Independent and interactive effects of HIV infection, clinical stage and other comorbidities on survival of children treated for severely malnourished in rural South Africa: A retrospective multi-cohort study

Background. There is still limited to no evidence on the independent and interactive effects of HIV infection, disease stage, baseline disease severity and other important comorbidities on mortality risk among young children treated for severe acute malnutrition (SAM) in South Africa (SA, using the World Health Organization (WHO) recommended treatment modality. Objectives. To determine baseline clinical characteristics among children with SAM and assess whether HIV infection, disease stage, critical illness at baseline and other comorbidities independently and interactively contributed to excess mortality in this sample. Methods. We followed up children aged 6 - 60 months, who were admitted with and treated for SAM at two rural hospitals in SA, and retrospectively reviewed their treatment records to abstract data on their baseline clinical characteristics and treatment outcomes. In total, 454 children were included in the study. Descriptive statistical tests were used to summarise patients' clinical characteristics. Kaplan-Meier failure curves were created for key characteristics and compared statistically using log-rank tests. Univariate and multivariate Cox regression was used to estimate independent and interactive effects. Results. The combined case fatality rate was 24.4%. HIV infection, clinical disease stage, the presence of lower respiratory tract infection, marasmus and disease severity at baseline were all independently associated with excess mortality. The critical stage for higher risk of death was when cases were admitted at WHO stage III. The interactions of two or three of these characteristics were associated with increased risk of death when compared with having none, with HIV infection and critical illness showing the greatest risk (hazard ratio 22, p<0.001). Conclusion. The high HIV prevalence rate in the study setting and the resultant treatment outcomes support the notion that the WHO treatment guidelines should be revised to ensure that mechanisms for effective treatment of HIV comorbidity in SAM are in place. However, a much more rigorous study is warranted to verify this conclusion

Histomorfometria do epitélio ruminal de cabritos 1/2 sangue Boer submetidos a dietas com tortas oriundas da produção do biodiesel / Histomorphometrics of the ruminal epithelium of 1/2 blood Bôer goats submitted to diets with pies from the production of biodiesel

Objetivou-se determinar o melhor nível de inclusão e de substituição das tortas de dendê e amendoim, respectivamente, em dietas para cabritos 1/2 sangue Boer, por meio da avaliação histomorfométrica das papilas ruminais. Foram utilizados 40 cabritos 1/2 sangue Boer, para cada período experimental, machos, não castrados, com idade aproximada de três meses e com peso inicial de 15,01±1,76kg. Os períodos experimentais constaram de 75 dias e 72 dias. As dietas consistiram de volumoso feno de Tifton-85 e de ração em mistura completa, contendo níveis de inclusão da torta de dendê nas proporções de 0,0; 7,0; 14,0; e 21,0% com base na matéria seca; e de mistura completa, contendo níveis de substituição do farelo de soja pela torta de amendoim nas proporções de 0,0; 33,0; 66,0; e 100%, constituindo-se os tratamentos. No epitélio do rúmen, foram avaliadas altura e largura das papilas, assim como densidade papilar e espessura da parede muscular do rúmen. Entre estas, a altura das papilas, no experimento com torta de amendoim, foi a única a sofrer efeito linear decrescente (P<0,0014); as demais variáveis, tanto dos animais alimentados com torta de amendoim quanto daqueles alimentados com torta de dendê, não foram afetadas pela dieta. As médias de altura encontradas foram de 2,6 e 2,3mm para as tortas de amendoim e dendê, respectivamente. Portanto, a inclusão de até 21% de torta de dendê e a substituição de 100% de torta de amendoim no concentrado de cabritos não alteraram a morfometria das papilas ruminais.

The aim of this study was to determine the best level of pies and replacement of palm oil and peanut, respectively, in diets of 1/2 blood Bôer goats from the histomorphometry of the rumen papillae. A total of 40 1/2 blood male, unneutered, aged approximately three months and initial weight of 15.01±1.76kg Bôer goats were used in each experimental period. The experimental periods consisted of 75 days and 72 days. The diets consisted of roughage hay Tifton-85 and total mixed ration containing levels of inclusion of palm kernel cake in the proportions of 0.0, 7.0, 14.0 and 21.0% based on dry matter; and the second experiment consisted of a complete mixture containing substitution levels of soybean meal by groundnut cake in the proportions of 0.0, 33.0, 66.0 and 100%. Epithelial cells were evaluated in the rumen height and width of the papillae, and density and thickness of the papillary muscle of the rumen. Among these, the height of the papillae in the experiment with peanut butter pie was the only one to suffer a negative linear effect (P<0.0014), the other variables, both in animals fed groundnut cake and palm oil, were not affected by the diet. The average heights found were 2.6 and 2.3, for pies, peanut and palm oil, respectively. Therefore, the inclusion of up to 21% palm kernel cake and replacement of 100% peanut cake in the concentrate of kids did not alter the morphology of the rumen papillae.

