Yield of family screening in dilated cardiomyopathy within low-income setting: Tanzanian experience.

BACKGROUND: Dilated cardiomyopathy (DCM) is often familial and screening of relatives is recommended. However, studies on the yield of screening are scarce in developing countries. AIM: The aim of the study was to identify and characterise First-degree relatives of patients with DCM in Tanzania. METHODS: We recruited first-degree relatives of 57 DCM patients. DCM in the relatives was diagnosed using the 2016 revised definition by the European Society of Cardiology working group on myocardial and pericardial diseases. RESULTS: We screened 120 first-degree relatives. All were asymptomatic (100%) with a median age of 39.0 years (29.5-49.0), slightly over a half (53.3%) were females and 17 (14.1%) were found to have previously unknown DCM. The mean (± SD) indexed left ventricular end-diastolic volume was significantly higher in relatives with DCM (71 ± 11.5 ml) compared to relatives without DCM (50 ± 11.5) (p = 0.001). CONCLUSION: First-degree relatives of patients with DCM are at risk of developing asymptomatic DCM at a young age.

Risk Factors and Prevalence of Dilated Cardiomyopathy in Sub-Saharan Africa: A Systematic Review.

Highlights  Prevalence of DCM varies widely in SSA.Cardiovascular risk factors are important in patients with DCM.The role of genetics in idiopathic DCM is not studied in major part of SSA.

Periventricular Leucomalacia/ Intraventricular Hemorrhage Among Very Low Birth Weight Infants at Muhimbili National hospital (MNH); Dar-esSalaam; Tanzania

Introduction: Periventricular leucomalacia (PVL) and intraventricular haemorrhage (IVH) are two most important antecedents of neuro-developmental outcome in very low birth weight infants.Study objective: To determine the incidence of PVL/IVH and it's associated perinatal factors among very low birth weight (VLBW) infants admitted at neonatal unit Muhimbili National Hospital.Material and methods: Prospective study with a nested case-control study was conducted at the neonatal unit from May to November 2000. Three hundred seventy two VLBW neonates were recruited to the study on admission to the neonatal unit and were followed up to the postnatal age of 4 weeks or death depending on which came first. All 372 neonates had initial cranial-ultrasound examination within 72 hours of life. Cranial-ultrasound was done on 179 and 151 neonates at the postnatal age of 2 weeks and 4 weeks respectively. Records of all 372 neonates were reviewed to determine the presence or absence of the various perinatal factors. These data were analysed as a nested case-control study whereby a case was defined as any VLBW who had been recruited in the follow up study and had diagnosis of either PVL or IVH or both by cranial ultrasound and those VLBW who had been recruited in the follow up study without a diagnosis of either PVL or IVH were taken as controls. Results: A total of 4539 neonates were admitted to the neonatal unit during the study period and among these 443 (9.8) were VLBW. Two hundred fifty seven (58) out the 443 VLBW neonates died before the postnatal age of 4 weeks. Among the 372 VLBW infants recruited in the study; PVL was seen in 121/372 (32.5) with an overall incidence rate of 0.125/infant week and IVH was seen in 230/372 (61.8) with an overall incidence rate of 0.247/ infant week. Most of the PVL and IVH occurred during the first 3 days of life. All neonates with grade IV IVH died before the postnatal age of 4 weeks. Forty-seven neonates (12.6) developed post-hemorrhagic hydrocephalus. Maternal hemoglobin and neonatal hemoglobin showed significant `association with PVL and IVH respectively.Conclusion:There is high incidence of VLBW; IVH and PVL. IVH grade IV carries a very high mortality. Routine cranial-ultrasound on all VLBW neonates along with clinical follow up for long-term neuro-developmental outcome is recommended

Prevalence and clinical presentation of HIV infection among newly hospitalised surgical patients at Muhimbili National Hospital, Dar es Salaam, Tanzania.

