Studies indicate that antibiotics are sold against regulation and without prescription in private drugstores in rural Tanzania. The objective of the study was to explore and describe antibiotics sale and dispensing practices and link it to drugseller knowledge and perceptions of antibiotics and antibiotic resistance.Exit customers of private drugstores in eight districts were interviewed about the drugstore encounter and drugs bought. Drugsellers filled in a questionnaire with closed- and open-ended questions about antibiotics and resistance. Data were analyzed using mixed quantitative and qualitative methods.Perceiving antibiotic resistance based on practical experience.Of 350 interviewed exit customers, 24% had bought antibiotics. Thirty percent had seen a health worker before coming and almost all of these had a prescription. Antibiotics were dispensed mainly for cough, stomachache, genital complaints and diarrhea but not for malaria or headache. Dispensed drugs were assessed as relevant for the symptoms or disease presented in 83% of all cases and 51% for antibiotics specifically. Non-prescribed drugs were assessed as more relevant than the prescribed. The knowledge level of the drugseller was ranked as high or very high by 75% of the respondents. Seventy-five drugsellers from three districts participated. Seventy-nine percent stated that diseases caused by bacteria can be treated with antibiotics but 24% of these also said that antibiotics can be used for treating viral disease. Most (85%) said that STI can be treated with antibiotics while 1% said the same about headache, 4% general weakness and 3% 'all diseases'. Seventy-two percent had heard of antibiotic resistance. When describing what an antibiotic is, the respondents used six different kinds of keywords. Descriptions of what antibiotic resistance is and how it occurs were quite rational from a biomedical point of view with some exceptions. They gave rise to five categories and one theme: The drugsellers have considerable "practical knowledge" of antibiotics and a perception of antibiotic resistance based on practical experience. In the process of upgrading private drugstores and formalizing the sale of antibiotics from these outlets in resource-constrained settings, their "practical knowledge" as well as their perceptions must be taken into account in order to attain rational dispensing practices. The discovery of antibiotics revolutionized the management of bacterial infectious diseases. Prompt access to and appropriate use of antibiotics render historically lethal diseases curable. Their function is however threatened by growing levels of antibiotic resistance and the problem is especially pertinent in less affluent parts of the world -3. In loOn the other hand, poor people's access to antibiotics is often highly restricted and one third of the world's population is estimated to lack regular access to essential medicines ,10. In TPeople seek care in private drugstores for mild ailments as well as serious diseases. Some of the main reasons include, but are not limited to, inability to pay both for medical consultation and drugs, proximity of the store to the home, availability of drugs and friendliness of the drugseller -18. HowePerceptions influencing antibiotic dispensing practices by drugsellers are not yet well understood . When seThis study was conducted in eight districts of Tanzania. Four of Tanzania's 22 mainland regions were purposively selected based on geographical location. Out of these, eight districts were randomly selected, two from each region: Mkuranga and Rufiji (Coast region), Korogwe and Muheza (Tanga region), Mvomero and Kilosa (Morogoro region) and Mpwapwa and Kongwa (Dodoma region). The population size of each district is around 250 000 inhabitants.A census of drugstores was carried out and a list of all registered drugstores in each district was obtained from the district authority. All drugstores that were still in business at the time of the visits were traced in the eight districts and were included in the study. If found, additional drugstores that were not in the formal list were included during data collection. Ninety-four drugstores were physically identified in the eight districts.The study was conducted in 2005 within the Peercon project aiming to improve drugstore practice. Exit interviews with drugstore customers were performed in all eight districts at the baseline phase of this project. During the intervention phase consisting of workshops and out-reach visits, interviews with drugsellers were performed before the onset of the actual teaching. Drugseller interviews were conducted in three of the above-mentioned districts that had been randomly allocated to the intervention group while the fourth intervention district had to be excluded due to time constraints. The intervention did not focus on antibiotics specifically but on Good Dispensing Practice (GDP), malaria and STI.Consecutive customers from all eligible drugstores in the eight districts were interviewed as they came out of the drugstore. The aim was to interview five customers per store based on power calculations for evaluation of the intervention. The actual number varied between 1-16 customers per store according to feasibility. The customers were asked to show the bought drug and to answer some questions about the encounter such as information provided, satisfaction with the service and perceived knowledge level of the drugseller. They were also asked which disease/symptom they bought drugs for. Data- collectors, mainly pharmacy and medical students, were trained during an interactive workshop led by the Tanzanian co-authors. The data-collectors asked the questions to the customers and filled in the questionnaire, which was developed in English collectively by the research team, translated into Swahili and pretested for clarity. Questionnaire available as additional file One drugseller from each drugstore identified in the intervention districts was invited to participate in the intervention. The intervention participants were asked to fill in a questionnaire at the onset of either the workshops or the out-reach visits before the actual teaching started. The questionnaire contained closed- and open-ended questions on knowledge and perception of antibiotics, their function and indications as well as the concept of antibiotic resistance. It was developed in English, based on findings from the baseline phase, and translated into Swahili. Pretesting led to some changes being made to the questionnaire mainly concerning the wording. Questionnaire available as additional file Verbal informed consent was given by the respondents. They were informed that participation was voluntary and confidential and that they could discontinue the study at any point without adverse consequences. It was emphasized that the study was not part of any official drugstore inspection function. Letters of permission were received from district authorities. Ethical approvals for the Peercon project were received through Muhimbili University of Health and Allied Sciences from the Tanzania Commission for Science and Technology No 2003-084-CC-2003-09 and from Karolinska Institutet No 04-514/3.Data were analyzed using mixed quantitative and qualitative methods.2 -test and, where the groups were too small, Fisher's exact test. A multivariate logistic regression analysis was fitted in Stata 8 using dependent variable: 'knows that antibiotics treat bacterial but not viral disease' and the independent variables: age, sex, education and district. The antibiotics mentioned by the drugsellers were listed and the number of times that each active ingredient or product name was mentioned was counted  for correct time." (Respondent no 36)"To be given drug without testing." (Respondent no 70)It is stated that if the drug is used for a long time it ceases to work. The germs are said to get used to the antibiotic. Also the belief that the body will get used to the antibiotic if used for a long time is brought up."Antibiotic resistance is that maybe it [the antibiotic] has been used for a long time, therefore the body becomes used to it then if you use for other diseases it does not help you because you have used it for a long time." (Respondent no 16)This category entails two sub-categories, one with a focus on waiting too long to treat a disease and one on having a disease for a long time, or having chronic disease.i. Treatment delayWaiting to long before treating the disease is said to make bacteria resistant. Refraining from treating a disease or a delay in seeking care is also mentioned."The meaning of antibiotic resistance is that there are some bacteria, even if you combine antibiotics, they are resistant because the disease has not been treated for a long time. " (Respondent no 8)"To not take drug that was given" (Respondent no 46)"Antibiotic resistance is caused by a patient delaying to get medical care." (Respondent no 27)ii. Chronic diseaseAntibiotic resistance and the causes are described in terms of "chronicity". Having a disease for a long time and the disease being chronic are mentioned repeatedly. Some responses are a bit confusing and it seems the respondent is trying to relate antibiotic resistance to the concept of chronic disease.