African Journals Online
African Health Sciences

I wish to welcome you to our second issue of Africa Health Sciences which is coming out just before Christmas, 2001.

While this is a festive season we in the Africa region have not got much to celebrate. It is the first anniversary of Dr. Mathew Lukwiya’ s tragic death at the hands of Ebola haemorrhagic fever. News from Gabon and the Democratic Republic of the Congo (DRC) is not good. They sighted some cases of haemorrhagic fever feared to be Ebola. The countries bordering the DRC are panicking because, as Uganda’s commissioner for communicable diseases says, " Ebola can travel across boundaries in a matter of hours. Even one thousand kilometers is not far enough. So be prepared!" In light of this, African Health Sciences brings you an update on Ebola haemorrhagic fever in an article by some of the doctors who experienced the last Ebola outbreak in Gulu, northern Uganda last year, first hand1. They give us a glimpse of the epidemic as it affected children and adolescents, a sector of the population that is usually spared. Their take-home message is that we need to develop strategies to protect children and adolescents from exposure to Ebola patients. One such strategy is health education to children ad adolescents to avoid contact with Ebola patients.

In this issue of African Health Sciences we also bring you Dr. Nuru Nakintu’s results of a comparative study of vaginal misoprostol and intravenous oxytocin for induction of labour in women with intra uterine fetal death2. Dr. Nakintu demonstrates that misporostol is cheaper and more effective than oxytocin in induction of labour in women with intrauterine fetal death. The study has very important implications for Obstetric practice in countries with limited resources such as Uganda.

We continue our series on the anti-microbial activities of extracts of several Ugandan medicinal plants with an article by Dr. Olila and colleagues3. In the current article they report results of their study of antibacterial and anti-fungal activities of two Ugandan medicinal plants.

One of the plants (W. ugandensis) had antibacterial activity against Escherichia coli and Staphylococcus aureus, as well as anti-fungal activity against Candiada albicans. However Z. cahlybeum had neither antifungal nor antibacterial activities. These are important findings since a large proportion of Africans still relies on the use of herbal remedies.

We welcome an article from the United Sates on contraceptive security, information flow and local adaptations to family planning practice in Morocco.4 Chandani and Breton use their Morocco experience tomake a few conclusions: both external and internal funding and technical expertise are critical components of a successful logistics system for supplying customers with the contraceptives they need, when, and where they need them.

In this era of escalating numbers of people with tuberculosis, it is essential to revisit methods of diagnosis. Erume and colleagues’ article5 on rapid detection of Mycobacterium avium subs. paratubeculosis using nested PCR, albeit in animals, demonstrates potential of this technology in the rapid diagnosis of paratuberculosis: a suspect causative agent of Crohn’s disease.

Dr Sydney Ogwal’s article on the bioavailability and stability of erythromycin delayed release tablets6 demonstrates how our own scientists, using relatively simple technology, can contribute to practical solution of common problems, and yet conform to international standards.

This issue of African Health Sciences concludes with two practical articles: one by Dr. Rosemary Byanyima on menstruation in an unusual place7, a manifestation of endometriosis in the thorax. The second one is an article by Dr. Mityuyasu, which we have reproduced with kind permission of Medscape. In this article Dr. Mitsuyasu explores the future of AIDS vaccines. He reminds us, if we need reminding, "that over 58 million people worldwide have been infected with HIV since the beginning of the pandemic, and that almost 5.3 million were infected in 2000 alone. Historically vaccines have provided safe, cost effective, and efficient of preventing illness, disability, and death."

The challenges of HIV vaccine development and implementation are enormous and extend beyond the scientific and medical communities into the realms of economics, politics, law and development. However there is some hope. Great hope. As one South African official said recently at the World AIDS Day Celebration in that country: the hope is that the majority of our people are not infected with HIV: and with appropriate interventions and change, we can contain the pandemic.

¹Dr. Nuru Nakintu

¹Department of Obstetrics and Gyneacology, Makerere University, P. O. Box 7072 Kampala, Uganda

Intrauterine fetal death is a major problem in obstetrics particularly in developing countries such as Uganda. Induction of labour in cases of fetal death using the available method of oxytocin is often difficult, expensive and frustrating.

