Extracts from Journals / For your Resource Centre - February 2009


Zinc Supplements Reduce Diarrhoea in Drug Users with HIV

Persistent diarrhoea affects the great majority of patients with HIV/AIDS, resulting in malabsorption, weight loss and reduced survival. Dr. Campa from Florida International University and colleagues randomised 231 HIV-positive drug users with diagnosed zinc deficiency, 62.3% of whom were on antiretroviral therapy, to receive either zinc supplements or a placebo. Men received 15 mg while women received 12 mg daily for a year.


Zinc supplementation cut the episodes of diarrhoea in half. Specifically, the prevalence of diarrhoea was 14.1% and 29.3% in the zinc-supplemented patients and the controls, respectively. Zinc supplements produced a significant benefit even after accounting for confounding factors like HAART, viral load and CD4+ cell counts. Dr. Campa and colleagues conclude that zinc supplementation is a safe and effective adjunct therapy for HIV-associated diarrhoea.

Extracted from email sent to [email protected] on 8/10/08 by C. Vidya Shankar, MD


HIV, antiretroviral treatment, and HIV sexual transmission: what’s new?

Many factors affect the risk of HIV transmission from one individual to another. These include structural, social and biological aspects of both the individual and the virus. One of the most important factors is the level of circulating virus in the blood or other body fluids including semen, vaginal secretions and, in mother to child transmission, breast milk.

Reducing the viral load in a person living with HIV by antiretroviral treatment greatly reduces the risk of HIV transmission. In studies of couples where one partner is positive and the other negative no transmissions have been reported when viral loads are below a certain level.

For individuals, understanding the issues of HIV transmission while on antiretroviral treatment will allow them to make decisions about their sexual relationships with long term partners, including the use of protection and decisions about conception. There are several important caveats when advising HIV positive individuals about the risk of sexual transmission while on long term suppressive antiretroviral treatment. These need to be dealt with at individual level and require clear unambiguous messages about risk.

At a population level the possibility exists that increasing the number of people who are aware of their HIV status and are on antiretroviral treatment may help reduce the number of new cases of HIV (incidence). Although we cannot treat our way out of the HIV epidemic, identifying and treating people living with HIV is of benefit in itself and for the prevention effect. Although it still needs to be understood that this is useful as one tool in the prevention portfolio.

There is an urgent need to scale up comprehensive country and population specific HIV prevention in order to properly address the 2.5 million new infections that occur every year.

Summary of an article by Ade Fakoya, senior adviser on HIV and health services in the Alliance secretariat’s HIV Best Practice Unit and extracted from The Loop - News from the International HIV/AIDS Alliance: Nov. 2008 http://www.aidsalliance.org.

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Congo-Kinshasa: Pre-eclampsia reduction

A diet rich in vegetables and increased physical activity lowered the risk of pregnancy-induced hypertension (pre-eclampsia) among rural women in the DR Congo. Pre-eclampsia incidence was 33.3% in pregnant women with rare daily servings of vegetables and little physical activity, compared to only 3.7% in those with three or more daily servings of vegetables and daily physical activity.
"Diets rich in vegetables and physical activity are associated with a decreased risk of pregnancy induced hypertension among rural women from Kimpese, DR Congo"
Extract from Nigerian Journal of Medicine 2008; 17(3): 265-269 http://www.ajol.info/viewarticle.php?jid=278&id=42662



Nutrition and Tuberculosis: A review of the literature and considerations for TB control program 

 This paper reviews the scientific literature on the role of nutrition in TB disease, summarises key findings and knowledge gaps, and investigates related programmatic experience. The primary target audiences are nutrition program managers in Africa and technical advisors in TB programs.


Based on the information in this report, it is clear that TB affects nutritional status. Many patients with active TB experience severe weight loss and some show signs of vitamin and mineral deficiencies. Persons with TB/HIV co-infection are even worse off nutritionally. However, the evidence surrounding best practices for nutritional management is very limited. HIV is one of the most important factors contributing to the increase in active TB cases in sub-Saharan Africa.

Published by Africa's Health in 2010 project/AED April 2008. Download at

For your resource centre

1. Free DVDs and CDs

  • See list of TALC CDs on page 13.


  • The free Tuberculosis Case Management CD-ROM, produced by the USAID-supported Quality Assurance Project/ Health Care Improvement Project, is for training health workers in TB diagnosis and treatment, using the World Health Organization's Directly Observed Therapy Short-Course (DOTS) approach. Users can practice and apply mastery of DOTS on simulated cases and improve treatment and diagnostic decisions using computer-generated feedback on their performance. Trials indicated that health workers learnt faster from this program than traditional paper-based training. Copies of the CD are free to health workers in Southern Sudan without access to overseas funds. For details and to order the CD email [email protected]. The project also publishes online materials on child survival, HIV and AIDS, malaria, reproductive health and family planning, safe motherhood and TB at http://www.qaproject.org.


  • The Unified Medical Dictionary is a free CD that is available from the World Health Organization, Eastern Mediterranean Regional Office. To request a copy contact M. Mazen Al Abbar,  [email protected]


  • Strategies for Hope Trust produce DVDs and other materials on community-based strategies of HIV care, support and prevention - see www.stratshope.org for details. A limited number of DVDs are available free to local NGOs, community groups, faith-based organisations or training centres in Southern Sudan (but not to international NGOs, UN organisations and government organisations that receive international aid or to individuals). To request the free DVDs email Glen Williams [email protected] and give a reliable postal address, details of your organisation and the work it does, and say how you would use these materials. Note that you need access to DVD equipment. Priced materials from Strategies for Hope Trust are available from TALC – see www.talcuk.org.