BACKGROUND: In Tanzania information is lacking on the prevalence of HIV infection in surgical patients in tertiary care facilities, in whom there are many points of special interest. OBJECTIVE: To determine the prevalence of HIV infection and associated clinical and demographic features among hospitalised surgical patients at Muhimbili National Hospital (MNH). SETTING: Muhimbili National Hospital. MATERIALS AND METHODS: Consecutive newly admitted patients were tested for HIV antibodies after pre-test counselling. Sera were tested using a dual ELISA algorithm. The data were analysed to determine the prevalence of HIV infection and relationships of serostatus with clinical and socio-demographic characteristics. RESULTS: Of 1,534 patients admitted during the study, 1,031(67.2%) consented to HIV testing following pre-test counselling. The prevalence of AIDS-related clinical features in patients who declined to be HIV tested was similar to that of seronegative patients, but significantly lower than that of seropositive patients. The overall age-adjusted HIV prevalence was 10.5% (95% CI = 9.9-14.0). The highest age-specific HIV prevalence was in the age group 35-44 years at 27.9%. No one was infected in the age group 0-4 years (n = 111). Differences in prevalence between age groups were statistically significant (p < 0.0001). Patients with granulomatous and suppurative infections had HIV prevalence of 28.3%. Twenty of 124 seropositive patients (16.1%) died in hospital compared to 58 of 907(6.4%) of seronegative patients (p = 0.0001). CONCLUSION: At Muhumbili National Hospital overall HIV prevalence in hospitalised surgical patients were 10.5%, compared to an overall national prevalence of 6.7%. Patients in the age groups 25 to 34 and 35 to 44 years had HIV seroprevalence of 26.8% and 27.9% respectively. Patients with infective conditions had the highest HIV prevalence. HIV seropositive patients were associated with higher hospital mortality than seronegative patients.

Kaposi's sarcoma before and during a human immunodeficiency virus epidemic in Tanzanian children.

BACKGROUND: With the onset of AIDS increased frequency of Kaposi's sarcoma (KS) has been reported. However, there is no case-based comparison of childhood (<14 years) KS before and during the HIV pandemic in sub-Saharan Africa. Here we report on the Tanzanian cancer registry data of pediatric KS in Tanzania and implications with regard to pathogenic factors. METHODS: One hundred fifty histologically confirmed pediatric KS (PKS) cases registered during 1968 through 1995 (28 years) were analyzed with regard to demographic and clinical characteristics before and during the AIDS epidemic. Statistical analysis was done with the Epi-Info program and chi square test. RESULTS: Of children with PKS 126 (84%) were male and 24 (16%) were female. The gender ratio was 5.1:1 and 5.4:1 during the endemic and epidemic periods, respectively. The highest occurrence of PKS was observed in the 0- to 5-years age group. Overall 73 (4.9/year) of these cases were registered during the pre and 77 (5.9/year) during the AIDS period. Over time a significant increase in anatomically disseminated KS cases was evident during the AIDS epidemic (P = 0.003). CONCLUSIONS: These observations indicate that children younger than 5 years are at high risk for developing KS, possibly reflecting low resistance to human herpesvirus (HHV) 8 infection. It is also likely that an increased susceptibility to HHV8 infection and morbidity is related to progressive immunodeficiency. The increase in AIDS PKS incidence appears to reflect a direct or indirect promoting effect of HIV on the development of KS lesions. Recognition of the high KS risk in small children warrants considerations of possible prevention measures including HIV/HHV8 vaccination and therapeutic options.

Breast cancer before and during the AIDS epidemic in women and men: a study of Tanzanian Cancer Registry Data 1968 to 1996.

Kaposi's sarcoma and malignant lymphoma are two cancers that are most often associated with human immunodeficiency virus (HIV) infection. Recently, other cancers, including cervical cancer, have been associated with AIDS. The role of HIV in the pathogenesis of these malignancies is not well understood, and few studies have been done to determine any general increase in cancers after the onset of the HIV epidemic. This study compared breast cancer before and during the AIDS period by studying the total Tanzanian Cancer Registry data (1968 to 1996). The mean age among males increased from 50.88 to 52.63 years (p = 0.45) and among females decreased from 44.79 to 43.23 years (p = 0.005) before and during the AIDS epidemic, respectively. A statistically significant decrease in the incidence of breast cancer was observed during the AIDS epidemic period in both males (p = 0.001) and females (p = 0.021). The male-to-female ratio widened significantly from 0.09:1 to 0.03:1 (p = 0.0001). Further studies are needed to determine the incidence and observed changes of different cancers, including breast among patients with HIV/AIDS.

