African Journals Online
African Health Sciences

Volume 2 Number 1 April 2001

African Health Sciences has come a long way since its long anticipated birth in August 2001. You are very much welcome to this first issue of volume 2, of 2002 which contains very interesting papers.

The papers include studies of the effect of Ugandan herbal extracts on measles virus1, sugar as a potential for vitamin A fortification2, experience with Directly Observed Therapy (DOT) for TB in South Africa3, the Bwamba virus in Tanzania and Uganda,4 an exploration of an interesting western lifestyle condition now on the rise in Uganda: diverticular disease of the colon5; as well as sexuality in Kenya6.

In their paper, Olila, Olwa-Odyek and Opuda Asibo1 tested the claimed efficacy of some plants in the treatment of measles - a disease of public health significance. They performed in vitro antiviral assays of extracts of two medicinal plants using measles virus as the test organism. One of the two plants had antiviral activity in seed extracts and it was established that this was due to the compound skimmianine. Clearly this is an important finding which needs to be followed up with further studies.

The paper on sugar2 as a potential for vitamin A fortification is timely in that there is a resurgence of interest in Vitamin A as an important micronutrient with anti-oxidant properties, among others. The use of sugar seems to be widespread in eastern Uganda and therefore, the author argues that sugar is a potential vehicle for vitamin A fortification. However, there is need for caution here since the use of sugar has been associated with obesity and dental ill health. No doubt the debate on this issue will continue.

Poor patient adherence to prescribed medication is one of the hindrances to effective TB control and is the rationale for DOT advocated by WHO. However this is a labour intensive practice, which over burdened health systems find difficult to implement. Kironde3 and Kahirimbanyi’s paper in today’s African Health Sciences, report on their experience with community involvement in the delivery of TB treatment in the northern Cape Province in South Africa. One third of the TB patients received treatment from lay DOT volunteers who had been trained and supported to administer and record the treatment. Treatment outcomes for new patients supervised in the community were equivalent to those who received treatment from the health units. For patients on re-treatment, community based treatment was superior to self-administered therapy. Clearly, community participation might be a viable way of achieving effectiveness of DOT.

In this issue we also bring you the study of the Bwamba virus (genus Bunya virus, family Bunyaviridae) from Uganda and northern Tanzania4. As it causes un identified fevers because of its benign nature, this may be more common than previously believed. The virus was isolated from several sources: mosquitoes obtained during the O’onyong-nyong virus fever out break in Rakai in 1997, and from a refugee in a camp in Ngara in north-eastern Tanzania. As the virus causes an illness similar to malaria, further studies are needed to clearly define its epidemiology and natural history.

Dr. Elsie Kiguli-Malwadde’s5 article reminds us that adoption of western life-styles such as the consumption of refined, fibre-poor foods might be responsible for the emergence of diverticular disease of the colon in Uganda.

Finally Missie Oindo’s article on contraception and sexuality among the youth in Kisumu Kenya brings out the gap between knowledge and practice - a serious situation in this era of HIV and AIDS6.

We wish you enjoyable reading.

1. Olila D, Olwa-Odyek, Opuda-Asibo J. Screening extracts of Zanthoxylum chalybeum and warburgia ugandensis for activity against measles virus (Swartz and Edmonston strains) in vitro. African Health Sciences 2002; 2(1): 2-10

Olilaa D, Olwa-Odyekb and Opuda-AsibocJ.

Departments of Veterinary Physiological Sciencesa,
Pharmacyb and Public Health and Preventive Medicinec,
Makerere University, Box 7062, Kampala, Uganda.

A large proportion of the population in Uganda still relies on the use of plant extracts for treatment of various ailments. This study tested the claimed efficacy of some plants in the treatment of measles. In vitro antiviral assays were performed on extracts of two medicinal plants (Warburgia ugandensis and Zanthoxylum chalybeum) using measles virus (Edmonston and Swartz strains) as the test organisms. The assays performed were the neutralisation tests and the plaque reduction assays. Of the two plants Z. chalybeum had demonstrable in vitro antiviral activity in the seed extracts (titer reduction factor [TRF]: 100, for the ethanolic extract). The in vitro antiviral activity of the seed extracts was demonstrated to be due to compound 27-135D (TRF=1000), which was characterized by 1H-NMR spectroscopy as the alkaloid skimmianine. Skimmianine had minimal toxicity to VERO cell lines. The petroleum ether extracts and the ethanolic extracts of Warburgia ugandensis had no inhibitory effect on cytopathic effect (CPE) formation, especially at the maximal non-toxic dose (MNTD). The extracts of W. ugandensis were highy toxic to VERO cell lines. The TRF values for the stem bark extracts of W. ugandensis were: water extract, 10; ethanolic extract, 1; fraction 27-163D, 100., which were regarded to be too low. Seed extracts of Z.chalybeum therefore probably cure measles due to the antiviral effect of skimmianine. It is not clear how extracts of W. ugandensis produce a beneficial response in measles disease, if at all.

