Melanin and HIV in sub-Saharan Africa

HIV is common in sub-Saharan Africa. Sexually transmitted bacterial and fungal infections increase the chance of HIV infection. Melanin can prevent the penetration of skin and mucus membranes by microorganisms, and soluble melanin can inhibit HIV replication. We suggest that melanin may reduce the incidence of HIV infection through venereally acquired skin lesions, thus reducing the risk of sero-conversion and slow the progress to AIDS. Indigenous sub-Saharan peoples are highly melanized, but there is pigment variation between populations. We show that skin reflectance, a negative correlate of melanin, is positively associated with adult rate of HIV in sub-Saharan countries. There is no such relationship in populations outside sub-Saharan Africa. We suggest that melanin concentration in black people may correlate with resistance to HIV infection.     

Malaria and urbanization in sub-Saharan Africa

There are already 40 cities in Africa with over 1 million inhabitants and the United Nations Environmental Programme estimates that by 2025 over 800 million people will live in urban areas. Recognizing that malaria control can improve the health of the vulnerable and remove a major obstacle to their economic development, the Malaria Knowledge Programme of the Liverpool School of Tropical Medicine and the Systemwide Initiative on Malaria and Agriculture convened a multi-sectoral technical consultation on urban malaria in Pretoria, South Africa from 2nd to 4th December, 2004. The aim of the meeting was to identify strategies for the assessment and control of urban malaria. This commentary reflects the discussions held during the meeting and aims to inform researchers and policy makers of the potential for containing and reversing the emerging problem of urban malaria.     

Projected benefits from integrating NTD programs in sub-Saharan Africa

The integration of preventive chemotherapy programs (PCPs) targeting multiple neglected tropical diseases (NTDs) with similar strategic approaches offers opportunities for enhanced cost-effectiveness. To estimate the potential cost savings and health outcomes of integrated programs, the data available for five NTDs (lymphatic filariasis, onchocerciasis, intestinal helminthiasis, schistosomiasis and trachoma) can be used to define eligible target populations, the probable overlap of at-risk populations, and the cost per person treated in stand-alone and integrated programs. If all targets for 2006 in sub-Saharan Africa are met, then savings of 26-47% can be projected from such integration (a cost of US dollar 58-81 million versus dollar 110 million for stand-alone PCPs). These first estimates can be refined as empirical data become available from integrated PCPs in the future.     

Early marriage and maternal health care utilisation: Evidence from sub-Saharan Africa

We use the recursive bivariate probit (RBVP) model to estimate the effects of early marriage on the utilisation of maternal health services in five sub-Saharan countries: Burkina Faso, Guinea, Mali, Niger and Chad. Based on recent Demographic and Health Surveys (DHS), we find that a woman who married before age 15 was 17 percentage points less likely to use prenatal services; and marrying before age 16 reduced that likelihood by 9.6 percentage points. We have not found any statistically significant reduction in maternal health care utilisation for women who married at age 17 or older.     

Evidence of sexual recombination among Cryptococcus neoformans serotype A isolates in sub-Saharan Africa

The most common cause of fungal meningitis in humans, Cryptococcus neoformans serotype A, is a basidiomycetous yeast with a bipolar mating system. However, the vast majority (>99.9%) of C. neoformans serotype A isolates possess only one of the two mating type alleles (MATα). Isolates with the other allele (MATa) were recently discovered and proven to mate in the laboratory. It has been a mystery whether and where C. neoformans strains undergo sexual reproduction. Here, we applied population genetic approaches to demonstrate that a population of C. neoformans serotype A clinical isolates from Botswana contains an unprecedented proportion of fertile MATa isolates and exhibits evidence of both clonal expansion and recombination within two partially genetically isolated subgroups. Our findings provide evidence for sexual recombination among some populations of C. neoformans serotype A from sub-Saharan Africa, which may have a direct impact on their evolution.     

