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Amoebic Liver Abscess in Infancy A Case Report
(University of Zimbabwe, 1983) Mgone, Charles S.
A case report on infantile amoebic abscess is presented. Pitfalls in the proper diagnosis are mentioned. These include the general belief that the condition is rare and the difficulties encountered in recovery of the offending organisms both in stools and from the liver abscess. The pus itself may also not be characteristic. The need for early diagnosis is emphasized and we recommend draining the abscess and instituting metronidazole.
Ketotifen in African children
(International journal of clinical pharmacology research, 1983) Mgone, Charles S.
Twenty-six asthmatic children, 16 boys and 10 girls with a mean age of 4.9 years, were given ketotifen, an oral prophylactic drug against asthma. Both the number of acute asthmatic attacks and their severity were reduced over a period of three months. Also reduced was the concomitant use of bronchodilators in these children. Only minimal side effects were noted. It is concluded that ketotifen has beneficial effects in childhood asthma.
Cerebral palsy in Dar es Salaam
(Central African Journal of Medicine, 1990) Mgone, Charles S.
Between December 1985 and July 1986 a study on cerebral palsy was undertaken among the inpatients and outpatients of the department of Paediatrics and Child Health, Muhimbili Medical Centre Centre, Dar Es Salaam. The objective of the study was to determine the clinical pattern of cerebral palsy and its associated handicaps. During this period, 100 children with cerebral palsy, 56 boys and 44 girls ranging in age between four months and 10 years, were seen. The commonest type of cerebral palsy seen was spastic tetraplegia which occurred in 36 percent of the cases followed by spastic diplegia and hemiplegia seen in 20 and 15 percent of the cases respectively. In 70 children the cerebral palsy was associated with other severe handicaps, the commonest being epilepsy which occurred in 35 percent of the children followed by deafness, speech disorders and blindness. Birth asphyxia, convulsions of undetermined causes, low birth weight, meningitis and cerebral birth trauma were found to be the leading causes of cerebral palsy. As these conditions are largely preventable or amenable to treatment, it is suggested that improvement of antenatal and perinatal care is important in the reduction of the incidence of cerebral palsy.
HIV and infant feeding practices
(AIDS, 1990) Mgone, Charles S.
In industrialized countries HIV-1-seropositive mothers who are nursing infants are advised to use artificial feeds, whilst HIV-infected women in the developing world are recommended to breastfeed. Current evidence is insufficient even to estimate the attributable risk associated with breastfeeding. There is a possibility that the policy promoted in industrialized societies will eventually become established in urban and peri-urban areas of sub-Saharan Africa. This may be defensible for some elite urban mothers providing safe artificial feeding. However, calculations of the consequence of any population-level change to bottle-feeding indicate that it would result in more deaths from infectious causes, substantially adding to the child deaths directly attributable to HIV-1 infection. These data demonstrate that there is a clear need for policy-makers and health care workers to undertake further promotion of breast-feeding despite the AIDS epidemic. PIP: The 3 retrospective studies conducted to date have involved a total of 12 children exposed to human immunodeficiency virus (HIV) via breastfeeding have yielded findings of 8 cases in which breastfeeding did appear to have led to HIV transmission and 4 cases where the children did not become infected. These findings, as well as the detection of HIV-1 in the breast milk of 3 women, have led to a policy in most developed countries that HIV-positive mothers are advised to use artificial milk. Of concern, however, is the possibility that this policy may become adopted in sub-Saharan African countries where child mortality from infectious diseases associated with bottle-feeding greatly exceed the risks of HIV transmission through breastfeeding. Compared to exclusively breastfed infants, artificial feeding in sub- Saharan countries is associated with a 1.8- 2.6 times greater risk of post perinatal mortality. To examine the impact of changes in infant feeding practices in this regions, a model sub-Saharan country with an infant mortality rate of 90/1000 live births (ignoring the effects of HIV) was constructed and a 10% rate of maternal HIV infection, a 30% vertical transmission rate of HIV, and a 20 % HIV-associated infant mortality rate were assumed. To allow for competing causes of death, the number of infants dying from HIV infection was reduced by 10%. Calculations suggest that a reduction from 90% to 75% in the prevalence of breastfeeding would result in an increase in infant wastage of 1780 at best and 3580 at worst. The maximum (assuming a transmission rate of 100%) saving in infant wastage if breastfeeding were entirely eliminated would be only 630. Although more research is needed on the true level of risk from breastfeeding by HIV-infected mothers, it i s recommended that breastfeeding should be continued in developing countries where artificial feeding does not present a safe alternative, irrespective of the prevalence of HIV-1.
