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Nyirenda HT, Mukanga B, Choka N, Jegede AI, Mulenga D, Nyirenda HBC, Nyirenda T. Sexual behaviour and risk compensation among single women of reproductive age using hormonal contraception in Zambia. EUR J CONTRACEP REPR 2021; 26:255-260. [PMID: 33554674 DOI: 10.1080/13625187.2021.1874335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Developing countries have seen an increase in the use of hormonal contraception due to its high efficacy in preventing pregnancy. Our study assessed risk compensation among single women of reproductive age using hormonal contraception. METHODS The study used data from a nationally representative, cross-sectional sample of the 2018 Zambia Demographic and Health Survey (DHS). Study participants (N = 2151) were single, sexually active women aged 15-49 years, of whom 595 were using hormonal contraception. RESULTS Hormonal contraception was used by 26% of participants, 81% of whom reported they had not used a condom every time they had sexual intercourse (p < .001). Sexually transmitted infections (STIs) were reported in 4% of hormonal contraceptive users, compared with 2% of non-hormonal contraceptive users (p = .036). The odds of condom use at each occurrence of sexual intercourse were lower for: hormonal contraceptive users (adjusted odds ratio [OR] 0.62; 95% confidence interval [CI] 0.48, 0.80); women aged 15-19 years (adjusted OR 0.62; 95% CI 0.36, 1.08) and 20-24 years (adjusted OR 0.56; 95% CI 0.33, 0.95); women with no education (adjusted OR 0.33; 95% CI 0.16, 0.69) and primary education (adjusted OR 0.62; 95% CI 0.42, 0.94); women in the low wealth quintile (adjusted OR 0.46; 95% CI 0.36, 0.61); and women who had one or more children (adjusted OR 0.59; 95% CI 0.45, 0.77). CONCLUSION Lack of knowledge about hormonal contraception predisposes women to sexual risk behaviour. As hormonal contraception is very effective in preventing unwanted pregnancy, and condoms are effective in reducing the risk of STI transmission, the use of both (dual protection) should be encouraged.
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Affiliation(s)
- Herbert Tato Nyirenda
- Public Health Unit, Department of Clinical Sciences, School of Medicine, The Copperbelt University, Ndola, Zambia
| | - Bright Mukanga
- Public Health Unit, Department of Clinical Sciences, School of Medicine, The Copperbelt University, Ndola, Zambia
| | - Nancy Choka
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
| | - Ayoola Isaac Jegede
- Department of Basic Sciences, School of Medicine, The Copperbelt University, Ndola, Zambia
| | - David Mulenga
- Public Health Unit, Department of Clinical Sciences, School of Medicine, The Copperbelt University, Ndola, Zambia
| | - Herbert B C Nyirenda
- Department of Adult Education and Extension Studies, School of Education, University of Zambia, Lusaka, Zambia
| | - Tambulani Nyirenda
- Department of Public Administration, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
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Onanuga IO, Jegede AI, Offor U, Ogedengbe OO, Naidu EC, Peter AI, Azu OO. Hypoxis hemerocallidea alters metabolic parameters and hepatic histomorphology in streptozotocin-nicotinamide-induced diabetic male rats under antiretroviral therapy. Arch Med Sci 2020; 16:212-224. [PMID: 32051726 PMCID: PMC6963141 DOI: 10.5114/aoms.2018.75220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/23/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Highly active antiretroviral therapy (HAART) and HIV/AIDS have been demonstrated to induce endocrine/metabolic dysfunction with a consequential increase in morbidity/mortality due to organ toxicities. This study aimed at investigating the possible protective effect of Hypoxis hemerocallidea (HH) against metabolic and hepatic histomorphology of diabetic rats under HAART. MATERIAL AND METHODS Sixty-two adult male Sprague-Dawley rats were divided into a normoglycemic group A (n = 6) and 7 diabetic (110 mg/kg nicotinamide + 45 mg/kg streptozotocin) groups (B-H) (n = 8) and treated according to protocols. Concomitant treatment with adjuvant HH and HAART resulted in the least %body weight gain as the liver weight decreased in all treated animals. RESULTS Significant changes in serum lipids were aggravated by treatment with HH and HAART, triglycerides and total cholesterol levels were elevated (p < 0.001/0.05), but changes in high-density lipoprotein (HDL) and total protein levels were insignificant. While artherosclerotic and cardiopulmonary indexes remained insignificant, concomitant use of HH with HAART in diabetes resulted in reduction of low-density lipoprotein (LDL) (p < 0.001), and increased triglyceride (p < 0.05) and total cholesterol (p < 0.001). The parameters of liver injury showed a significant (p < 0.05) increase in ALT of animals treated with HH alone, HAART + HH and melatonin; however, an insignificant decline in AST level was recorded. Treatment with adjuvant HAART, HH and melatonin resulted in significant (p < 0.005/0.0001) up-regulation of ALP and total bilirubin levels. Histopathology derangement ranged from severe hepatocellular distortions, necrosis with reduced glycogen expression following co-treatment of HAART+melatonin, HH and HAART alone in diabetes. CONCLUSIONS Presumptive hypoglycemic use of HH with HAART by people living with HIV/AIDS requires caution as implications for hepatocellular injuries are suspected with further uncontrolled metabolic disorder.
