Strengthening national health laboratories in sub-Saharan Africa: a decade of remarkable progress.

OBJECTIVES: Efforts to combat the HIV/AIDS pandemic have underscored the fragile and neglected nature of some national health laboratories in Africa. In response, national and international partners and various governments have worked collaboratively over the last several years to build sustainable laboratory capacities within the continent. Key accomplishments reflecting this successful partnership include the establishment of the African-based World Health Organization Regional Office for Africa (WHO-AFRO) Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA); development of the Strengthening Laboratory Management Toward Accreditation (SLMTA) training programme; and launching of a Pan African-based institution, the African Society for Laboratory Medicine (ASLM). These platforms continue to serve as the foundations for national health laboratory infrastructure enhancement, capacity development and overall quality system improvement. Further targeted interventions should encourage countries to aim at integrated tiered referral networks, promote quality system improvement and accreditation, develop laboratory policies and strategic plans, enhance training and laboratory workforce development and a retention strategy, create career paths for laboratory professionals and establish public-private partnerships. Maintaining the gains and ensuring sustainability will require concerted action by all stakeholders with strong leadership and funding from African governments and from the African Union.

Proteinuria and onchocerciasis in an endemic area in Cameroon under community-based treatment with ivermectin.

The present study was aimed at determining the prevalence of onchocerciasis and proteinuria as well as the association between manifestations of heavy chronic onchocerciasis (HCO) and proteinuria among patients in Cameroon. Of the 482 (277: 57.5% females and 205: 42.5% males) subjects recruited from an area with an ivermectin treatment coverage rate of 77.8%, the average prevalence of microfilaridermia by skin snip (mf/ss) was 31.9%, the community microfilaria load was 9.3 mf/ss and the overall prevalence of proteinuria was 4.4%. There was no statistically significant difference in the prevalence of symptoms of HCO when subjects were matched in the presence and absence of proteinuria with regard to positive ss (P = 0.0860), presence of nodules (P = 0.5000), depigmentation (P = 0.1459), visual impairment (P = 0.5000) and recent ingestion of ivermectin (P = 0.6366). Fourteen (66.6%) of the 21 subjects with protein to creatinine ratios (P/CR) > or = 0.2 had HCO, while 15 (71.4%) of the 21 subjects with P/CR < 0.2 had HCO. This gives an odd ratio of 0.8 and a P value of 0.62. However, there is need to carry out studies with a larger sample size before firm conclusions can be drawn about the association between onchocerciasis and proteinuria.

Presence of diverse human immunodeficiency virus type 1 viral variants in Cameroon.

Phylogenetic analysis of the gp41 region of 123 HIV-1-seropositive specimens from Cameroon showed that 89 were subtype A (71% of these sequences were IbNg-like), 12 (10%) were subtype D, 11 (9%) were subtype G, 5 (4%; closely related to subtype F2) were subtype F, 1 was subtype H, 2 (1.6%) remained unclassifiable, while 3 were group O. Further analysis of the two unclassifiable specimens in gag(p24), pol(prot), and env (C2V3 or gp41) showed that one (98CM19) was a complex mosaic between subtype A in p24 and subtype J prot, and unclassifiable in env (C2V3 or gp41). The second, 98CM63, clustered distinctly from all known subtypes in p24, prot, C2V3, or gp41. 98CM63 clustered with a specimen from Cyprus and these two geographically and epidemiologically unlinked specimens, with their distinct clustering pattern, may represent a new subcluster of subtype A. In conclusion, these findings confirm the high HIV-1 genetic variability and further suggest the continuous appearance of new viral strains in this population.

Plasma nicotinic acid level in chloroquine treated rats.

The effect of chloroquine phosphate on plasma nicotinic acid levels in adult male albino rats was investigated. Pyrogen free chloroquine phosphate in physiological saline was administered subcutaneously to rats in a dose of 15 mg/kg body weight daily for eleven succeeding days in the treatment group. A control group was given equal volume of physiological saline daily for eleven succeeding days. Nicotinic acid concentration in the plasma was determined [1] Plasma nicotinic acid level was found to be significantly reduced (P < 0.01) throughout the duration of treatment. No change was observed in the control group. The significant reduction of plasma nicotinic acid level observed in this study may not be unrelated to competitive inhibition of the enzyme tryptophan dioxygenase by chloroquine phosphate.

