The efficacy and safety of a controlled release formulation of salbutamol in the management of patients with asthma in Nairobi, Kenya.

The treatment of asthma in Africa is influenced by cultural and environmental factors as well as the availability of drugs. Poor compliance with regard to long-term maintenance treatment of chronic asthma is also a problem in Africa. The present study reports on 45 patients from 2 centres in Nairobi treated with 8 mg twice daily of an oral controlled release formulation of salbutamol ("Volmax"). The treatment produced a significant improvement in lung function measured by the PEFR compared with baseline data on previous therapy. Controlled release salbutamol was rated as effective or very effective by 84.2% of patients and for 81.6% of patients their physicians preferred this preparation to the therapy used before the study. Side effects were infrequent and usually occurred during the first few days of treatment. The study which is the first report in Africa to assess this novel formulation of salbutamol in a group of African patients, demonstrates that controlled release salbutamol 8 mg administered twice daily is safe and effective, offering benefits over current therapies in the treatment of asthma.

Short course chemotherapy for pulmonary tuberculosis in routine service in Kenya.

The results are reported of the application of a short-course regimen for pulmonary tuberculosis in routine service in three districts in Kenya. All patients were treated in hospital for one month receiving Streptomycin, Isoniazid, Rifampicin and Pyrazinamide daily and followed by Rifampicin and Isoniazid daily on outpatient basis for five months. There was no failure of chemotherapy among 194 patients with pre-treatment sensitive strains at the end of chemotherapy. Six (3.9%) had a doubtful status but none relapsed during follow-up. Among 123 patients assessed after completion of follow-up only one (0.8%) relapsed and 16 of 22 patients with pretreatment resistant strains had a favourable response at the end of chemotherapy and follow-up. The therapeutic results achieved are excellent under programme conditions though of necessity with some amount of supervision that is not routinely available. Considering the advantages of short course regimens, a case for the choice of an appropriate short regimen to be used nationwide in the near future is made.

An effective traditional medicine for bronchial asthma: clinical demonstration and preliminary toxicological evaluation.

This clinical paper reports the investigations conducted on a traditional African anti-asthmatic formulations and evaluates its toxicological and phyto-chemical effects.

Controlled clinical trial of a regimen of two durations for the treatment of isoniazid resistant pulmonary tuberculosis.

Patients with pulmonary tuberculosis who were failures of primary chemotherapy with strains resistant to isoniazid or to isoniazid and streptomycin were allocated at random to receive a regimen of rifampicin and ethambutol for 6 (4RE) or 9 months (7RE), supplemented in both treatment series by streptomycin plus pyrazinamide for the first 2 months. The patients were treated in hospital for the first 2 months and thereafter treatment was supervised on a daily basis in the nearest health institution by an appointed member of staff or at home by responsible members of the community. A total of 306 patients was admitted and 226 patients remained for analysis at the end of chemotherapy, 179 with a strain resistant to isoniazid alone and 47 with a strain resistant to isoniazid and streptomycin. There were only two failures at the end of chemotherapy, one in the 6-month series who had resistance to both isoniazid and streptomycin pretreatment, and one in the 9-month series who had resistance to isoniazid alone. For the 144 patients with initial resistance to isoniazid alone assessed up to 30 months, the relapse rates were low in both series: 4% for the 72 patients in the 6-month series and 3% for the 72 patients in the 9-month series. However, for the 34 patients with resistance to both drugs, three of the 14 in the 6-month but none of 20 in the 9-month series relapsed.

A study of the use of maternity and child welfare clinics in case-finding for pulmonary tuberculosis in Kenya.

This investigation is the seventh in a series of case-finding studies in Kenya. It explores the potential value of questioning mothers attending maternity and child welfare (M & CW) clinics to identify tuberculosis suspects (individuals aged 6 years or more with a cough for 1 month or more or hemoptysis) living in their households. The study was carried out in all the eight M & CW clinics in two divisions (populations 86,000 and 112,000) of two different districts. The mothers were asked to give a standard letter, which explained the possible importance of a chronic cough, to each suspect they identified and invited the suspect to attend the district hospital chest clinic. Each suspect attending the clinic was entered in a special register and two sputum specimens were collected. For those who failed to attend, the specimens were collected at a home visit. Of the total of 342 suspects living in the two study areas who were registered at the M & CW clinics during 1 year, 261 were identified by the mothers but 19 denied having received the standard letter. The remaining 81 had not been identified by mothers but had attended the M & CW clinics on their own initiative. Of the 242 suspects who received the letter, 89 (39%) attended the hospital chest clinic, 74% within a week of the letter being issued from the M & CW clinic. The main reasons given for not attending the hospital chest clinic by the remaining suspects were financial or because their cough had improved or disappeared. Sputum was collected from 238 suspects and examined bacteriologically: in six (2.5%) it was positive for tubercle bacilli on smear and culture and in a further two (0.8%) the sputum was positive on culture only. Of those attending the hospital chest clinic 2.9% were smear- and culture-positive and 4.7% were culture positive. This method of case-finding has yielded disappointing results, for only 4% of the estimated annual incidence of smear-positive cases was detected.

Studies of case-finding for pulmonary tuberculosis in outpatients at 4 district hospitals in Kenya.

