Detection and partial characterization of simian immunodeficiency virus SIVsm strains from bush meat samples from rural Sierra Leone. (9/88)

Human immunodeficiency virus type 2 (HIV-2) originated from simian immunodeficiency viruses (SIVs) that naturally infect sooty mangabeys (SMs; Cercocebus atys). In order to further investigate the relationship between HIV-2 and SIVsm, the SIV specific to the SM, we characterized seven new SIVsm strains from SMs sold in Sierra Leone markets as bush meat. The gag, pol, and env sequences showed that, while the viruses of all seven SMs belonged to the SIVsm-HIV-2 lineage, they were highly divergent viruses, in spite of the fact that most of the samples originated from the same geographical region. They clustered in three lineages, two of which have been previously reported. Two of the new SIVsm strains clustered differently in gag and env phylogenetic trees, suggesting SIVsm recombination that had occurred in the past. In spite of the fact that our study doubles the number of known SIVsm strains from wild SMs, none of the simian strains were close to the groups in which HIV-2 was epidemic (groups A and B).  (+info)

Emergence of atovaquone-proguanil resistance during treatment of Plasmodium falciparum malaria acquired by a non-immune north American traveller to west Africa. (10/88)

The importation of drug-resistant malaria is a growing public health problem in non-endemic countries. The combination of atovaquone and proguanil (Malarone) has become established as an agent of choice to prevent and treat chloroquine-resistant Plasmodium falciparum malaria in travelers. We describe the first reported case in North America of genetically confirmed atovaquone/proguanil-resistant P. falciparum malaria. Polymerase chain reaction and sequence analysis of the primary and recrudescent isolates confirmed the acquisition of a point mutation (Tyr268Ser) in the cytochrome b gene of the recrudescent isolate known to confer high-level resistance to atovaquone. Suboptimal therapy may have played a contributory role in the emergence of resistance.  (+info)

A follow-up study of patients with spinal cord injury in Sierra Leone. (11/88)

Over an 18-month period, 24 patients were admitted with spinal cord injuries in a non-governmental organization hospital in one of the world's poorest countries, Sierra Leone. Seven patients died while in hospital. Follow-up data was available for 13 of the 17 survivors an average of 17.4 (10-28) months after discharge. Five patients were still alive.  (+info)

Technical efficiency of peripheral health units in Pujehun district of Sierra Leone: a DEA application. (12/88)

BACKGROUND: The Data Envelopment Analysis (DEA) method has been fruitfully used in many countries in Asia, Europe and North America to shed light on the efficiency of health facilities and programmes. There is, however, a dearth of such studies in countries in sub-Saharan Africa. Since hospitals and health centres are important instruments in the efforts to scale up pro-poor cost-effective interventions aimed at achieving the United Nations Millennium Development Goals, decision-makers need to ensure that these health facilities provide efficient services. The objective of this study was to measure the technical efficiency (TE) and scale efficiency (SE) of a sample of public peripheral health units (PHUs) in Sierra Leone. METHODS: This study applied the Data Envelopment Analysis approach to investigate the TE and SE among a sample of 37 PHUs in Sierra Leone. RESULTS: Twenty-two (59%) of the 37 health units analysed were found to be technically inefficient, with an average score of 63% (standard deviation = 18%). On the other hand, 24 (65%) health units were found to be scale inefficient, with an average scale efficiency score of 72% (standard deviation = 17%). CONCLUSION: It is concluded that with the existing high levels of pure technical and scale inefficiency, scaling up of interventions to achieve both global and regional targets such as the MDG and Abuja health targets becomes far-fetched. In a country with per capita expenditure on health of about USD 7, and with only 30% of its population having access to health services, it is demonstrated that efficiency savings can significantly augment the government's initiatives to cater for the unmet health care needs of the population. Therefore, we strongly recommend that Sierra Leone and all other countries in the Region should institutionalize health facility efficiency monitoring at the Ministry of Health headquarter (MoH/HQ) and at each health district headquarter.  (+info)