2. Free hard copy newsletters

photo: TALC. Nurses using books supplied by TALC.

  • ICTHES World Care (International Community Trust for Health and Educational Services) is a Scotland-based medical charity. It publishes, in partnership with the World Health Organization and other organisations, the following printed journals which they send, free of charge, to health workers principally in Sub Saharan Africa and Asia.
    • Community Ear and Hearing Health covers the prevention, management and rehabilitation of ear and hearing disorders and promotes ear and hearing health.
    • Developing Mental Health covers mental health issues.
    • Community Dermatology covers the diagnosis and treatment of skin disease, and the promotion of skin health. It has many illustrations to aid diagnosis and treatment.

To request the newsletters send your name and postal address to Mary Bromilow [email protected]. Multiple copies may be available. For more information see  www.icthesworldcare.com.


3. Items to download from the Internet

  • Childhealth Advocacy International (CAI) online manual: The Practical Approach to Emergencies in the Pregnant Mother, Newborn infant and Child is online at http://www.caiuk.org/projects/emch_manual.htm. This is an illustrated easy-to-use manual covering essential surgical skills with special emphasis on emergency maternal & child health. The 14 topics include infection prevention, triage, pain management, complications of labour and post-operative care; each section can be downloaded separately.

Also on the CAI website (www.caiuk.org) is the section 1 of the e-version of International Child Healthcare: a practical manual for hospitals worldwide previously published by BMJ books and Blackwells. Download at http://www.caiuk.org/publications/international_child_health.htm. Other sections of the book will be put on the website when ready.


The website and publications are supported by the UK-based medical charities CAI and Advanced Life Support Group (www.aslg.org).

CAI and ALSG have also produced two interactive CDs/DVDs – ‘Advanced Paediatric Life Support – the practical approach’ and ‘Essential Surgical Skills – emergency maternal and neonatal Healthcare’. Copies are available to consult at the Juba Teaching Hospital Resource Center.


October 2008 Burn Management.

November 2008 Surgical Site Infections, Antimicrobial Agents, Universal Precautions and Post-exposure Prophylaxis.

December 2008 Surgical Alternatives to Cesarean Section in Obstructed Labour: Maternal and Fetal Destructive Procedures.

  • The International Child Health Review Collaboration is a project that reviews the evidence basis behind ‘WHO Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Illnesses with Limited Resources’. To see these reviews go to http://www.ichrc.org.


  • International Journal of Diabetes in Developing Countries at www.ijddc.com is an Open Access journal produced by Research Society for the Study of Diabetes in India.


  • National diabetes information clearinghouse at http://diabetes.niddk.nih.gov contains materials on diabetes facts, treatments, statistics, and reports for health professionals, people with diabetes, and the general public. Publications may be downloaded or ordered online, free of charge. The site is supported by the US National Institutes of Health.

  • The latest issue of MotherNewBorNews covers Community-Based Management of Newborn Infections. Download a copy at MotherNewBorNews_Neontal Sepsis_July 2007-June 2008_Final.pdf (168KB).


  • PATH has redesigned and upgraded its Vaccine Resource Library – which gathers
    immunisation resources in an easy-to-use website. Materials are from a variety of sources, such as news media, scientific journals, and leaders in public health. Subjects included range from diseases and vaccines like influenza, hepatitis B, and rotavirus, to related immunisation topics such as injection safety, service delivery, and immunisation financing. Visit PATH's Vaccine Resource Library at:


New guidelines from WHO: Guidelines for the Programmatic Management of Drug-resistant Tuberculosis: Emergency Update 2008

The emergence of extensively drug-resistant strains of tuberculosis, especially in countries with a high prevalence of human immunodeficiency virus seriously jeopardises efforts to control the disease. These important developments and the availability of new evidence related to the diagnosis and management of drug-resistant tuberculosis are the reason for these updated guidelines that replace previous WHO publications.


The guidelines give recommendations for the diagnosis and management of drug-resistant tuberculosis, and the recording of data that enables the monitoring and evaluation of programmes.

See www.who.int. Hard copies priced; e-copies free online (to download put title of material in WHO, google or other search engine).


The Uganda Continuing Medical Education Newsletter September - October 2008 Issue 53 includes the following articles:                          

  • New diseases may still occur
  • The young are our future (WHO data about adolescent health)
  • Where is the primary site of a cancer?
  • Psychiatric disorders associated with chronic physical diseases.
  • What is the cause of the fever?
  • A reminder of the opportunistic infections (and some other complications) in AIDS and when to expect them.
  • Staphylococcus aureus and its dangers.

To request an e-copy of this and other Uganda CME newsletters, email Dr David Tibbutt  at [email protected]


The website Health Researchers in Sudan

  http://hrsudan.pbwiki.com compiled by Dr Ghaiath M. A. Hussein ([email protected]) aims to create an online community for the researchers and all those involved in research involving Sudanese people. The site gives information on Grants and Fellowships, and National and International Guidelines (including guidelines for preparing a research proposal). The materials may soon be available on CD.