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Affiliation(s)
- Ismail Olasile Onanuga
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Anatomy, Faculty of Biomedical Sciences, Kampala International University, Dar es Salaam, Tanzania
| | - Ayoola Isaac Jegede
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Anatomy Department, Faculty of Basic Medical Sciences, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Ugochukwu Offor
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Oluwatosin O. Ogedengbe
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Edwin C.S. Naidu
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Anetkan I. Peter
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Onyemaechi Okpara Azu
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Anatomy, School of Medicine, Windhoek, Namibia
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Offor U, Edwin CSN, Ogedengbe OO, Jegede AI, Peter AI, Onyemaechi OA. Renal histopathological and biochemical changes following adjuvant intervention of Momordica charantia and antiretroviral therapy in diabetic rats. Iran J Basic Med Sci 2019; 22:1359-1367. [PMID: 32128103 PMCID: PMC7038428 DOI: 10.22038/ijbms.2019.31848.7663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/27/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Diabetic nephropathy (DN) is an important primary cause of end-stage kidney disease. This study explores the mechanisms of the reno-protective effects of Momordica charantia (M. charantia) in diabetic rats following treatment with highly active antiretroviral therapy (HAART) regimen triplavar. MATERIALS AND METHODS Adult male Sprague-Dawley rats (n=48) were divided into 7 groups (A-G).Treatment groups (B-G) had 7 animals per group and control group (Group A) had 6 animals per group. Diabetes was induced with streptozotocin (STZ) by intraperitoneal injection (STZ 45 mg/kg body weight). The animals were euthanized on the tenth week with kidneys removed for examination and blood obtained via cardiac puncture. RESULTS Key renal parameters showed no albuminuria, normal blood urea nitrogen (BUN), serum creatinine and electrolytes in all groups treated with M. charantia. Untreated diabetic (Group B) and HAART treated diabetic (Group C) showed severe albuminuria, a significantly raised BUN and serum creatinine (P<0.05) and gross electrolyte disturbances. Blood glucose levels were consistently and significantly raised in all groups not receiving the adjuvant M. charantia (P<0.05). Levels of oxidative stress enzymes Superoxide dismutase (SOD), Catalase and activities of Reduced Gluthaione (GSH) and Malondiadehyde (MDA) were significantly lower in all groups not receiving M. charantia. Histopathology in untreated diabetic and HAART treated animals showed severe degenerative changes in the glomeruli and inflammatory cellular infiltration while M. charantia treated animals showed an essentially normal glomerular appearance with capillary loops and normal cytoarchitecture. CONCLUSION M. charantia extract administration improved blood glucose levels, reinstates renal function, reduces body weight loss and restores hyperglycemia.