[Example of confusing answer in relation to antibiotic resistance and chronic disease]"Antibiotic resistance is, maybe it depends on how the patient expresses himself because many patients, when they have a big problem, a serious disease, they tend to be shy to express and that is a source for the disease to be chronic". (Respondent no 10)"Resistance of bacteria to antibiotics is because of disease staying very long time in the body, then it is hard to feel strong by medical care." (Respondent no 45)knowing-in-action[To our knowledge, this is the first study from Tanzania linking antibiotic sale and dispensing practices in private drugstores to drugseller knowledge and perceptions of antibiotics and antibiotic resistance. Although the drugsellers lack higher education and formal pharmacy training, they describe the topics quite rationally from a biomedical point of view. Of all drugs dispensed, the vast majority were assessed as relevant for the symptom or disease presented. Antibiotics were significantly less often assessed as relevant compared to other drugs. The drugsellers however have a sense of which diseases can be treated with antibiotics and which cannot. What we find is probably an example of "practical knowledge", or what has been described by Schön as in-action. Schön'sin-action. When edin-action,29.resistance in Swahili is described by the word 'usugu'. This word however also means chronic. Deeper anthropological studies are needed on these matters.We do believe however that reflecting on one's practice without having access to scientific facts might lead to drawing unconventional or even incorrect conclusions in science-based professions such as pharmacy and medicine. The categories 'Getting used to antibiotics' and 'Letting the disease linger' are examples of this. Medical anthropology studies have shown that peoples' conceptions about medicines and health are influenced by culture and local terminology -32. HaakThe "reflective drugseller" with the perception that long-term use of antibiotics leads to resistance might be inclined to dispense short treatment courses. This practice has earlier mainly been thought to depend on the patients' limited ability to pay -37. In oDrugstores are only licensed to sell OTC drugs but as many as one third of the customers had a prescription which is comparable to findings of another study on private drugstores in Tanzania . Having The perspective in relation to antibiotic resistance, that antibiotics are common goods for health, was not investigated in our study and no drugseller brought up this matter. Perhaps the drugsellers cannot allow themselves the luxury of worrying about wider consequences of antibiotic resistance. Their challenge is instead how to best treat their customers with whichever antibiotic is available and affordable while at the same time making enough profit to sustain their business.The biomedical background of the researchers and data-collectors might have biased the responses towards allopathically acceptable responses. Other types of bias inherent in the different methods of analysis might however have been reduced because of method triangulation ,39. The The number of drugsellers answering the open-ended questions was large for a qualitative study and the material used was short written statements. The regions were purposively selected and the quantitative results can therefore not be generalized to the whole of Tanzania. The results however provide a useful report of the situation in the studied regions and we find no reason to believe that they would differ markedly from other rural regions with respect to the issues studied. New private drugstores continuously open up and others close down. The exact number of drugstores in business as well as response rates are therefore hard to attain. The antibiotic questionnaire data was collected at different points in time in the different districts and in conjunction to either out-reach visits or workshops. 'District', used as a proxy for this in the multivariate logistic regression analysis, showed no statistically significant association with the outcome. The fact that the clustering effect was very small also supported that the individual respondents could be used as unit of analysis. It was not studied which kind of knowledge the drugsellers might have gained through other sources such as earlier training, other interventions or pharmaceutical representatives. The respondents' education level was however not found to be decisive for the knowledge level regarding antibiotics. The very high percentage of drugsellers answering that antibiotics can be used to treat STI might to a certain extent be due to sensitization as STI was one of the topics of the intervention although the teaching had not yet started. The assessments of the sold drugs are based on the symptoms or disease reported by the exit customer and should therefore be interpreted with some care.The drugsellers have considerable "practical knowledge" of antibiotics and a perception of antibiotic resistance based on practical experience. In the process of upgrading private drugstores and formalizing the sale of antibiotics from these outlets in resource-constrained settings, their "practical knowledge" as well as their perceptions must be taken into account in order to attain rational dispensing practices.The authors declare that they have no competing interests.All authors participated in project design, planning and interview guide preparation. The data was collected by research assistants supervised by PM and WK. The data analysis and manuscript preparation was performed by NV with support from PM, WK, GT and CSL. All authors approved the final version of the manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2334/10/270/prepubQuestionnaire for Exit interviews with drugstore customers. The English version of the questionnaire used for interviewing customers coming out from the drugstores.Click here for fileDrugseller antibiotic questionnaire. The English version of the questionnaire on antibiotics and antibiotic resistance that was filled in by the drugsellers.Click here for file