Socio-biological status of Nigerian males with primary and secondary infertility.

Husbands in 100 consecutive couples complaining of lack of pregnancy after one year of normal intercourse were engaged in this study. Information from a structured questionnaire administered to these 100 men showed that 46% had primary infertility (had never impregnated any woman) and 54% secondary infertility (had in the past impregnated at least one woman irrespective of the outcome of the pregnancy). The mean ages (years) and standard error of mean for the primary and secondary infertile groups were 33.46 +/- 1.45 and 39.28 +/- 1.41 respectively. The difference was statistically significant (p < 0.05). Semen culture for growth of bacteria was positive in 59.3% of subjects with secondary infertility as opposed to 40.7% for primary infertility. The difference was, again, statistically significant (p < 0.05). These findings indicate that a higher proportion of husbands in infertile couples in a group of this environment had secondary infertility, were older and were more likely to harbour infections in their semen than those with primary infertility. Hence there should be a greater awareness of the significant involvement of bacterial infection of the genital tract of infertile Nigerian subjects than and before this factor should be taken into account in the prevention and treatment strategies for infertility in this and presumably other tropical countries.

Serological and clinical correlates of gonorrhoea and syphilis in fertile and infertile Nigerian women.

OBJECTIVE: To test the hypothesis that infertile Nigerian women have higher serum levels of antibodies against Neisseria gonorrhoea and Treponema pallidum compared with fertile controls. DESIGN: The prevalence of serum antibodies against N gonorrhoea and T pallidum was compared in fertile and infertile Nigerian women. SETTING: Population based case-control study in Ile-Ife, southwestern Nigeria. SUBJECTS: 60 women with infertility identified from a community based questionnaire survey of 1075 women were compared with 53 age matched fertile controls. METHODS: Sera of fertile and infertile women were tested for the presence of gonococcal antibodies with indirect agglutination test and syphilis antibodies using rapid reagin method. MAIN OUTCOME MEASURES: Prevalence of anti-gonococcal and anti-treponemal antibodies in cases and controls. Frequency of self reports of sexually transmitted infections (STIs) in cases and controls. RESULTS: In comparison with fertile women, infertile women were more likely to report having had repeated lower abdominal pains (p < 0.01), yellow vaginal discharge (p < 0.004), and whitish vaginal discharge (p < 0.02). There was no significant difference between cases and controls in the proportions reporting previous STI diagnoses. However, two infertile women reported previous gonococcal infection compared with none in the fertile group. Sixteen of the infertile women (26.7%) demonstrated anti-gonococcal antibodies in their sera compared with only four of the 53 fertile controls (7.5%) (p < 0.02; OR 4.5). There was no significant difference between fertile and infertile women in the proportion showing serological reactivity to T pallidum. CONCLUSION: Infertile women have a higher prevalence of anti-gonococcal antibodies compared with fertile controls. Infertile women are also more likely to report previous lower abdominal pains and vaginal discharge. These results provide credible evidence implicating STIs and N gonorrhoea in particular as important factors contributing to female infertility in this population. Public health measures are warranted to address the high rate of STIs and N gonorrhoea in Nigeria.

Haematogram and serum iron status of malnourished Nigerian children.

Haematological parameters, total serum iron, and total iron binding capacity (TIBC) concentrations were estimated in twenty protein energy malnourished (PEM) children, five kwashiorkor (K), five marasmus (M), five marasmic-kwashiorkor (M-K), and five undernourished (U) aged between one and five years on admission and after 18 days hospitalisation at Obafemi Awolowo University Teaching Hospital Complex. The Hospital diet for K and M-K consisted of 8% protein and 802 calories per litre while that for M and U consisted of 30% protein and 1350 calories per litre. After the period of 18 days of rehabilitation there was no significant (p > 0.05) difference (Student's t-test) in the weight for age. None of the haematological parameters was significantly different after rehabilitation for all the four types of PEM. Of the four types only Kwashiorkor with mean serum iron values of 15.6 +/- 1.51 micrograms/100 ml and 21.17 +/- 0.33 micrograms/100 ml on admission and after rehabilitation respectively was significantly (P < 0.05) different. More attention by the OAUTHC authorities needs to be paid to the management, feeding and diet given to these children so that there will be a greater and more rapid improvement in their rehabilitation.