Monitoring of HIV-1 infection prevalence and trends in the general population using pregnant women as a sentinel population: 9 years experience from the Kagera region of Tanzania.

In the Kagera region of Tanzania, a population-based study was initiated in 1987 followed by the establishment of antenatal-clinic-based sentinel surveillance system in the town of Bukoba in 1990. Repeat studies in both populations in Bukoba in 1993 and 1996 made it possible to study the dynamics of HIV infection prevalence and incidence in the area. This study aims at comparing the findings from this sentinel surveillance system with those of cross-sectional studies in the general population to assess its validity in estimating HIV prevalence and their trends in the general population. A multistage cluster sampling technique was used in the population-based studies whereas the antenatal-clinic-based population was obtained by consecutively recruiting antenatal care attenders coming for the first time during a given pregnancy. Antibodies against HIV infection were tested using two independent enzyme-linked immunosorbent assay (ELISA) antibody detection tests. Unlinked anonymous testing strategy was adopted for the sentinel population. Age-adjusted prevalence among antenatal care attenders decreased from 22.4% (95% confidence interval [CI], 20.6-25.2) in 1990 to 16.1% (95% CI, 15.9-18.8) in 1993 and further to 13.7% (95% CI, 11.8-14.3) in 1996. These results closely resemble those of the general population of adult women in the clinic's catchment area (the town of Bukoba) where the age-adjusted prevalence of 29.1% (95% CI, 24.4-34.6) in 1987 showed a decrease in the studies in 1993 18.7% (95% CI, 15.1-23.0) and in 1996 14.9% (95% CI, 12.0-17.1). The study indicates that general population trend estimates can be generated using sentinel surveillance data based on pregnant women visiting an antenatal clinic for the first time during a given pregnancy. The benefits of using this group outweigh its limitations that are brought about by possible selection bias. Continued surveillance of the epidemic based on antenatal care patients as a sentinel population is therefore recommended.

The accuracy of an alternative confirmatory strategy for detection of antibodies to HIV-1: experience from a regional laboratory in Kagera, Tanzania.

BACKGROUND: Constant improvement of HIV tests often results in withdrawal of poorer quality tests by the manufacturing companies. It is thus often necessary to evaluate new HIV testing kits and modify the existing testing strategies. OBJECTIVES: To evaluate an alternative HIV antibody testing strategy which involves consecutive testing of sera by two enzyme-linked immunosorbent assays (ELISA), which both are recombinant antigen-based but utilise different test principles, followed by re-testing of sera giving discordant results. STUDY DESIGN: Sera (n = 1558) from a cross-sectional study of the HIV-1 seroprevalence in the Kagera region of Tanzania were tested using two ELISAs in parallel: Enzygnost anti-HIV-1/2 plus and Wellcozyme HIV-1 recombinant. Western blot analysis was done on all concordantly reactive and repeatedly discordant reactive samples as well as on 10% of concordantly ELISA negative sera. RESULTS: Two hundred and four sera (13.1%) were confirmed HIV-1-antibody positive. Both ELISAs had a sensitivity of 100%. The specificities of the ELISAs at initial and repeated testing were 99.8 and 99.9%, respectively, for Enzygnost and 97.7 and 99.5%, respectively, for Wellcozyme. None of the sera was concordantly false positive in both ELISAs. The mean ratio of the optical density of a sample to the cut off value of the test run (OD/CO ratio) was lower for samples giving false positive reactions than for confirmed HIV-1-antibody-positive samples. It is therefore important to interpret with caution HIV antibody ELISA test results on samples giving low OD/CO ratios. None of 10% of randomly selected concordantly ELISA negative sera gave a positive Western blot reaction. CONCLUSIONS: This field evaluation of an HIV antibody testing strategy involving the use of a recombinant antigen-based sandwich ELISA (Enzygnost) followed by a recombinant antigen-based competitive ELISA (Wellcozyme) showed that it had a sensitivity and specificity of 100%.

Prevalence of HIV infection among hospital patients in north west Tanzania.