Application of Direct cDNA Sequencing for the Characterisation of Molecular Pathology in Acute Intermittent Porphyria
(University of Glasgow, 1991) Mgone, Charles S.
Acute intermittent porphyria (AIP) is an autosomal dominant disorder caused by partial deficiency of the enzyme porphobilinogen deaminase (PBG-D). It is heterogeneous and commonly gene carriers of the disorder remain asymptomatic and may not always be diagnosed by conventional biochemical methods. Since detection of gene carriers is of central importance to the management of this condition, an alternative method of diagnosis is essential. Mutations causing acute intermittent porphyria have not however, been fully characterised. In the current study, direct cDNA sequencing of polymerase chain reaction (PCR) amplified templates has been developed and applied for the characterisation of mutations associated with this disorder. The procedure was developed by amplifying RNA from various sources including human placenta, chorion, lymphocytes and lymphoblastoid cells. The amplification was performed by a technique referred to as reverse-transcriptase polymerase chain reaction (R-T PCR) in which both the first strand cDNA synthesis and the subsequent amplification are performed in the same reaction mixture. Two approaches to the R-T PCR amplification were employed and compared. In the first approach, the first strand cDNA synthesis was carried out with one of the primers complementary to the non-erythroid PBG-D mRNA and in the second, by using oligo(dT)12-18. Both methods were successful and comparable, but the later was preferred because it could be modified in asymmetric PCR to directly produce either the sense or the anti-sense strand. The PBG-D cDNA synthesised and amplified by the R-T PCR was either directly sequenced as double-stranded (ds) templates or eluted and reamplified by asymmetric PCR to produce singlestranded templates. Alternatively, single-stranded templates were produced directly by 'asymmetric' R-T PCR. Prior to sequencing, the PCR amplified templates were concentrated, desalted and purified to remove excess deoxyribonucleoside triphosphates (dNTPs) and amplification primers. Several purification methods were employed and their efficacy compared. These included, spun-column chromatography, nucleic acid chromatography system (NACS) purification, centrifuge-driven dialysis, geneclean TM purification, gel fractionation and selective precipitation in ammonium acetate and propan-2-ol. Selective precipitation with ammonium acetate and propan-2-ol was found to be the simplest and most effective method of template purification. In addition it was also inexpensive, reliable and convenient. Dideoxy sequencing of both double-stranded and single-stranded (ss) templates was performed with either Sequenase T7 DNA polymerase or Taq DNA polymerase. Sequencing of the singlestranded templates, especially when produced by asymmetric reamplification of cDNA gave the most consistent and reliable results. For routine sequencing, there was no difference in the performance of the two sequencing enzymes used, although Taq DNA polymerase was better than Sequenase T7 DNA polymerase in handling templates with complex secondary structures. The procedure of direct sequencing was applied on asymetrically amplified templates of thirty patients with acute intermittent porphyria (AIP) and ten normal controls. The diagnosis of acute intermittent porphyria was based on increased excretion of aminolevulinic acid (ALA) and porphobilinogen (PBG) in urine and decreased activity of erythrocyte porphobilinogen deaminase (PBG-D) coupled with a clinical history of one or more acute attacks. The mean erythrocyte porphobilinogen activity in the acute intermittent porphyria patients was 22. 3 nmol/h/ml erythrocytes. The normal adult activity range for the enzyme is 25-42 nmol/h/ml erythrocytes in the females and 30-48 in males. After optimisation of the R-T PCR, correct sized products were obtained from the amplification of all samples, indicating absence of any major deletions, Sequencing of these products revealed seven point mutations in twelve patients with acute intermittent porphyria and none in the control subjects. All mutations were due to single base substitutions, four of which were associated with amino acid substitutions and are likely to be the cause of AIP in these individuals. The remaining three were silent mutations without change of amino acid and are therefore regarded as neutral polymorphisms. The detected mutations were Q34K (C100→A) seen in two related individuals, L177R (T530→G) also observed in two unrelated individuals, R167Q (G500→A) and H256N (C766→A) each seen separately in single subjects. The silent mutation L42L (G117→A) was seen in one individual whereas S45S (G135→A) and V202V (G606→T) were seen in two and four individuals respectively. With the exception of the mutation R167Q which has been previously reported in four other individuals, the rest of the mutations were novel, emphasising the heterogeneity of this condition. (Abstract shortened by ProQuest.).
