African Journals OnLine
East African Medical Journal

Volume 79, No 5, May 2002
Abstracts

PREVALENCE OF HELICOBACTER PYLORI AND ENDOSCOPIC FINDINGS IN HIV SEROPOSITIVE PATIENTS WITH UPPER GASTROINTESTINAL TRACT SYMPTOMS AT KENYATTA NATIONAL HOSPITAL, NAIROBI

F. Alimohamed, MBChB, MMed, Registrar, G. N. Lule, MBChB, MMed, Associate Professor, Department of Medicine , College of Health Sciences, University of Nairobi, P. O. Box 19676, Nairobi, A. Nyong’o,* MSc (Micro) MD, Associate Professor (Formerly, Department of Human Pathology, University of Nairobi), Chief of Pathology, Nairobi Hospital, P.O. Box 30026, Nairobi, J. Bwayo, MBChB, PhD, Associate Professor, and F. S. Rana, MBChB, MMed Senior Lecturer, Department of Pathology, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya

*Deceased

Request for reprints to: Prof. G. N. Lule, Department of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya

ABSTRACT

Background: Human immunodeficiency virus (HIV) seropositive patients frequently experience upper gastrointestinal tract (GIT) symptoms that cause considerable morbidity and are due to multiple aetiologies. The role of Helicobacter pylori gastric mucosal infection in HIV related upper GIT morbidity is unclear. No data exist on the prevalence of H.pylori gastric mucosal infection and upper gastrointestinal endoscopic findings in HIV seropositive patients at the Kenyatta National Hospital.

Objectives: The aim of the study was to determine the prevalence of H. pylori gastric mucosal infection and the pattern of upper gastrointestinal endoscopic findings in HIV seropositive patients.

Design: A hospital-based prospective case-control study.

Setting: Kenyatta National Hospital, Endoscopy Unit.

Subjects: Fifty two HIV seropositive patients with upper GIT symptoms were recruited (as well as 52 HIV seronegative age and gender matched controls).

Intervention: Both cases and control subjects underwent upper GIT endoscopy and biopsies were taken according to a standard protocol. H. pylori detection was done by the rapid urease test and histology, and H. pylori gastric mucosal infection was considered to be present in the presence of a positive detection by both tests; biopsies were also taken for tissue diagnosis and CD4+ peripheral Iymphocyte counts were determined using flow cytometry.

Results: H. pylori prevalence was 73.1% [95% CI 59.9-83.8] in HIV positive subjects and 84.6% [95% CI 72.9-92.6] in HIV negative controls (p=0.230). Prevalence of H. pylori decreased with decreasing peripheral CD4+ Iymphocyte counts. Median CD4+ Iymphocyte count was 67 cells per cubic millimetre in HIV positive patients. On endoscopy, the most common lesion in HIV positive patients was oesophageal candidiasis (occurring in 51.9%), which was often associated with presence of oral candidiasis and, together with erosions, ulcers and nodules in the oesophagus, occurred exclusively in these patients. A few cases of cytomegalovirus and herpes simplex oesophagitis were seen, as were cases of upper GIT Kaposi’s sarcoma, and one gastric Iymphoma.

Conclusions: H. pylori prevalence was not significantly different between HIV positive and HIV negative subjects, and decreased in HIV positive subjects with decreasing CD4+ cell counts. Oesophageal candidiasis was the most important endoscopic finding in HIV positive patients and was often associated with oral thrush.

UPPER GASTROINTESTINAL FINDINGS IN DIABETIC OUTPATIENTS AT KENYATTA NATIONAL HOSPITAL, NAIROBI

J.M. Wafula, MBChB, MMed, P.O. Box 76385, Nairobi, Kenya, G.N. Lule, MBChB, MMed, Associate Professor, C.F. Otieno, MBChB, MMed, Lecturer, Department of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, A. Nyong’o,* MSc (Micro), MD, Associate Professor of Pathology (Formerly Department of Human Pathology, University of Nairobi), Chief of Pathology, Nairobi Hospital, P.O. Box 30026, Nairobi and S.M. Sayed, MBChB, MMed, Consultant Pathologist, Kenyatta National Hospital, P.O. Box 20723, Nairobi.

*Deceased

Requests for reprints to: Prof G.N. Lule, Department of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya

ABSTRACT

Objective: To determine the prevalence of H. pylori and the associated upper gastrointestinal endoscopic lesions in diabetic outpatients with dyspepsia.