In order to estimate hospital HIV prevalence, the economic impact of AIDS on health care and to assess the implications of HIV testing on clinical suspicion of AIDS this hospital based study was done at the government regional hospital of Kagera, Tanzania. Consecutive admissions were recruited into the study, and those consenting had a blood specimen taken, one portion of which was used to aid clinical diagnosis, while the other was tested anonymously for HIV antibodies using two ELISA systems. A short questionnaire was used to specify demographic characteristics, hospital ward of admission and diagnosis of each study subject. The overall age adjusted HIV-1 prevalence was 32.8% (N = 1422) and there was no significant difference in the age adjusted sex specific prevalence. The highest prevalence (53.3%) was found in the 25-34 years age group as well as in the gynaecological and medical wards (41.2% and 40.4%, respectively). The diagnostic category of clinical AIDS had a sensitivity of 11.3% and a specificity of 99.3%, indicating that only 11.3% of the HIV seropositives would have been HIV tested on clinical suspicion of AIDS. Similarly, the HIV-1 antibody sensitivity and specificity for tuberculosis were 5.9% and 97.9%, respectively. Patients who were HIV-1 infected were more likely to have a history of previous hospital admissions, RR = 1.34 (95% CI = 1.16-1.56), and were at an increased risk of developing tuberculosis, RR = 2.02 (95% CI = 1.50-2.70). The diagnostic categories with the highest HIV-1 infection prevalence were clinical AIDS (88.5%), herpes zoster and other HIV-1 skin manifestations combined (85.7%) and pulmonary tuberculosis (58.3%). In conclusion, the prevalence of HIV-1 infection was high among hospitalized patients in Bukoba hospital indicating that the major cause of illness leading to admission to the hospital may have been underlying HIV-1 infection. The findings also indicate that in a high HIV-1 prevalence area, testing for HIV infection on the basis of clinical suspicion of AIDS alone is not sufficient to provide rational care to the majority of HIV infected patients.

PIP: A study was conducted to assess the prevalence of HIV infection among patients at Bukoba regional government hospital in the Kagera region of Tanzania, the economic impact of AIDS upon health care, and the implications of HIV testing upon clinical suspicion of AIDS. 1471 consecutive admissions were recruited into the study, of whom 1422 completed questionnaires and had their blood sera tested for HIV antibodies. The overall age-adjusted HIV-1 prevalence among the hospitalized patients was 32.8%, with no statistically significant difference in the age-adjusted, sex-specific HIV-1 prevalence rate. The highest HIV-1 prevalence of 53.3% was found among people aged 25-34 years, as well as in the gynecological and medical wards (41.2% and 40.4%, respectively). HIV-1-infected patients were more likely to have a history of previous hospital admissions, and were at an increased risk of developing tuberculosis (TB). The diagnostic categories with the highest HIV-1 infection prevalence were clinical AIDS (88.5%), herpes zoster and other HIV-1 skin manifestations combined (85.7%), and pulmonary TB (58.3%). The prevalence of HIV-1 infection was high among these patients, indicating that the major cause of illness leading to admission to the hospital may have been underlying HIV-1 infection. However, since the diagnostic category of clinical AIDS was only 11.3% sensitive, only 11.3% of the HIV-seropositive cases would have been HIV tested on the clinical suspicion of AIDS. These findings indicate that in a high HIV-1 prevalence area, testing for HIV infection on the basis of clinical suspicion of AIDS alone is insufficient to provide rational care to the majority of HIV-infected patients.

Acceptability of voluntary HIV testing with counselling in a rural village in Kagera, Tanzania.

A pilot study on acceptability of voluntary HIV testing with counselling was performed in a rural village in Kagera, Tanzania as a potential intervention against HIV transmission. Village residents were prepared by their leaders and subsequently invited to health education group meetings to volunteer for the test. Consenting individuals were interviewed to determine awareness and acceptance of the offer followed by pre-test counselling and taking of a blood sample for subsequent HIV testing. Two months later, the results of the test were returned with post-test counselling coupled with a short interview of a random sample of adults in the village. Of the 245 adults responding to the call, 137 (55.9%) subsequently volunteered. The main reason for volunteering was to know the HIV status (96%). Among those who were aware of the offer, the main reason for not volunteering was that they felt unlikely to catch AIDS, implying that they had a false perception of being at low risk. In this study a significant proportion were willing to volunteer for the HIV test and to receive the results, indicating a moderate level of acceptability. The results also indicate the need for developing innovative ways of enhancing acceptability of voluntary HIV testing with counselling. However, the relationship between knowledge of HIV status and behavioural change is complex and therefore several potential mechanisms may exist by which HIV testing in combination with counselling can influence behaviour. For this reason, people should be given the choice of knowing their HIV status since it may constitute a potential mechanism for influencing behaviour towards reduction of HIV transmission.