Prevalence of HIV-1 infection and symptomatology of AIDS in severely malnourished children in Dar Es Salaam, Tanzania.
(Journal of acquired immune deficiency syndromes, 1991) Mgone, Charles S.
In Dar es Salaam, Tanzania, 200 children with severe malnutrition and controls matched for age, sex, and area of residence were screened for serological evidence of infection with the human immunodeficiency virus type 1 (HIV-1) over 5 months in 1988. The prevalence of HIV-1 antibodies in the malnourished group was 25.5% (51 of 200) compared with 1.5% (three of 200) in the controls. The seroprevalence rate was equally high in malnourished children above the age of 18 months (26 of 102; 25.5%), as in those below this age (25 of 98; 25.5%). The prevalence rate was higher in children with marasmus (38.2%) as compared to children with marasmic-kwashiorkor (12.3%) or kwashiorkor (12.2%). The prevalence of clinical features known to be associated with AIDS was higher in the HIV seropositive malnourished children as compared to the seronegative children. The modified World Health Organization clinical case definition of AIDS in children was also evaluated and found to have a low sensitivity and positive predictive value (62.8 and 57.1%, respectively) but a fairly high specificity (83.9%). It is recommended to routinely rule out HIV infection in malnourished children, especially those with marasmus.
Detection of seven point mutations in the porphobilinogen deaminase gene in patients with acute intermittent porphyria, by direct sequencing of in vitro amplified cDNA
(Human genetics, 1992) Mgone, Charles S.
Direct cDNA sequencing has been performed on asymmetrically amplified transcripts from the human porphobilinogen deaminase gene. Lymphocytes from 30 patients with acute intermittent porphyria were the source of mRNA; of the seven separate point mutations detected, three were silent, whereas four resulted in amino acid changes. Three of these changes involved highly conserved amino acids, and the remaining one a conserved charge. One of these mutations was predicted to cause structural alterations in the protein product. The application of this method to affected families allows the direct identification of these heterogeneous mutations, thus permitting the unequivocal detection of carriers.
Detection of a high mutation frequency in exon 12 of the porphobilinogen deaminase gene in patients with acute intermittent porphyria
(Human genetics, 1993) Mgone, Charles S.
Direct cDNA sequencing was performed on asymmetrically amplified transcripts from the porphobilinogen deaminase (PBG-D) gene of thirteen unrelated individuals with acute intermittent porphyria. Four different mutations and a polymorphic site were detected in exon 12 of the gene, four being the result of single base substitutions and one being caused by dinucleotide deletion. All of these mutations are located in domain 3 of the PBG-D molecule, with the single base substitutions affecting the hydrophobic interfaces between domains 1 and 3. The dinucleotide deletion results in a frame-shift producing a premature stop codon.
