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Audet CM, Shepherd BE, Aliyu MH, Moshabela M, Pettapiece-Phillips MJ, Wagner RG. Healer-led vs. clinician-led training to improve personal protective equipment use among traditional healers in South Africa: a randomized controlled trial protocol. Glob Health Action 2021; 14:1898131. [PMID: 33797347 PMCID: PMC8023590 DOI: 10.1080/16549716.2021.1898131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/01/2021] [Indexed: 11/30/2022] Open
Abstract
There are estimated two million traditional healers in sub-Saharan Africa (SSA), with more than 10% (200,000) working in South Africa. Traditional healers in SSA are frequently exposed to bloodborne pathogens through the widespread practice of traditional 'injections', in which the healers perform dozens of subcutaneous incisions to rub herbs directly into the bloodied tissue with their hands. Healers who report exposure to patient blood have a 2.2-fold higher risk of being HIV-positive than those who do not report exposure. We propose a randomized controlled trial (61 healers in the intervention group and 61 healers in the control group) in Mpumalanga Province. Healers will receive personal protective equipment (PPE) education and training, general HIV prevention education, and three educational outreach visits at the healer's place of practice to provide advice and support for PPE use and disposal. Healers in the control arm will be trained by health care providers, while participants in the intervention arm will receive training and outreach from a team of healers who were early adopters of PPE. We will evaluate intervention implementation using data from surveys, observation, and educational assessments. Implementation outcomes of interest include acceptability and feasibility of PPE use during clinical encounters and fidelity of PPE use during treatments that involve blood exposure. We will test our two intervention strategies to identify an optimal strategy for PPE education in a region with high HIV prevalence.
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Affiliation(s)
- Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Muktar H. Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mosa Moshabela
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | | | - Ryan G. Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
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Audet CM, Gobbo E, Sack DE, Clemens EM, Ngobeni S, Mkansi M, Aliyu MH, Wagner RG. Traditional healers use of personal protective equipment: a qualitative study in rural South Africa. BMC Health Serv Res 2020; 20:655. [PMID: 32669101 PMCID: PMC7362457 DOI: 10.1186/s12913-020-05515-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Traditional healers are frequently exposed to hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) through the widespread practice of traditional "injections", in which the healer performs dozens of subcutaneous incisions using a razor blade to rub herbs directly into bloodied tissue. An average healer in Agincourt, a rural northeastern sub-district in Mpumalanga province, South Africa, experiences approximately 1500 occupational blood exposures over the course of their lifetime. Healers in Agincourt have an HIV prevalence of 30% compared to 19% in the general population, and healers who report exposure to patient blood have an adjusted 2.4-fold higher odds of being HIV-positive than those with no exposure. Although research on appropriate PPE use has been well documented for allopathic care providers, little is known about the practices of traditional healers. METHODS This qualitative study was conducted with 30 traditional healers who practice in the rural Bushbuckridge sub-district of Mpumalanga province, northeastern South Africa. We elicited traditional healer attitudes towards glove use during traditional treatments - including patient baths, injections, or other treatments that exposed healers to patient blood or open sores. RESULTS While 90% of healers reported using latex gloves during some treatments, the majority do not use them regularly. Most employ a combination of gloves, plastic shopping bags, bread bags, paper, and sticks to prevent blood exposure. Healers reported plastic bags slipping or breaking during procedures, exposing them to patient blood. Only three healers consistently used gloves, regardless of the cost. CONCLUSIONS Inadequate PPE use and high HIV prevalence make traditional healers particularly susceptible to contracting HIV in rural South Africa. Despite positive attitudes, consistent glove use remains low due to financial constraints and glove availability. Addressing issues of accessibility and cost of gloves for traditional healers could have a significant impact on the adherence to PPE and, in turn, reduce new HIV infections among this high-risk group.
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Affiliation(s)
- Carolyn M Audet
- Department of Health Policy, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1200, Nashville, TN, 37203, USA.