Design: Cross-sectional study

Setting: Kenyatta National Hospital (KNH), Nairobi, Kenya.

Subjects: Adult diabetic outpatients with dyspepsia attending the KNH diabetic clinic.

Results: Of the 257 randomly selected diabetic outpatients screened, 137 (53.3%) had dyspepsia. Seventy one of these patients underwent an upper gastrointestinal endoscopy. Fifty five (77.5%) of the 71 patients had H. pylori infection identified by rapid urease test and histology. The prevalence of H. pylori increased with HbA1c level but there was no statistically significant association with poor glycaemic control (HbA1c >7.0%). Forty eight (67.6%) of the 71 had gastritis, 17 (25.7%) had duodenitis, eight (11.3%) had oesophageal candidiasis, seven (9.9%) had bile reflux, six (8.5%) had reflux oesophagitis, six (8.5%) had ulcers (five duodenal, one gastric) and one (1.4%) had gastric cancer. Fourteen (19%) had

endoscopically normal mucosa. The prevalence of H. pylori was 82.3% (32/38) in patients with antral gastritis. All ulcers and the cancer lesion (adenocarcinoma) were associated with H. pylori. Histological gastritis was found in 57 (81.8%) and was significantly associated with H. pylori.

Conclusion: Although dyspepsia is common in diabetic outpatients at KNH, endoscopic findings and H. pylori status are not significantly different from those of non-diabetic population.

IN-VITRO SENSITIVITY OF PLASMODIUM FALCIPARUM TO CHLOROQUINE, HALOFANTRINE, MEFLOQUINE AND QUININE IN MADAGASCAR

M. Randrianarivelojosia, PhD, A. Ratsimbasoa, MD, L. Randrianasolo, MD, A. Randrianarijaona, MD and R. Jambou, MD, PhD, Unité d’Immunologie, Institut Pasteur de Dakar BP 220 Dakar, Sénégal

Request for reprints to: Dr. M. Randrianarivelojosia, Groupe Recherche sur le Paludisme, Institut Pasteur de Madagascar, Antananarivo 101 Republique Malgache

ABSTRACT

Objective: To determine how sensitive Plasmodium falciparum is to the major antimalarial drugs in Madagascar.

Design: Assessment of Plasmodium falciparum isolates sensitivity to antimalarials, by use of the in-vitro radioisotope method.

Setting: Ankazobe and Saharevo in the foothill areas; and Toamasina and Tolagnaro

in the coastal areas (between January 1998 and November 1999).

Subjects: Primary Plasmodium falciparum isolates from patients with uncomplicated malaria attack.

Results: Between January 1998 and November 1999, of the 293 in-vitro tests done with at least one antimalarial, 70% (205/293) were interpretable. As there was no significant difference between results from the four study sites, the data have been expressed as a whole. All of the successfully tested isolates were sensitive to halofantrine (n = 56) and to quinine (n = 199), 5.8% (12/205) of the isolates were resistant to chloroquine and 2% (4/199) to mefloquine. The geometric mean IC50 was 0.3 µg/L for halofantrine (95% CI = 0.1 - 0.4 µg/L); 9.4 µg/L for chloroquine (95% CI = 7.3 - 10.8 µg/L); 3.8 µg/L for mefloquine (95% CI = 3.3 - 4.3 µg/L); and 26.8 µg/L for quinine (95% CI = 24.3 - 29.4 µg/L). The low positive correlation found between halofantrine and chloroquine IC50s (n=56; r = 0.41, P = 0.002) suggests a risk of cross-resistance between these two drugs.

Conclusion: The degree and frequency of chloroquine resistance in-vitro is stationary in Madagascar compared to previous results during the last decade. The in-vitro sensitivity of P. falciparum to quinine, mefloquine and halofantrine encourages the use of these drugs as alternative in case of chloroquine treatment failure. Nevertheless, it is important to maintain and to extend malaria and drug sensitivity surveillance in Madagascar.

LABORATORY METHODS FOR DIAGNOSIS AND DETECTION OF DRUG RESISTANT MYCOBACTERIUM TUBERCULOSIS COMPLEX WITH REFERENCE TO DEVELOPING COUNTRIES: A REVIEW

W.A. Githui, PhD, Senior Research Officer, Centre for Respiratory Diseases Research, Kenya Medical Research Institute, P.O. Box 47855, Nairobi, Kenya.

