Increased risk of hip fracture associated with dually treated HIV/hepatitis B virus coinfection.

HIV and hepatitis B virus (HBV) infections are each associated with reduced bone mineral density, but it is unclear whether HIV/HBV coinfection is associated with an increased risk of fracture. We determined whether dually treated HIV/HBV patients had a higher incidence of hip fracture compared to treated HBV-monoinfected, antiretroviral therapy (ART)-treated HIV-monoinfected and HIV/HBV-uninfected patients. We conducted a cohort study among 4156 dually treated HIV/HBV-coinfected, 2053 treated HBV-monoinfected, 96,253 ART-treated HIV-monoinfected, and 746,794 randomly sampled uninfected persons within the US Medicaid populations of California, Florida, New York, Ohio and Pennsylvania (1999-2007). Coinfected patients were matched on propensity score to persons in each comparator cohort. Weighted survival models accounting for competing risks were used to estimate cumulative incidences and hazard ratios (HRs) with 95% confidence intervals (CIs) of incident hip fracture for dually treated coinfected patients compared to (i) HBV-monoinfected receiving nucleos(t)ide analogue or interferon alfa therapy, (ii) HIV-monoinfected on ART and (iii) uninfected persons. Dually treated coinfected patients had a higher cumulative incidence of hip fracture compared to ART-treated HIV-monoinfected (at 5 years: 1.70% vs 1.24%; adjusted HR, 1.37 [95% CI, 1.03-1.83]) and uninfected (at 5 years: 1.64% vs 1.22%; adjusted HR, 1.35 [95% CI, 1.03-1.84]) persons. The cumulative incidence of hip fracture was higher among coinfected than treated HBV-monoinfected patients (at 5 years: 0.70% vs 0.27%), but this difference was not statistically significant in competing risk analysis (adjusted HR, 2.62 [95% CI, 0.92-7.51]). Among Medicaid enrollees, the risk of hip fracture was higher among dually treated HIV/HBV-coinfected patients than ART-treated HIV-monoinfected and uninfected persons.

The inception and development of basic animal health systems: examples of German development co-operation.

About thirty years ago the financial, logistic and manpower resources of veterinary and animal production services in the developing world were stretched to the limit. Epizootic disease control was their main and often only field activity, which left livestock owners to manage their daily production and health problems alone. To meet their requirements, Veterinary Services in these countries came under increasing public and political pressure to modify and adjust their approaches. This gave rise to a series of workshops in Africa (e.g. Bujumbura in Burundi and Blantyre in Malawi) and South-East Asia (e.g. Singapore, and Khon Kaen in Thailand), most of which were organised and facilitated by the German Agency for Technical Co-operation (GTZ) in close collaboration with French and British development co-operation agencies and universities. These workshops stimulated discussion with the key stakeholders and, thus, were most beneficial in supporting the process of developing alternative approaches. This paper reports in particular on the outcomes of the regional workshops held in Bujumbura, Burundi, in 1984, Blantyre, Malawi, in 1985, Bangui, Central African Republic, in 1988, Khon Kaen, Thailand, in 1989, Schmitten, Germany, in 1991, and Mzuzu, Malawi, in 1996 and 2000. For more than two decades, concepts of community-based livestock services in general, and primary animal health activities (PAHAs) in particular, have been developed and established in various developing countries. Over the years the PAHA concept has proved to be effective and has shown that livestock-keeping communities clearly benefit from such programmes. In presenting key features from some prominent and successful project examples (GTZ-supported projects in Thailand, Malawi and Somalia) it can be demonstrated that such approaches are not static but rather dynamic, requiring open minded innovative partners on both sides. Over the last few years, the delivery of PAHA has become the domain of non-governmental organisations. The propagation and application of this approach in various developing countries with limited veterinary infrastructure is supporting a privatisation process within the existing governmental veterinary structures, thus, allowing veterinary departments more freedom to focus on their core functions.

Farm and personal characteristics of the clientele of a community-based animal-health service programme in northern Malawi.

The social background, farm characteristics, indicators of income and self-evaluation returns of 96 randomly selected users of a Basic Animal Health Service (BAHS) programme in northern Malawi were compared with those of 96 matched past-users and 96 non-users, respectively. All 288 farms were visited between July and October 1997. Data analysis was performed using univariate and multivariate techniques. The results showed that, on average, BAHS users had larger cattle herds (16.3) than part-users (14.7) or non-users (12.4). Similarly, the annual yields of crops were higher for users compared to either of the other groups. Users occupied better houses and owned a larger number of farm and household items than did part-users or non-users. A third of all farmers were engaged in additional income generation to lessen the risk of poverty. However, analysis of the livestock management and the educational background of the farmers suggested that usage of the BAHS programme was not only determined by already existing 'wealth'. Improved livestock husbandry and management measures, which do not require capital investment, were more frequently applied by users compared to either of the other groups. Non-users and part-users had attained a lower level of education, were less open towards improved farming methods and felt less knowledgeable than BAHS users. The average straight-line distances from farms using BAHS to their respective village animal health worker (2.2 km) or veterinary assistant (2.9 km) were similar but varied according to ecological zone. Intensified extension and awareness meetings in villages will be required to get more non-users involved in BAHS.

Characteristics and performance of village animal health workers and veterinary assistants in northern Malawi.

Fourty-two village animal health workers called keymen (KM) and 84 veterinary assistants (VA) involved in a Basic Animal Health Service (BAHS) Programme in northern Malawi were interviewed during 1998. The general characteristics and perceptions of both groups were analysed using uni- and multivariate techniques. Detailed sales and treatment patterns of six KM and 12 VA were evaluated for the period September 1996 to August 1997. Results indicated an overall job-satisfaction for 82% of KM and 83 % of VA. Estimated weekly involvement in livestock service delivery, particularly of KM, was 3.7 days on average. Total annual drug sales of KM and VA between 1996 and 1997 on average were equivalent to US$ 124 and US$ 218 respectively. Most livestock remedies were issued for treatment of calves, followed by adult cattle, chickens and small ruminants. The changes suggested by VA and KM in order to improve field performance focused on regular refresher training by the BAHS programme.

Metaphylactic deworming program for buffalo calves (Bubalis bubalis) in North-East Thailand.

One hundred newborn swamp buffalo calves (Bubalis bubalis) from three villages in North-East Thailand were divided equally into treatment and control groups. Treated calves received two doses of a piperazine/thiabendazole mixture (196.6 and 50 mg/kg bodyweight respectively) at three, and again at ten weeks of age. Control calves received placebo treatments at the same times. Egg excretion rates for the roundworms Strongyloides papillosus and Toxocara vitulorum were recorded as high as 85% and 58% respectively during the first three months of life. During the trial period, four calves in the treated group died and one was treated for coccidiosis, compared to seven deaths and nine additional anthelmintic treatments required in the control group. All calves that either died or required additional anthelmintic treatment showed signs of severe enteritis, anorexia and emaciation that was attributed to parasitic infestation. Calves receiving emergency anthelmintic treatment all recovered uneventfully. All except four of the calves that died or became sick did so between 25 and 40 days post partum, with the remainder developing clinical signs of parasitosis before day 50. There was no difference in weight gains between treated and untreated calves over the trial period (16 weeks). Thus, the advantage of anthelmintic treatments as described at three and ten weeks of age in buffalo calves under village conditions was seen as a reduction in the combined morbidity/mortality rate from 32% to 10% (P less than 0.05). From the pattern of infection observed in this study it is suggested that further gains could be made by giving the second treatment at six (instead of ten) weeks of age, and by increasing the dosage of anthelmintic used.