Diagnostic options for pulmonary fungal diseases in Africa.

Background: Fungal lung diseases are global in distribution and require specific tests for diagnosis. We report a survey of diagnostic service provision in Africa. Methods: A written questionnaire was followed by a video conference call with each respondent(s) and external validation. To disseminate the questionnaire, a snowball sample was used. Results: Data were successfully collected from 50 of 51 African countries with populations >1 million. The questionnaire was completed by respondents affiliated with 72 health facilities. Of these 72 respondents, 33 (45.8%) reported data for the whole country while others reported data for a specific region/province within their country. In the public sector, chest X-ray and computed tomography are performed often in 49 countries (98%) and occasionally in 37 countries (74%), and less often in the private sector. Bronchoscopy and spirometry were done often in 28 countries (56%) and occasionally in 18 countries (36%) in the tertiary health facilities of public sector. The most conducted laboratory diagnostic assay was fungal culture (often or occasionally) in 29 countries (58%). In collaboration with the Africa Centre for Disease Control and Prevention, regional webinars and individual country profiles provided further data validation. Conclusion: This survey has found a huge disparity of diagnostic test capability across the African continent. Some good examples of good diagnostic provision and very high-quality care were seen, but this was unusual. The unavailability of essential testing such as spirometry was noted, which has a high impact in the diagnosis of lung diseases. It is important for countries to implement tests based on the World Health Organization Essential Diagnostics List.

The effect of prepubertal calcium carbonate supplementation on the age of peak height velocity in Gambian adolescents.

BACKGROUND: Limited evidence suggests that calcium intake before puberty influences adolescent height growth and the timing of puberty. Such an effect might be particularly marked in populations in whom low calcium intake, stunting, and delayed puberty are common. OBJECTIVE: The objective was to test whether 12 mo of calcium supplementation at age 8-12 y to increase intakes toward international recommendations had long-term effects on adolescent growth and pubertal development in rural Gambian children. DESIGN: This was a longitudinal study of 160 Gambian boys (n = 80) and girls (n = 80) who had participated in a 12-mo, randomized, double-blind, placebo-controlled, calcium carbonate supplementation trial (1000 mg Ca/d, 5 d/wk) at age 8-12 y. Anthropometric measures were made every 1-2 y until age 21-25 y; pubertal status and menarche data were collected. Repeated-measures ANCOVA and Superimposition by Translation and Rotation Method (SITAR) growth models were used to assess the effects of treatment. RESULTS: In boys, midadolescent height growth was advanced in the calcium group, which resulted in greater stature at a mean age of 15.5 y (mean ± SEM: 2.0 ± 0.8 cm; P = 0.01) and an earlier age of peak height velocity by 7.4 ± 2.9 mo. Subsequently, the calcium group stopped growing earlier (P = 0.02) and was 3.5 ± 1.1 cm shorter (P = 0.002) at a mean age of 23.5 y. Weight and midupper arm circumference paralleled height. No significant effects were observed in girls, but a sex-by-supplement interaction on height growth could not be confirmed. CONCLUSION: Calcium supplementation of boys in late childhood advanced the age of peak height velocity and resulted in shorter adult stature in a population in whom low calcium intakes and delayed puberty are common. This trial was registered at isrctn.org as ISRCTN28836000.

Bone mineral contents and plasma osteocalcin concentrations of Gambian children 12 and 24 mo after the withdrawal of a calcium supplement.

BACKGROUND: Our randomized, placebo-controlled supplementation study of 160 rural Gambian children aged 8.3-11.9 y showed that an increase in calcium intake of 714 mg/d for 12 mo resulted in a 5% increase in forearm bone mineral acquisition and a 22% decrease in plasma osteocalcin concentration, a bone formation marker, but had no effect on height or bone dimensions. OBJECTIVE: We investigated whether these results were sustained after supplement withdrawal. DESIGN: All participants were followed up 12 (FU1) and 24 (FU2) mo after supplementation ended. Bone mineral content (BMC), bone mineral density (BMD), and BMC adjusted for bone width, body weight, and height (size-adjusted BMC) were measured at the midshaft and distal radius. Plasma osteocalcin concentration was measured at FU1. RESULTS: At follow-up, the calcium group had greater bone mineral status than did the placebo group at the midshaft radius (mean difference +/- SE), FU1: BMC (4.7 +/- 1.6%; P = 0.004), BMD (5.1 +/- 1.1%; P