ABSTRACT

Objective: To outline principles, advantages and limitations of the currently available laboratory methods for diagnosis and detection of drug resistance of Mycobacterium tuberculosis complex.

Data source: Published series of peer reviewed journals and manuals written on laboratory methods that are currently used for diagnosis and detection of drug resistance of Mycobacterium tuberculosis complex were reviewed using the index medicus, pubmed and medline search. Conventional bacteriological microscopy and culture, BACTEC, and molecular-based techniques were included. Basic principles, advantages and limitations of the cited techniques have been highlighted.

Conclusion: Conventional bacteriological microscopy and culture are usually used for diagnosis of tuberculosis (TB) particularly in developing countries. However, their limited sensitivity, specificity and delayed results make this provision inadequate. Despite the development of quicker and more sensitive novel diagnostic techniques, their complexity and high cost has limited their use in many poor-resource countries. Due to the rapidly growing TB problem in these countries, there is urgent need to assess promising alternative methodologies in settings with high disease prevalence.

CELLULAR AND MOLECULAR INTERACTIONS IN HIV INFECTIONS: A REVIEW

A. G. Tumbo-Oeri, BSc. (Hons), PhD, OGW, Associate Professor and C. A. Omwandho, BSc (Hons), MSc, PhD, Lecturer, Department of Biochemistry, College of Biological and Physical Sciences, University of Nairobi, P.O. Box 30197, Nairobi, Kenya.

Request for reprints to: Prof. A.G. Tumbo-Oeri, Principal’s Office, College of Biological and Physical Sciences, University of Nairobi, P.O. Box 30197, Nairobi, Kenya.

ABSTRACT

Objective: To review the cellular and molecular interactions between HIV and the host immune system that lead to full-blown AIDS.

Data Sources: Published reports on HIV/host interaction during a fifteen year period beginning from 1987.

Study selection: Only those studies involving humans and non-human primates were selected. The studies included original articles and state-of-the-art reviews covering in vivo and in vitro findings.

Data extraction and synthesis: This article presents a critical review of the cellular and molecular mechanisms of HIV infection and their relationship to the onset of AIDS.

Conclusion: HIV has elaborated diverse and somewhat complicated mechanisms for the subversion and evasion of the host immune defence strategies. These include escape through mutation, prolonged latency of the infection, masking of the viral envelope proteins, downregulation of MHC-I and up-regulation of the Fas-ligand on infected cell surfaces. This review enhances our understanding of HIV/AIDS disease and presents a basis on which management strategies could be developed.

OCCUPATIONAL RISK OF INFECTION BY HUMAN IMMUNODEFICIENCY AND HEPATITIS B VIRUSES AMONG HEALTH WORKERS IN SOUTHEASTERN NIGERIA

V. O. Ansa, FWACP, Lecturer, Department of Medicine, E. J. Udoma, FWACS,Senior Lecturer, Department of Obstetrics and Gynaecology, M. S. Umoh, FWACS, Lecturer 1, Department of Surgery and M.U. Anah, MBBS, Senior Registrar, (Paediatrics), Department of Paediatrics, University of Calabar Teaching Hospital, P.M.B. 1278 Calabar, Cross River State, Nigeria.

Request for reprints to: Dr. V. O. Ansa, Department of Medicine, University of Calabar Teaching Hospital, P.M.B. 1278 Calabar, Cross River State, Nigeria.

ABSTRACT

Objective: To assess the occupational risk of infection by human immunodeficiency virus (HIV) as well as hepatitis B virus (HBV) among healthcare workers in south-eastern Nigeria.

Design: Cross-sectional study.

Setting: Three tertiary health institutions in south-eastern Nigeria.

Subjects: Doctors, nurses, laboratory staff and cleaners.

Main outcome measures: Observation of the availability and use of protective equipment and materials in the various departments of the hospitals.

Results: Materials and equipments needed for protective and hygienic practices (adequate water supply, protective clothing and availability of disinfectants) were inadequate in all hospitals. Where available, they were found to be inconsistently used. Health workers in the three institutions were thus constantly exposed unnecessarily to blood and other body fluids which might be potentially infectious as well as injury from used sharps.

Conclusion: The risk of acquiring HIV and HBV infections by health workers in this region of Nigeria in the course of performing their duties is therefore still apparently high. Though distinct viruses, they share similar mode of transmission and risk factors. Use of personal protective equipment and adoption of standard hygienic practices among health workers must be encouraged. Supply of protective materials and equipment should be greatly improved. It is recommended that reduction of occupational risks among health workers using this approach should form part of control strategies for both infections in the country.

