Southern African Journal of HIV Medicine - Volume 2004, Issue 16, August 2004

<I>Objective</I>. To determine the efficacy of secondary preventive therapy against tuberculosis (TB) among goldminers working in South Africa. <br><I>Design</I>. An observational study. <br><I>Methods</I>. The incidence of recurrent TB was compared between two cohorts of HIV-infected miners: one cohort had received secondary preventive therapy with isoniazid and the other had not. <br>Setting. Health service providing comprehensive care for goldminers. <br>Participants. 338 men received secondary preventive therapy and 221 did not. <br><I>Main outcome measure</I>. Incidence of recurrent TB. <br><I>Results</I>. The overall incidence of recurrent TB was reduced by 55% among men who received isoniazid preventive therapy (IPT) compared to those who did not (incidence rates 8.6 and 19.1 per 100 person-years respectively, incidence rate ratio 0.45; 95% CI 0.26 - 0.78). The efficacy of isoniazid preventive therapy was unchanged after controlling for CD4 count and age. The number of person-years of isoniazid preventive therapy required to prevent one case of recurrent TB among individuals with a CD4 count < 200/µl and >200/µl was 5 and 19, respectively. <br><I>Conclusion</I>. Secondary preventive therapy reduces TB recurrence: the absolute impact appears to be greatest among individuals with low CD4 counts. International TB preventive therapy guidelines for HIV-infected individuals need to be expanded to include recommendations for secondary preventive therapy in settings where TB prevalence is high.

<I>Study design</I>. A retrospective descriptive study of the mortality trend among inpatients at Motebang district hospital in Lesotho. <br><I>Aim</I>. To assess the impact of HIV / AIDS on the mortality of Motebang Hospital inpatients from 1989 to 2003. <br><I>Rationale</I>. If the hypothesis that AIDS had modified the mortality in a unique way could be confirmed, mortality trends could be used to supplement other methods of estimating the impact of HIV / AIDS such as antenatal and sexually transmitted infections sentinel surveillance. <br><I>Methodology</I>. Inpatients' data were collected from January 1989 to December 2003. The 15-year period was split into three 5-year periods (1989 - 1993, 1994 - 1998, and 1999 - 2003) and the diagnoses were grouped into Global Burden of Disease groups I, II, and III. The data were analysed to establish time, gender and age trends. <br><I>Results</I>. The mortality rate and number of deaths increased over the 15-year period. Group I (communicable diseases, maternal, perinatal, and nutritional conditions) contributed 69% of all deaths. The rise in mortality was most pronounced in the 15 - 49-year age range, progressively forming a 'bulge' on the death incidence by age curve, with the female peak occurring at the 25 - 29-year age category, 5 years earlier than males. The study found that AIDS-related deaths accounted for 51 - 65% of total deaths and 70 - 80% of group I deaths. Although the number of the inpatients in group II was low, there was evidence of increasing burden from non-communicable diseases. However, the burden from group III (injuries) remained stable. <br><I>Conclusion</I>. AIDS modified the mortality trend of the Motebang Hospital inpatients by raising the deaths of younger adults, thereby deviating from the expected natural trend. This implied that mortality data of the hospital provenance can provide information necessary for, <I>inter alia</I>, evaluation of the impact of current and future interventions, for instance, the impact of the proposed provision of antiretroviral drugs.

<I>Background</I>. The risk of vertical transmission of HIV during breast-feeding has prompted renewed interest in the role of supplementary feeding during childhood. However, it is also known that supplementary feeding is an important vector of disease transmission. The aim of this study was to investigate the level of microbial contamination present in bottle feeds given to infants living in Mangaung, South Africa. <br><I>Methods</I>. The study followed a cross-sectional design. Two hundred randomly selected households were visited and caregivers of bottle-feeding infants in the selected area were requested to provide a sample of the infants' bottle feed. Nutritional and microbial content of each bottle feed were measured. Bottle feeds were classified as unfit for human consumption if they had a standard plate count greater than 50 000 organisms per millilitre feed, or a total coliform count greater than 10 coliform organisms per millilitre. <br><I>Findings</I>. A total of 84.5% of all the bottle feeds were classified as unfit for human consumption. There was no major difference in nutritional quality of the fit and unfit feeds. The infants receiving unfit bottle feeds were younger than those receiving fit bottle feeds (11.1 ± 6.9 months compared with 14.0 ± 7.6 months, respectively; p = 0.010) and also weighed less. &lt;br&gt;&lt;I&gt;Interpretation&lt;/I&gt; This finding underlines the need to address the content of feeding literacy programmes. Bottle-feeding in Mangaung is currently not a safe alternative to breast-feeding and should therefore not be promoted.