Leptospira prevalence is high in catfish and tilapia -- Tanzania Journal of Health Research Vol.16 No.2

Today we are featuring the Tanzania Journal of Health Research vol.16 no.2. It was updated on Bioline in July. 

This issue includes "Leptospira infections in freshwater fish in Morogoro Tanzania: a hidden public health threat" by Mgode et al. This study looks at Leptospirosis, an infection which affects both animals and humans. The infection is caused by the spirochete bacterium genus of Leptospira. Birds and rodents have the capability of transmitting leptospires. This study aims to examine Leptospira in fish and assess the public health risk this could pose. Researchers examined 48 live tilapia, catfish and eel fish caught in Mindu Dam in the Morogoro Municipality in eastern Tanzania. Blood samples were collected for serological detection of leptospirosis using a microagglutination test, using local and reference Leptospira serovars Sokoine, Kenya, Pomona and Hebdomadis. 26 of the first tested positive for serovars Kenya and Sokoine. Leptospira prevalence was high in catfish and tilapia. The results indicated that different fish types are infected with Leptospira, and that fish could be a source of Leptospira infections in humans, especially because catfish and tilapia are widely consumed in Tanzania. The study concludes that further research on bodies of water such as dams and lakes needs to be done to assess public health risk.

This article also includes "Providing anti-retroviral therapy in the context of self-perceived stigma: a mixed methods study from Tanzania" by Tarimo & George. This mixed-method study examines how stigma and the perceived influence of stigma can affect the adherence of anti-retroviral therapy among patients prescribed anti-retroviral therapy and health care providers. 295 patients were given a survey. 95% of patients said they were satisfied at the services provided by the Care and Treatment Centres. 36% of patients said the set-up of care was associated with stigma. 30% said the line-ups were also a contributing factor to stigma. Influence of stigma on adherence to anti-retroviral therapy was further examined through focus group discussions with health care providers. In these discussions, health care providers mentioned that the set-up of Care and Treatment Centres created a friendly environment but violated confidentiality. They also said that many patients receiving anti-retroviral therapy hid identification cards to avoid being recognized, rushed to avoid being recognized, and in their rush picked up the wrong medicine. Lastly, health care providers said that some patients threw away the box with the manufacturer's instructions on it, and as a result took the wrong dosages. The study concluded that dosage instructions should be given in another form. The study also suggested that Care and Treatment Centre adopt a dispensing window for all patients and an appointment system could help reduce stigma and line-ups.

You can find these articles and other articles from this issue here.

Esha Homenauth -- A Student Perspective: Role of Nutrition in Anti-Retroviral Therapy

In Africa, approximately 25 million people are victim to HIV/AIDS (UNAIDS, 2006). In Malawi 46% of young adults between the ages of 15-24 are affected, with 60% of the infections occurring mostly among girls. Gender, demographic and geographical discrepancies in HIV/AIDS prevalence exists within the country, reinforcing the need for government interventions. Through improved education on modes of HIV transmission, risk reduction, blood screening and efficient barrier methods, antibody testing, disclosure and notification of partners, prevention of mother-to-child transmission (PMTCT) services, medical treatment and management of infected individuals including the use of anti-retroviral therapy (ART), the risk of transmission of HIV/AIDS will be greatly reduced.

Wasting and weight loss are the main problems among HIV-infected individuals. Adequate nutrition is important for successful ART. Research shows that malnutrition prior to ART is significantly associated with increased mortality (Ni et al, 2006). As such, nutritional intervention plays an integral role in the HIV treatment program, reinforcing the need for an improved diet to enhance ART acceptability, adherence and effectiveness.

A study by Bisika and Mandere published in vol. 20 no 3 of the Malawi Medical Journal focuses on identifying an intervention that would complement the the use of ART in Malawi. Qualitative data was collected through consultative workshops and in-depth interviews with health professionals and representatives from community-based organizations. 85% of the ART beneficiaries reported inability to afford a balanced diet due to illness, while 17% reported missed treatment due to lack of food. Bisika and Madere argue that the institutional capacity to implement nutritional support is limited due to already strained human resources, food storage facilities and size of health facilities. They also highlight the cost associated with nutritional support for ART beneficiaries as well as differential food assistance for individuals at different stages of infection.

Most patients on ART battling HIV indicate the need for nutritional support when ill.Health officials suggested the need for therapeutic and supplementary feeding and food rationing for individuals experiencing weight loss due to malnutrition. Therapeutic and supplementary feeding was provided based on information about adult BMI, pregnant or lactating mothers and children weight for height ratio. Due to unfamiliarity of therapeutic nutrition, the need for nutritional education is imperative. Food rationing was provided to individuals who lacked food security. Researchers suggest that advances in nutrition for HIV infected individuals on ART will require increasing the number of facilities that provide nutritional support as well as addressing limitations such as irregular food supplies and human resources.

In summary, this paper highlights the importance of adequate nutrition for individuals affected with HIV/AIDS. An appropriate diet is important for all individuals utilizing anti-retroviral therapy, not just those affected in developing countries. However, the role of nutrition is fundamental in developing countries due to unpredictable availability and unequal distribution of food supply. Information regarding the measures in place in developing countries like Malawi is important as it highlights the short comings in dealing with the HIV/AID epidemic. In Malawi, as the number of individuals affected by HIV/AIDS increases, the pressure on these already strained resources also increases. Providing open access to this article as well as others in this issue allow relevant information regarding the importance of improved nutrition on the health status of HIV/AIDS-affected individuals. It allows provides a forum for discourse among public health officials in these developing countries to seek out interventions in order to improve the livelihood of these infected individuals.

Bisika, T., & Mandere, G.(2008)Integration of nutrition in the antiretroviral therapy scale up plan for Malawi. Malawi Medical Journal; 20(3):93 - 98