Expression of correct neurotransmitters is crucial for normal nervous system function. How neurotransmitter expression is regulated is not well-understood; however, previous studies provide evidence that both environmental signals and intrinsic differentiation programs are involved. One environmental signal known to regulate neurotransmitter expression in vertebrate motoneurons is Hepatocyte growth factor, which acts through the Met receptor tyrosine kinase and also affects other aspects of motoneuron differentiation, including axonal extension. Here we test the role of Met in development of motoneurons in embryonic zebrafish.met is expressed in all early developing, individually identified primary motoneurons and in at least some later developing secondary motoneurons. We used morpholino antisense oligonucleotides to knock down Met function and found that Met has distinct roles in primary and secondary motoneurons. Most secondary motoneurons were absent from met morpholino-injected embryos, suggesting that Met is required for their formation. We used chemical inhibitors to test several downstream pathways activated by Met and found that secondary motoneuron development may depend on the p38 and/or Akt pathways. In contrast, primary motoneurons were present in met morpholino-injected embryos. However, a significant fraction of them had truncated axons. Surprisingly, some CaPs in met morpholino antisense oligonucleotide (MO)-injected embryos developed a hybrid morphology in which they had both a peripheral axon innervating muscle and an interneuron-like axon within the spinal cord. In addition, in met MO-injected embryos primary motoneurons co-expressed mRNA encoding Choline acetyltransferase, the synthetic enzyme for their normal neurotransmitter, acetylcholine, and mRNA encoding Glutamate decarboxylase 1, the synthetic enzyme for GABA, a neurotransmitter never normally found in these motoneurons, but found in several types of interneurons. Our inhibitor studies suggest that Met function in primary motoneurons may be mediated through the MEK1/2 pathway.We found that met is not expressed in primary motoneurons until many hours after they have extended axons to and innervated their muscle targets, Met knockdown causes some of these cells to develop a hybrid phenotype in which they co-expressed motoneuron and interneuron neurotransmitters and have both peripheral and central axons.We provide evidence that Met is necessary for normal development of zebrafish primary and secondary motoneurons. Despite their many similarities, our results show that these two motoneuron subtypes have different requirements for Met function during development, and raise the possibility that Met may act through different intracellular signaling cascades in primary and secondary motoneurons. Surprisingly, although  Although different subtypes of motoneurons of invertebrate species use different neurotransmitters to activate muscle ,2, all vExpression of the correct neurotransmitter is crucial for normal nervous system function, although the mechanisms that establish appropriate neurotransmitter expression are not well understood. Interneurons in the chick spinal cord can be induced to express ACh inappropriately by forced expression of MNR2, Lhx3, or Islet1 transcription factors ,9. Howevin vitro  for 30 minutes at room temperature, rinsed in PBT, and then followed by a regular immunohistochemistry protocol  under the control of the gata2 promoter [Tg(gata2:GFP)], which has been shown to be expressed in ventrally-projecting SMNs g Islet1  have beeg Islet1 , zebrafig Islet1 -94; whetAlthough vertebrate motoneurons are generally considered exclusively cholinergic, several recent studies provide evidence that mammalian spinal motoneurons can release both ACh and glutamate at central synapses on Renshaw cells -6. HowevIt has been known for many years that environmental signals can alter subtype specification in newly post-mitotic motoneurons . Here weACh: Acetylcholine; AChR: ACh receptor; áBTX: ábungarotoxin; ChAT: Choline acetyltransferase; GABA: Gamma-amino butyric acid; GFP: Green fluorescent protein; HGF: Hepatocyte growth factor; MAPK: Mitogen activated protein kinase; MO: Morpholino antisense oligonucleotide; NMJ: neuromuscular junction; PI3K: Phosphatidylinositol 3-kinase; PMN: Primary motoneuron; SMN: Secondary motoneuron.The authors declare that they have no competing interests.AT carried out all of the experiments described in this paper and helped draft the manuscript. JSE participated in the conception and design of the study and helped draft the manuscript. All authors read and approved the final manuscript.


HIVAIDS is spreading globally, hitting the younger generations. In Pakistan, the prevalence of HIV in high-risk subpopulations is five per cent or higher. This poses a serious threat of a generalised epidemic especially among the younger population. In the wake of HIVAIDS epidemic this is worrying as a well informed younger generation is crucial in restricting the spread of this epidemic. This study investigated Pakistani young adults'  knowledge and awareness of the HIV/AIDS disease.A population-based, cross-sectional study of 1,650 male and female adults aged 17–21 years living in Karachi was conducted using a structured questionnaire. A multi-stage cluster sampling design was used to collect data representative of the general population in an urban area. Bivariate and multivariate analyses were performed separately for males and females.Of 1,650 subjects, 24 per cent (n = 390) reported that they had not heard of HIV/AIDS. Among the males, those with a poor knowledge were younger , with less than six years of schooling  and no computer at home . Among the females, the risk factors for poor knowledge were young age , low socio-economic status , lack of enrolment at school/college  and being unmarried .Alarming gaps in knowledge relating to HIV/AIDS were detected. The study emphasises the need to educate young adults and equip them with the appropriate information and skills to enable them to protect themselves from HIV/AIDS. However, taboos surrounding public discussions of sexuality remain a key constraint to preventive activities. Young people aged 15–24 account for an estimated 45% of new HIV infections worldwide .According to UNAIDS estimates, the prevalence of HIV/AIDS among the population of men and women aged 15–24 in Pakistan is about 0.1 per cent ,7. This Between 1981 and 2000, the mean age at marriage in Pakistan rose from 25.1 to 26.3 years for males and 20.2 to 22.1 years for females [Youth populations are likely to engage in high-risk sexual behaviour. In those low-income countries where males are assigned a higher social status than females, it is mostly put on young women's shoulders to protect themselves from sexually transmitted infections and unwanted pregnancies but at the same time they often lack access to appropriate information about contraceptives and have poor access to relevant services for prevention and treatment -12.Access and exposure to appropriate HIV/AIDS information and discussing it with others has the potential positively to impact knowledge, attitudes, beliefs and sexual practices . Still, This population-based study assessed the level of knowledge and awareness of the HIV/AIDS epidemic among young adults, aged 17–21 years, in Karachi, Pakistan, focusing on modes of spread and preventive measures. Males and females were compared and particular risk groups were identified.This population-based, cross-sectional study of young adults aged 17–21 years was conducted in the metropolitan city of Karachi, where the population consists of several ethnic groups from all areas of the country. The sample size was calculated at a total of 1,650 with the assumption that 50 and 57 per cent of the males and females respectively would have insufficient knowledge of the modes of spread of HIV/AIDS , applyinA multi-stage cluster sampling design was used to identify the respondents. The city of Karachi comprises 18 towns (administrative units), further divided into union councils. The calculated sample size  was then divided in proportion to the population size of the towns, as reported in the last census of 1998. One union council from each of the towns was randomly selected and further divided into blocks, each comprising 50 households. Proportionate numbers of blocks were chosen at random from the list of all the given blocks. Finally, 10 eligible households with one or more persons aged 17–21 years were chosen using systematic sampling . In all, 165 blocks were chosen and, by taking 10 households from each block, the desired sample size was reached.If there was more than one eligible person in the household, one was randomly chosen. Equal numbers of males and females were selected. There were 10–15 per cent refusals in some of the blocks. This was taken into account by moving to the next household until the desired sample was obtained.A questionnaire based on existing validated instruments from national surveys of reproductive health of youth in Pakistan was used ,19, but The data were collected by a team of male and female interviewers of about the same age as the male and female respondents in order to facilitate communication. The interviews were conducted at their homes, ensuring that no other person could overhear the conversation. Six interviewers  were trained at a two-day workshop (classroom discussion sessions) to ensure a full understanding of the instrument and its purpose. The training was conducted by the principal investigator, supported by a field manager and a field supervisor, who together developed the instruction manual for the interviewer training.Two open-ended questions assessed knowledge of HIV/AIDS; one on the modes of spread phrased 'What are the various modes by which HIV/AIDS is being spread' and the other on preventive strategies phrased 'Name a few strategies using which an individual can prevent himself/herself from getting infected with HIV/AIDS'. The responses were assessed as 'correct' or 'incorrect' by the researchers. Each of the two variables was then coded into four categories, i.e. 