Historical Lassa fever reports and 30-year clinical update. (13/88)

Five cases of Lassa fever have been imported from West Africa to the United States since 1969. We report symptoms of the patient with the second imported case and the symptoms and long-term follow-up on the patient with the third case. Vertigo in this patient has persisted for 30 years.  (+info)

Alzheimer's Quick Test cognitive screening criteria for West African speakers of Krio. (14/88)

OBJECTIVES: To obtain normative data for Alzheimer's Quick Test (AQT) measures of perceptual and cognitive speed from West African speakers of Krio. SUBJECTS: Normal adults, who were functionally independent, from Sierra Leone (n = 164) aged 25-79 years. METHODS: Perceptual and cognitive speed were measured with AQT single- and dual-dimension colour-number (C-N) and colour-animal (C-A) naming tasks. Tests were administered individually in the participants' communities. RESULTS: Men and women performed similarly (P>0.05), whereas literate speakers used significantly less time than preliterate peers (P<0.01). Correlations between age and colour naming were low (P<0.01) and speed decreased by <0.1 s per year. Dual-dimension naming remained stable across ages. Correlations with years of education were low for dual-dimension naming (P<0.01) and speed increased approximately 0.4 s per added year. Correlations between age and education and AQT naming were non-significant for literate participants. Criterion time cut-offs (seconds) for screening were developed for preliterate and literate speakers of Krio for typical (<+1 SD), slower-than-typical (between +1 and +2 SD) and atypical (>+2 SD) performance. CONCLUSION: AQT C-N and C-A naming are time efficient (3-5 min each), objective and reliable and can be administered in Krio to West African adults in Africa, Europe or North America to screen for cognitive impairments and facilitate referral for medical workup.  (+info)

Low efficacy of the combination artesunate plus amodiaquine for uncomplicated falciparum malaria among children under 5 years in Kailahun, Sierra Leone. (15/88)

OBJECTIVE: In 2004, Sierra Leone adopted artesunate plus amodiaquine as first-line antimalarial treatment. We evaluated the efficacy of this combination in Kailahun, where a previous study had shown 70.2% efficacy of amodiaquine in monotherapy. METHODS: Method and outcome classification of the study complied with WHO guidelines. Children 6-59 months with uncomplicated malaria were followed-up for 28 days. PCR genotyping was used to distinguish recrudescence from reinfection. Reinfections were reclassified as cured. RESULTS: Of 172 children who were referred to the study clinic, 126 satisfied inclusion criteria and were enrolled. No early treatment failures were reported. The day 14, efficacy was 98.2% (95% CI: 93.8-99.8). Of 65 recurrent parasitaemias analysed by PCR, 17 were recrudescences. The PCR-adjusted day 28 efficacy was 84.5% (95% CI: 76.4-90.7). All true failures occurred in the last 8 days of follow-up. Of 110 children who completed the 28-day follow-up, 54 (49.1%) experienced a novel infection. CONCLUSION: The efficacy of this combination was disappointing. The high reinfection rate suggested little prophylactic effect. In Kailahun a more efficacious combination might be necessary in the future. The efficacy of AS + AQ needs to be monitored in Kailahun and in the other regions of Sierra Leone.  (+info)

Perkins traction for adult femoral shaft fractures: a report on 53 patients in Sierra Leone. (16/88)

A retrospective study of 53 consecutive adult patients with 54 femoral shaft fractures treated with Perkins traction over a 25-month period was carried out. Mean length of stay was 52.1 days (range 25-108), and mean duration of traction was 45.0 days (range 23-66). At a mean follow-up of 4.6 months (range 3-9), 50 (92.6%) had healed and 5 (9.3%) had a malunion. There were 4 (7.4%) non-unions, 3 (5.5%) had shortening of more than 2.5 cm and 2 (3.7%) had a re-fracture. The rate of pin tract infection was very high at 42.6% (23 patients).  (+info)