PIP: The acceptability of voluntary HIV testing with counseling was investigated in a pilot study conducted in a rural village in Kagera, Tanzania, in 1993. Village residents were informed about the study by their leaders and invited to attend health education group meetings to learn more about the study. 245 (54%) of the 450 adults in the village attended the group meetings. 137 attendees (55.9%) volunteered to participate and received both pretest counseling and HIV testing at that time. 2 months later, researchers returned to the village to give test results and conduct post-test counseling. 13 volunteers (9.8%) were HIV-positive. After post-test counseling, half the infected volunteers and 37.5% of HIV-negatives indicated they would adapt safer sex practices, including reducing their number of sexual partners. Interviews conducted at the second visit with 195 village residents revealed half of the volunteers compared with only one-third of nonparticipants had a relative with AIDS. 96% of those who volunteered did so to learn their HIV status. Seven men and 22 women did not want their spouse to know their HIV test result. Among those who were aware of the study but did not volunteer, the main reasons for nonparticipation were the perception of low personal HIV risk and feeling healthy and strong. These findings indicate a moderate level of acceptability of voluntary HIV screening. The extent to which such testing can reduce HIV transmission remains to be addressed in well-controlled studies.

Decline in the prevalence of HIV-1 infection in young women in the Kagera region of Tanzania.

In northwestern Tanzania, a population-based survey of HIV-1 infection in the Kagera region in 1987 demonstrated a high prevalence (24.2%) in adults of Bukoba town, whereas it was lower (10.0%) in the surrounding rural district of Bukoba. In 1993 and 1996, population-based cross-sectional studies were carried out in urban and rural Bukoba districts, respectively, to monitor the time trend in the prevalence of HIV-1 infection in the region. In both studies, a multistage cluster sampling technique was adopted in selecting study individuals. Consenting individuals between 15 and 54 years of age were interviewed using a structured questionnaire. Following individual counseling, blood samples were drawn and tested for HIV infection using enzyme-linked immunosorbent assay (ELISA) antibody detection tests. The overall age-adjusted HIV-1 seroprevalence in urban Bukoba decreased from 24.2% (134 of 553) in 1987 to 18.3% (118 of 653) in 1993 (p = .008). The age-adjusted gender-specific prevalence declined significantly in women, from 29.1% (95 of 325) to 18.7% (74 of 395; p = .0009). Except for men > or = 35 years of age, whose prevalence appeared to have an upward trend between the two studies, all other age groups in both genders had a downward trend; this finding was most significant in women between 15 and 24 years of age (from 27.6% to 11.2%; p = .0004). For the rural population, the overall prevalence decreased from 10.0% (54 of 538) in 1987 to 6.8% (118 of 1728) in 1996 (p = .01). Except for rural women between 15 and 24 years of age whose prevalence decreased from 9.7% (12 of 124) to 3.1% (12 of 383; p = .002), other age groups in the rural populations showed no change in prevalence. Ongoing interventions in this area leading to behavioral change may have contributed to this observation. An incidence study is under way to confirm this observation and to investigate the factors that are responsible for the decline in the HIV-1 prevalence.

PIP: A population-based survey of HIV-1 infection conducted in northwestern Tanzania's Kagera region in 1987 identified a 24.2% HIV prevalence among adults in Bukoba town and a prevalence of 10.0% in the surrounding rural district. In response to these findings, various interventions and community support activities (e.g., IEC, condom distribution, spiritual counseling, home-based care for AIDS patients, and the supply of safe blood for transfusion) were initiated. Additional population-based cross-sectional studies were conducted in the region in 1993 (urban population) and 1996 (rural population) to assess HIV prevalence trends over time. The overall age-adjusted HIV-1 seroprevalence among adults in urban Bukoba decreased from 24.2% in 1987 to 18.3% in 1993; most significant was the decline among women, from 29.1% in 1987 to 18.7% in 1993. With the exception of men 35 years of age and above, whose prevalence showed an upward trend between studies, all other age groups and both genders had a downward trend; this trend was most significant among women 15-24 years of age (from 27.6% to 11.2%). For the rural population, overall HIV-1 seroprevalence declined from 10.0% in 1987 to 6.8% in 1996. With the exception of rural women 15-24 years of age, whose prevalence decreased from 9.7% to 3.1%, other age groups showed no significant change in prevalence. An incidence study is underway to confirm these trends and identify the specific interventions responsible for the decline in HIV-1 prevalence.

