Feasibility and effect of community health worker support and home monitoring for blood pressure control in Nigeria: a randomised pilot trial

In a three-arm, randomised, controlled trial among 60 Nigerian adults with hypertension, community health worker support and home blood pressure monitoring led to greater reductions in systolic blood pressure at four weeks compared to the usual care

Comparison of the demographic and diagnostic profile of new patients attending a neurodevelopmental clinic in 2008/2009 and 2016

Background. Literature suggests an increasing prevalence of developmental disabilities, and specifically ofconditions such as autism and attention deficit/hyperactivity disorder. The resulting burden on paediatric neurodevelopmental services has not been described in the South African setting.Objective. To compare the demographic and diagnostic profile of new patients attending a neurodevelopmental service across two 12-month periods, after a change in referral pathway and the introduction of a secondary clinic.Methods. We conducted a retrospective, descriptive cross-sectional folder review of new patients seen in the neurodevelopmental service at Tygerberg Hospital in 2008/2009 and 2016.Results. The number of new patients increased from 84 in 2008/2009 to 240 in 2016. In both periods the majority of patients were male.The median (IQR) age decreased from 62 (31 - 92) months in 2008/2009 to 53 (37 - 67) months in 2016 (p=0.17). In 2008/2009 only one patient was from the Khayelitsha health subdistrict compared with 49 (20.4%) in 2016, following the subdistrict's addition to the hospital's drainage area in 2011. The number of patients referred by allied health professionals increased between the two periods (30.4% in 2016 v. 16.4% in 2008/2009). Cases of autism spectrum disorder (ASD) increased notably: from 10 (8.4%) in 2008/2009 to 84 (35%) in 2016.Conclusion. The notable increase in neurodevelopmental referrals over the past 8 years cannot be fully explained by a regional population increase or a change in referral pathway. The number of ASD cases has increased disproportionately, with important implications for health and educational service planning

Relation entre santé parodontale chez la femme enceinte et faible poids du nouveau-né à la naissance à Dakar/Sénégal: étude cas-témoin

INTRODUCTION: Plusieurs facteurs de risques ont été incriminés dans la survenue du faible poids. Cependant Barnett et al trouvent que 25% des naissances de faible poids ou prématurés se produisent sans facteurs de risque connus. La relation entre la maladie parodontale et la grossesse et particulièrement le faible poids à la naissance a été évoquée par Offenbacher en 1996. L'objectif de ce travail est d'étudier la relation état parodontal chez la femme enceinte et la survenue du faible poids à la naissance du nouveau-né. MÉTHODE: L'étude était de type cas-témoin portant sur 397 patients dont 129 femmes enceintes donnant un bébé de faible poids (cas) versus 258 femmes enceintes donnant un bébé de poids normal (témoins). Les données collectées concernaient les caractéristiques sociodémographiques, les habitudes de vie, les données concernant le faible poids et celles parodontales : indice de plaque, indice de saignement papillaire perte d'attache clinique, profondeur de poche et le CPITN. Les données en analyse univariée étaient exprimées en proportions et moyennes puis des rapports de cotes avec leurs intervalles de confiance en analyse multivariée. RÉSULTATS: Les caractéristiques parodontales sont plus élevées chez les cas que chez les témoins. Il apparait que la parodontite était significativement associée au faible poids (P= 0,00013) ajustée sur l'âge de la mère, l'IMC et les autres paramètres parodontaux. L'âge de la mère et l'indice de plaque étaient marginalement associés au faible poids (P= 0,05 et 0,053) tandis que l'IMC, l'indice gingival et de saignement papillaire étaient aussi associés à la survenue du faible poids

Application of the Information; Motivation and Behavioural Skills Model for Targeting HIV Risk Behaviour amongst Adolescent Learners in South Africa

This paper discusses the application of an information; motivation and behavioural skills (IMB) model in a school-based programme for the reduction of HIV risk behaviour among 259 Grade 11 learners in two high schools in Alexandra township; Johannesburg. School 1 was the Experimental group; while School 2 was the Control group. After a baseline study (Time 1) at both schools; a 3-week intervention programme was conducted at School 1. A post-test (Time 2) was conducted at both schools. The intervention was repeated at School 2; followed by another post-test (Time 3) at both schools. A final test (Time 4) was conducted at both schools. While there were positive changes in the levels of HIVetAIDS IMB in learner participants; these changes may not be entirely attributed to the intervention. If an IMB model-based intervention is to be maximally effective in reducing HIV-risk behaviour among adolescents; it must focus on the behavioural; structural and socio-cultural contexts in which adolescents live

Exercise-induced asthma in adult Nigerian asthma patients: a comparison of step test, free running, and bicycle ergometer

Exercise is not only a very common precipitant of acute asthmatic episodes but also a potent non-pharmacological test for diagnosis of asthma. Different exercise protocols have been used; however a simple exercise test would be valuable and helpful for detecting exerciseinduced asthma (EIA). The main goal of this study was to compare the exercise-inducing capacity of free running; step test; and cycle ergometer. Forty-eight asthma patients performed and completed the exercise tests reaching at least 80-85of the predicted maximal heat rate. The peak expiratory flow (PEF) values and heart rate (HR) were used to monitor pulmonary function post-exercise and the intensity of the exercise respectively. The PEF values were measured at baseline; immediately after the exercise then at 5-minute intervals up to 30 minutes. Subjects who reached the percentage fall in PEF 15were considered positive for EIA. Free running was found to be the most asthmagenic exercise followed by the step test and cycle ergometer: 36 subjects (75) for free running versus 27 subjects (56) for step test; versus 24 subjects (50) for cycle ergometer. There is a strong and significant correlation between the percentage fall in PEF of cycle ergometer and step test (r=0.61; p0.001). Free running produced the most positive result. However; the step test is a safe; simple; portable; and readily available instrument which compares well with laboratory-based cycle ergometer. We conclude that the step-test is an inexpensive and responsive exercise protocol for assessing and evaluating asthmatics in low-income countries

The Social and Clinical Characteristics of Patients on Antiretroviral Therapy who are 'Lost to Follow-up' in KwaZulu-Natal; South Africa: a Prospective Study

A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms; quality of life; depression; herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-naive patients recruited from three (one urban; one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008. The aim of this study was to investigate predictors of loss to follow-up or all caused attrition from an ART programme within a cohort followed up for over 12 months. A total of 735 patients (217 men and 518 women) prior to initiating ART completed a baseline questionnaire and 6- and 12-months' follow-up. At 12-months follow-up 557 (75.9) individuals continued active ART; 177 (24.1) were all cause attrition; there were 82 deaths (13.8); 58 (7.9) transfers; 7 (1.0) refused participation; 8 (1.1) were not yet on ART and 22 (3.0) could not be traced. Death by 12-months of follow-up was associated with lower CD4 cell counts (risk ratio; RR=2.05; confidence intervals; CI=1.20 - 3.49) and higher depression levels (RR=1.05; CI=1.01 - 1.09) at baseline assessment. The high early mortality rates indicate that patients are enrolling into ART programmes with far too advanced immunodeficiency; median CD4 cell counts 119 (IQR=59 - 163). Causes of late access to the ART programme; such as delays in health care access (delayed health care seeking); health system delays; or inappropriate treatment criteria; need to be addressed. Differences in health status (lower CD4 cell counts and higher depression scores) should be taken into account when initiating patients on ART. Treating depression at ART initiation is recommended to improve treatment outcome