The psychosocial conditions and intensified education that may affect school performance of HIV/AIDS orphaned children on antiretroviral drugs.

OBJECTIVE: This study begins with interpreting basic academic results from the House of Family (HOF) comprehensive project for HIV/AIDS orphaned children. We reviewed school performance during the academic period from 2007 to 2012. METHODS: All the children in the HOF project have vertically acquired HIV infection, with approximately 90% being with AIDS/Clinical Stage C at the time of admission. Initiation of antiretroviral drugs (ARV) was at the average age of 7 (mean 6.94, median 6.5, and a mode of 6). In the year 2007, 44 children had been receiving ARV. The majority of these children 32 (72.7%) were on ARV for at least 1 year, 6 (13.6%) of the children on ARV for 4 years, 7 (15.9%) were on ARV for 3 years, 5 (11.3%) for 2 years, 14 (31.8%) for 1 year, and 12 (27.2%) started ARV on that year. Later on, an additional 2 children started ARV in 2008, 1 child in 2009, and 4 children in 2010. RESULTS: We found that the total number of children achieving a certain academic level changed very little between each scholastic year. During the four years of school reviewed, it was noted that the Poor performers made improvement and an increase in Good performance grades was also achieved. The trend of Fair levels remained mostly unchanged at 65%, 70.2%, 68.5%, and 64.6% respectively. The overall passing performance, including both Fair and Good scores, improved from 67.5% in 2008 to 80.8% the following year of school. This passing rate of 80.8% in 2009 remains stable over the next two years at 80.3% and 80.3% respectively. CONCLUSION: Despite the late introduction of ARV medicine, limited family and social support, and deficient academic achievement, the children of HOF were able to improve their school performance due to intensified psychosocial and educational support provided at the HOF comprehensive project.

Tropical neuroinfections in south sudanese rural hospitals - analysis of 8,709 patients.

OBJECTIVE: Infections involving the central nervous system have very serious consequences and affect thousands of people in Africa. Despite the availability of new antibiotics and vaccines, neuroinfections act as dangerous and life-threatening conditions. The most frequent neuroinfections which are of the greatest importance for public health systems are viral diseases (such as HIV, encephalitis, poliomyelitis, rabies), bacterial diseases (bacterial meningitis, neurological complications of leprosy and tuberculosis) and parasitic infections (cerebral malaria, sleeping sickness, trypanosomiasis, schistosomiasis, toxoplasmosis etc.). METHODS: A descriptive study to assess the occurrence of neuroinfections in two rural hospitals in Sudan (Mapuordit in Yirol and Gordim in Aweil) was performed in two periods of two years: (i) 2005-2006 and (ii) 2010-2011. We obtained data on patients from Mapuordit and from Gordim by studying their medical records. RESULTS: Several cases of neuroinfections were observed during both periods; those were represented by tetanus, meningococcal meningitis, leprosy with neuropathy (altogether 442 patients) in Mapuordit. Also in Gordim, severe neuroinfections such as cerebral malaria were very rare (1 case), as well as tetanus (1 case), meningococcal meningitis (8 cases) and sleeping sickness (9 cases). However, the incidence of neuroinfections decreased from 44/1000 in 2005-2006 to 2/1000 in 2010-2011. CONCLUSIONS: Decreased incidence of serious neuroinfections (cerebral malaria, sleeping sickness, meningococcal meningitis) in Sudan may be related to improvement of effective therapeutic options, represented by (i) intermittent preventive therapy (IPT) for malaria, (ii) by suppression of sleeping sickness vectors and (iii) by better accessibility of antibiotics.

Neurologic disorders in HIV-positive orphans: 10 years of follow up.

OBJECTIVE: Neuropsychic manifestations of AIDS are still noticeable especially in developing countries. The aim of this short communication is to describe psychological, behavioral and neurologic disorders caused by either HIV-related disorders, or drug related toxicities in HIV-infected children from Cambodia (Phnom Penh, Sihanoukville) treated during 10 years with highly active antiretroviral therapy (HAART). METHODS: One hundred and thirty seven (137) HIV-positive children (age 2-19 years) treated with HAART since 2003 (6-10 years follow up) have been analyzed concerning opportunistic infections, other co-infections, renal parameters, hematologic parameters, chest X-ray, antiretroviral treatment, anti-tuberculotics and antibiotics treatment. We recorded prospectively all data since the start of HAART from 2003-2005 up to December 2012. RESULTS: Occurrence of drug related neuritis due to stavudine (HAART) was less than 1% and was associated with anti-tuberculous agents accompanying HAART in HIV- and tuberculosis co-infected patients. Co-infections with neurotropic viruses were more frequent: 1 case of CMV retinitis, 18 cases of herpes zoster neuritis and 37 cases of generalized HZV infections (varicella), after onset HAART in children were recorded. All children responded well to anti-viral therapy with ganciclovir (CMV), vanciclovir or acyclovir (HZV) in combination with first line HAART. CONCLUSION: Neurologic disorders in children with HAART are less frequent than in adults. Anti-retrovirals and anti-tuberculosis drugs seem to be safe and less toxic in children then in adults. Co-infections with neurotropic viruses were more frequent, however, were successfully treated with anti-virals.

Numbers of non-severe as well as cerebral malaria cases are decreasing with higher altitude in Burundi Highlands, but still remains high.

OBJECTIVE: We aimed to assess the occurrence of malaria-positive cases in 4 rural Burundian hospitals during December 2011 placed at different altitudes above sea level. METHODS: Diagnosis of malaria was made upon considering clinical symptoms, microscopic evaluation and rapid diagnostic test results. We performed analysis of patient's clinical data collected in 4 hospitals in Burundi to compare the occurrence of malaria at different altitudes. RESULTS: The lowest incidence of malaria during December 2011 was detected at Murago Hospital (606 cases per month, 47.6%), which is located in the highest altitude, and the highest occurrence was in Gasura (1,559 cases, 91.3%), then in Rutovu (732 cases, 81.2%) and Buraniro (4,436 cases, 78.6%). Compared with other types of consultations (gynecological, HIV/AIDS, other tropical diseases), malaria was the most frequent reason for medical consultation. CONCLUSION: We have observed the lowest occurrence of malaria at hospitals located in the highest altitude. Despite the lower number of malaria cases in higher altitudes, its impact on public health should not be underestimated.