'poor knowledge' (no correct answer), 'some knowledge' (1 correct answer), 'good knowledge' (2 correct answers) and 'very good knowledge' (3 or more correct answers). A composite variable based on the two items was created and defined at three levels, i.e. 'poor knowledge' (both variables had only incorrect responses), 'some knowledge' (exactly one variable had at least one correct response) and 'good knowledge' (both variables had at least one correct response). For multivariate analyses, the composite variable was dichotomised into 'poor knowledge' as opposed to 'some knowledge' and 'good knowledge' taken together.Socio-economic status (SES) was based on the possession of assets by the households. Initially, an average current price in the market was assigned to the various assets and scores were developed on the basis of their values. Socio-economic status was dichotomised at the median  into medium to high as opposed to low SES. As total monthly income was reported by only 23 per cent of the study subjects, it could not be used.Age was classified into two groups; 17–18 and 19–21 years of age. Educational level was based on the number of years of education and dichotomised into those with ≥ 6 years of schooling and < 6 years. Enrolment at school/college was classified as enrolled or not enrolled. Working status was defined as those in paid employment/voluntary work as opposed to those not in paid employment/voluntary work, including students. Marital status was defined as ever married or unmarried. Residential status was classified as permanent or migrant; those ethnic groups who were native to the city of Karachi at the time of independence (1947), including the migrants from India, were classified as permanent. Family type was dichotomised into 'nuclear families' (living with their children only) as opposed to 'extended families' .Cronbach's alpha coefficient was used to measure the internal consistency of the items defining the dependent variable, knowledge of HIV/AIDS; it was 0.75. Odds ratios were used to estimate bivariate associations between socio-demographic and psychosocial factors and knowledge of HIV/AIDS. Multiple logistic regression analyses further identified different tentative models of association and possible confounding factors. Only those variables that displayed statistically significant associations in the bivariate analyses were entered stepwise. Marital status was only marginally significant in the bivariate analysis for females, but it was included in the logistic regression models due to its inherent importance. All the analyses were performed separately for males and females.The data were double entered into Epi Info version 6.04d . Ten perEthical approval for the study was obtained from the Aga Khan University Ethical Review Committee (AKU-ERC). Informed consent was obtained both from the parents and from the respondents. Due to the sensitivity of reproductive health matters among youth in Pakistan's social context, great care was taken in training the interviewers not to cause any argument or controversy while approaching the respondents.Average life circumstances in the study population differed for males and females. More females belonged to the migrant group and more females also lived in an extended family setting, had a lower socio-economic status and reported not being in paid employment as compared to the males Table . Only 7.Of the total population of 1,650 adolescents, 390 reported that they had not heard of HIV/AIDS, i.e. 221 (26.8 per cent) males and 169 (20.5 per cent) females.Due to the relatively high proportion of young people who were ignorant on HIV, analyses were made to compare those who had not heard of HIV/AIDS (n = 390) with those who had some knowledge (n = 1260). The males who had not heard of HIV/AIDS were less well educated in that 76.0 per cent had ≥ 6 years of school/college, as compared to 89.4 per cent (p < 0.001) among those reporting a knowledge of HIV, and had less access to computers . Similarly, the females who had not heard of HIV/AIDS were less well educated , more frequently belonged to a family with low socio-economic status  and fewer were married  as compared to those reporting a knowledge of HIV/AIDS.Varied responses were noted for knowledge and awareness among the 1,260 reporting knowledge of HIV. A screening question inquiring about whether or not HIV/AIDS is curable revealed that only 32 per cent of the males but 55 per cent of the females gave a correct 'no' response to this question. However, almost twice as many females (28.1 per cent) as males (15.4 per cent) reported that they did not know how the HIV/AIDS virus is spread  , less than six years of schooling , migrant residential status  and no computer in the household  were associated with poor knowledge , while the other two were open ended and only these were selected for further analysis (modes of spread and preventive strategies) as these items required the respondent to take a stand to formulate an answer, as opposed to when pre-set responses are used. This procedure was judged to sufficiently reflect knowledge and awareness.If the participant gave at least one accurate response, it was counted as 'correct'. This somewhat liberal attitude might, lead to an overestimation of the level of knowledge and awareness among adolescents, which means that our figures relating to 'poor knowledge' are not inflated.A multi-stage cluster sampling technique was used to identify the participants, based on stringent criteria. The sample was collected from all over Karachi and randomness was ensured at each step in order to obtain a representative population. However, there were 10–15 per cent refusals in some of the blocks in the higher socio-economic status areas. This was taken into account by moving to an adjacent household and there is no reason to believe that this changed the representativeness of the study population in terms of socio-economic status, as blocks are fairly homogeneous in this respect.The interviewers were well versed with the questionnaire and they strictly followed the instruction manual. Furthermore, the field manager scrutinised each form at the field site for completion and good quality of data. However, due to strong religious and cultural beliefs, only questions phrased in a general sense could be asked and issues such as the individuals' own sexual experiences could not be discussed. Despite these constraints, we believe this study was able to identify knowledge and awareness among the young people to benefit the design of appropriate interventions.As concerns generalisability of our findings, we consider them applicable to urban populations throughout Pakistan, yet the situation is somewhat different in northern parts of the country with in general a lower level of education in the population.In this study population, more males than females reported not having heard about HIV/AIDS (76 per cent). A national survey reported that about 91 per cent of young people had heard of HIV/AIDS in an urban setting . This slA study from Chile, investigating knowledge of HIV/AIDS among 15–19 year olds found a different pattern in that no significant differences were found in terms of knowledge of preventive practices related to HIV/AIDS according to either gender or educational level . A studyIt was somewhat surprising to discover that more females than males responded in the affirmative when