Medi Kawuma

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

Background: Despite measures put in place by the Uganda Government ten years ago to combat Vitamin A deficiency, the number of children suffering from this deficiency remains high.

Objective: To determine whether sugar may be used as a vehicle for vitamin A fortification.

Design: Cross - sectional descriptive study

Setting: Kamuli district in Uganda

Patients: One thousand one hundred and four children, and one thousand one hundred and two mothers or care-takers participated in the study. Sugar consumption patterns for the two age groups were determined. The methods of sugar storage in households were also determined.

The children were aged 12 to 36 months, and mothers /caretakers 16 to 45 years.

Results: The overall proportion of households where sugar was consumed in the last seven days was 89.2% for children, and 88.3% for mothers/ caretakers. Sugar was stored in covered tins in 67% of the households, and in covered baskets in 28% of households.

Conclusion: Sugar is a potential vehicle for fortification with vitamin A for Kamuli district. Storage of sugar in covered tins and baskets means that the stability of the vitamin A in the fortified sugar might not be affected by exposure to light.

Samson Kironde^a, Martha Kahirimbanyi^b

^aMedical Research Council, P.O.Box 2388, Kimberley 8300, South Africa
^bAccess to Care Program, 429 West 127th Street, New York NY 10027, United States

Background: Currently, there is renewed interest in the role community participation can play in Primary Health Care (PHC) programmes such as the delivery of effective anti-TB treatment to patients in high-burden settings.

Objectives: To explore the feasibility of community participation in a high-burden Tuberculosis Control Programme and to establish how supervision of treatment by lay volunteers compares with other methods of tuberculosis treatment delivery in the Northern Cape province of South Africa.

Methods: Prospective study involving 769 patients with confirmed pulmonary TB who were followed-up over a one-year period. Questionnaire interviews were also carried out with 135 lay volunteers participating in the TB programme.

Results: One-third of the TB patients in the study received their treatment from lay volunteers in the community. Treatment outcomes for new patients supervised from the community were found to be equivalent to those who received treatment through other modes of treatment delivery (RR=1.04[0.94-1.16], p=0.435). For the re-treatment patients, community-based treatment was found to be superior (RR=5.89[2.30-15.09], p<0.001), to self-administered therapy.

Conclusions: Health care planners should consider community participation as a viable way of ensuring accessibility and effectiveness in PHC programmes. There is need for more research into ways of achieving sustainability in resource-limited but high disease burden settings.

Key words: community participation, tuberculosis, high-burden settings, resource limitations.

African Health Sciences 2002; 2(1): 16-23

Julius J. Lutwama, Elly B. Rwaguma, Peter L. Nawanga and Anthony Mukuye

Department of Arbovirology, and Emerging and Re-emerging Viral Infections
Uganda Virus Research Institute,
P.O. Box 49, Entebbe, Uganda.

Bwamba virus (Genus Bunyavirus, family Bunyaviridae) is widely distributed in Africa. It causes many unidentified fevers because of its benign nature.

Samples of blood from patients were received at Uganda Virus Research Institute for diagnosis and confirmation of infections. Mosquito collections obtained in the O’nyong-nyong virus fever epidemic in Rakai in 1997 were also investigated in an effort to confirm the vectors of O’nyong-nyong virus fever.

Patients’ serum and aliquots of mosquito pools were inoculated into the brain of 1-day old albino mice for attempted isolation of viruses. Positive isolates from sick mice were confirmed to be Bwamba virus by immunoflourescence assay microscopy and by plaque reduction neutralization tests.

Three positive isolates of Bwamba virus were obtained. One of the strains was isolated from a sample of blood from a refugee in Burigi Camp, Ngara, in north eastern Tanzania; another strain was isolated from a health worker at the Uganda Virus Research Institute, working with the Rakai Project on HIV in Rakai district; while the third strain was isolated from a pool of 50 Anopheles funestus mosquitoes collected during the O’nyong-nyong virus fever epidemic in Rakai district in 1996/1997.