Identification of five novel mutations in the porphobilinogen deaminase gene
(Human molecular genetics, 1994) Mgone, Charles S.
We have studied the porphobilinogen deaminase gene transcripts from seven unrelated patients from the West of Scotland, all suffering from acute intermittent porphyria. This was achieved by reverse transcription and PCR amplification of mRNA followed by asymmetric amplification and direct sequencing. Five novel and two previously described mutations were identified and found to be single base substitutions. Of the five novel mutations, three were missense (R116Q, T2691, G274R) and two were nonsense (Q204 Stop, W283 Stop). Using Escherichla coll PBGD as a model, it is possible to predict and explain the deleterious effects that these mutations might have on the function and structure of the enzyme.
Occurrence of the erythrocyte band 3 (AE1) gene deletion in relation to malaria endemicity in Papua New Guinea
(Transactions of the Royal Society of Tropical Medicine and Hygiene, 1996) Mgone, Charles S.
South-east Asian ovalocytosis status was determined in 1629 individuals originating from 12 different geographical areas of Papua New Guinea, representing different ethnic groups and degrees of malaria endemicity. This was achieved by using polymerase chain reaction amplification to demonstrate a 27 base pair deletion in the erythrocyte band 3 (AE1) gene. By using this method, the prevalence of erythrocyte band 3 gene deletion was determined to range from zero in both the lowland inland area of Wosera, East Sepik Province and the highland region of Goroka, Eastern Highlands Province to 35% on the north coast of Madang Province. In general, the prevalence correlated well with altitude, being highest on the coast where malaria transmission is high, intermediate in the lowlands, and lowest in the non-malarious highlands. However, Wosera, a lowland area in the Sepik River Plains, which is hyperendemic for malaria, was an exception in that no ovalocytosis was detected. These results largely confirm the prevalence rates that have been reported in the past using microscopy. In keeping with the autosomal dominant mode of inheritance, the male:female ratio was 1.02 and no homozygote was detected, indicating that homozygosity for the ovalocytosis band 3 gene deletion is lethal.
Detection of four mutations in six unrelated South African patients with acute intermittent porphyria
(Molecular and cellular probes, 1996) Mgone, Charles S.
We have screened the hydroxymethylbilane synthase cDNA from six South African patients with acute intermittent porphyria, using a combination of chemical cleavage mismatch analysis and direct sequencing of asymmetrically amplified PCR products. Four mutations were detected, a novel T insertion (771insT) and three missense mutations (R26H, R116W and R173Q). The 771insT mutation produces a stop codon, thirty-three codons downstream and a loss of approximately 20% of the protein is predicted. The R116W mutation, which was found to have a high prevalence in the Dutch population, was detected in three unrelated South African patients.
Elevated levels of methaemoglobin in Tanzanian children with severe and uncomplicated malaria
(Transactions of the Royal Society of Tropical Medicine and Hygiene, 1996) Mwaikambo, Esther D.
Elevated levels of methaemoglobin, the ferric form of haemoglobin incapable of oxygen transport, have been previously found during Plasmodium vivax infections and in acidotic infants. We measured methaemoglobin in the following 5 groups of children with P. falciparum malaria admitted to Muhimbili Medical Centre, Dar es Salaam, Tanzania, (i) Cerebral malaria (CM) with unrousable coma (n = 50), including 32 with complete recovery (CMCR) and 18 with death or neurological sequelae (CMDS); (ii) malaria with severe anaemia but without severe respiratory distress (SA; n = 6); (iii) uncomplicated malaria (UM; n = 37); (iv) asymptomatic parasitaemia (AP; n = 5); and (v) healthy controls (HC; n = 34). Mean methaemoglobin levels were elevated in all groups with malaria, forming up to 16·4% of circulating haemoglobin. The degree of methaemoglobinaemia correlated with disease severity and severity of anaemia. Mean methaemoglobin levels in children with AP, UM, SA, CMCR and CMDS were 3·3%, 4·1%, 5·6%, 4·7% and 5·8% respectively; the mean levels in those with clinical disease were significantly higher than those in healthy controls (2·0%). Methaemoglobinaemia >10% was found in 5·4%, 16·7%, 12·5% and 22·2% of those with UM, SA, CMCR and CMDS, respectively. In the presence of parasite sequestration, impaired tissue perfusion, and a reduction in oxygen carrying capacity of blood due to anaemia, a further reduction in oxygen carrying capacity from even a modest concentration of methaemoglobin is likely to exacerbate tissue hypoxia, perhaps critically so in a minority of anaemic and acidotic patients with severe falciparum malaria.