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Affiliation(s)
- Ugochukwu Offor
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
- Department of Preclinical Sciences, School of Health Care Sciences, Faculty of Health Sciences, University of Limpopo, South Africa
| | - Coleridge Stephen Naidu Edwin
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Oluwatosin Olalekan Ogedengbe
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
- Department of Anatomy, College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Ayoola Isaac Jegede
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
- Department of Basic Sciences, School of Medicine, Copperbelt University, Zambia
| | - Aniekan Imo Peter
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
- Department of Anatomy, Faculty of Basic Medical Sciences, University of Uyo-Nigeria, Nigeria
| | - Okpara Azu Onyemaechi
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
- Department of Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
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Offor U, Naidu EC, Ogedengbe OO, Jegede AI, Peter AI, Azu OO. Nephrotoxicity and highly active antiretroviral therapy: Mitigating action of Momordica charantia. Toxicol Rep 2018; 5:1153-1160. [PMID: 30627515 PMCID: PMC6319328 DOI: 10.1016/j.toxrep.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 09/03/2018] [Accepted: 09/15/2018] [Indexed: 12/24/2022] Open
Abstract
Momordica charantia (M. charantia) is known for its antioxidant and antidiabetic properties. The aim of this study is to investigate the renoprotective effects of M. charantia in rats following treatment with highly active antiretroviral therapy (HAART) regimen triplavar. Adult male Sprague-Dawley rats weighing 178.1-220.5 g (n = 36) were divided into six groups (A-F) with each group comprising of six (n = 6) rats. The drugs and extract were administered via oral gavage. The therapeutic dose of triplavar was adjusted using the human therapeutic dose equivalent for the rat model. Animals were euthanized on the tenth week with kidneys removed for examination and blood obtained via cardiac puncture. Levels of oxidative stress enzymes (superoxide dismutase-SOD, catalase-CAT, and reduced glutathione-GSH) were significantly lowered in all groups not receiving M. charantia. The levels of thiobarbituric acid reactive substances (TBARS) were increased resulting in free radical formation via auto-oxidation. Renal parameters showed no albuminuria, normal blood urea nitrogen (BUN), serum creatinine (SCr) and electrolytes in groups treated with M. charantia. HAART treated (Group B) showed severe albuminuria, a significantly (p < 0.05) raised BUN and SCr and gross electrolyte disturbances. Blood glucose levels were significantly raised in groups not receiving the adjuvant M. charantia (p < 0.05). Histopathology in HAART treated animals showed glomerular capillary abnormalities and cellular infiltrations while M. charantia treated animals showed an essentially normal glomerular appearance with capillary loops and normal cytoarchitecture. In conclusion M. charantia extract administration improved blood glucose levels, restored renal histology, reinstate renal function, reduce body weight loss and restores hyperglycemia.
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Key Words
- 6-HD, 6-hydroxydopamine
- AIDS, acquired immune deficiency syndrome
- ALB, albumin
- ANOVA, analysis of variance
- AREC, animal research ethics committee
- BGL, blood glucose levels
- BRU, Biomedical Resource Unit
- BUN, blood urea nitrogen
- BW, body weight
- CAT, catalase
- DETAPAC, diethylenetriamine – penta acetic acid
- DNA, deoxyribonucleic acid
- DTNB, 5, 5'-dithiobis-(2-nitrobenzoic acid)
- GSH, reduced glutathione
- H and E, haematoxylin and eosin
- HAART
- HAART, highly active antiretroviral therapy
- HIV, human immunodeficiency virus
- Histopathology
- KW, kidney weight
- KWBR, kidney weight body ratio
- Kidney
- LPO, lipid peroxidation
- M. charantia, Momordica charantia
- MDA, malondialdehyde
- MT, Masson’s Trichome
- Momordica charantia
- NRTIs, nucleoside reverse transcriptase inhibitors
- Nephrotoxicity
- PAS, Periodic Acid Schiff
- PBS, phosphate buffer solution
- PLWHA, people living with HIV and AIDS
- ROS, reactive oxygen species
- SCr, serum creatinine
- SD, standard deviation
- SDS, sodium dodecyl sulfate
- SOD, superoxide dismutase
- Sprague-Dawley rats
- TBARS, thiobarbituric acid reactive substances
- TCA, trichloroacetic acid
- UKZN, University of KwaZulu Natal
- rpm, revolutions per minute
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Affiliation(s)
- Ugochukwu Offor
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Edwin Coleridge Naidu
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Oluwatosin Olalekan Ogedengbe
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
- Department of Anatomy, College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Ayoola Isaac Jegede
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Aniekan Imo Peter
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
- Department of Anatomy, Faculty of Basic Medical Sciences, University of Uyo-Nigeria, Nigeria
| | - Onyemaechi Okpara Azu
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
- Department of Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
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Ogedengbe OO, Jegede AI, Onanuga IO, Offor U, Peter AI, Akang EN, Naidu ECS, Azu OO. Adjuvant potential of virgin coconut oil extract on antiretroviral therapy-induced testicular toxicity: An ultrastructural study. Andrologia 2017; 50. [PMID: 29230854 DOI: 10.1111/and.12930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 01/10/2023] Open