Kaposi's sarcoma before and during the HIV epidemic in Tanzania.

The Tanzania cancer registry recorded 39,920 cancer cases from 1968 to 1995. Kaposi's sarcoma (KS) constituted 4% of the cases of which 79.9% were males. During the AIDS period changes in the demographics of KS were noted showing an increase in the diagnosis of KS (p=0.0001). There was an overall decrease in the mean age from 41.7 years before to 37.3 years during the AIDS epidemic (p=0.002). In males this decreased from 42.7 to 38.8 years (p=0.01) but was not statistically significant in females (p=0.06). In both periods the cases were observed in the sexually active age groups. The narrowing of the male/female ratio during the AIDS period (p=0.0004), and an increase in extra-limb lesions from 19.7% before to 48.7% during the AIDS epidemic indicates the emergence of an aggressive form of KS in Tanzania, suggesting a co-factor role of HIV in KS pathogenesis.

Sentinel surveillance and cross sectional survey on HIV infection prevalence: a comparative study.

Despite widespread use of sentinel surveillance systems in monitoring the magnitude of HIV-1 infection in populations, little is known of how the trends they produce compare with those of the larger populations which they support to represent. The objective of this study, therefore, was to assess how useful sentinel surveillance data on HIV-1 infection might be in estimating the magnitude of HIV-1 infection in the general population. To achieve this, results from a population based study on HIV-1 infection in Bukoba town were compared with those from antenatal mothers and blood donors, all from the same town. The studies were done during the period of 1987-90. The overall HIV-1 prevalence was highest in the general population sample at 24.2% (95% CI 20.6-27.8) followed by that in antenatal mothers at 22.4% (95% CI 20.6-25.2) and lowest in blood donors at 11.9% (95% CI 9.1-15.3). Seroprevalence among antenatal clinic attenders was significantly lower than that of females from the general population sample (p = 0.016). Prevalence among female blood donors did not differ significantly from that of females from the general population sample (p = 0.06). Blood donor males had a lower HIV-1 seroprevalence when compared to that from the general population males (p = 0.038). The age group 25-34 years had the highest prevalence of HIV-1 infection in all the three populations indicating that this group is at the highest risk of HIV infection and that the three populations show a similar trend of age specific prevalence. From these findings, it is noted that female blood donors as a sentinel population represents more closely estimates of HIV-1 seroprevalence of females in the general population than antenatal clinic attenders or male blood donors. Further studies are proposed in different settings in order to come up with guidelines on the methodology of using sentinel surveillance populations in monitoring HIV-1 infection.

PIP: Researchers compared the results of a sentinel surveillance study on HIV-1 infection in 1292 pregnant women 15-47 years old attending prenatal care and in 454 blood donors (mean age = 28.7 years) in Bukoba, Tanzania, in 1990 with those from a cross sectional population-based study on HIV-1 infection among 553 people 15-54 years old also conducted in Bukoba during August 1987 to April 1988 to determine which sentinel populations most closely represented the HIV-1 infection rate of the general population. The HIV-1 prevalence rate was 24.4% for the population-based sample, 22.4% for the pregnant women, and 11.6% for the blood donors. The general population females had the highest HIV-1 prevalence rate, while the male blood donors had the lowest rate (29.4% vs. 10.5%). Pregnant women had a significantly lower rate than general population females (22.4% vs. 29.4%; p = 0.016). The 25-34 year old age group had the highest prevalence of HIV-1 infection in all three populations, suggesting that this group faces the highest risk of HIV infection and that the three populations have a similar trend of age-specific prevalence. There were no significant differences between the HIV-1 prevalence rates among general population females and those among female blood donors, suggesting that female blood donors more closely represent the HIV-1 seroprevalence rate of general population females than pregnant women attending prenatal care or male blood donors. There is a need for additional studies in different settings in order to establish guidelines on the methodology of using sentinel surveillance studies in monitoring HIV-1 infection.

