Non communicable diseases and infections refuse to go away despite current knowledge and scientific advances

It is a pleasure to welcome you to this first issue of African Health Sciences for 2014. We bring you papers on non-communicable diseases, infections, herbal medicine, reproductive health and medical education. The paper by Adisa and Fakeye¹, introduces us to an interesting component of patient management in type 2 diabetes, that is, adherence to the medication. More than 75% of the patients were not aware of the indication for the prescribed medicine. Possible barriers to non-adherence included lack of knowledge, poor attitude, high cost, confusing doze of medicine, and premature discontinuation due to side effects. Saudi authors have studied the ‘impact of mild versus moderate intensity aerobic walking exercise training on markers of bone metabolism and hand grip strength in moderate hemophilia patients’.² On the other hand, Ugandan authors³ describe histopathological types of cancer of the esophagus , while Chinese authors⁴ report on the anti-human gastric cancer effect of astragalosides.

Quality of life of patients with cancer has become a critical issue in non-communicable disease management. Chinese workers studied the quality of life in rectal cancer patients with colostomy.⁵ Keeping with Chinese scientists, Chao Ou et al⁶ report the effect of biloba extract on Cox-2 and GST-Pi in rats with hepatocellular carcinoma risk. They conclude that ‘EGb can regulate the expression of GST-Pi, but it can't take an effect on the Cox-2 expression in the liver of HCC risk rats.’ Wang⁷ reports on the symptom clusters and quality of life in Chinese patients with lung cancer undergoing chemotherapy, while Nigerian⁸ dentists have an interesting paper on maxillofacial tumors and tumor-like lesions. Most of the tumours were benign and late presentation remains a critical issue.

The next two papers are on mundane subjects vis: removal of metallic objects from tissues⁹ and pterygium recurrence after surgery.¹⁰ We have emphasized this because foreign bodies and pterygium are quite common, especially in rural Africa. Cameroonian workers report on ‘dentofacial injuries in commercial motorcycle accidents' and cost implication of care,¹¹ while Feng describes the relationship between the morphology of A-1 segment of anterior cerebral artery and anterior communicating artery aneurysms.¹² On the other hand Chen and others¹³ have studied the treatment of ruptured cerebellar artery aneurysms. We conclude this section with a seminal paper by Talay¹⁴ on the value of mean platelet volume in the diagnosis of acute pulmonary embolism.

We bring you very interesting papers on malaria and infections among pregnant women. Sezi¹⁵ discusses the use of bed nets and indoor house spraying in the control of malaria and argues that bed nets and indoor spraying have been catapulted into “a phenomenon of diminishing returns.” Nigerian authors report that herbal medicine, together with artesunate, are effective against Plasmodium berghei malaria.¹⁶ These two papers are important because of the challenge of rapid emergence of resistance of mosquitoes to chemicals used for spraying and malaria parasite resistance to medications used for prevention and treatment.

Abate in Ethiopia¹⁷ has studied syphilis among pregnant women and found that the prevalence was highest in the 21–25 age group and that students had the highest risk. The authors call for emphasis on ‘education to young people on STI risk behavioral change and partner follow up and notification for exposure to syphilis and treatment.’ Hitherto, the burden of CMV amongst pregnant women has remained largely unknown. Nigerian workers¹⁸ found that 91% of pregnant women had evidence of CMV infection. Although the HIV status was not mentioned, it is important to regularly screen pregnant women for CMV, especially those who are HIV infected. While measles has been largely eliminated from sub-Saharan Africa, occasional epidemics occur. Kuti et al¹⁹ have studied the effect of supplemental measles immunization on cases of measles admitted at the Wesley guild hospital, Ilesa, Nigeria. They found that there was a remarkable reduction in the prevalence of measles cases after the introduction of supplemental immunization activities (SIAs). Zinc is a very important micro-nutrient, especially amongst children where it is involved in boasting immunity against infection. Nigerian workers²⁰ report that 98 versus 64% of the children with pneumonia and without had low zinc levels in the blood. This calls for policies for use of zinc in the management of children with pneumonia. Nabukeera and others²¹ report on the ppresentation and outcome of tuberculous meningitis among children: experiences from a tertiary children's hospital.

Tanzanian workers studied the effectiveness of counseling at primary health facilities specifically looking at the level of knowledge of antenatal attendee and their attitude on Prevention of Mother to Child Transmission of HIV in primary health facilities in Dar es salaam, Tanzania.²² Peltzer describes the prevalence and factors associated with tuberculosis treatment outcome among hazardous or harmful alcohol users in public primary health care in South Africa²³, while Cameroonian authors report activities of selected medicinal plants against multi-drug resistant Gram-negative bacteria.²⁴

Chinese researchers assess the ‘in vitro evidence of baicalein's inhibition of the metabolism of zidovudine,²⁵ while Nigeria workers report the haematological, hepatic and renal functions of petroleum tanker drivers in Lagos,²⁶ Nigeria. In vitro evidence for endocrine-disrupting chemical (EDC)'s inhibition of drug metabolism²⁷, and correlation between the cystathionine- γ -lyase (CES) and the severity of peptic ulcer disease²⁸ are two key physiology/biochemistry papers with potential practice impact. Turkish authors review locomotor differences in Mongolian gerbils with the effects of midazolam administration in the form of eye drops²⁹ while a review of the chemistry and pharmacology of 7-methyljugulone³⁰ and the influence of bile acids homeostasis by cryptotanshinone-containing herbs³¹ completes this section.

June Bardy³² has written for us a beautiful piece on sponsorship and gifts from formula companies while Karatas has written for us on the evaluation of chromosomal abnormalities and common trombophilic mutations in cases with recurrent miscarriage;³³ while Aliku³⁴ presents a a case of anomalous origin of the left coronary artery presenting with acute myocardial infarction and cardiovascular collapse. How medical education can contribute towards the reduction of maternal mortality in Angola³⁵,burnout and psychological distress among nurses³⁶ in a Nigerian tertiary health institution are seminal papers needing our attention.. The next set of papers concern women and children.^37,38 We conclude this series with two submissions on the importance of the mean platelet volume in the diagnosis of supraventricular tachycardia,³⁹ and the relationship between RDW levels and atrial fibrillation in hypertensive patient.⁴⁰