Attitudes of men towards family planning in Mbeya region, Tanzania: a rural-urban comparison of qualitative data

Family planning programmes in Tanzania date back to the 1950s. By the early 1990s, however, only 5-10% of women of childbearing age used contraceptives in the country. Low contraceptive prevalence in Tanzania is reportedly attributable to men's opposition to family planning. This paper employs focus groups to explore the role of Tanzanian men in family planning. More specifically, it presents a rural-urban comparison of the attitudes of men in Mbeya region, Tanzania, to family size preference, sex composition, partners' communication on family planning matters and contraceptive behavior. Findings indicate that men express positive attitudes towards fertility-regulating methods. There is, moreover, little rural-urban variation in male attitudes towards family planning in the study area. Possible reasons for this normative convergence (including structural similarities and rural-urban migration between the two communities) are discussed.     

Thoracic empyema in Dar es Salaam, Tanzania

A review of 114 thoracic empyema cases attended in the thoracic unit of the Muhimbili Medical Centre from July 1986 to July 1990 is presented. 87.7% of the cases were males. Their ages ranged from 9 to 79 years with a mean of 32 years. Tuberculosis was the major cause accounting for 63.2% of all the cases. 53.4% of the patients underwent either open chest drainage decortication or thoracoplasty. The duration of hospital stay ranged from 2-8 months with a mode around 3.5 months. A 7% mortality was noted.     

A serological survey of measles vaccine in a rural region of Eski?ehir in Turkey

Haematuria and proteinuria are important symptoms of primary and secondary nephropathies. We report three african children presenting to our center in whom infection with S. haematobium resulted in haematuria and proteinuria. The third patient concomitantly suffered from steroid-sensitive relapsing nephrotic syndrome with the histological features of focal and segmental glomerulo-sclerosis. The diagnosis was in all cases established by light microscopy and urinary symptoms improved after treatment with praziquantel. In the third patients long term remission of the nephrotic syndrome could be maintained after 4 doses of praziquantel for recurrent bladder symptoms. We conclude that bilharziosis must be considered in the differential diagnosis of children with haeamturia and proteinuria even in Europe. The diagnosis can be established easily by light microscopy and an effective and low-risk treatment (with Praziquantel) can be offered.     

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

Illness representations were assessed in 63 adults with rheumatoid arthritis (RA) and 66 with multiple sclerosis (MS). The relationship of illness representations to concurrent and later mood was explored. MS patients' beliefs in symptom variability were associated with higher depressed mood 4 months later, over and above initial levels of depression. RA patients who saw RA as curable or who saw themselves as responsible for the illness reported significant increases in depression over time. Belief in the serious consequences of RA interacted with later illness severity to predict change in depression. When belief in the serious consequences of RA was high, less severe illness status was associated with less depression and more severe illness status was associated with more depression. When RA was initially viewed as only moderately serious, less severe illness was associated with somewhat higher levels of depression.     

Comparative investigation of the long non-coding M-F genome region of wild-type and vaccine measles viruses

The sequence of the 300 nucleotides region of the measles virus genome was determined that includes a part of the 3'-untranslated region of the matrix (M) gene, the intergenic region and a part of the 5'-untranslated region of the fusion (F) gene [M-F region] for vaccine strain Leningrad-16 and 14 wild-type isolates. The data obtained demonstrate the variability of this long non-coding M-F region. No mutations in this region of the genome were found which seem to be specific for vaccine strains of measles virus (MV).     

Efficacy of measles vaccine during the 1993 measles epidemic in Korea

Immunization to eliminate measles is recommended at 15 months of age with the option of giving vaccine at 6 to 9 months of age during measles outbreaks in Korea. Because of the recent resurgence of measles and concern about the possibility of reduced vaccine efficacy caused by genomic differences between vaccine virus and contemporary wild measles viruses, we conducted a measles vaccine efficacy study involving children with household exposure ages 1 to 5 years during measles outbreak that had occurred 1993 in Seoul and Seong-nam city, with the demographic analysis of patients brought to the hospitals. A total of 380 patients (M:F = 216:164) were included in this study. Two hundred nine cases (55.0%) occurred in children less than 5 years of age, and 167 (43.9%) were younger than 16 months of age. The recorded age-specific incidence rates showed bimodal patterns, i.e. highest peak in those below 16 months of age and second peak in those ages 6 to 9 years of age. Only 9.6% (16 of 167) of the measles cases less than 16 months, 59.5% (25 of 42) of those 16 months to 4 years and 91.8% (157 of 171) of the cases in school age children have been vaccinated. Attack rates among the 122 vaccinated siblings and 12 unvaccinated siblings ages 1 to 5 years who contacted measles were 5.7 and 75%, respectively, and the clinical vaccine efficacy was 92.4% (95% confidence interval, 83.6, 96.4). The high vaccine efficacy in household exposures suggests that measles outbreaks in Korea are not caused by reduced vaccine efficacy.     

