A trial in Kenya has shown that text messages can help patients adhere to their treatment, and improved absolute adherence rates by 12 percent and viral load suppression by 9 percent.

The study, written by Richard T. Lester, MD, of the University of British Columbia in Vancouver, and colleagues, was released online Nov. 9 in the Lancet. It also will be presented later this month at the 2010 mHealth Summit in Washington, D.C.

The study assessed whether cellphone communication between healthcare workers and patients starting antiretroviral therapy (ART) in Kenya improved drug adherence and suppression of plasma HIV-1 RNA load. The randomized trial assessed HIV-infected adults initiating ART in three clinics in Kenya, where patients received a cellphone short message service (SMS) intervention or standard care.

Patients in the intervention group received weekly SMS messages from a clinic nurse and were required to respond within 48 hours. Patients in the control group received standard follow-up without text messages. Primary outcomes were self-reported ART adherence (greater than 95 percent of prescribed doses in the past 30 days at both six- and 12-month follow-up visits) and plasma HIV-1 viral RNA load suppression at 12 months.

The health workers used multiple recipient (bulk) messaging functions to improve efficiency. Patients in the intervention group were instructed to respond within 48h that either they were doing well or that they had a problem. The clinician then called patients who said they had a problem or who failed to respond within two days.

Between May 2007 and October 2008, 273 patients participated in the SMS intervention arm and 265 patients participated in the standard care arm. Adherence to ART was reported in 62 percent of those patients receiving the SMS intervention, compared with 50 percent in the control group. Suppressed viral loads were reported in 57 percent of patients in the SMS group and 48 percent in the control group.

“This study shows that mobile health innovations can improve HIV treatment outcomes. Patients who received the SMS support were more likely to report adherence to ART and were more likely to have their viral load suppressed below detection levels than patients who received the standard care alone,” the authors stated.

Only 3.3 percent of the weekly text messages identified a definitive requirement for follow-up, one nurse could potentially manage 1,000 patients by SMS and expect to call only 33 patients per week, the authors stated. SMS intervention is inexpensive (each SMS costs about 5 cents, equivalent to $20 per 100 patients per month, and follow-up voice calls averaged $3.75 per nurse per month) and the cellphone protocol used existing infrastructure.

“The applicability of this study to other countries and other diseases remains to be assessed,” the authors concluded. “Although the uptake of wireless telecommunication devices is becoming ubiquitous, introduction of mobile health initiatives is variable. We believe that the patient-centered communication effect, in particular the timely support of a patient by a health professional, is universal and can be improved by mobile telecommunication.”

Source: http://www.cmio.net/index.php?option=com_articles&view=article&id=25060&division=cmio

The exact cause of uterine fibroids remains largely unknown, but their growth seems to depend on estrogen, the female hormone

Dear Ask-a-doc,

I usually have heavy menstrual bleeding and very bad abdominal cramps during my periods. I recently visited my doctor, who asked me to have an ultrasound examination done, and it showed I have Uterine Fibroids. Since then, I have been very worried. How did I get fibroids? I heard you cannot give birth if you have fibroids. Is that true? I am young and wish to have children. Do I have to have my uterus removed? Is there a cure for fibroids?
Worried.

By Brenda Banura

Some women conceive easily the first time but can’t get a second child. Brenda Banura looks at secondary infertility, the reason why women are unlucky the second time round.

Patience has so many siblings and as a result, her parents always had financial problems. This forced them to take the children to sub standard, cheap schools. She thus promised herself to have few children that she would be able to take care of with ease.

At first she wanted two children but then she thought those were few. She then thought of having three but since she hates odd numbers, she settled for four children.  At 27, she gave birth to her first born and was ready for another one two years later. But Patience is now 32 and after three years of trying to get pregnant, she has not yet conceived a second child.

Do not let the thought that this happens to a few women cross your mind because Othaman Kakaire, a gynaecologist at Mulago Hospital, says out of every 10 women he sees, six have the same complaint as Patience’s.

This condition is known as secondary infertility. Kakaire defines secondary infertility as a condition where a woman who has conceived before or a man who has impregnated before engages in regular unprotected sex but fails to procreate for over a year. 

“In men, if you are unable to erect or the erection is too weak to allow you to penetrate, or the sperms in the semen are too few, absent or abnormal, then you may not impregnate a woman.” Save for the inability to erect, Kakaire says secondary infertility is not a symptomatic disease so do not expect any signs. There are certain things about one’s lifestyle that may make one vulnerable and cause this condition.

If you are the kind that has many sexual partners, chances of contracting sexually transmitted infections like gonorrhea and chlamydia are high. These infections can block the fallopian tubes where fertilisation takes place and once this happens, it is impossible for a woman to conceive.

Another lifestyle contributing factor is psychological stress for both partners. You could be stressed because of work or relatives who are demanding to see you have children. Also, men whose way of life requires them to stay in places with a lot of heat are vulnerable to secondary infertility.

Because too much heat affects sperm production, it is not advisable to go to the sauna a lot; this also puts male chefs at a risk, given the nature of their humid work environment.

The gynaecologist adds that obesity, which is usually a result of one’s lifestyle, can also cause this condition.  “When one is obese, the fats in the body produce oestrogen, a substance that interferes with the proper functioning of one’s reproductive hormones starting from the brain. Obesity in men also affects the sperm production, as do taking alcohol and smoking,” he warns.