asked 'have you heard of HIV/AIDS'. This could be explained by the fact that females are more exposed to TV and radio broadcast campaigns about HIV/AIDS, as they spend more time in the home. These campaigns may have some effect in conveying the message , but, inWhen it came to the mode of spread and preventive strategies for HIV/AIDS, a high percentage knew about the source through which the infection could spread, which is quite similar to the findings reported in a national survey . In our When knowledge about HIV/AIDS was assessed on the basis of a composite variable, more females were distributed at either extreme, i.e. more females had a 'poor knowledge' but, at the same time, more females had a 'good knowledge' compared with the males. This dispersion is most probably explained by the vulnerable situation most females have to face with lower school attendance and higher levels of illiteracy among females as compared to males. At the same time, some females, mainly from families with a higher socio-economic status, are given the opportunity to enter into higher education and they perform well.In some studies conducted in neighbouring India, it was revealed that female adolescents were less knowledgeable about HIV/AIDS compared with male adolescents, while the males reported significantly greater exposure to HIV/AIDS education compared with the females . MoreoveIt was further found that the risk factor profile differed somewhat between the males and the females. These differences are due to women and men living different lives in Pakistan, mainly due to gender disparities. This is specifically evident in terms of access to education . In addiOur findings suggest that there is a huge need to educate young adults and equip them with sufficient information and skills about HIV/AIDS and to further support them to adopt healthy behaviours to prevent a more widespread epidemic in the general population. This is a matter not only of educating the young people, it also involves a change of attitudes and beliefs to take the final step also to change behaviour. This study is able to show that there are huge gaps in knowledge and awareness and to build a healthy nation the other steps towards changing behaviours also needs attention from policy makers, health staff, the school system and families.The school system needs to assume responsibility for life skills education of which sexual and reproductive health issues constitute a main part. Though, the young adults who are outside the formal educational system also need to be informed. Community leaders, youth clubs and peers are key people at grass root level.Taboos surrounding the public discussion of sexuality remain a key constraint to preventive activities. Parents often feel ill equipped to talk to their children, even though they may be young people's preferred source of information, but also school teachers have been mentioned in this respect. Political leaders need to address young people's need for information, education and services, investing in national gender awareness programmes to support the health and development of young people.However, as the prevalence of HIV/AIDS is still comparatively low, the epidemic has not yet enforced a general discussion on the importance of a well-informed younger generation. More qualitative research, addressing the perceptions of young people themselves, is needed.The findings from this study will provide input for policy formulation and programme design, addressing adolescents' awareness of HIV/AIDS.The authors declare that they have no competing interests.SFH was the principal investigator and was involved in all steps up to manuscript writing, EJ contributed in the logistics while GK helped in analysis and critical review of the manuscript. All authors have read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2334/9/38/prepub


Increased funding for global human immunodeficiency virus prevention and control in developing countries has created both a challenge and an opportunity for achieving long-term global health goals. This paper describes a programme in Zimbabwe aimed at responding more effectively to the HIV/AIDS epidemic by reinforcing a critical competence-based training institution and producing public health leaders.The programme used new HIV/AIDS programme-specific funds to build on the assets of a local education institution to strengthen and expand the general public health leadership capacity in Zimbabwe, simultaneously ensuring that they were trained in HIV interventions.The programme increased both numbers of graduates and retention of faculty. The expanded HIV/AIDS curriculum was associated with a substantial increase in trainee projects related to HIV. The increased number of public health professionals has led to a number of practically trained persons working in public health leadership positions in the ministry, including in HIV/AIDS programmes.Investment of a modest proportion of new HIV/AIDS resources in targeted public health leadership training programmes can assist in building capacity to lead and manage national HIV and other public health programmes. The last several years have seen a remarkable increase in funding for global health -3. Most Many of these new resources may be wasted if human resource constraints are not addressed ,8. The cIn difficult environments, where few trained persons might be available, it has been very tempting for international organizations to hire away well-trained persons from national institutions for specific small projects, typically funded by nongovernmental organizations (NGOs) ,13. BecaZimbabwe is one of the countries most severely affected by HIV/AIDS. The estimated HIV prevalence in 2003 was reported at 24.6% . In 2000In particular, the number of persons trained for leadership and management of new HIV intervention programmes was insufficient. Inadequate remuneration for public health officials and faculty was leading to loss of staff, or to staff working extra jobs to compensate for poor public sector salaries, thus limiting time available both to perform public health tasks and train public health staff. A related problem, as alluded to above, was "internal brain drain" reflected by hiring of national public sector staff to work on internationally funded HIV projects, further draining the necessary coordinating capacity and infrastructure ,13.Zimbabwe had long recognized the need for locally trained public health professionals. A Masters in Public Health (MPH) programme using the applied epidemiology training programme model had been started in 1994 through support of the Public Health Schools without Walls (PHSWOW) Programme of the Rockefeller Foundation and has continued with support from CDC's Division of Global Public Health Capacity Development (DGPHCD)  ,18-20. PThe Zimbabwe MPH programme began in 1993 as a joint effort of the Ministry of Health and Child Welfare (MOH) and the Department of Community Medicine at the University of Zimbabwe (UZ). A CDC advisor was resident in Zimbabwe during 1994–1996. During 1994–2000, a total of 41 trainees graduated. Most trainees were physicians and nurses, but pharmacists, veterinarians, nutritionists, laboratorians and other health staff were trained.The programme was well respected and well integrated into the public health system and the MOH, as indicated by the fact that the majority of graduates were employed within the national public health system at either national-level positions in MOH, as Provincial Medical Directors or as City Health Directors. However, with only four to eight graduates per year, the number of public health professionals still did not meet the country's needs. In addition, the MPH curriculum in Zimbabwe had not been updated in response to the emergence of the HIV/AIDS crisis. Despite the >50% national burden of disease attributable to HIV in Zimbabwe , the focWhen CDC GAP began to work in Zimbabwe in 2000, despite 10 years of Zimbabwean research and reports on HIV/AIDS, there was limited implementation of truly nationwide HIV prevention and treatment programmes to slow the epidemic and attenuate its impact. CDC GAP, together with the MOH, jointly developed specific goals related to HIV prevention and control for