ADVANCE PROVISION OF ORAL CONTRACEPTIVES TO FAMILY PLANNING CLIENTS IN KENYA

J. Stanback, MA, PhD, Family Health International, P.O Box 13950, Research Triangle Park, NC 27709, USA, Z. P. Qureshi, MBBS, MMed and C. Sekkade-Kigondu, PhD, Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya.

Request for reprints to: Dr. J. Stanback, Family Health lnternational, P.O. Box 13950, Research Triangle Park, NC 27709 USA.

ABSTRACT

Objective: In sub-Saharan Africa, many family planning programmes do not encourage advance provision of oral contraceptives to clients who must wait until menses to initiate pill use. Since some resistance to advance provision of pills is due to provider fears that the practice may be harmful, we conducted a study in Kenya in 1997 to compare pill-taking outcomes between 20 “advance provision” clients and 280 “standard” clients.

Design: Prospective observational study.

Setting: Six family planning clinics in Central and Western Kenya.

Subjects: Women presenting as new clients at MOH family planning clinics.

Interventions: Researchers used prospective tracking to compare indicators of pill-taking success between non-menstruating clients given pills to carry home for later use and menstruating clients who began pill use immediately.

Main outcome measures: Pill-taking outcomes such as side effects, compliance, knowledge, satisfaction, and a continuation proxy.

Results: Among clients returning for re-supply, those receiving advance provision of pills did no worse than, and often had superior outcomes to, their counterparts who started taking pills immediately after the clinic visit.

Conclusions: Advance provision of pills, already practiced worldwide, is safe and feasible. Explicit mention should be made of advance provision of pills in national family planning guidance documents and training curricula in Kenya and throughout sub-Saharan Africa.

ATTITUDES OF MEDICAL STUDENTS TO INDUCED ABORTION

G. A. B. Buga, MBChB, MMed, PhD University of Transkei, Private Bag X01, Unitra, Umtata, South Africa

ATTITUDES OF MEDICAL STUDENTS TO INDUCED ABORTION

G. A. B. BUGA

ABSTRACT

Background: Unsafe abortion causes 13% of maternal deaths worldwide. Safe abortion can only be offered under conditions where legislation has been passed for legal termination of unwanted pregnancy. Where such legislation exists, accessibility of safe abortion depends on the attitudes of doctors and other healthcare workers to induced abortion. Medical students as future doctors may have attitudes to abortion that will affect the provision of safe abortion.

Little is known about the attitudes of South African medical students to abortion.

Objectives: To assess sexual practices and attitudes of medical students to induced abortion and to determine some of the factors that may influence these attitudes.

Design: A cross-sectional analytic study involving the self-administration of an anonymous questionnaire.

Setting: The questionnaire was administered to medical students at a small, but growing, medical school situated in rural South Africa.

Main Outcome measures: Demographic data, sexual practices and attitudes to induced abortion.

Results: Two hundred and forty seven out of 300 (82.3%) medical students responded. Their mean age was 21.81 ± 3.36 (SD)years, and 78.8% were Christians, 17.1% Hindus and 2.6% Muslims. Although 95% of the respondents were single, 68.6% were already sexually experienced, and their mean age at coitarche was 17.24±3.14 (SD) years. Although overall 61.2% of the respondents felt abortion is murder either at conception or later, the majority (87.2%) would perform or refer a woman for abortion under certain circumstances. These circumstances, in descending order of frequency, include: threat to mother’s life (74.1%), in case of rape (62.3%), the baby is severely malformed (59.5%), threat to mother’s mental health (53.8%) and parental incompetence (21.0%). Only 12.5% of respondents would perform or refer for abortion on demand, 12.8% would neither perform nor refer for abortion under any circumstances. Religious affiliation and service attendance significantly influenced some of these attitudes and beliefs.

Conclusion: Although many of the medical students personally felt abortion is murder, the majority are likely to perform or refer patients for abortion under certain circumstances; only about a tenth are likely to perform or refer patients for abortion on demand.

PREVALENCE OF MAJOR DEPRESSION IN DELIBERATE SELF-HARM INDIVIDUALS IN HARARE, ZIMBABWE

D. Chibanda, MD, MMed Psych (UoZ), Harare Central Hospital, P.O. Box St 1414 Southerton, Harare, Zimbabwe, M.B. Sebit, MBChB, MD, PhD and S.W. Acuda, FRCPsych. Department of Psychiatry, Faculty of Medicine, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe.