To compare the effectiveness of vaginal misoprostol and intravenous oxytocin in induction of labour in women with intrauterine fetal death

One hundred and twenty mothers were allocated in a randomised controlled way to one of the two induction groups. Oxytocin infusion was titrated based on patient response. The starting dose was 50mcg (1/4 tablet) in misoprostol group and the dose was doubled every six hours till effective contractions were achieved. The two groups were compared for induction to delivery intervals, costs of the drugs and their safety during induction.

The success rate within 48 hours of induction was 100% in the misoprostol group and 96.7% in oxytocin group. The mean induction to delivery time was significantly longer in the oxytocin group compared with the misoprostol group (23.3 versus 12.4 hours; p= 0.004). In the gestational age before 28 weeks, the induction to delivery interval in oxytocin group, was more than twice that used in misoprostol. However beyond 28 weeks, there was no significant difference.

Women with intact membranes had induction to delivery interval of 27.9 hours in the oxytocin group and 14.7 hours in the misoprostol group (p=0.002). When the membranes were ruptured, the values were 10.5 and 8.5 hours respectively (p=0.6). The induction to delivery time in cases with Bishop’s score < 6 was 29.8hours in the oxytocin group and 15.9 hours in misoprostol group (p=0.001). The corresponding values for Bishop’s scores > 6 were 10 and 7.9 hours respectively (p=0.6). The majority of patients in misoprostol group (62%), required less than one tablet for successful induction. Misoprostol was cheaper (0.65 USD than oxytocin (7.86 USD)

Retained placenta occurred in only 3.3% of the patients in the misoprostol group. There were no cases of ruptured uterus in both groups.

Intravaginal misoprostol is more effective and cheaper than intravenous oxytocin for inducing labour in patients with intrauterine fetal death.

Ebola haemorrhagic fever among hospitalised children and adolescents in nothern Uganda : Epidemiologic and clinical observations

¹Mupere E, ²Kaducu O.F and ²Yoti Z

¹ Gulu Regional Referral Hospital Northern Uganda P. O. Box 160 Gulu; 
² St Mary’s Hospital Lacor, Northern Uganda

Background

A unique feature of previous Ebola outbreaks has been the relative sparing of children. For the first time, an out break of an unusual illness-Ebola haemorrhagic fever occurred in Northern Uganda - Gulu district.

Objectives

To describe the epidemiologic and clinical aspects of hospitalised children and adolescents on the isolation wards.

Methods

A retrospective descriptive survey of hospital records for hospitalised children and adolescents under 18 years on the isolation wards in Gulu, Northern Uganda was conducted. All patient test notes were consecutively reviewed and non was excluded because being deficient.

Results

Analysis revealed that 90 out of the 218 national laboratory confirmed Ebola cases were children and adolescents with a case fatality of 40%. The mean age was 8.2 years ± SD 5.6 with a range of 16.99 years. The youngest child on the isolation wards was 3 days old. The under fives contributed the highest admission (35%) among children and adolescents; and case fatality because of prolonged close contact with the seropositive relatives among the laboratory confirmed cases. All (100%) Ebola positive children and adolescents were febrile while only 16% had haemorragic manifestations.

Similar to previous Ebola outbreaks, a relative sparing of children in this outbreak was observed. The under fives were at an increased risk of contact with the sick and dying.

Recommendations

Strategies to shield children from exposure to dying and sick Ebola relatives are recommended in the event of future Ebola outbreaks. Health education to children and adolescents to avoid contact with sick and their body fluids should be emphasized.

Olila, D.¹, Olwa-Odyek², and Opuda-Asibo,J³

¹Departments of Veterinary Physiological Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda.

² Department of Pharmacy Makerere University, P.O. Box 7072, Kampala, Uganda.

³ Veterinary Public Health and Preventive Medicine, Makerere University, P.O. Box 7062, Kampala, Uganda.