Zimbabwe. These included expansion of Prevention of Mother to Child Transmission of HIV (PMTCT), expansion of HIV testing capacity, improved understanding of the epidemic through better surveillance methods, behavioural interventions, improvement of care for opportunistic infections and introduction of antiretrovirals (ARV) throughout the country.A key supporting strategy of CDC GAP was to build human capacity and strengthen the existing health institutions to provide the needed leadership in a sustainable way. This paper describes one specific collaborative effort, begun in 2001, that built on the strength and resources of many partners to respond more effectively to the HIV/AIDS epidemic by reinforcing a crucial training institution and thereby expanding production of epidemiologists and public health leaders.CDC GAP provided financial resources for a broad array of national HIV/AIDS programmes, including extensive in-country technical support. The University of Zimbabwe, Department of Community Medicine, already had faculty members and experience with running a successful field training-based MPH programme. The MOH had been providing the province-level posts and first-line mentorship during the critical field training period. In addition, and probably most important, the MOH was the major employer of MPH graduates, recruiting them into positions of responsibility and establishing this training programme as its main career-development conduit for senior public health leaders and managers. The Division of Global Public Health Capacity Development (DGPHCD) at CDC had long partnered with the UZ/MPH programme and had substantial experience in supporting applied epidemiology training in many other countries.The partners shared a vision that programmatic HIV prevention and care goals could be met by strengthening public health systems and supporting specific areas of national human capacity development rather than by narrowly addressing only HIV programmatic needs.This collaboration developed a number of goals for the programme:• Strengthen the public health leadership training programme and increase its output.• Increase the focus on training to produce public health leaders explicitly equipped to design and implement HIV intervention programmes.• Increase the number of HIV and related positions in the MOH filled by programme graduates.• Increase the informatics capacity of the public health training system to meet HIV/AIDS information requirements while using an approach that had broad applicability to public health in Zimbabwe.Interventions to strengthen the MPH programme included a faculty-run curriculum review with technical support from CDC/DGPHCD to ensure that course objectives addressed the needed topics and received adequate focus in the training. Faculty training was provided, both locally and internationally. Modest financial assistance to support retention was provided to departmental faculty working in the MPH programme in return for quality training and mentoring of trainees . Support was provided both to increase the number of trainees and to improve trainee resources, including computers, textbooks and housing.A local expatriate technical advisor was hired to assist with teaching and curriculum development and to provide additional technical support for trainees' field projects. An assistant field coordinator, a graduate of the MPH programme, was added to assist in teaching and trainee support and to assist in trainee recruitment. Efforts to increase the number of trainees included providing more resources and increasing recruitment among health professionals by the newly hired staff.Expansion of HIV/AIDS training in the curriculum was addressed by collaborating with many of the persons and agencies involved in HIV/AIDS in the country to create an HIV interventions course tailored to Zimbabwe's situation. National leaders from major HIV-related programmes lectured trainees. Exercises were conducted to place trainees in the position of designing appropriate HIV interventions based on local data and in the context of Zimbabwe's actual programme constraints and opportunities. As a resource for trainees to use during and after the course, all core national HIV/AIDS policy, strategy and programme documents were collected and put on a CD-ROM for trainees.The trainees in applied epidemiology spend 14 months in the field applying the public health lessons they have learnt during their classroom instruction. They are required to complete five service learning activities at their field site. The topics addressed by the trainees are chosen based on local priorities. They are expected to apply the knowledge and skills from the HIV course to local issues in the provinces and cities where they conduct their field work. The expansion of computer training and capacity in the MPH programme, the university and the MOH was accomplished through a number of activities. Funds were provided to ensure that each MPH trainee had a laptop computer. Computer training was provided to MPH trainees and others by means of a newly created training lab with 36 computer stations. E-mail access was expanded so that all provinces had access to e-mail through a toll-free number without requiring Internet browser access. In addition, the e-mail programme was improved so attachments could be mailed easily, something that had been very difficult in the past.CDC committed approximately USD 400 000/year to this programme, or approximately 5% of its then USD 8 million annual budget for Zimbabwe. The level of support remained relatively constant for the years encompassed by this manuscript 2001–2006). In the nearly six years since the programme began, several important changes and indicators support the success of the programme. Table –2006. InThe curriculum review led to restructuring of the epidemiology course and clarifying of course objectives. A CD-ROM was created for the course lectures and teaching materials to serve as a resource for trainees and faculty.Since the strengthening process began, an increased number of trainee projects have been accepted for presentation at international conferences. In the first eight years of the programme, five papers had been accepted for presentation at the CDC Epidemic Intelligence Service Conference. In the past four years, seven papers have been presented. Also, at least eight manuscripts from trainees are being prepared or have been submitted for publication from the last three years, compared with one for the three years preceding this programme. In addition, whereas most trainee work had previously been published only in regional journals, manuscripts are now being submitted to international journals.Associated with the difficult economic climate in Zimbabwe, overall in the Faculty of Medicine at UZ, as of June 2004, only 133 (43%) of 307 available positions were filled, primarily due to the departure of staff from Zimbabwe. In contrast, the faculty staffing in the Department of Community Medicine had nearly a full complement, with 13 (76%) of 17 posts filled. The number of trainees graduating from the programme has increased since the intervention (Table A one-week HIV/AIDS course (Responding to the Epidemic) was created and was delivered to the MPH trainees beginning in 2002. The course goals were to provide practical knowledge about key evidence-based technical strategies for HIV prevention and care, orientation to key national frameworks for response to HIV/AIDS, an assessment of the HIV/AIDS situation, and skills in monitoring and evaluation of HIV/AIDS interventions. Ultimately, the course aimed to empower trainees to help implement and manage health-sector interventions for HIV/AIDS. The one-week HIV course has now been incorporated as a standard part of the MPH curriculum.Evaluation after the first year led to greater involvement of the trainees' field supervisors. For the second and subsequent years, the field supervisors were oriented to the training; several supervisors  were asked to participate in the planning and presentation of the HIV course for the trainees.The resource CD created for the HIV course incorporating a number of review and reference materials was well received and used. In the six-month post-course