| | - Elisa Gobbo
- Vanderbilt University, 2201 West End Ave, Nashville, TN, 37235, USA
| | - Daniel E Sack
- School of Medicine, Vanderbilt University, 1161 21st Ave S # D3300, Nashville, TN, 37232, USA
| | - Elise M Clemens
- School of Medicine, Vanderbilt University, 1161 21st Ave S # D3300, Nashville, TN, 37232, USA
| | - Sizzy Ngobeni
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa
| | - Mevian Mkansi
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa
| | - Muktar H Aliyu
- Department of Health Policy, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1200, Nashville, TN, 37203, USA
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa
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Crabtree KL, Wojcicki JM, Minhas V, Kankasa C, Mitchell C, Wood C. Association of Household Food- and Drink-Sharing Practices With Human Herpesvirus 8 Seroconversion in a Cohort of Zambian Children. J Infect Dis 2017; 216:842-849. [PMID: 28961804 DOI: 10.1093/infdis/jix399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Human herpesvirus 8 (HHV-8) infection occurs in early childhood and is associated with human immunodeficiency virus type 1 (HIV-1) infection and risk for Kaposi sarcoma, but behaviors associated with HHV-8 transmission are not well described. Methods We enrolled and followed a prospective cohort of 270 children and their household members to investigate risk factors for HHV-8 transmission in Lusaka, Zambia. Results We report an incidence of 30.07 seroconversions per 100 child-years. Independent risk factors for HHV-8 incident infection included having a child who shared utensils with a primary caregiver (hazards ratio [HR], 2.33; 95% confidence interval [CI], 1.49-7.14), having an increasing number of HHV-8-infected household members (HR, 1.27; 95% CI, 1.09-2.79), and having ≥5 siblings/children in the household (HR, 2.24; 95% CI, 1.03-4.88). Playing with >5 children a day was protective against infection (HR, 0.54; 95% CI, .33-0.89), as was increasing child age (HR, 0.96; 95% CI, .93-.99). Conclusions This is the first study to find a temporal association between limited child feeding behaviors and risk for HHV-8 infection. Child food- and drink-sharing behaviors should be included in efforts to minimize HHV-8 transmission, and households with a large number of siblings should receive additional counseling as childhood infections occur in the home context.
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Affiliation(s)
- Kay L Crabtree
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska, Lincoln, Nebraska.,Department of Biomedical Sciences, Bryan College of Health Sciences, Lincoln
| | - Janet M Wojcicki
- Department of Pediatrics, University of California, San Francisco
| | - Veenu Minhas
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska, Lincoln, Nebraska.,Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Chipepo Kankasa
- Department of Pediatrics, University Teaching Hospital, University of Zambia, Lusaka, Zambia
| | | | - Charles Wood
- Nebraska Center for Virology and the School of Biological Sciences, University of Nebraska, Lincoln, Nebraska.,Department of Biochemistry, University of Nebraska-Lincoln
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Smiley Evans T, Lowenstine LJ, Gilardi KV, Barry PA, Ssebide BJ, Kinani JF, Nizeyimana F, Noheri JB, Cranfield MR, Mudakikwa A, Goldstein T, Mazet JAK, Johnson CK. Mountain gorilla lymphocryptovirus has Epstein-Barr virus-like epidemiology and pathology in infants. Sci Rep 2017; 7:5352. [PMID: 28706209 PMCID: PMC5509654 DOI: 10.1038/s41598-017-04877-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/22/2017] [Indexed: 01/10/2023] Open
Abstract
Epstein-Barr virus (EBV) infects greater than 90% of humans, is recognized as a significant comorbidity with HIV/AIDS, and is an etiologic agent for some human cancers. The critically endangered mountain gorilla population was suspected of infection with an EBV-like virus based on serology and infant histopathology similar to pulmonary reactive lymphoid hyperplasia (PRLH), a condition associated with EBV in HIV-infected children. To further examine the presence of EBV or an EBV-like virus in mountain gorillas, we conducted the first population-wide survey of oral samples for an EBV-like virus in a nonhuman great ape. We discovered that mountain gorillas are widely infected (n = 143/332) with a specific strain of lymphocryptovirus 1 (GbbLCV-1). Fifty-two percent of infant mountain gorillas were orally shedding GbbLCV-1, suggesting primary infection during this stage of life, similar to what is seen in humans in less developed countries. We then identified GbbLCV-1 in post-mortem infant lung tissues demonstrating histopathological lesions consistent with PRLH, suggesting primary infection with GbbLCV-1 is associated with PRLH in infants. Together, our findings demonstrate that mountain gorilla's infection with GbbLCV-1 could provide valuable information for human disease in a natural great ape setting and have potential conservation implications in this critically endangered species.