This investigation is the sixth in a series of case-finding studies in Kenya. It explores the potential for case-finding by the identification of tuberculosis suspects (individuals with a cough for 1 month or more) through careful screening of general outpatients attending 4 district hospitals for the first time. Of 2299 suspects identified among 87 845 new outpatients attending the hospitals, 4.7% had culture-positive pulmonary tuberculosis, 3.6% having sputum positive on smear as well. In the 3 hospitals with radiographic facilities, 1.3% of suspects (whose sputum was negative on culture) were considered on review of their clinical history and chest radiograph by an independent assessor to have radiographically active tuberculous lesions and a further 2.5% to have inactive lesions. The proportion of bacteriologically positive cases per 1000 of the general population aged 6 years or more decreased as the distance of their homes from the hospital increased (P less than 0.001 for the trend). However, the proportion of cases per 1000 of the suspects identified increased as the distance of their homes from the hospital increased (P less than 0.001 for the trend). History of cough for between 1 and 12 months was the most useful factor for the identification of cases of tuberculosis among the suspects, and would have identified 92% of the smear-positive cases from the examination of 70% of the suspects; a history of weight loss identified 84% of the smear-positive cases from the examination of 64% of the suspects. A history of weight loss and/or a history of cough for between 1 and 12 months would have detected all the smear-positive cases from the examination of 89% of the suspects. The proportion of bacteriologically positive cases in the younger suspects aged 9-32 years (who had been eligible for a mass BCG campaign) was greater among the non-vaccinated than among the vaccinated suspects, 4.9% and 2.3% respectively (P=0.04), implying protection from vaccination of the order of 50%.

Study of case-finding for pulmonary tuberculosis in outpatients complaining of a chronic cough at a district hospital in Kenya.

This investigation is the fifth in a series of case-finding studies in Kenya. It explores the potential for case-finding by the identification of persons with suspected tuberculosis (persons with a cough for 1 month or more) through careful screening of general outpatients attending a district hospital. Of 601 suspects identified among 20,756 new outpatients attending hospital during a period of 11 wk, 5.6% were considered by an independent assessor to have active pulmonary tuberculosis (2.2% with sputum positive on both smear and culture, 1.2% on culture only, and 2.2% negative sputum but radiographically active lesions). A further 2.0% were considered to have inactive tuberculosis. This method of case-finding appears to be uniformly effective within a radius of approximately 9 miles of the hospital, becoming less effective outside this range. There were certain important diagnostic pointers. There was an excess of tuberculosis cases in males, in those with weight loss, in those with a history of cough of less than a year, in those with a history of hemoptysis, and in those 35 yr of age or older. This investigation provides additional support to our previous studies, which demonstrated serious problems of case-finding in the peripheral health units and suggests that unless the infrastructure of primary health care at the periphery can be improved, the policy should be to diagnose tuberculosis in the district hospital and to operate a simple referral system for persons with suspected tuberculosis from the periphery.

Impaired glucose tolerance in a hospital population in Jamaica / 11th Congress of the International Diabetes Federation

During the period January to December 1979, 75 g glucose tolerance tests were performed on 311 patients in the Chemical Pathology Department of the University Hospital. There were 14 (4.5 percent) non-pregrant adult patients, not previously diagnosed as diabetic, whose 2-h post-ingestion blood glucose values, using venous whole blood, fell within the range 140-200 mg percent (8-11 mmol/l). On these results they were diagnosed as impaired glucose tolerance (IGT) and no therapy given except for dietary advice. Two years later, during the month of January 1982, they were contacted by postal telegrams to return to the hospital for reassessment. A 75-g glucose load was given to each respondent and a 2-h post-ingestion blood glucose level determined. Eight (57 percent) had normal values of mean blood glucose 115 mg percent (6.4 mmol/l): 4 were female, and 4 male; age range 20-76 yr, mean age 40 yr; body mass index range 19.7-35.1, mean value 29.2 (>26 regarded as obesity). Two (14.3 percent) females remained in the IGT group: mean blood glucose value 173 mg percent (9.6 mmol/l); mean age 32 yr; and mean body mass index 29.7. Four (28.6 percent) were frank diabetics, mean blood glucose 347 mg percent (19.3 mmol/l): 3 males 1 female; age range 20-66 yr, mean age 48 yr; body mass index range 24.1-28.7, mean value 25.7

A third study of case-finding methods for pulmonary tuberculosis in Kenya, including the use of community leaders.

Five methods of identifying tuberculosis suspects were investigated in the Machakos District of Kenya by: (1) 3-monthly interrogation of the Community Elders, (2) interrogation of household heads, (3) identifying suspects amongst outpatients attending local health units, (4) examination of patients registered during the previous 10 years in the District Tuberculosis Register and also (5) their close contacts. Sputum was bacteriologically examined by smear and culture from suspects found by all the methods. The initial interrogation of the Elders yielded 216 suspects, of whom 9 were culture-positive, including 6 smear-positive. Reinterrogating the Elders 4 times at 3-monthly intervals produced a further 114 suspects including 4 culture-positive cases (3 being smear-positive). The examination of a second sputum specimen from suspects after a 3-month interval yielded 4 further culture-positive cases (all smear-negative) but the examination of a third specimen after a further 3 months yielded no further cases. A single interrogation of 1093 household head suspects yielded 22 culture-positive cases, including 11 smear-positive. The response in 5 health units covering a population of about 24 500 was poor. During a 2-year period only 109 suspects were recorded; 7 were culture-positive, including 3 smear-positive. Of 61 cases of tuberculosis registered during the previous 10 years, 8 were currently culture-positive, 5 being smear-positive. Of 318 household contacts of these cases, 6 were culture-positive cases, 2 being smear-positive. The problems presented by different active case-finding methods are discussed, identifying those that appear promising and those unpromising.