Histomorfometria do epitélio ruminal de cabritos 1/2 sangue Boer submetidos a dietas com tortas oriundas da produção do biodiesel / Histomorphometrics of the ruminal epithelium of 1/2 blood Bôer goats submitted to diets with pies from the production of biodiesel

Objetivou-se determinar o melhor nível de inclusão e de substituição das tortas de dendê e amendoim, respectivamente, em dietas para cabritos 1/2 sangue Boer, por meio da avaliação histomorfométrica das papilas ruminais. Foram utilizados 40 cabritos 1/2 sangue Boer, para cada período experimental, machos, não castrados, com idade aproximada de três meses e com peso inicial de 15,01±1,76kg. Os períodos experimentais constaram de 75 dias e 72 dias. As dietas consistiram de volumoso feno de Tifton-85 e de ração em mistura completa, contendo níveis de inclusão da torta de dendê nas proporções de 0,0; 7,0; 14,0; e 21,0% com base na matéria seca; e de mistura completa, contendo níveis de substituição do farelo de soja pela torta de amendoim nas proporções de 0,0; 33,0; 66,0; e 100%, constituindo-se os tratamentos. No epitélio do rúmen, foram avaliadas altura e largura das papilas, assim como densidade papilar e espessura da parede muscular do rúmen. Entre estas, a altura das papilas, no experimento com torta de amendoim, foi a única a sofrer efeito linear decrescente (P<0,0014); as demais variáveis, tanto dos animais alimentados com torta de amendoim quanto daqueles alimentados com torta de dendê, não foram afetadas pela dieta. As médias de altura encontradas foram de 2,6 e 2,3mm para as tortas de amendoim e dendê, respectivamente. Portanto, a inclusão de até 21% de torta de dendê e a substituição de 100% de torta de amendoim no concentrado de cabritos não alteraram a morfometria das papilas ruminais.(AU)

The aim of this study was to determine the best level of pies and replacement of palm oil and peanut, respectively, in diets of 1/2 blood Bôer goats from the histomorphometry of the rumen papillae. A total of 40 1/2 blood male, unneutered, aged approximately three months and initial weight of 15.01±1.76kg Bôer goats were used in each experimental period. The experimental periods consisted of 75 days and 72 days. The diets consisted of roughage hay Tifton-85 and total mixed ration containing levels of inclusion of palm kernel cake in the proportions of 0.0, 7.0, 14.0 and 21.0% based on dry matter; and the second experiment consisted of a complete mixture containing substitution levels of soybean meal by groundnut cake in the proportions of 0.0, 33.0, 66.0 and 100%. Epithelial cells were evaluated in the rumen height and width of the papillae, and density and thickness of the papillary muscle of the rumen. Among these, the height of the papillae in the experiment with peanut butter pie was the only one to suffer a negative linear effect (P<0.0014), the other variables, both in animals fed groundnut cake and palm oil, were not affected by the diet. The average heights found were 2.6 and 2.3, for pies, peanut and palm oil, respectively. Therefore, the inclusion of up to 21% palm kernel cake and replacement of 100% peanut cake in the concentrate of kids did not alter the morphology of the rumen papillae.(AU)

AIDS in Africa : the implications of economic recession and structural adjustment

Very little has been written about the socio-economic context of the spread of AIDS in Africa. The focus of this paper will therefore be on those socio-economic factors; historical and current; predisposing to the spread of HIV infection; as well as on the aggravation of these factors by economic recession and structural adjustment programmes (SAPs). The first part of this paper examines the epidemiological factors (both biological and social) in the transmission of HIV in Africa; the second addresses the likely impact of the economic recession and SAPs on HIV transmission and control and the implications for current and future policies; the third and the final section reviews the social; economic and health sector impact of AIDS in Africa