Susceptibility to measles, rubella and parotitis in young adults

BACKGROUND: The aim of this study was to know the prevalence of antibodies against measles, rubella and parotiditis in young adults. METHODS: The study was carried out in health care students during the academic year of 1992-1993. Demographic and geographic variables were obtained as were vaccination and history of diseases. Antibodies against measles, rubella, and parotiditis were determined by ELISA techniques with commercial reagents. RESULTS: Three hundred and six individuals of 21.3 +/- 2.2 years (range 17-36 years) with 27.5% being males were studied. Past history of measles, rubella and parotiditis was reported in 43.5, 30.7 and 37.3%, respectively, with vaccination being 23.2, 43.8 and 20.6%, respectively. The prevalence of antibodies was 93.1% (measles), 96.4% (rubella) and 92.1% (parotiditis). CONCLUSIONS: The prevalence of infection of measles, rubella and parotiditis in the young population studied is mainly due to infection by wild type virus. The foreseeable growth of susceptibility groups in this population which should be adequately evaluated by extensive seroepidemiologic questionnaires, favors the appearance of epidemic outbreaks. The use of the triple viral vaccine is suggested as an alternative to rubella vaccination in presumable susceptible young women.     

HIV infection among pregnant women in Lindi, Tanzania, 1989-1993

One obstacle to contain the HIV-1 epidemic in the general population in Africa is a lack of knowledge about how it is spread in rural areas. We examined 683 pregnant women in 1989 and 484 in 1993 who attended antenatal clinics in Lindi district, Tanzania to determine changes in the prevalence of HIV-1 in a remote area in East Africa. The prevalence rose from 0.44% in 1989 to 8.7% in 1993. Women with more than 1 partner (17.25% vs 2.78%), STD patients (42.4% vs 6.2%), women from urban areas (10.2% vs 3.57%) and patients younger than 21 years were more likely to have HIV antibodies. By logistic regression analysis, 1993 as year of testing was associated with the greatest risk for HIV seropositivity (P < 0.00002) followed by clinical signs of STD (P < 0.00005) and urban residence (P = 0.0275). Teaching of all women attending antenatal care how to minimize their future risk of acquiring HIV is urgently needed as one tool to prevent a fast spread of HIV throughout the continent.     

Age-related seroprevalence of measles, mumps and rubella antibodies in 1996

In 1996 the effects on the immunity profile of a Swiss population exposed to MMR vaccination, which has been recommended since 1985, were evaluated with an age-stratified seroprevalence study for measles, mumps and rubella (MMR). At the age of 1.5-2.5 years, seroprevalence attained 76% for measles and rubella, which is respectively 17% and 24% above the values observed in 1992. The seroprevalence for mumps attained only 55% at the same age, which could reflect the poor immunogenicity of this component of the MMR vaccine. The seroprevalence for measles IgG showed a slow but steady increase from vaccination age to adulthood, attaining nearly 100%. The concentrations of measles IgG were about 700 IU/l into adolescence and rose to a plateau at about 1500 IU/l during young adulthood. These observations are compatible with low endemic activity of measles in the last 20 years and a predominance of vaccine-induced immunity up to about 20 years of age. This corresponds to the time period when measles vaccines--single or as MMR--have been in use. In 1992, at the peak of epidemic activity, seroprevalence for mumps rose substantially faster than in 1996. In addition, the rapid increase in quantitative values during preschool age mirrors the ongoing wild virus circulation with minimal vaccine effect. In the vaccine cohort (2-12 years of age) the seroprevalence of rubella IgG reached 70-80%. That there is no rise in the curve during school age shows that the recommended catch-up vaccinations before or during school age have been neglected. The median concentrations of rubella IgG were about 65 IU/ml at vaccination, declined to 40-50 IU/ml during preschool age, and rose again during school age, suggesting wild virus circulation. These data show that the MMR vaccine cover in Swiss children is insufficient to interrupt virus circulation, and administration of a second dose of MMR for catch-up immunisation has been omitted. The poor efficacy of the mumps component of the MMR vaccine that has mainly been used in Switzerland is also evident. The average age at infection is therefore expected to rise, thus involving a risk of increasing age-dependent complications. Efforts to implement the MMR vaccination program in Switzerland should be improved.     

Growth of rubella, measles and mumps viruses in rat fetus

The larvae of 12 cestode species of the genus Aploparaksis have been studied. In order to confirm the determination, the definitive hosts, birds, were experimentally infected with 5 species and the intermediate hosts, oligochaetes, with 6 species of cestodes. A great variability was observed in the morphology of tail appendix of cysticercoids belonging to five types of larvae. It is assumed that the polymorphism of larvae of the genus Aploparaksis results from the morphological adaptation to the development under arctic conditions.     

The knowledge of pediatricians in Salvador, Brazil about measles vaccine

The success of international initiatives for the eradication of measles depends in large part on knowledge about vaccination. In 1992, a cross-sectional study was carried out to evaluate knowledge about measles vaccine among pediatricians in the Brazilian city of Salvador, Bahia. Of the 506 pediatricians residing in the city, 299 (59%) could be located and responded to a questionnaire containing 15 questions that posed hypothetical situations regarding indications and contraindications for this vaccine. The average number of correct responses was 9.3 out of 15, which illustrates the pediatricians' poor knowledge of measles vaccine. Conditions commonly seen in pediatric practice in Brazil--malnutrition, upper respiratory tract infection, diarrhea, and prematurity--were often erroneously considered contraindications for immunization. More than half (62%) of the pediatricians did not know the correct way to administer the vaccine. Knowledge about the vaccine did not differ according to the length of time that had elapsed since the physicians' university training in pediatrics or as a result of working in health centers operated by the State Health Secretariat. University professors, pediatricians with a postgraduate degree, and those pursuing postgraduate studies scored slightly higher than the rest. These results point to the need to strengthen training on measles vaccination in medical schools and programs of continuing education for pediatricians.