Beyond abortion: refusal of caesarean section

Social pressures and legal restrictions are proliferating against pregnant women. A dramatic infringement on women's rights is the court ordered cesarean section, as illustrated by the case of Angela C., a terminally ill cancer patient, 26 weeks pregnant, whose refusal of a cesarean section was overridden by a District of Columbia court. The premature infant and the mother died within two days. This case epitomizes a developing judicial pattern whose ethical reasoning the author criticizes. Within the context of the right to privacy and the concept of viability, which could legally override that right, Mahowald analyzes different situations where cesarean delivery is refused. After arguing that court ordered cesarean sections are inconsistent with court refusals to force persons to undergo less invasive procedures (e.g., bone marrow donation for the benefit of family members), she proposes alternatives to the present inconsistent practice.     

Biotechnology and sustainable development in sub-Saharan Africa

Whether development is defined by the long-standing economic parameter of per capita gross national product (GNP) or by the newly introduced Human Development Index (HDI), which is not based exclusively on per capita GNP, the countries of sub-Saharan Africa rank at or near the bottom of the developing world. Agriculture and agro-based processing are the mainstays of the economies of the majority of these countries. Because of this, and also because many of the diseases endemic in these countries are communicable, the application of modern biotechnology (including genetic engineering, tissue culture and monoclonal antibody technology) and related biotechnologies could play an important part in creating sustainable development in the region. There is, therefore, an urgent need to train more of the region's indigenous citizens, and to equip more laboratories, in modern biotechnology. It is suggested that, in order to accelerate the harnessing of the fruits of biotechnology, more countries in the region should affiliate with the International Centre for Genetic Engineering and Biotechnology (ICGEB). It is further suggested that a regional equivalent of the ICGEB be built and the services of non-governmental biotechnology organizations used.The author is with Nnamdi Azikiwe University, P. M. B. 5025, Awka, Nigeria. Address correspondence to P. M. B. 1457, Enugu, Nigeria     

Molecular dynamics of G6PD variants from sub-Saharan Africa

Precision medicine uses genomic guidance to improve drug treatment safety and efficacy. Prior knowledge of genetic variant impact can enable such strategies, but current knowledge of African variants remains scarce. G6PD variants are linked to haemolytic adverse effects for a number of drugs commonly used in African populations. We have investigated a set of G6PD variants with structural bioinformatics techniques to further characterise variants with known effect, and gain insights into variants with unknown impact. We observed wide variations in patterns of root-mean-square deviation between wild-type and variant structures. Variants with known, highly deleterious impact show structural effects which may likely result in the destabilisation of the G6PD homodimer. The V68M and N126D variants (which are both common across African populations, and together form the A- haplotype) induce large conformational shifts in the catalytic NADP+ binding domain. We observed a greater impact for the haplotype than for each of the individual variants in these cases. A novel African variant (M207T) shows the potential to disrupt interactions within the protein core, urging further investigation. We explore how characterising the molecular impact of African G6PD variants can enable advanced strategies for precision medicine, as well as impact the use of novel therapeutics aiming to treat G6PD deficiency. This knowledge can assist in bridging current knowledge gaps, and aid to facilitate precision medicine applications in African populations.     

Anti-malarial market and policy surveys in sub-Saharan Africa

At a recent meeting (Sept 18, 2009) in which reasons for the limited access to artemisinin-based combination therapy (ACT) in sub-Saharan Africa were discussed, policy and market surveys on anti-malarial drug availability and accessibility in Burundi and Sierra Leone were presented in a highly interactive brainstorming session among key stakeholders across private, public, and not-for-profit sectors. The surveys, the conduct of which directly involved the national malaria control programme managers of the two countries, provides the groundwork for evidence-based policy implementation. The results of the surveys could be extrapolated to other countries with similar socio-demographic and malaria profiles. The meeting resulted in recommendations on key actions to be taken at the global, national, and community level for better ACT accessibility.At the global level, both public and private sectors have actions to take to strengthen policies that lead to the replacement of loose blister packs with fixed-dose ACT products, develop strategies to ban inappropriate anti-malarials and regulate those bans, and facilitate technology and knowledge transfer to scale up production of fixed-dose ACT products, which should be readily available and affordable to those patients who are in the greatest need of these medicines.At the national level, policies that regulate the anti-malarial medicines market should be enacted and enforced. The public sector, including funding donors, should participate in ensuring that the private sector is engaged in the ACT implementation process. Research similar to the surveys discussed is important for other countries to develop and evaluate the right incentives at a local level.At the community level, community outreach and education about appropriate preventive and treatment measures must continue and be strengthened, with service delivery systems developed within both public and private sectors, among other measures, to decrease access to ineffective and inappropriate anti-malarial medicines.What was clear during the meeting is that continuing commitment, strengthened interaction and transparency among various stakeholders, with focus on communities, national governments, and evidence-based policy and action are the only way to sustainably address the control of malaria, a disease which continues to have a significant health and socio-economic impact worldwide, particularly in sub-Saharan Africa.Details on the methodology employed in carrying out the studies discussed at this meeting, as well as more detailed results, data analysis and discussion of the studies are soon to be published.     