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Affiliation(s)
- Tierra Smiley Evans
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA.
| | - Linda J Lowenstine
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
| | - Kirsten V Gilardi
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
| | - Peter A Barry
- Center for Comparative Medicine, Department of Pathology and Laboratory Medicine, California National Primate Research Center, University of California, Davis, CA, 95616, USA
| | - Benard J Ssebide
- Gorilla Doctors, Mountain Gorilla Veterinary Project, Inc., Kampala, Uganda
| | - Jean Felix Kinani
- One Health Approach for Conservation, Gorilla Health, Kigali, Rwanda
| | - Fred Nizeyimana
- Gorilla Doctors, Mountain Gorilla Veterinary Project, Inc., Kampala, Uganda
| | - Jean Bosco Noheri
- Gorilla Doctors, Mountain Gorilla Veterinary Project, Inc., Musanze, Rwanda
| | - Michael R Cranfield
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
| | | | - Tracey Goldstein
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
| | - Jonna A K Mazet
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
| | - Christine Kreuder Johnson
- Karen C. Drayer Wildlife Health Center, One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, 95616, USA
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Audet CM, Salato J, Blevins M, Silva W, González-Calvo L, Vermund SH, Gaspar F. Occupational hazards of traditional healers: repeated unprotected blood exposures risk infectious disease transmission. Trop Med Int Health 2016; 21:1476-1480. [PMID: 27580349 DOI: 10.1111/tmi.12775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Healers provide support for acute and chronic illnesses in rural Mozambique, such as socially acceptable traditional 'vaccinations' (subcutaneous cuts in the skin to rub herbs directly into the bloody lesion). We aimed to document the frequency of blood exposure by traditional practitioners in Mozambique. METHODS We conducted surveys with a simple random sample of 236 traditional healers in Zambézia province. Chi-square and Wilcoxon rank-sum tests were used to compare 'injection' behaviours across districts. RESULTS Healers treated a median of eight patients in the past month (IQR: 4-15). About 75% conducted 'injections'. These healers 'injected' a median of four patients (IQR: 1-8), used a new razor a median of three times (IQR: 1-8), and almost never used gloves. Lifetime blood exposures among those who provided 'injections' during treatments were estimated to be 1758 over a healer's career. CONCLUSION The majority of healers are exposed repeatedly to patient blood. Given the high prevalence of HIV, hepatitis B and C virus, and other blood-borne agents, specific healer practices are an occupational hazard and reuse of razors is risky for their clients.
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Affiliation(s)
- Carolyn M Audet
- Vanderbilt Institute for Global Health, Nashville, TN, USA. .,Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - José Salato
- Friends in Global Health, Quelimane and Maputo, Mozambique
| | - Meridith Blevins
- Vanderbilt Institute for Global Health, Nashville, TN, USA.,Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Wilson Silva
- Vanderbilt Institute for Global Health, Nashville, TN, USA.,Friends in Global Health, Quelimane and Maputo, Mozambique
| | - Lázaro González-Calvo
- Vanderbilt Institute for Global Health, Nashville, TN, USA.,Friends in Global Health, Quelimane and Maputo, Mozambique
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
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Gebrekirstos K, Abebe M, Fantahun A. A cross sectional study on factors associated with harmful traditional practices among children less than 5 years in Axum town, north Ethiopia, 2013. Reprod Health 2014; 11:46. [PMID: 24952584 PMCID: PMC4082281 DOI: 10.1186/1742-4755-11-46] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 06/18/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Every social grouping in the world has its own cultural practices and beliefs which guide its members on how they should live or behave. Harmful traditional practices that affect children are Female genital mutilation, Milk teeth extraction, Food taboo, Uvula cutting, keeping babies out of exposure to sun, and Feeding fresh butter to new born babies. The objective of this study was to assess factors associated with harmful traditional practices among children less than 5 years of age in Axum town, North Ethiopia. METHODS Community based cross sectional study was conducted in 752 participants who were selected using multi stage sampling; Simple random sampling method was used to select ketenas from all kebelles of Axum town. After proportional allocation of sample size, systematic random sampling method was used to get the study participants. Data was collected using interviewer administered Tigrigna version questionnaire, it was entered and analyzed using SPSS version 16. Descriptive statistics was calculated and logistic regressions were used to analyze the data. RESULTS Out of the total sample size 50.7% children were females, the mean age of children was 26.28 months and majority of mothers had no formal education. About 87.8% mothers had performed at least one traditional practice to their children; uvula cutting was practiced on 86.9% children followed by milk teeth extraction 12.5% and eye borrows incision 2.4% children. Fear of swelling, pus and rapture of the uvula was the main reason to perform uvula cutting. CONCLUSION The factors associated with harmful traditional practices were educational status, occupation, religion of mothers and harmful traditional practices performed on the mothers.
