Urban/rural differences in prevalence and risk factors for intestinal helminth infection in southern Malawi.

Urbanization may increase the risk of human infection with intestinal helminths. A cross-sectional survey was conducted to investigate the prevalence, intensity and potential risk factors of acquiring such infection, among children aged 3-14 years in similar urban and rural communities in southern Malawi. Stool samples were collected from 553 children (273 urban and 280 rural). The overall prevalence of helminth infection was significantly higher in the urban subjects than in the rural (16.5% v. 3.6%; P < 0.001), mostly because of differences in the prevalence of Ascaris lumbricoides infection. Living in an urban community was associated with a significantly higher risk of infection [odds ratio (OR) = 5.3; 95% confidence interval (CI) = 2.6-12.1], even after controlling for potential confounding factors. In the urban community, risk factors included having pools of water/sewage around houses (OR = 3.0; CI = 1.4-6.5), not wearing shoes (OR = 7.1; CI = 2.7-19.2), not attending school (OR = 2.8; CI = 1.2-6.5), having mothers with 4-8 years of education (OR = 5.2; CI = 2.0-14.0), and having mothers below 35 years of age (OR = 4.09; CI = 1.39-16.28). In this part of Africa, efforts to reduce helminth infections may best be focused on reducing geohelminth burden in urban areas.

Aetiological and epidemiological aspects of acute head injury in Malawi.

One hundred and four patients (88 males and 16 females) with acute head injuries admitted to the Queen Elizabeth Central Hospital, Blantyre from July 1st to December 31st 1995 were prospectively studied using a questionnaire. Forty seven (45.2%) of the injuries were caused by road traffic accidents, 42(40.4%) by assaults, nine (8.7%) resulted from falls from heights, two (1.9%) from occupational injuries and the remaining four (3.8%) were of miscellaneous origins. RTA associated head injuries involved 17 (36.2%) pedestrians; 14 (29.8%) vehicular passengers, 10 (21.3%) pedal cyclists; five (10.6%) drivers and one motor cyclist. Malawi males aged between 20 and 29 were mostly involved. Assault related head injuries occurred also in young adult males commonly at the weekend with more than 50% occurring on Saturday and Sunday. Fifty per cent were sustained at home, a quarter on the streets and surprisingly few at drinking houses making them the safest place to be in Malawi to avoid assaults! Alcohol usage was not statistically significant among those assaulted; it was not possible to define its aetiological role among assailants. The head injuries associated with falls from heights (FFH) involved eight males and one female; five were children. Strategies for the prevention of assaults, the various types of road traffic accidents and falls from heights are discussed.

Pattern of acute head injuries in Kuwait.

Of two hundred and six consecutive head injuries, 28% had fallen from heights, and 58% had been involved in road traffic accidents, mainly pedestrians (50%). Head injury preventive measures in Kuwait should be directed to road traffic accidents and falls from heights.

Sexual behaviour and use of the condom by men attending gay bars and clubs in Glasgow and Edinburgh.

How widespread are the safer forms of sexual behaviour reportedly adopted by male homosexuals in recent years? A questionnaire was completed by 173 and 83 gay men attending gay bars and clubs in Edinburgh and Glasgow respectively. Comparisons were made between those who reported using the condom (n = 137, [54%]) and those who did not (n = 119, [46%]). Sixty percent of respondents reported more than 5 partners during the previous year. Condom use was much less common among men with less than 5 years' experience as a practising homosexual. Less than one-fifth of respondents reported always using a condom during anal intercourse. Orogenital contact without a condom was reported by 84% of all respondents, and unprotected anal intercourse by 40%, (over 30% for those who used condoms). About one-third of condom users but only 14% of non-users thought they were at risk of catching HIV because of their sexual behaviour, although 80% of users and 70% of non-users said their lifestyles had been affected by the HIV epidemic. While there were some encouraging signs of behaviour change, unprotected anal sex is still widely practised. Gay bars and clubs represent important venues for conveying the safer sex message.

PIP: Completed questionnaires were received from 173 and 83 gay men attending gay bars and clubs in Edinburgh and Glasgow, respectively, in a study of respondents' sexual behavior and condom use. The questionnaire response rate in Glasgow was half that achieved in Edinburgh. Respondents were of mean age 28 years who had had sex with men in the past year. 21% also reported having at least one female sex partner during that period. 60% reported having more than five sex partners during the previous year. 137 reported using condoms and 119 reported not using them. Condom use was relatively less common among men with less than five years experience as a practicing homosexual. Less than 20% of respondents reported always using a condom during anal intercourse. Orogenital contact without a condom was reported by 84% of all respondents and unprotected anal intercourse by 40%. 31% of condom users and 14% of non-users thought they were at risk of contracting HIV because of their sexual behavior, but 80% of users and 70% of non-users said their lifestyles had been affected by the HIV epidemic. The authors note on the basis of these findings that unprotected anal sexual intercourse remains widely practiced despite some encouraging signs of behavior change. As such, gay bars and clubs are important venues in which safer sex messages could be conveyed.