Bwamba fever may be more common than it is usually thought to be. It is often mistaken for malaria and because it is a mild infection, many people do not go to hospital when infected. Further studies are needed to understand the epidemiology and natural history of Bwamba virus.

Elsie Kiguli-Malwadde, Henry Kasozi

Department of Radiotherapy, Faculty of Medicine, P. O. Box 7072 Kampala, Uganda

Background: Diverticular disease of the colon has been reported to be a disease of the western world, however of recent it has been described in the Africans.

Objective: To study the clinical, demographic and radiological features of diverticular disease of the colon in Kampala, Uganda.

Methods: A retrospective and prospective descriptive study was carried out between January 1995 — December 1996 and January 1998 — December 2000. The period January 1995-December 1996 was retrospective while January 1998-December 20000 was prospective. Thirty-one consecutive patients were found to have diverticular disease of the colon at barium enema studies in two major hospitals and two private x-ray units in Kampala, Uganda.

Results: Thirty-one patients were seen during the study period; all were over 40 years of age. The commonest presenting complaint was rectal bleeding in 13 patients followed by abdominal pain in 12 patients. Most patients were found to eat a mixed type of diet, that is both low and high residue food.

Radiologically the diverticulae appeared as flask shaped or rounded outpouchings at barium enema. This would sometimes be accompanied by a serrated appearance of the affected area. The commonest site affected was the sigmoid colon followed by the ascending colon.

Conclusion: Although it was previously reported that diverticular disease was unknown in black Africans, it has been noted that cases are now being increasingly discovered. It is recommended that our index of suspicious for diverticular disease of the colon and its complications should also increase.

Missie L. Oindo

Partnership Department, Tropical Institute of Community Health and Development (TICH) in Africa
P. O. Box 2224 Kisumu, Kenya

Background: A significant proportion of youth is infected by HIV and other sexually transmitted infections mainly through sexual intercourse, while the prevalence of unwanted pregnancies is rising.

Objective: To describe knowledge, attitude and practice and factors influencing sexual relationships and contraceptive practice among the youth in Kisumu town in western Kenya.

Methods: A descriptive cross-sectional study using a semi-structured questionnaire, key informant interviews, focus group discussions and informal conversations was carried out. The sample population of 388 youth aged 15 — 24 years was determined by simple random cluster sampling. Quantitative data were analysed using SPSS computer package.

Results: The majority of the youth are sexually experienced (73.5%) with most of the first sexual experiences occurring within the 15-19 years age group. There is a high level of knowledge (99.2%) of contraceptive methods and a positive attitude towards contraception. However, the level of contraceptive use is relatively lower (57.5%) even for the sexually active. Factors influencing this practice are associated with the individual’s background as well as health delivery systems and policy.

Conclusion: There is a wide disparity between contraceptive knowledge and practice, which needs to be bridged. There is need to review policies and practices regarding reproductive health, sexuality and family life education.

As head injury is an important cause of traumatic death, it is essential to establish which clinical parameters available soon after injury can be used to accurately predict outcome.

Injury Prevention Initiative for Africa: Achievements and Challenges

Ronald Lett¹, Olive Kobusingye²

¹Associate Member Representative, IPIFA

²Secretary General, IPIFA

We would be most grateful if you brought to the attention of the readers of African Health Sciences, the following information for IPIFA. The Injury Prevention Initiative for Africa (IPIFA) ratified its constitution at the fourth Annual General Meeting in February 2001. At that meeting, members from 8 African countries, and Associate members present, chose 9 representatives to constitute the IPIFA steering committee. The countries represented were Egypt, Ethiopia, Kenya, Mozambique, South Africa, Uganda, Zambia and Zimbabwe. The executive was re-elected: Erastus Njeru (Kenya), President; Olive Kobusingye (Uganda) Secretary General, and Fatma Hassan (Egypt) Treasurer. The Injury Control Center Uganda (ICC-U) was designated as the IPIFA secretariat and IPIFA was registered as an NGO in Uganda in 2002.

At a meeting convened by UNICEF, the International Paediatric Association and the Union of National Paediatric Societies and Associations in Nairobi in February, 2002, the delegates from over 30 African countries, the World Bank, Paediatric AIDS foundation, WHO (Harare and Geneva), the Global Alliance Vaccine Initiative(GAVI), the African Union and others deliberated on the deteriorating child health situation in Africa and developed strategies to address the issues. The results of the meeting are embodied in the following declaration released after the meeting.