Request for reprints to: Dr. M.B. Sebit, Department of Psychiatry, Faculty of Medicine, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe.

ABSTRACT

Objective: To investigate the prevalence of major depression in deliberate self-harm

individuals.

Design. A cross sectional descriptive study.

Setting. Three tertiary health care centres in Harare, Zimbabwe.

Subjects: Three hundred and eighty seven deliberate self-harm consecutive subjects were recruited from July 1, 1997 to December 31, 1997 for this study. Diagnostic procedures included complete medical history, physical and neurological examinations. The DSM-IV criterion for major depression was used for the diagnostic purpose.

Main outcome measures: The prevalence of major depression, number of attempts and recent life events, methods used, feeling in deliberate self-harm individuals.

Results: The prevalence of major depression was 20.7% (n=80, 95% CI= 16.7-24.2) according to the DSM-IV criterion. Sixty-two percent (95% CI= 57.2-66.8) of the subjects with DSH were aged <30 years. Significant differences (P<0.05) were found between DSH subjects with and without major depression related to age, education, life events and number of previous attempts.

Conclusion: The most predictive factors associated with DSH risks are age, depression, recent loss, divorced, loss of job and history of previous attempts. Further studies are needed to address some causes of DSH.

ALTERNATIVE METHODS FOR ASSESSING GROWTH IN CHILDREN UNDER FIVE YEARS OF AGE

B.C. Msamati, MD, PhD, and P.S. Igbigbi, MBBS, MSc, Department of Anatomy, College of Medicine, University of Malawi, Private Bag 360, Blantyre 3, Malawi

Request for reprints to: Prof B.C. Msamati, Department of Anatomy, College of Medicine, University of Malawi, Private Bag 360, Blantyre 3, Malawi.

ABSTRACT

Objective: To establish alternative methods for growth assessment in children under five years of age.

Design: A cross sectional study of healthy Malawian children.

Setting: Postnatal wards and under-five clinics at the Queen Elizabeth Central Hospital, Ndirande and Chilomoni Health Centres in Blantyre city, Malawi.

Main outcome measures: Cephalic, thoracic and pelvic measurements and their indices were examined for assessment of growth in these children. Thoracic and pelvic measurements were found to be the most appropriate alternative parameters to weight.

Results: All measurements significantly correlated positively with weight but their indices did not. The degree of significance, however, was higher in pelvic and thoracic dimensions (P = 0.000) than in cephalic ones (P< 0.001 for maximal cephalic length (MCL) and P <0.022 for maximal cephalic breadth (MCB), respectively. The MCL also showed a high correlation with age (R = 0.842, P = 0.002) but age only correlated moderately with the MCB (R = 0.569).

The thoracic circumference (TC) and inter-nipple distance (IND) showed a very high positive correlation with age (R = 0.908, P = 0.005) and R = 0.870, P = 0.001), respectively.

Similarly, a high positive correlation was shown with age by pelvic circumference (PC) and inter-spinous distance (ISD), (R = 0.891, P = 0.006 and R= 0.692, P = 0.027), respectively.  Whereas the pelvic index positively correlated with age (R = 0.040), cephalic and thoracic indices significantly correlated negatively with age. Skull shapes were dolicocephalic in 43.6% of the children, mesocephalic in 31.1% and branchycephalic in 25.3%, a clear difference from Caucasian children reported earlier by other authors. 

Conclusion: We have established that cephalic, thoracic and pelvic dimensions significantly correlate positively with weight as age does but their indices remained relatively constant. More importantly, thoracic and pelvic measurements were the most appropriate alternative methods for growth assessment in our studied population.

BACTERIOLOGICAL QUALITIES OF IN-DOOR AND OUT-DOOR DRINKING WATER IN KIBERA SUB-LOCATION OF NAIROBI, KENYA

J.K. Chemuliti, BVM, MSc, Kenya Trypanosomiasis Research Institute,

P.O. Box 362, Kikuyu, P.B. Gathura, BVM, MSc, PhD, M.M. Kyule, BVM, MSc, MVPM, PhD,

and F.M. Njeruh, BVM, MSc, PhD, Department of Public Health Pharmacology and Toxicology, University of Nairobi, P.O.Box 29053, Nairobi, Kenya.

