. Community health workers should be alert to report fever and neurological changes following ivermectin. GARDON J , GARDON-WENDEL N, DEMANGA-NGANGUE, et al. Serious reactions after mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection. Lancet 1997;350: 18-22 BURNHAM GM. Ivermectin where Loa loa is endemic. Lancet 1997;350:2-3

Morbidity and mortality in prisons in Malawi

and emergency department with lower abdominal pain. Ann R Coil Surg EngI1995;77:193-7 4 Robinson HP, DeCrespingny Lch. Ectopic pregnancy. Clin Obstet Gynecol 1983;10:407-21 5 Najem AZ, Barillo DI; Spillert CR, Kerr IC, Iazaro EI. Appendicitis versus pelvic inflammatory disease: a diagnostic dilemma. Am Surg 1985;51:217-22 6 Twomey D. Awareness of ectopic pregnancy. Nigerian J Surg Sci 1994;4:48 7 Atanassov ID, Gelov GN, Atanassov PA, Gelov GN. Differential diagnostic difficulties of acute appendicitis in pubescent girls and young women [Abstract]. Dr J Surg 1995; 82(suppl 1):5 8 Walker BI, West CR, Colmer MR. Acute appendicitis: does removal of a normal appendix matter, what is the value of diagnostic accuracy and is surgical delay important. Ann R Coil Surg Engl 1995;77:358--63 9 Lujan lA, Robles R, Soria V, Torralba lA, Liron R. Value of laparoscopy for the management of acute right lower quadrant pain in females between 12 and 50 years of age [Abstract]. Dr J Surg 1994;81(suppl 1):6

Traditional healers and their practices in Malawi

Itt is likely that most villages in Malawi have at least one traditional healer, and traditionall healer consultation appears to be very common. Forty-three per cent of in-patientss at Queen Elizabeth Central Hospital (QECH), Blantyre, admitted a prior consultationn with a traditional healer (Seke and Maher, personal communication), and nearlyy 40% of smear-positive pulmonary tuberculosis (PTB) patients receiving treatmentt at QECH stated that they had seen a traditional healer before TB had been diagnosedd [1]. However, little has been written about the number of patients seen by traditionall healers or about traditional healer beliefs in Malawi.