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Affiliation(s)
- Kahsu Gebrekirstos
- Department of Nursing, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
| | - Mesfin Abebe
- Department of nursing, College of health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atsede Fantahun
- Department of Nursing, College of Health Sciences, Mekelle University, Mek’ele, Ethiopia
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Gebrekirstos K, Fantahun A, Buruh G. Magnitude and Reasons for Harmful Traditional Practices among Children Less Than 5 Years of Age in Axum Town, North Ethiopia, 2013. Int J Pediatr 2014; 2014:169795. [PMID: 25045359 PMCID: PMC4089850 DOI: 10.1155/2014/169795] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 06/04/2014] [Indexed: 11/17/2022] Open
Abstract
Background. In addition to beneficial traditional practices, there are around 140 harmful traditional practices affecting mothers and children in almost all ethnic groups of Ethiopia. Therefore this study might give a clue about their practice and associated factors. The objective of this study was to assess magnitude of harmful traditional practices among children less than 5 years of age in Axum Town, North Ethiopia. Methods. Community based cross-sectional study was conducted on 752 participants who were selected using multistage sampling. Simple random sampling method was used to select ketenas from all kebelles of Axum Town. After proportional allocation of sample size to eachketena, systematic random sampling method was used to get the study participants. Data was collected using interviewer administered questionnaire; it was entered and analyzed using SPSS version 16 and descriptive statistics was calculated. Results. Majority of the respondents (81.2%) were Orthodox, 78.2% of the mothers had no work, and majority of mothers had no formal education. Among the harmful traditional practices performed on children, uvula cutting alone was performed on 72.8% of children followed by milk teeth extraction and uvula cutting with eyebrow incision. Conclusion. The leading harmful traditional practice performed on children in this study was uvula cutting.
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Affiliation(s)
- Kahsu Gebrekirstos
- Department of Nursing, College of Health Sciences, Mekelle University, Mekelle, 18713 Tigray, Ethiopia
| | - Atsede Fantahun
- Department of Nursing, College of Health Sciences, Mekelle University, Mekelle, 18713 Tigray, Ethiopia
| | - Gerezgiher Buruh
- Department of Nursing, College of Health Sciences, Mekelle University, Mekelle, 18713 Tigray, Ethiopia
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Crabtree KL, Wojcicki JM, Minhas V, Smith DR, Kankasa C, Mitchell CD, Wood C. Risk factors for early childhood infection of human herpesvirus-8 in Zambian children: the role of early childhood feeding practices. Cancer Epidemiol Biomarkers Prev 2013; 23:300-8. [PMID: 24296855 DOI: 10.1158/1055-9965.epi-13-0730] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Human herpesvirus-8 (HHV-8) infection in early childhood is common throughout sub-Saharan Africa with prevalence increasing throughout childhood. Specific routes of transmission have not been clearly delineated, though HHV-8 is present in high concentrations in saliva. METHODS To understand the horizontal transmission of HHV-8 within households to children, we enrolled for cross-sectional analysis, 251 households including 254 children, age two and under, in Lusaka, Zambia. For all children, plasma was screened for HHV-8 and HIV type I (HIV-1) and health and behavioral questionnaires were completed. Multilevel logistic regression analysis was conducted to assess independent factors for HHV-8 infection in children. RESULTS Risk factors for HHV-8 infection included increasing number of HHV-8-positive household members [OR = 2.5; 95% confidence interval (CI), 1.9-3.3; P < 0.01] and having a primary caregiver who tested the temperature of food with their tongue before feeding the child (OR = 2.4; 95% CI, 1.93-3.30; P = 0.01). Breastfeeding was protective against infection with HHV-8 for children (OR = 0.3; 95% CI, 0.16-0.72; P < 0.01). CONCLUSIONS These results indicate that exposure to HHV-8 in the household increases risk for early childhood infection, with specific feeding behaviors likely playing a role in transmission. IMPACT Interventions to protect children from infection should emphasize the possibility of infection through sharing of foods.
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Affiliation(s)
- Kay L Crabtree
- Authors' Affiliations: Nebraska Center for Virology and School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska; Department of Pediatrics, University of California, San Francisco, California; Department of Pathobiology and Population Medicine, Mississippi State University, Mississippi State, Mississippi; University of Zambia, School of Medicine and University Teaching Hospital, Zambia; and University of Miami Miller School of Medicine, Miami, Florida
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van Bogaert LJ. Anogenital Lesions: Kaposi's Sarcoma and Its Mimicks. ISRN AIDS 2012; 2012:486425. [PMID: 24052876 PMCID: PMC3767349 DOI: 10.5402/2012/486425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/13/2012] [Indexed: 11/23/2022]
Abstract
Kaposi's sarcoma (KS) is a low-grade vascular neoplasm associated with human herpes virus-8 (HHV-8) infection, and, in the epidemic form, with the human immunodeficiency virus (HIV). Although HHV-8 is present in all body fluids and is sexually transmitted, there are surprisingly few reports of anogenital KS. Clinically, especially in HIV/KS endemic areas, dark stained skin patches or nodules are prone to misdiagnosis, especially in dark-skinned individuals. Therefore, a biopsy is recommended. The histologic appearance spans a broad spectrum of KS and non-KS lesions; therefore, the final diagnosis should be confirmed by HHV-8 immunohistochemistry. We report a series of 36 anogenital biopsies from a group of 16 documented HIV-positive patients; in 20 the HIV serostatus was unknown. There were ten KS (five in HIV-positive patients), and 26 non-KS (11 in HIV-positive subjects) lesions. In the era of HIV/AIDS, anogenital lesions may be the first manifestation of KS in immunocompromised individuals and should be biopsied. The histological diagnosis should be confirmed by HHV-8 immunohistochemistry.