High prevalence of trichomonal vaginitis and chlamydial cervicitis among a rural population in the highlands of Papua New Guinea
(Papua and New Guinea medical journal, 1996) Mgone, Charles S.
We conducted a community-based study of the prevalence of sexually transmitted diseases in rural and periurban communities in Eastern Highlands Province. We interviewed a stratified random sample of women and men, examined the women for evidence of sexually transmitted diseases (STDs) and collected specimens for diagnosis of syphilis, by serology and dark-field microscopy, gonorrhoea, by Gram stain and culture, chlamydial infection, by polymerase chain reaction (PCR) and direct immunofluorescence (DIF), trichomoniasis, by wet mount, and bacterial vaginosis, by wet mount and Gram stain. The men were tested for chlamydial infection only (first void urine tested by PCR and DIF). 201 women and 169 men were tested. Additionally, adults in the same communities who had not been randomly selected were offered the same services. An extra 243 women and 85 men were tested in this way. The laboratory results confirmed the clinical impression of an extremely high prevalence of STDs in this population. Among those randomly selected, 46% of the women had trichomonal vaginal infections and 26% had Chlamydia trachomatis infections detected by PCR, while 25% of the men had chlamydial infections. Other infections were much less common. 58% had one or more STDs. The prevalence of infection in self-selected adults was similar to that found in those randomly selected.
Nitric oxide in Tanzanian children with malaria: inverse relationship between malaria severity and nitric oxide production/nitric oxide synthase type 2 expression
(The Journal of experimental medicine, 1996) Mwaikambo, Esther D.
Summary Nitric oxide (NO)-related activity has been shown to be protective against Plasmodium faki- parum in vitro. It has been hypothesized, however, that excess NO production contributes to the pathogenesis of cerebral malaria. The purpose of this study was to compare markers of NO production [urinary and plasma nitrate + nitrite (NO~)], leukocyte-inducible nitric oxide syn- thase type 2 (NOS2), and plasma TNF-c~ and IL-10 levels with disease severity in 191 Tanza- nian children with and without malaria. Urine NO• excretion and plasma NOx levels (cor- rected for renal impairment) were inversely related to disease severity, with levels highest in subclinical infection and lowest in fatal cerebral malaria. Results could not be explained by dif- ferences in dietary nitrate ingestion among the groups. Plasma levels of IL-10, a cytokine known to suppress NO synthesis, increased with disease severity. Leukocyte NOS2 antigen was detectable in all control children tested and in all those with subclinical infection, but was undetectable in all but one subject with cerebral malaria. This suppression of NO synthesis in cerebral malaria may contribute to pathogenesis. In contrast, high fasting NO x levels and leu- kocyte NOS2 in healthy controls and asymptomatic infection suggest that increased NO syn-thesis might protect against clinical disease. NO appears to have a protective rather than patho-logical role in African children with malaria.
Sequence diversity and molecular evolution of the merozoite surface antigen 2 of plasmodium falciparum
(Journal of molecular evolution, 1997) Mgone, Charles S.
