Expose of Fallacious Claims that Male Circumcision Will Increase HIV Infections in Africa

Despite over two decades of extensive research showing that male circumcision protects against heterosexual acquisition of HIV in men; and that includes findings from large randomized controlled trials leading to acceptance by the WHO/UNAIDS and the Cochrane Committee; opponents of circumcision continue to generate specious arguments to the contrary. In a recent issue of the Journal of Public Health in Africa; Van Howe and Storms claim that male circumcision will increase HIV infections in Africa. Here we review the statements they use in support of their thesis and show that there is no scientific basis to such an assertion. We also evaluate the statistics used and show that when these data are properly analyzed the results lead to a contrary conclusion affirming the major role of male circumcision in protecting against HIV infection in Africa. Researchers; policy makers and the wider community should rely on balanced scholarship when assessing scientific evidence. We trust that our assessment may help refute the claims by Van Howe and Storms; and provide reassurance on the importance of circumcision for HIV prevention

Recent upsurge of tuberculosis in paediatric admissions at the University Hospital of the West Indies

These case reports describe the clinical course of eight children who were admitted to the University Hospital of the West Indies, Kingston, Jamaica, between July 2000 and November 2001 because of a diagnosis of tuberculosis. This represented an increase in the incidence of the disease in children at this institution. The purpose of this report is to make healthcare workers aware of the resurgence of tuberculosis. The diagnosis of paediatric tuberculosis is challenging and requires a high index of suspicion in the presence of suggestive clinical and laboratory findings. The diagnosis should not be limited to the immunocompromised patient, as in this report the majority of the patients were HIV negative

Primary malnutrition. Can we always tell?

Patterns of disease in the English-speaking Caribbean have changed considerably over the past two decades. There has been a decrease in the incidence of common infectious diseases, an increase in the prevalence of chronic non-communicable disorders and an increase in the incidence and prevalence of HIV/AIDS. However, published estimates suggest that malnutrition continues to be a serious public health problem. It is possible that changing patterns of disease within the epidemiological transition may affect patterns of presentation of severe forms of childhood malnutrition. We have examined records of 435 children admitted to the clinical research ward of the Tropical Metabolism Research Unit (TMRU) from January 1, 1990, to December 31, 1999; among these were 25 children who were subsequently found to have severe childhood malnutrition (SCM) due to a defined medical or surgical disorder (i.e. secondary SCM). Among children with secondary SCM, the HIV/AIDS group was the largest and comprised 60 of these admissions. Regression analyses show that, over the ten-year period, there was a small, non-significant decline in the number of cases of primary SCM (incidence rate ratio, IRR = 0.99, 95 confidence interval = 0.96, 1.02, p = 0.98), while the number of cases of secondary SCM increased (IRR = 1.18, 95 CI = 1.03, 1.35, p = 0.02). These data are indicative of the need for continued vigilance in the evaluation of children who have clinical features of the syndromes of severe malnutrition and draw attention to the potential impact of HIV/AIDS in yet another area of healthcare delivery.

The changing face of paediatrics in the English-speaking Caribbean

Childhood mortality and morbidity patterns in the English-speaking Caribbean have changed significantly over the past 40 years. Acute respiratory illness, physical injury and conditions originating in the perinatal period have replaced malnutrition, gastroenteritis and other infectious diseases as major causes of illness and death in Caribbean children. Although population growth has slowed down, about one-third of the population of the English-speaking Caribbean remains under the age of 15 years. Infant mortality rates have also fallen but the major contributor to this decline has been a reduction in post-neonatal deaths. The decrease in mortality and morbidity from infectious diseases has led to a prominence of disorders originating in the perinatal period, psychosocial problems and chronic childhood disorders. Adverse economic conditions are held culpable for the re-emergence of protein energy malnutrition (PEM) and pulmonary tuberculosis in some territories. There is an urgent need to focus attention on the areas of perinatal and adolescent health, childhood disability, accidental and non-accidental injury, sexual abuse and human immunodeficiency virus (HIV) infection. Immunization programmes also require continuing support and expansion. These tasks cannot be accomplished without meaningful long term investment of financial and human resources in the health and educational services of the region.