evaluation, approximately 80% (19 of 23) of the trainees reported using these materials in their field assignments for teaching in provincial and district level courses and in the community, and to provide reference material for provincial and district projects on various HIV interventions.During the three years since the course began, there has been a substantial increase in the number of HIV-related trainee projects Table . HoweverDuring 1993–2000, of 41 MPH dissertation projects completed, three (7%) were HIV-related. From 2001–2004, 13 (34%) of 38 dissertation topics studied HIV-related programmes. Examples of other HIV-related trainee projects and their impact on policy and practice in Zimbabwe include:• a study of infant feeding among HIV-positive mothers in 2003 that led to increased training in feeding counselling for PMTCT staff;• an evaluation of a commercial sex worker (CSW) peer education programme in 2003 that led to programme expansion and the development of a new Sexually Transmitted Infection clinic for CSWs in Chinoyi;• a study on treatment outcomes for patients on antiretroviral therapy (ART) in Bulawayo 2004 that demonstrated favourable outcomes among patients on ART and high adherence levels;• a study of adverse events and adherence to Highly Active Antiretroviral Therapy (HAART) in Harare that led to clinicians' adopting a modified form of the ACTG grading system on adverse events to guide them in managing adverse events and to switch therapy as appropriate;• a study on factors associated with non-adherence to HAART in Harare, 2006, that facilitated the opening up of dialogue on coordination of activities by private doctors and the city health doctors concerning ART.The expansion of HIV resources, from both the CDC GAP programme and other programmes, public and private, has created a number of positions that require well-trained public health professionals prepared to develop, run and evaluate HIV/AIDS-intervention programmes. Graduates from the MPH programme have been hired for a number of these positions. As of September 2005, HIV/AIDS-related positions in the MOH filled by MPH graduates include Director, National Department of Disease Prevention and Control; Director, PMTCT Programme; Director, ARV Treatment Programme; TB Manager, AIDS and TB Unit; Workplace Officer, AIDS and TB Unit; Training Officer, AIDS and TB Unit; and ANC Surveillance Officer.MPH graduates in HIV/AIDS positions with other organizations include WHO HIV/AIDS Officer for Zimbabwe; the lead programme officer for HIV Care at United States CDC in Zimbabwe; the Senior Technical Officer for USAID's ARV Treatment Program; and programme officer for HIV projects at UZ-UCSF Research Program. Training in this programme has made the graduates attractive for both MOH positions as well as other public health positions in the country; 30 of 35 recent graduates (2000–2003) are employed in public health positions in Zimbabwe.The computer laboratory has been established and used to teach EpiInfo ; the WHOIn the past, trainees often had to wait for the regular mail system to send and receive hardcopy comments on their fieldwork. In addition, the strengthening of the telecommunications infrastructure  has facilitated the ongoing technical support for the trainees from an expatriate technical advisor who is no longer resident and has substantially improved communication with other technical experts outside Zimbabwe. Moreover, because this strengthened communication capacity now exists at provincial health departments where the trainees' core field training takes place, it has directly facilitated expansion of HIV programmes by supporting distance-based technical support for HIV prevention and treatment programmes and sharing of files and reports for monitoring and evaluation.This programme demonstrates the ability of the CDC Global AIDS Program in Zimbabwe to invest a relatively small proportion of its HIV programme-specific funds to effectively and substantially help to expand the public health leadership in key positions. Moreover, rather than create a detached HIV training programme, CDC GAP collaborated with multiple partners to strengthen an existing critical component of the public health capacity-building system that in turn directly assists the MOH and CDC to meet HIV-specific programme goals. The key element of this vision was the appreciation that achieving HIV/AIDS programme goals could be realized through catalytic support of general public health leadership capacity development, and did not require narrow HIV-specific training programmes.We are not able to attribute the rise in HIV-related trainee projects solely to the increased HIV coursework. The number of projects also increased at a time of increased HIV resources and activities in the public health sector. However, this is exactly the type of outcome desired, as the curriculum was designed to reflect the actual health priorities and burden of disease in the country. This programme thus addresses the identified need to develop public health curricula that reflect the emerging needs of the health system where the trainees will work after training .Much of the strength and effectiveness of the programme comes from the fact that others had invested in public health capacity strengthening several years before ,27. The Many persons who leave developing countries for higher education programmes do not return to their country of origin . In-counProgramme evaluations have found that trainees and graduates of applied epidemiology training programmes form solid networks in the country's health systems, with the majority of them remaining in public health in their home countries ,20,22,29Given the current economic and political difficulties in Zimbabwe -33, retaThe higher retention of faculty for the programme compared with the other departments in the Faculty of Medicine may be partially related to the modest support and training provided, but could also be related to differential external opportunities for the non-clinical faculty in the Department of Community Medicine. These resources are no longer being provided and may not be crucial to programme success.Evaluation of similar programmes has shown that the managers and decision-makers report numerous examples of how information from trainees and graduates was valuable to them in designing and implementing health programmes, e.g. introducing rubella vaccine and hepatitis B vaccination programmes in Thailand after FETP investigations . The sucThis report provides an example of how investment of a modest proportion of new HIV/AIDS resources in targeted public health leadership training programmes can assist in building human capacity to lead and manage national HIV and other public health programmes.As donors seek to expand programmes to address global disease concerns, including the HIV epidemic, access to well-trained staff and supportive and collaborative ministry officials will be essential. Investment in well-trained staff and emerging programme leaders will be essential to addressing absorption capacity for the medium term while also addressing short-term emergency needs. This model of linking public health leadership capacity building to the HIV/AIDS programme goals provides one example for intervention in this area.The authors declare that they have no competing interests.The paper was conceived by DJ and written with participation from all authors. The original project was conceived by MSL, PN and MT. GW, SH and NS, together with all the other authors, participated in the programme implementation and management. All authors have reviewed and commented on drafts, and have seen and approved the final version.DJ is a Medical Epidemiologist, Division of Global Public Health Capacity Development , CDC. MT is Field Coordinator, MPH Programme, Department of Community Medicine, University of Zimbabwe Faculty of Medicine. GW is a Senior Research Epidemiologist, RTI International . PN is a Medical Epidemiologist, Division of Global Public Health Capacity Development , CDC. NS is a Health Communication Specialist, Global AIDS Program, CDC. SH is Senior Deputy Director, HIV/AIDS Administration . MSL is a Senior Science Officer, Coordinating Office for Global Health, CDC .