Request for reprints to: Dr. J. K. Chemuliti, KETRI, P.O. Box 362, Kikuyu, Kenya

ABSTRACT

Objectives: To compare the bacteriological quality of out-house (tank or standpipe) water and in-house drinking water (storage containers) and determine the risk factors influencing it.

Design: A cross-sectional study.

Setting: The study was carried out in Kibera slums located 7 km southwest from the Nairobi City centre.

Subjects: Water samples from twenty outside tanks/standpipes and sixty from in-house water storage containers.

Main outcome measures: Pour plate method was used to enumerate total bacterial counts in water, while the multiple tube technique was used to determine faecal coliform (FC) and faecal streptococci (FS) numbers. A questionnaire and environmental observation were used to determine the risk factors influencing bacteriological quality of water.

Results: The mean total bacterial counts (TBC) for out-house water was 46.6 per 100 ml while that for in-house water was 818.2 per 100 ml. Faecal coliforms were isolated from 7 (35%) standpipes and 57 (95%) in-house storage containers. The mean faecal coliform count was 93 and 103.4 per 100 ml for out-house and in-house water, respectively. The counts were significantly higher in the latter. Faecal streptococci were isolated from 2 (10%) standpipes and 37 (61.7%) in-house storage containers. The mean faecal streptococci counts were 35 and 65 per 100 ml for out-house and in-house water sources, respectively. Escherichia coli was isolated in 2 (10%) of out-house water and 30 (50%) of in-house. Of these, four were enteropathogenic, serotype 011 from one out-house water source and serotypes 011, 011, 0112ac from in-house water sources.

Conclusions: Bacteriological contamination of water at the source with a further deterioration between the collection points and homes was observed. A defective water delivery system and inadequate environmental sanitation were a potential source of contamination for out-house water. Scoops were a major source of contamination for stored water.

CIGARETTE SMOKING AND KHAT CHEWING AMONG UNIVERSITY INSTRUCTORS IN ETHIOPIA

Y. Kebede, MD, MPH, Gondar College of Medical Sciences, P.O. Box 196, Gondar, Ethiopia.

ABSTRACT

Objective: To assess the prevalence and risk factors of cigarette smoking and khat chewing.

Design: College based cross sectional.

Setting: Four colleges found in north west Ethiopia namely Gondar College of Medical Sciences, Gondar College of Teachers Education, Bahr Dar University Engineering Faculty, and Bahr Dar University Education Faculty.

Subjects: All instructors in these colleges.

Main outcome measures: Prevalence of cigarette smoking and khat chewing.

Results: Seventy six (42.0%) instructors were either lifetime smokers or lifetime khat chewers or both. The current prevalence rates of cigarette smoking and khat chewing were found to be 13.3% and 21.0%, respectively. The majority of the instructors started smoking (56.8%) and khat chewing (40.0%) while they were senior high school or first year college students. Most of the instructors (82.1%) knew that cigarette smoking is a risk factor for lung diseases including lung cancer. Statisticallyly significant difference (p<0.05) was seen between the outcome variable and the independent variables faculty, religion, education status, income and family history of khat chewing.

Conclusion: The prevalence of cigarette smoking seemed to decrease among university instructors but the prevalence of khat chewing is almost the same as it was some years ago. Instructors knew the common health risks associated with cigarette smoking. The high schools and colleges should inform their students about the health and socioeconomic problems associated with cigarette smoking and khat chewing. Additionally, college students need counseling service on ways of coping with their problems.

HERPES ZOSTER MYELITIS: REPORT OF TWO CASES

E.O. Amayo MBChB, MMed(Med), Senior Lecturer, T.O. Kwasa, BSc., MBChB, MMed (Med), Senior Lecturer and C.F. Otieno MBChB, MMed(Med), Lecturer, Department of Medicine, College of Health Sciences, University of Nairobi, P. O. Box 19676 Nairobi, Kenya

Request for reprints to: Dr. E.O. Amayo, Department of Medicine, College of Health Sciences, University of Nairobi, P. O. Box 19676, Nairobi, Kenya

SUMMARY

Two male patients aged 40 and 45 years with HIV infection and paraplegia are presented. The two had sub-acute onset paraplegia with a sensory level, which developed 10 days after herpes zoster dermatomal rash. They both had asymmetrically involvement of the lower limbs. Investigation including imaging of the spinal cord did not reveal any other cause of the neurological deficit. The two responded very well to treatment with acyclovir. Herpes zoster myelitis is a condition likely to rise with the upsurge of HIV infection and there is a need to identify the condition early. We also review the literature on the subject.