Measles is a killer disease of children in Uganda. The treatment of the disease is mainly directed at the secondary microbial infections. A large proportion of the population in Uganda still relies on the use of herbal remedies, which have been claimed to produce beneficial responses. In this study, the efficacy of Warburgia ugandensis and Zanthoxylum chalybeum against common bacteria and fungi was investigated. Bactericidal and antifungal assays were done using extracts derived from Z. chalybeum and W. ugandensis (agar well diffusion, disc diffusion and colony count assays). All extracts (ethanolic, petroleum ether and aqueous) of Z. chalybeum did not show antimicrobial activity. Phytochemical investigations of Zanthoxylum chalybeum (seed) yielded a pure crystalline alkaloid (27-135D) which was characterized as skimianine based on 1H-NMR spectroscopy and comparison with spectra of authentic samples. Skimmianine did not have antimicrobial activity in this test system. W. ugandensis water extracts elicited antibacterial activity against both Escherischia coli and Staphylococcus aureus in the agar well assay but not in the disc diffusion assay. Warburgia ugandensis water extracts and fraction 27-163D also showed antifungal activity against Candida albicans. Chromatography of extracts of Warburgia ugandensis stem bark afforded compound 49-169K, which was characterized as the sesquiterpine muzigadial (by 1H-NMR spectroscopy), which did not show antibacterial activity but had antifungal activity against C. albicans. Therefore, the claimed efficacy of W. ugandensis could be attributable to antibacterial and antifungal activity of its components. Since Z. chalybeum extracts had neither antifungal nor antibacterial activities, its mode of action is unclear from these results.

Yasmin Chandani and Gerry Breton, DELIVER, John Snow Inc. 1616 N. Fort Myer Drive, 11th Floor, Arlington, Virginia, USA 22209

Many developing countries increasingly recognize and acknowledge family planning as a critical part of socio-economic development. However, with few health dollars to go around, countries tend to provide essential drugs for curative care, rather than for family planning products. Donors have historically provided free contraceptives for family planning services.

Whether products are donated or purchased by the country, a successful family planning program depends on an uninterrupted supply of products, beginning with the manufacturer and ending with the customer. Any break in the supply chain may cause a family planning program to fail. A well-functioning logistics system can manage the supply chain and ensure that the customers have the products they need, when they need them.

Morocco was selected for the case study. The researchers had ready access to key informants and information about the Logistics Management Information System. Because the study had time and resource constraints, research included desktop reviews and interview, rather than data collection in the field.

The case study showed that even in a challenging environment an LMIS can be successfully deployed and fully supported by the users. It is critical to customize the system to a country-specific situation to ensure buy-in for the implementation.

Significant external support–funding and technical expertise–are critical components to ensure the initial success of the system. Nonetheless, evidence from the case study shows that, after a system has been implemented, the benefits may not ensure its institutionalization. Other support, including local funding and technical expertise, is required.

¹Joseph Erume, ²Joachim Spergser and ²Renate Rosengarten

¹Faculty of Veterinary Medicine, Makerere University, P.O.Box 7062, Kampala, Uganda. ²Institute of Bacteriology, Mycology and Hygiene, University of Veterinary Medicine Vienna, Veterinärplatz 1, A-1210 Vienna, Austria.

Paratuberculosis, caused by Mycobacterium avium subsp. paratuberculosis, a suspect causative agent of Crohn’s disease in man, is an emerging disease of international proportions affecting all ruminants. Early stage detection of Mycobacterium avium subsp. paratuberculosis infection would accelerate progress in control programmes. Despite new molecular approaches the standard diagnostic test for this disease is at present still the time consuming classic isolation procedure. Therefore, alternative diagnostic tests such as PCR, are needed for quick detection of infected animals. In this study, the conventional enrichment and isolation procedure and two IS900-based PCR methods for detection of Mycobactrium avium subsp. paratuberculosis in clinical samples from zoo animals and cattle were compared. A total number of 48 different clinical specimens obtained from animals suspected of having paratuberculosis were examined. The samples included faeces (n = 15) and organ tissues (n = 33). Of the faecal specimens two were identified as positive by nested PCR, whereas none was positive by single PCR or by culture. 28 organ specimens were found positive by culture. Mycobactrium avium subsp. paratuberculosis DNA was detected by nested PCR in 82% of the organ specimens identified positive by culture (23 samples) as opposed to 57% by single PCR (16 samples). Nested PCR also identified two positive samples that were not detected by either culture or single PCR. These findings show the great potential of nested PCR as a useful tool for the rapid diagnosis of paratuberculosis in animals.