Eleven new alleles of the Plasmodium falciparum merozoite surface antigen 2 (MSA2) from Papua New Guinea were analyzed by direct sequencing of polymerase chain reaction (PCR) products. We have used the sequence information to trace the molecular evolution of MSA2. The repeats of ten alleles belonging to the 3D7 allelic family differed considerably in size, nucleotide sequence, and repeat copy number. In the repeat region of these new alleles, codon usage was extremely biased with an exclusive use of NNT codons. Another new allele sequenced belonged to the FC27 family and confirmed the family-specific conserved structure of 96 and 36 bp repeats. In order to assess sequence microheterogeneity within samples defined as the same genotype by restriction fragment length polymorphism (RFLP), we have analyzed single-strand conformation polymorphism (SSCP) of different samples of the most frequent allele (D10 of the FC27 family) in the study population. No sequence heterogeneity could be detected within the repeat region. Based on analysis of the repeat regions in both allelic families, we discuss the hypothesis of a different evolutionary strategy being represented by each of the allelic families.
Seroepidemiology of Rickettsia typhi, spotted fever group rickettsiae, and Coxiella burnetti infection in pregnant women from urban Tanzania
(The American journal of tropical medicine and hygiene, 1997) Mwaikambo, Esther D.
Abstract Immunofluorescent antibody (IFA) testing was performed on sera drawn from 150 pregnant women in the port city of Dar es Salaam, Tanzania. Prevalence of antibodies to Rickettsia typhi was 28%, higher than in any of the 12 other African countries in which serosurveys using IFA testing have been performed. Seroprevalence of antibodies to spotted fever group rickettsiae antigens was 25.3%, comparable with that found in other sub-Saharan countries endemic for Amblyomma ticks. Only 4.7% of women were seropositive for Coxiella burnetii.
An expanded histatin gene polymorphism and test of a possible disease resistant phenotype
(Human mutation, 1997) Mwaikambo, Esther D.
Abstract Histatins are small molecular weight salivary proteins that are important in the non‐immune host defense system. Two frequent cis‐linked coding‐change mutations were previously described in exon 5 of the HIS2 gene of Blacks. The polymorphic mutant allele was termed HIS22 and the wild‐type allele HIS21. We here describe two new non‐coding change polymorphisms of the HIS2 gene: a deletion in intron 5 (7183‐7198 del) and a C⇒T mutation in exon 5 [C⇒T (7104)] that characterize two new HIS2 alleles, HIS23 and HIS24 respectively. Both mutations occur on a HIS21 background. The HIS23 allele occurred only in Afro‐Americans, but not in 67 Japanese, 51 Chinese and 50 Whites. Among 66 random DNA samples from Afro‐Americans, frequencies of HIS21, HIS22, HIS23 and HIS24 were 0.67, 0.22, 0.05 and 0.07 respectively, with a heterozygosity of 0.45. The frequencies of the HIS24 allele in 50 Whites and 50 Chinese were 0.06, and 0.1 respectively. In a comparison of 60 matched saliva and DNA samples from the Afro‐American population, the DNA‐based mutation analysis reliably identified salivary histatin phenotypes. The salivary histatin polymorphism (inferred from PCR analysis) was used to test a biologically plausible hypothesis, that the mutant histatin phenotype (coded by the HIS22 allele) confers relative resistance to severe and fatal malaria. In a study of 185 Black Tanzanian subjects, there were no significant differences in HIS22 allelic frequencies between the various test groups: for 86 cerebral malaria subjects, 54 uncomplicated malaria subjects, and 45 combined asymptomatic parasitemia and health controls, HIS22 frequencies were 0.16, 0.17 and 0.17 respectively. Thus, there was no support for the hypothesis in this population. Hum. Mutat. 10:58–64, 1997. © 1997 Wiley‐Liss, Inc.
Community based study of sexually transmitted diseases in rural women in the highlands of Papua New Guinea: prevalence and risk factors
(Sexually transmitted infections, 1998) Mgone, Charles S.