Healthcare provider-focused antimicrobial stewardship in sub-Saharan Africa: opportunities and challenges

To address the antimicrobial resistance (AMR) crisis, governments around the world have created action plans to optimize antimicrobial use (AMU). These plans include antimicrobial stewardship (AMS) that encompasses educational programs for healthcare workers. We discuss these programs in sub-Saharan Africa, including the opportunities and challenges arising from a highly constrained healthcare environment.     

Towards control of schistosomiasis in sub-Saharan Africa

Approximately 80% of the 200 million people infected with schistosomiasis inhabit sub-Saharan Africa, and the annual mortality is estimated to be 280,000. Praziquantel is the drug of choice in the treatment of schistosomiasis and pregnant women may now be treated. It was agreed at the World Health Assembly in 2001 that at least 75% of school-aged children in high burden areas should be treated for schistosomiasis and soil-transmitted helminth infections by 2010 to reduce morbidity. A grant from the Bill and Melinda Gates Foundation to the Schistosomiasis Control Initiative, Imperial College of Science, Technology and Medicine, London has enabled control programmes to be initiated in Uganda, Tanzania, Zambia, Burkina Faso, Niger and Mali. Additional programmes have recently commenced in Zanzibar with a grant from the Health Foundation to The Natural History Museum, London and in Cameroon. Combination treatment for schistosomiasis, gastrointestinal helminths and filariasis reduces costs of control programmes. The EC Concerted Action Group on 'Praziquantel: its central role in the chemotherapy of schistosome infection' met in Yaoundé Cameroon in 2004 to discuss recent developments in laboratory and field studies. The use of standard operating procedures will enable data on drug action on schistosomes produced in different laboratories to be compared. With the ever increasing use of praziquantel there is a possibility of the development of resistance by schistosomes to the drug, hence the necessity to explore the activities of other compounds. Artemether, unlike praziquantel, is effective against immature schistosomes. The effectiveness of mirazid, an extract of myrrh, is controversial as data from different laboratories are equivocal. It is suggested that an independent body such as the World Health Organization should determine whether mirazid should be used in the treatment of schistosomiasis.     

Anti-malarial market and policy surveys in sub-Saharan Africa

Background

Malaria microscopy and rapid diagnostic tests are insensitive for very low-density parasitaemia. This insensitivity may lead to missed asymptomatic sub-microscopic parasitaemia, a potential reservoir for infection. Similarly, mixed infections and interactions between Plasmodium species may be missed. The objectives were first to develop a rapid and sensitive PCR-based diagnostic method to detect low parasitaemia and mixed infections, and then to investigate the epidemiological importance of sub-microscopic and mixed infections in Rattanakiri Province, Cambodia.

Methods

A new malaria diagnostic method, using restriction fragment length polymorphism analysis of the cytochrome b genes of the four human Plasmodium species and denaturing high performance liquid chromatography, has been developed. The results of this RFLP-dHPLC method have been compared to 1) traditional nested PCR amplification of the 18S rRNA gene, 2) sequencing of the amplified fragments of the cytochrome b gene and 3) microscopy. Blood spots on filter paper and Giemsa-stained blood thick smears collected in 2001 from 1,356 inhabitants of eight villages of Rattanakiri Province have been analysed by the RFLP-dHPLC method and microscopy to assess the prevalence of sub-microscopic and mixed infections.

