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The use of condoms can reduce the risk of sexually transmitted infections (STIs) including the human immunodeficiency virus (HIV) infection. We conducted this study to determine factors that impact condom use among patients attending an STI clinic in Montego Bay, Jamaica. A questionnaire containing sections on socio-demographic characteristics, knowledge of STIs and HIV, preventive measures for STI/HIV transmission and sexual practices including condom use was administered to 212 participants. Using logistic regression, we determined the relationship between the different factors and condom use during the last sexual episode. Approximately 43% of study participants reported condom use during the last sexual episode. Employment (OR=2.2; 95%CI=1.1-4.1) and greater knowledge of STIs (OR=1.9, 95%CI=1.02-3.6) were associated with increased likelihood of condom use during the last sexual episode. Having multiple sexual partners was associated with decreased likelihood to report condom use (OR=0.3, 95%CI=0.1-0.9). Also, persons belonging to a religious organization were less likely to report condom use (OR=0.5, 95%CI=0.2-0.9). The results of this study can be used in formulating effective strategies to increase condom use in Montego Bay. This would decrease the transmission of STIs and HIV.

Purpose. We examined the relationship between various health parameters and aflatoxin B 1 (AFB 1 ) albumin adduct levels in plasma. Design. A cross-sectional field study was conducted in four villages in the Ashanti region of Ghana. Methods. A survey on socio-demographic and health characteristics was administered to 162 volunteers and blood (20 ml) was donated by 140 participants. AFB 1 albumin adduct levels, liver function, hepatitis B and C viruses (HBV, HCV) and malaria infections were determined. Results. AFB 1 levels ranged from 0.12 to 2.995 pmol mg 21 albumin (mean¡standard deviation50.89¡0.46) and was categorized based on the median as low (,0.80 pmol mg 21 ) or high (>0.80 pmol mg 21 ) and used in the analyses. By multivariate analysis, significantly higher levels of AFB 1 were obtained for participants who reported symptoms of acute aflatoxicosis: history of yellow mouth (odds ratio55.5, confidence interval51.04-29.07, p50.04); history of sore swollen stomach (odds ratio54.54, confidence interval51.28-15.62, p50.01). A history of painful vomiting was marginally associated (p50.09) with high AFB 1 levels. Between 30 and 40% of the study group had abnormal liver function and HBV/HCV infections. Total protein and alanine transaminase (ALT) were positively correlated to AFB 1 levels (p,0.01 and p50.02, respectively). For every unit increase in AFB 1 , total protein increased by 0.27 units and ALT increased by 0.20 units. HBV was associated with high AFB 1 levels (p50.055) and HCV was marginally associated with low AFB 1 levels (p50.08). Approximately 20% of study participants were positive for malaria antigen in blood. A number of symptoms and disease markers were not significantly associated with AFB 1 . J Nutr Environ Med Downloaded from informahealthcare.com by Chulalongkorn University on 01/05/15For personal use only.Conclusions. These results show high levels of AFB 1 and symptoms of acute aflatoxicosis in a population that also has high levels of HBV/HCV infections and abnormal liver function. Thus, a high proportion of these study participants are at significant risk of developing hepatocellular carcinoma.

Many countries in Africa, including Sierra Leone, have adopted artemisinin-based combination therapy as first-line therapy for treatment of patients with malaria. Because laboratory testing is often unavailable in rural areas, the cost-benefit and viability of this approach may depend on accurately diagnosing malaria by using clinical criteria. We assessed the accuracy of syndromic diagnosis for malaria in three peripheral health units in rural Sierra Leone and determined factors that were associated with an accurate malaria diagnosis. Of 175 children diagnosed with malaria on syndromic grounds, 143 (82%) were confirmed by the Paracheck-Pf test. In a multivariate analysis, splenomegaly (P = 0.04) was the only clinical sign significantly associated with laboratory-confirmed malaria, and sleeping under a bed net was protective (P = 0.05). Our findings show that clinical malaria is diagnosed relatively accurately in rural Sierra Leone. Incorporating bed net use and splenomegaly into the national Integrated Management of Childhood Illness guidelines for evaluation of fever may further enhance diagnostic accuracy for malaria.

Introduction Humoral immune responses play a pivotal role in naturally acquired immunity to malaria. Understanding which humoral responses are impaired among individuals at higher risk for malaria may improve our understanding of malaria immune control and contribute to vaccine development. Methods We compared humoral responses with 483 Plasmodium falciparum antigens between adults in, Kisumu (high, year-long malaria transmission leading to partial immunity), and adults in Kisii (low, seasonal malaria transmission). Then within each site, we compared malaria-specific humoral responses between those at higher risk for malaria (CD4+ ≤ 500) and those at lower risk for malaria (CD4+>500). A protein microarray chip containing 483 P. falciparum antigens and 71 HIV antigens was used. Benjamini–Hochberg adjustments were made to control for multiple comparisons. Results Fifty-seven antigens including CSP, MSP1, LSA1 and AMA1 were identified as significantly more reactive in Kisumu than in Kisii. Ten of these antigens had been identified as protective in an earlier study. CD4+ T-cell count did not significantly impact humoral responses. Conclusion Protein microarrays are a useful method to screen multiple humoral responses simultaneously. This study provides useful clues for potential vaccine candidates. Modest decreases in CD4 counts may not significantly impact malaria-specific humoral immunity.