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Affiliation(s)
- Louis-Jacques van Bogaert
- National Health Laboratory Service, Polokwane/Mankweng Hospital Complex and University of Limpopo, Groblersdal 0470, South Africa
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Butler LM, Were WA, Balinandi S, Downing R, Dollard S, Neilands TB, Gupta S, Rutherford GW, Mermin J. Human herpesvirus 8 infection in children and adults in a population-based study in rural Uganda. J Infect Dis 2011; 203:625-34. [PMID: 21273188 DOI: 10.1093/infdis/jiq092] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human herpesvirus 8 (HHV-8) infection is endemic in sub-Saharan Africa. We examined sociodemographic, behavioral, and biological factors associated with HHV-8 infection in children and adults to determine HHV-8 seroprevalence and potential routes of transmission. METHODS Participants were 1383 children and 1477 adults from a population-based sample in a rural community in Uganda. Serum samples were tested for HHV-8 antibodies with use of an enzyme immunoassay against K8.1. RESULTS HHV-8 seroprevalence increased from 16% among children aged 1.5-2 years to 32% among children aged 10-13 years (P <.001) and from 37% among participants aged 14-19 years to 49% among adults aged ≥ 50 years (P <.05). HHV-8 seropositivity in children was independently associated with residing with a seropositive parent (P < .001) and residing with ≥ 1 other seropositive child aged <14 years (P < .001). History of sharing food and/or sauce plates was marginally associated with HHV-8 infection in children (P = .05). Among 1404 participants aged ≥ 15 years , there was no association between correlates of sexual behavior (eg, number of lifetime sex partners and HIV infection) and HHV-8 seropositivity (P > .10). CONCLUSIONS Our data suggest that HHV-8 is acquired primarily through horizontal transmission in childhood from intrafamilial contacts and that transmission continues into adulthood potentially through nonsexual routes.
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Affiliation(s)
- Lisa M Butler
- Department of Epidemiology and Biostatistics & Global Health Sciences, University of California, San Francisco, CA 94105, USA.
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A population-based study of how children are exposed to saliva in KwaZulu-Natal Province, South Africa: implications for the spread of saliva-borne pathogens to children. Trop Med Int Health 2010; 15:442-53. [PMID: 20149165 DOI: 10.1111/j.1365-3156.2010.02474.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In sub-Saharan Africa, many viral infections, including Epstein-Barr virus, cytomegalovirus, Kaposi's sarcoma-associated herpesvirus and hepatitis B are acquired in childhood. While saliva is an important transmission conduit for these viruses, little is known about how saliva is passed to African children. We endeavoured to identify the range and determinants of acts by which African children are exposed to saliva. METHODS To identify the range of acts by which African children are exposed to saliva, we conducted focus groups, semi-structured interviews and participant observations in an urban and a rural community in South Africa. To measure the prevalence and determinants of the identified acts, we administered a questionnaire to a population-based sample of caregivers. RESULTS We identified 12 caregiving practices that expose a child's oral-respiratory mucosa, cutaneous surfaces or anal-rectal mucosa to saliva. Several acts were heretofore not described in the contemporary literature (e.g., caregiver inserting finger lubricated with saliva into child's rectum to relieve constipation). Among 896 participants in the population-based survey, many of the acts were commonly practised by all respondent types (mothers, fathers, grandmothers and siblings). The most common were premastication of food, sharing sweets and premastication of medicinal plants that are spit onto a child's body. CONCLUSIONS African children are exposed to saliva through a variety of acts, practised by a variety of caregivers, with no single predominant practice. This diversity poses challenges for epidemiologic work seeking to identify specific saliva-passing practices that transmit viruses. Most acts could be replaced by other actions and are theoretically preventable.
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