The brain
Apart from one’s life style, secondary infertility can be a result of problems in the brain. In the brain are two organs; the hypothalamus sends a message to the pituitary glands and controls the reproductive function; and the pituitary sends messages commanding the release of ova. If either is damaged, for example by a tumor, the messages will not be sent or received and that is how secondary infertility comes about. The ovaries will not be released and you may not even have periods. Excess bleeding following child birth also destroys the pituitary glands.

The ovaries
Kakaire says sometimes when people get tumors in the ovaries, surgery is carried out to remove them. “If this surgery is conducted by a non-professional, they may remove the ovaries as well without consulting you.” The ovaries can also get infected by viruses which destroy the follicles that normally grow and later burst to release eggs.

The fallopian tubes
Apart from the fallopian tubes being blocked, permanent family planning, where the tubes are tied, means you cannot give birth again. Unclean delivery can also come with infections that damage the tubes, or other infections of the organs near the tubes, for example; a poorly managed appendix. Induced abortion can also damage the fallopian tubes and according to Kakaire, this is the commonest cause of secondary fertility among women in Uganda.

The uterus
“The uterus can be destroyed by fibroids. The edomatia (part of the uterus) may also be destroyed if you undergo dilatation & curettage (the widening/opening of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping. It is also sometimes used for first trimester, the doctor says. This procedure is also carried out if one has abnormal vaginal bleeding.

Kakaire calls upon people to avoid unwanted pregnancies, which call for considering abortions. Keeping in good body shape, feeding well and treating infections early helps one avoid this condition. “If you cheat and catch an infection, do not treat yourself alone; you have put your partner at risk, so ensure that they too get treatment before the infection damages any organs.”

Treatment is available for some of the conditions for instance, surgery can take out fibroids and in-vitro fertilisation (IVF) can be done if fallopian tubes are blocked or the man’s sperms are of poor quality. Excessive prolactin production can be treated. 

You just have to go to a professional to help you out and ensure that both of you go. “If you are not conceiving for over a year, go as husband and wife and see a gynaecologist for a checkup instead of seeking help from traditional healers. It is wise that you get the problem sorted out early. Your patience will be highly required,” concludes the gynaecologist.

Source: Daily Monitor

File | NATION Surgeons carry out an operation on a patient suffering from a heart disease. Surgery on Coast men infected with lymphatic filariasis has given them a new lease of life.

By MAZERA NDURYA mdurya@ke.nationmedia.com and BOZO JENJE bjenje@ke.nationmedia.com

Timely intervention has given a new lease of life to thousands of men in Coast Province who have been walking in the shadow of a debilitating disease targeting male sex organs.

Lymphatic filariasis, a parasitic disease that causes the scrotum to swell enormously, has been a nightmare for men in Kwale, Mombasa, Malindi, Kilifi, Kaloleni, Tana River and Lamu districts.

But even as the disease continues to stalk thousands, a joint initiative by the government, World Health Organisation and MAP International has offered surgical procedures that have eliminated the grotesque condition.

For 53-year-old Kadzitu Kambi, of Kinarani village in Kaloleni District, things changed for the worse when a small itchy spot on his scrotum slowly but painfully developed into a gross swelling.

Walking became a problem for the father of three, who was once energetic and active. It was also difficult for him to do the tasks he used to perform to earn a living for the family.

Although he had seen this condition in other men in the area, where it is estimated that more than 40,000 people suffer from lymphatic filariasis infection, it never occurred to him that he would be included in the statistics.

“The gross swelling on my private part gave me psychological trauma. I used to be teased and ridiculed. I am a football player but became a mere spectator due to the ugly swelling,” he said.

His wife put up with the situation before the operation that restored his normal being.

Told to leave him

“I was told to leave him and get married to another man but I chose to stick with him because when my husband married me he was normal. I chose to suffer in silence with him until help came from an organisation that conducted successful operations,” said Mr Kambi’s wife.

The wife of another patient, Mr Safari Mudzomba, said: “I was always ashamed and uncomfortable walking with him because he could not wear trousers due to the swelling. This frustrated me so much and could not stand the ridicule.”

The condition also affected the productivity of Mr Muhambi Nditwa, a 50-year-old labourer who used to harvest sand near River Nzovuni.

“I used to be very active but with the progression of the disease I could not move swiftly as I used to. Finally, my productivity decreased. I could not work as hard as before and, as a result, my income declined, contributing to my poverty,” he said.

Commenting on the disease, the MAP International country director, Dr Julius Kavuludi, said: “Because of its prevalence, often in rural areas, lymphatic filariasis is primarily a disease of the poor. It has steadily increased due to poverty. As many patients are physically incapacitated, it prevents them from having a normal working life.”

MAP International has organised surgical operations for those with the condition in a campaign called ‘Operation Restore Hope’.

Today Mr Kambi, Mr Mudzomba and Mr Nditwa, who are among the 130 beneficiaries of the surgeries in the last two years, are telling a different story of hope.

“We now have high hopes to pick up once again and move on to fend for our families,” they said.

Cannot afford treatment

According to Mr Safari Ngowa, the programme manager of MAP International, most of the patients operated on had been living with the condition for more than 15 years and could not afford the treatment. One operation costs about Sh20,000.

MAP International chief executive officer Michael Nyenhuis said: “It is gratifying to see a person who was helpless some few years ago now able to take his tools and get back to work and earn a living instead of being an object of pity and ridicule.”

“The 130 people who have been successfully operated on are a living example of what good health can transform lives of a people who can access basic needs such as food, clothing, education and shelter,” he added.

Source: Daily Nation