Population-based study of fertility in women with HIV-1 infection in Uganda

To assess the effects of HIV-1 and other sexually transmitted infections on pregnancy; we undertook cross-sectional and prospective studies of a rural population in Rakai district; Uganda. Methods: 4813 sexually active women aged 15-49 years were surveyed to find out the prevalence of pregnancy by interview and selective urinary human chorionic gonadotropin tests. The incidence of recognised conception and frequency of pregnancy loss were assessed by follow-up. Samples were taken to test for HIV-1 infection; syphilis; and other sexually transmitted diseases. Findings: At time of survey 757(21.4) of 3544 women without HIV-1 infection or syphilis were pregnant; compared with 46 (14.6) or 316 HIV-1 negative women with active syphilis; 117 (14.2) or 823 HIV-1 positive women with no concurrent syphilis; and 11(8.5) of 130 women with both syphilis and HIV-1 infected women was 0.45 (95CI0.35-0.57); the odds of pregnancy were low both in HIV-1-infected women without symptoms (0.49 [0.39-0.62]) and in women with symptoms of HIV-1-associated and syphilis the odds of pregnancy were low both in HIV-1-infected women without symptoms (0.49[0.39-0.62] and in women with symptoms of HIV-1-associated disease (0.23[0.11-0.48]). In women with concurrent HIV-1 infection and syphilis the odds ratio was 0.28(0.14-0.55). The incidence rate recognised pregnancy during the prospective follow-up study was lower in HIV-1 positive than in HIV-1 negative women (23.5 vs 30. 1 per 100 woman-years; adjusted risk ration 0.73[0.57-0.93]). Rates of pregnancy loss were higher among HIV-1-infected than uninfected women (18.5 vs 12.2; odds ratio 1.50 [1.01-2.27]). The prevalence of HIV-1 infection was significantly lower in pregnant than in non-pregnant women (13.9 vs 21. 3). Interpretation: Pregnancy prevalence is greatly reduced in HIV-1-infected women; owing to lower rates of conception and increased rates of pregnancy loss. HIV-1 surveillance confined to pregnant women underestimates the magnitude of the HIV-1 epidemic in the general population

Tropical spastic paraparesis ocurring in HLTV-1 associated infective dermatitis: report of two cases

An association between HTLV-1 infection and infective dermatitis(ID), a relapsing eczematous condition of Jamaican children, was reported in 1990. These patients are at a risk of developing other known HTLV-1 related diseases. We have observed the development of HTLV-1 associated myelopathy/tropical spastic paraparesis im two patients, ages 14 and 35 years, who were diagnosed with ID at ages 2 and 10 years, respectively. Infective dermatitis of children serves as an early marker of HTLV-1 infection and may predict later development of either the malignant outcome, adult T-cell leukaemia/lymphoma or the neurologic manifestation HAM/TSP among adult carriers of HTLV-1 infection

Maternal weight, height and risk of poor pregnancy outcome in Ahmedabad, India.

This paper explores the relationships between maternal weight, height and poor pregnancy outcome using a data set from a case-control study of low birth weight (LBW) and perinatal mortality in Ahmedabad, India. Maternal height and weights were compared between mothers of 611 perinatal deaths, 644 preterm-LBW, and 1465 normal birth weight controls as well as 617 small-for-gestational age (SGA) and 1851 appropriate-for-gestational-age (AGA) births. Weight and height were much lower in this population compared to western standards. Low weight and height were associated with increased risk of perinatal death, prematurity and SGA. After adjusting for confounders, maternal weight remained significantly associated with poor pregnancy outcomes, whereas height was only weakly associated. Attributable risk estimates show that low weight is a much more important contributor to poor outcome than low height. Improvement in maternal nutritional status could lead to substantial improvement in birth outcome in this population.