Carcinoma of the male breast: a sexually transmitted disease?

Male breast cancer is a rare disease. In an African population, the occurrence of this cancer is high. The male/female ratio in Tanzania is 1:14 (0.071). This narrow ratio does not differ significantly in the majority of sub-Saharan African countries. The overall ratio being 0.0143 (CI = 0.0317-0.877). When this was compared with the ratio of the African American population with breast cancer in USA, it was observed to be significantly high (p < 0.05). The narrow male/female ratio amongst indigenous people with breast cancer in sub-Saharan countries was seen only in those geographical areas where cervical malignancy ranked in the leading position. There is a clear association, with a pronounced linear correlation between these two cancers (r = 0.8). In view of this association it is hypothesised that since cervical cancer behaves as a sexually transmitted disease, then possibly this could also be the case in respect to the male breast carcinoma in sub-Saharan Africa. If these results are confirmed by other investigators, an opportunity to examine the factors contributing to the oncogenesis of this disease may be invaluable in developing prevention and treatment strategies.

Breast cancer and conservative surgery in sub Saharan Africa.

This study investigated the profile of breast cancer patients in Tanzania during 1974-87 period. The results were compared with those of African patients in countries south of the Sahara. The maximum number of patients with breast cancer were seen in the sexually active age groups. In Sudan breast cancer was in leading position amongst all female cancers but with a lower proportion of women below 30 years, 6.4% (95% CI 5.3-7.6); x2 = 7.3 (p = 0.006). While in other sub-Saharan countries the disease ranked second to cervical cancer in frequency, but with a high proportion of patients below 30 years of age. This proportion was highest in Nigeria when compared with other African countries studied 14.7% (95% CI 8.9-22.3); x2 = 3.9 (p = 0.04). Mastectomy continues to be the treatment of choice for breast cancer in the sub Saharan countries despite the fact that this procedure is resented. Also that the Halstedian principle which governed the treatment of the disease for a century now has been disputed regarding its usefulness. The biological basis for adopting conservative surgery for breast cancer, the need for early detection and the oncogenesis of the disease are discussed.

HIV-1 associated Kaposi's sarcoma in an African population.

Eighty-seven patients with Kaposi's sarcoma were studied for human immunodeficiency virus (HIV-1) status, age and gender pattern during a three year period from 1990 to 1992. The results of this prospective study were compared with other Tanzanian series. The mean age in males decreased from 44.9 to 37.2 years for the periods of 1980-82 and 1990-92 respectively (p = 0.0001). No significant change in mean age was observed in females. The gender distribution was altered significantly: the present study recorded a male-female ratio of 2.6:1 compared with that of the pre-AIDS era 1980-82 which was 4:1. The role of HIV-1 infection as a potential cofactor of KS is discussed.

Comparative study of superficial cancer in Tanzania.

Examination of the Tanzania Cancer Registry from 1978 to 1988 showed squamous cell carcinomas to be the most frequent form of superficial malignancy, followed by Kaposi's sarcoma and then malignant melanoma. Males were more afflicted than females, and the lower limbs were predominant sites of the lesion. In terms of relative importance of various types of superficial cancers, the pattern seen in Tanzania was similar to that in another East African country. In a West African country, Kaposi's sarcoma was not common. On the other hand, among blacks in the USA, basal cell carcinomas were almost similar in frequency to squamous cell carcinomas.

Comparative study of superficial cancer in Tanzania

Examination of the Tanzania Cancer Registry from 1978 to 1988 showed squamous cell carcinomas to be the most frequent form of superficial malignancy; followed by Kaposi's sarcoma and then malignant melanoma. Males were more afflicted than females; and the lower limbs were predominant sites of the lesion. In terms of relative importance of various types of superficial cancers; the pattern seen in Tanzania was similar to that in another East African country. In a West African country; Kaposi's sarcoma was not common. On the other hand; among blacks in the USA; basal cell carcinomas were almost similar in frequency to squamous cell carcinomas