Abstract
The effects of Virgin coconut oil as an adjuvant to highly active antiretroviral therapy (HAART) were investigated on the testicular ultrastructure and biochemical markers in rats. Twenty male Sprague-Dawley rats, weighing 153-169 g were divided into four groups and treated as follows: control A (distilled water), B (HAART), C (HAART+Virgin coconut oil 10 ml/kg) and D (Virgin coconut oil [VCO] 10 ml/kg). Testicular segments were evaluated using transmission electron microscopy. Serum was assayed for testosterone, luteinising hormone, follicle stimulating hormone and testicular tissue for malondialdehyde and glutathione. Ultrastructure of basement membrane (Bm), mitochondria and spermatocytes was normal in the control group. HAART-treated group showed significant increase (p < .01) in Bm thickness with significant decrease in Leydig cell nuclear diameter (p < .05) and volume (p < .01) when compared with control group. Mitochondrial cristae appear collapsed, and Sertoli cells showed cytoplasmic vacuolations. HAART+VCO group showed improved ultrastructural details in Bm, and Sertoli cell and Leydig cells show abundant lipid droplets. Virgin coconut oil-treated group showed thinning of Bm with otherwise normal ultrastructural features of organelles. HAART-treated group showed significant increase (p < .01) in testosterone levels. There was no significant effect on malondialdehyde and glutathione levels. Virgin coconut oil improved testicular morphology and reversed HAART-induced ultrastructural alterations. Further studies on putative mechanism are required.
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Affiliation(s)
- O O Ogedengbe
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa.,Department of Anatomy, College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - A I Jegede
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - I O Onanuga
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - U Offor
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - A I Peter
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - E N Akang
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa.,Department of Anatomy, College of Medicine, University of Lagos, Lagos, Nigeria
| | - E C S Naidu
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - O O Azu
- Discipline of Clinical Anatomy, Nelson R. Mandela School of Medicine, University of Kwazulu-Natal, Durban, South Africa.,Department of Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
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Azu OO, Jegede AI, Ugochukwu O, Onanuga IO, Kharwa S, Naidu EC. Hepatic histomorphological and biochemical changes following highly active antiretroviral therapy in an experimental animal model: Does Hypoxis hemerocallidea exacerbate hepatic injury? Toxicol Rep 2016; 3:114-122. [PMID: 28959529 PMCID: PMC5615786 DOI: 10.1016/j.toxrep.2015.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 11/24/2022] Open
Abstract
As the roll-out of antiretroviral therapy continues to drive downwards morbidity and mortality in people living with HIV/AIDS (PLWHAs), organ toxicities (especially the liver) are frequently becoming a major concern for researchers, scientists and healthcare planners. This study was conducted to investigate the possible protective effect of Hypoxis hemerocallidea (AP) against highly active antiretroviral therapy (HAART)-induced hepatotoxicity. A total of 63 pathogen-free adult male Sprague-Dawley rats were divided into 9 groups and treated according to protocols. While no mortality was reported, animals treated with adjuvant HAART and AP recorded least% body weight gain. Significant derangements in serum lipid profiles were exacerbated by treatment of with AP as LDL (increased p < 0.03), triglycerides (increased p < 0.03) with no change in total cholesterol levels. Adjuvant AP with HAART caused reduction in LDL (p < 0.05 and 0.03), increased HDL (p < 0.05) and TG (p < 0.05 and 0.001 for AP100 and AP200 doses respectively). Markers of liver injury assayed showed significant increase (p < 0.003, 0.001) in AST in AP alone as well as HAART+ vitamins C and E groups respectively. Adjuvant HAART and AP and vitamins C and E also caused significant declines in ALT and ALP levels. Serum GGT was not markedly altered. Disturbances in histopathology ranged from severe hepatocellular distortions, necrosis and massive fibrosis following co-treatment of HAART with vitamins C and E as well as HAART alone. These results warrant caution on the adjuvant use of AP with HAART by PLWHAs as implications for hepatocellular injuries are suspect with untoward cardiometabolic changes.
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Affiliation(s)
- Onyemaechi Okpara Azu
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Ayoola Isaac Jegede
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa.,Anatomy Department, Faculty of Basic Medical Sciences, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Osun, Nigeria
| | - Offor Ugochukwu
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Ismail Olasile Onanuga
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa.,Department of Anatomy, Faculty of Basic Medical Sciences, Kampala International University, Kansaga, Ggaba Road, Uganda
| | - Salem Kharwa
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Edwin Coleridge Naidu
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences. Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4001, South Africa
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