¹Sydney Ogwal and ²Xide T.U

¹Department of pharmacy, Faculty of Medicine, Makerere University P. O. Box 7072 Kampala Uganda

²Department of Biopharmaceutics, Faculty of Pharmacy, China Pharmaceutical University, 24 Tong jia Xiang, 210009, Nanjing P. R. of china.

Erythromycin is available as the free base, ethylsuccinate, estolate, stearate, gluceptate, and lactobionate derivatives. When given orally erythromycin and its derivatives except the estolate are inactivated to some extent by the gastric acid and poor absorption may result.

To establish whether delayed release erythromycin tablets meet the bioequivalent requirement for the market

Methods

Spectrophotometric analysis was used to determine the dissolution percentage of the tablets in vitro. High performance liquid chromatography and IBM/XT microcomputer was used to determine the biovailability and pharmacokinetic parameters in vivo.

Dissolution percentage in thirty minutes reached 28.9% and in sixty minutes erythromycin was completely released. The parameters of the delayed release tablets were Tlag 2.3hr,Tmax.4.5hr, and Cmax 2.123g/ml Ka 0.38048hr-1

T _ 1.8 hr, V*C/F 49.721 AUC 12.9155.The relative biovailability of erythromycin delayed release tablet to erythromycin capsules was 105.31%

The content, appearance, and dissolution biovailability of delayed release erythromycin tablets conforms to the United States pharmacopoeia standards. The tablets should be stored in a cool and dry place in airtight containers and the shelf life is temporarily assigned two years.

¹Rosemary Kusaba Byanyima

¹Department of Radiology, Makerere Medical School, P. O. Box 7072 Kampala, Uganda

While pelvic endometriosis is relatively common, thoracic menstruation is rare. A report of what is believed to be the first case of thoracic endometriosis in Uganda is given. A 34 year old female was complaining of on and off chest pain mainly on the right side. Clinically she had signs of pleural effusion and 500 mls of altered blood were tapped from her right pleural space. Worried about a possibility of a malignant process, an urgent chest CT scan was performed. A right posterior pleural mass and pleural effusion were found. A pleural biospy was taken and confirmed at histology as endometrial tissue. She did well on surgical excision and hormonal therapy. This was a rare case of endometriosis which shows the usefulness of imaging in the patient work up.

¹Ronald T. Mitsuyasu

¹Associate Professor of Medicine, University of California Los Angeles, and Director of the UCLA CARE Center, UCLA Medical Center, Los Angeles.

Reprinted with kind permission from Medscape HIV AIDS (http://w.w.w.medscape.com/Medscape/HIVjournal/2001/v07.n05/
mha0927.01.mitsmha0927.mits-01,html ) © 2001 Medscape INC.

AIDS Vaccine 2001, a new addition to the international conference calendar that will undoubtedly become a biannual event, was designed to provide a setting for sharing the latest basic, clinical, and public health data relevant to AIDS vaccine development and to facilitate international and interdisciplinary collaboration in the field of AIDS vaccinology. The 3-day meeting in Philadelphia provided considerable information on the preclinical development and early clinical evaluation of several vaccine candidates, and ample opportunity for discussion on AIDS vaccine and immunotherapy study implementation. The overall impression is that a great deal of effort and considerable expertise is now being directed towards dissecting the immunologic and virologic components of protective immunity against HIV and towards the development of novel immunotherapeutic approaches to the prevention of HIV infection. This effort is in no small part due to the worldwide attention being given to the devastating effects of HIV and AIDS in resource-poor, developing countries of the world, and to the realization that treatment of HIV in and of itself is unlikely to contain the spread of this epidemic.