Objective: To estimate the prevalence of sexually transmitted diseases (STDs) and determine their risk factors/markers among a rural population of women in the highlands of Papua New Guinea. Methods: Community based random cluster sample of women of reproductive age were interviewed and examined and had specimens collected for laboratory confirmation of chlamydial and trichomonal infection, gonorrhoea, syphilis, and bacterial vaginosis. Results: Chlamydia trachomatis was detected in 26%, Trichomonas vaginalis in 46%, Neisseria gonorrhoeae in 1%, syphilis in 4%, pelvic inflammatory disease (PID) (diagnosed clinically) in 14%, and bacterial vaginosis in 9% of 201 women. 59% of the women had at least one STD. In a multivariate logistic regression analysis taking the clustered sampling into account, independent risk factors for chlamydial infection were age < 25 years, < four living children, visualisation of yellow mucopurulent endocervical secretions on a white swab, and bacterial vaginosis. Being married to a man who did not have other wives was protective. For trichomonal infection, independent risk factors were having no formal education, infertility, more than one sexual partner in the previous 12 months, treatment for genital complaints in the previous 3 months, abnormal vaginal discharge detected on examination, and chlamydial infection. Similar levels of trichomonal infection were found in all age groups. Among married women, rates of infection correlated with their perception of their husband having had other sexual partners in the previous 3 months, and this relationship was significant for chlamydial infection among women over 25. Conclusion: STDs are a major problem in this population, with the risk factors varying by outcome. Current treatment regimens are inappropriate given the high prevalence of trichomonal infection, and the available services are inadequate. Effective interventions are required urgently to reduce this burden and to prevent the rapid transmission of HIV.
Red cell morphology and malaria anaemia in children with Southeast- Asian ovalocytosis band 3 in Papua New Guinea
(British journal of haematology, 1998) Mgone, Charles S.
Southeast-Asian ovalocytosis (SAO) was diagnosed in children from Madang, Papua New Guinea, by detection of the SAO band 3 gene variant using the polymerase chain reaction. SAO band 3 was present in 16/241 (6.6%) children living in the community and 32/389 (8.2%) children with acute Plasmodium falciparum malaria (P=0.42). SAO band 3 was detected in 8.2% (23/281) of alpha+-thalassaemia homozygotes, 9.4% (20/214) of heterozygotes and 2.4% (2/85) of children with a normal alpha-globin genotype (P=0.12). The most consistent feature of SAO band 3 on microscopy of thin blood films was red cells with two or more linear or irregularly-shaped pale regions. In children living in the community, these were present in 15 with SAO band 3 (sensitivity 93.8%) and only two normals (specificity 99.1%). The presence of > or = 20% ovalocytosis was a poorer indicator of SAO band 3 (sensitivity 68.8% and specificity 100%). Haematological data were similar in SAO band 3 and normal children. However, in children with acute malaria, haemoglobin levels and red cell counts were significantly lower in SAO band 3 than normal children. The degree of ovalocytosis was lower in children with SAO band 3 during acute malaria, suggesting that a selective loss of ovalocytes may contribute to malaria anaemia in Southeast-Asian ovalocytosis.
Birthweight and neonatal outcome at the Muhimbili Medical Centre, Dar Es Salaam, Tanzania
(East African Medical Journal, 1998) Mgone, Charles S.
A prospective study of neonatal morbidity and mortality was made over four months in 1990 at the neonatal unit in Muhimbili Medical Centre. The incidence of low birthweight (LBW) was 16%. Seven hundred and eighty four LBW infants and 612 heavier infants admitted for care in the unit were followed up for six weeks. The mean birth weight was 2854 grams. LBW carried a seven-fold increased risk of mortality (291/784;37%); this was 64% (291/341) of the total. The risk of morbidity in LBW infants was increased three-fold (436/784;56%) being 73% (436/598) of the total. Factors significantly associated with increased morbidity and mortality were prematurity, birth asphyxia, sepsis, respiratory distress syndrome, hypothermia and hypoglycaemia. The majority of the deaths (83%) occurred within the first week of life.

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