Results

The sensitivity and specificity of the new RFLP-dHPLC was similar to that of the other molecular methods. The RFLP-dHPLC method was more sensitive and specific than microscopy, particularly for detecting low-level parasitaemia and mixed infections. In Rattanakiri Province, the prevalences of Plasmodium falciparum and Plasmodium vivax were approximately two-fold and three-fold higher, respectively, by RFLP-dHPLC (59% and 15%, respectively) than by microscopy (28% and 5%, respectively). In addition, Plasmodium ovale and Plasmodium malariae were never detected by microscopy, while they were detected by RFLP-dHPLC, in 11.2% and 1.3% of the blood samples, respectively. Moreover, the proportion of mixed infections detected by RFLP-dHPLC was higher (23%) than with microscopy (8%).

Conclusions

The rapid and sensitive molecular diagnosis method developed here could be considered for mass screening and ACT treatment of inhabitants of low-endemicity areas of Southeast Asia.     

Iron status,malaria parasite loads and food policies: Evidence from sub-Saharan Africa

This brief article investigates the consequences of improving children's iron status for malaria parasite loads by analyzing data from Cote d’Ivoire, Zambia, and Tanzania; the treatment of iron deficiencies has been argued to flare up malaria in under-nourished populations. The data from a randomized controlled trial in Cote d’Ivoire showed statistically insignificant effects of the consumption of iron-fortified biscuits on children's malaria parasite loads. Second, nutrient intakes data from Zambia showed insignificant correlations and associations between children's iron and folate intakes and malaria parasite loads. Third, malaria parasite loads did not change significantly for Tanzanian children receiving anthelmintic treatment; malaria loads were lower for older children and for those using bed nets. Overall, the evidence from sub-Saharan African countries suggests that small improvements in iron status achieved via suitable food policies are unlikely to have detrimental effects for children's malaria parasite loads.     

Biogas technology in sub-Saharan Africa: status, prospects and constraints

Africa is a continent with abundant, diverse and un-exploited renewable energy resources that are yet to be used for improving the livelihood of the vast majority of the population. The production of biogas via anaerobic digestion of large quantities of agricultural residues, municipal wastes and industrial waste(water) would benefit African society by providing a clean fuel in the form of biogas from renewable feedstocks and help end energy poverty. Biogas technology can serve as a means to overcome energy poverty, which poses a constant barrier to economic development in Africa. Anaerobic digestion of the large quantities of municipal, industrial and agricultural solid waste in developing countries present environmental conditions that make use of anaerobic biotechnology extremely favourable under perspective of sustainable development. However, the use of biogas is not widespread in Africa. There are many reasons of economic, technical and non-technical nature for the marginal use of biogas in Africa. The key issue for biogas technology in Africa is to understand why large scale-up has not occurred despite demonstration by several programmes of the viability and effectiveness of biogas plants. This article provides knowledge-based review of biogas technology status, constraints and prospects in Africa. In addition, recommendations to overcome the technological and non-technological challenges to commercialise biogas are discussed. Recommendations for large scale adoption for biogas technology include establishing national institutional framework, increasing research and development, education and training and providing loans and subsidies and major policy shift in the energy sector. The conclusion is that biogas technology must be encouraged, promoted, invested, researched, demonstrated and implemented in Africa.     

Ethnicity and contraceptive use in sub-Saharan Africa: the case of Ghana

Using a sub-sample of ever-married women from the 1993 Ghana Demographic and Health Survey (GDHS), this study examines differentials in contraceptive use in six cultural groups: Ga-Adangbe, Twi, Fante/other Akans, Ewe, Guan/others and Mole-Dagbani. Multivariate analysis is used to explore whether reported ethnic differentials in contraceptive use can be attributed to ethnicity or to other characteristics that distinguish the ethnic groups. Overall, the findings are generally more consistent with the 'characteristics' hypothesis, because contraceptive use differentials by ethnic group is accounted for by differences in socioeconomic and demographic characteristics of these women. However, for the Fante/other Akans, even after the necessary controls, ethnicity continued to emerge as a significant determinant of contraceptive use. Programmatic implications of these results are discussed.