In the present paper, we consider the impact of HIV/AIDS on human development in African countries, showing that, beyond health issues, this disease should and must be seen as a global development concern, affecting all components of human development. Consequently, we stress the necessity of multidisciplinary approaches that model, estimate and predict the real impact of HIV/AIDS on human development of African countries in order to optimise the strategies proposed by national countries, international institutions and their partners.In our search strategy, we relied on secondary information, mainly through National Human Development Reports of some African countries and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organization (WHO) and the World Bank. We restricted ourselves to reports dealing explicitly with the impact of HIV/AIDS on human development in African countries.HIV/AIDS is affecting the global human development of African countries through its devastating impact on health and demographic indicators such as life expectancy at birth, healthcare assistance, age and sex distribution, economic indicators like income, work force, and economic growth, education and knowledge acquisition and other indicators like governance, gender inequality and human rights.On the basis of the national reports reviewed, it appears clearly that HIV/AIDS is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors. Consequently, HIV/AIDS is a development question and should be viewed as such. The disease is impeding development by imposing a steady decline in the key indicators of human development and hence reversing the social and economic gains that African countries are striving to attain. Being at the same time a cause and consequence of poverty and underdevelopment, it constitutes a challenge to human security and human development by diminishing the chances of alleviating poverty and hunger, achieving universal primary education, promoting gender equality, reducing child and maternal mortality, and ensuring environmental sustainability. Since 1990, five main composite indices were developed by the United Nations to measure the average achievements in basic human development (human development index (HDI), gender-related development index (GDI), human poverty indices (HPI-1 and HPI-2) and the gender empowerment measure (GEM) . HDI is In the present paper, we consider the impact of HIV/AIDS on human development in African countries, showing that, beyond health issues, this disease should and must be seen as a global development concern, affecting education and knowledge acquisition, income and social status, productivity and economic growth, and other direct and indirect components of human development such as gender equality and human rights. Consequently, we stress the necessity of multidisciplinary approaches that model, estimate and predict the real impact of HIV/AIDS on human development of African countries in order to optimise the strategies proposed by national countries, international institutions and their partners.In our search strategy, we relied on secondary information mainly through National Human Development Reports of some African countries and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organization (WHO) and the World Bank. For national reports, we restricted ourselves to the eight National Human Development Reports which dealt explicitly with the impact of HIV/AIDS globally on human development, or partially on its components during the last years.With malnutrition as a common contributor, the five biggest infectious killers in the world are HIV/AIDS, malaria, tuberculosis, acute respiratory infections and diarrhoeal disease, responsible for nearly 80% of the total infectious disease burden and claiming about 12 million people per year Table  5]. Des. Des5]. During the last decades, the prevalence and incidence of HIV/AIDS have seen an exponential growth Figure . AfricanThe 2007 Zambia Human Development Report (HDR) focuses on the sixth Millennium Development Goal (MDG), which is combating HIV/AIDS, malaria and other diseases. Under the title "Enhancing household capacity to respond to HIV and AIDS" , it is iStressing the danger of the growing prevalence of HIV/AIDS Table , the MozKenya National HDR 2006 has dealt with HIV/AIDS as a challenge to human security and human development . As streUnder the title "reversing HIV/AIDS in Malawi", the Malawi HDR 2005 devoted a chapter to the impact of HIV and AIDS on households welfare, orphaned children, the extended family, educational and health sectors, agricultural production, business and public service delivery. The chapter concludes that HIV and AIDS have the potential to reverse those gains made in human development in the last few years .According to the Benin HDR 2005, HIV/AIDS is at the same time a cause and consequence of poverty and underdevelopment . AccordiThe prevalence of HIV/AIDS varies according to different regions of Benin. The region with the highest prevalence has the lower life expectancy index Table .Zimbabwe HDR 2003 "towards reducing vulnerability: the ultimate war for survival", states that HIV/AIDS is impeding development by imposing a steady decline in the key indicators of human development. The report concludes that it is critical that the relationship between epidemic and human development be acknowledged at all levels and that the principles of sustainable development be a major focus and priority of the country's policies and programmes . ZimbabwSouth Africa HDR 2003 indicates the magnitude and far-reaching consequences of the HIV/AIDS pandemic, stressing that the disease is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors . The repUnder the title "Towards an AIDS-Free generation" , the BotAs indicated in Table In 1999, the Commission on Macroeconomics and Health was established to explore the relationship between health and economic development. In the report published by the commission in 2001, empirical evidence was provided on how investing in health can achieve economic development and poverty reduction. It was indicated that, by 2010, eight million lives per year could be saved by essential interventions against infectious diseases and nutritional deficiencies, resulting in economic benefits adding up to more than US$ 360 per year by 2015 . In ordeHowever, beyond the international agreement on principles, at the 7-year juncture, most African countries, have made little (if any) headway in preventing and controlling the HIV/AIDS epidemics in particular, nor in reducing the rates of extreme poverty and making progress in the MDGs targeted for 2015 in general ,24. MeanHIV/AIDS is directly affecting heath and demographic indicators such as mortality rates, life expectancy, and sex and age distributions. By 2000-2005, Zimbabwe, Botswana, Swaziland and Lesotho have lost respectively 35, 28, 28 and 24 years of life expectancy ,18-20. MThe burden of the disease is not felt only at individual level; it affects households, communities and the whole nation  ,15,17. MContrary to the majority of diseases, HIV/AIDS kills and disables adults in the most productive part of their lives. Consequently, it is affecting business, investment, industry and agricultural sustainability, and ultimately reducing families' income and economic growth. Although at different degrees, all the national reports reviewed stress the negative impact of HIV/AIDS on income at individual, community and national levels -18.At the moment, it is difficult to estimate precisely the real economic impact of HIV/AIDS on the whole African continent. However, many tentative estimates have been made. In 2000, the World Health Organization estimated a yearly reduction of 1% of the GDP in the most affected African countries. In 2002, UNAIDS gave a much higher estimation of 2.6%. According to the Macroeconomics and Health Commission, in 2001, the cost of HIV/AIDS was between 11.7% and 35.1% of the Gross National Product in Africa . For SouThese partial and sometimes controversial estimates, combined with the paucity of national data, indicate the necessity of global interdisciplinary studies that can model, estimate and predict the economic impact of HIV/AIDS in Africa.As stressed in the MDGs, education is essential for human development and needs to be enhanced especially in low- and medium-income countries. Unfortunately, HIV/AIDS is reversing the trend towards the achievement of universal primary education in most African countries. In Africa, less than 65% of children are enrolled in primary school ,29 and tOn the basis of the national reports reviewed, it appears clearly that HIV/AIDS is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors . ConsequWe are aware of the importance of the topic considered in this paper and the necessity to deal with it seriously and precisely. However, our search relied only on published data by different African countries and international institutions. Consequently, we were limited to data and the numbers available and this may be frustrating not to give a complete panorama of this interesting subject.This paper is dedicated to African children afflicted by poverty and HIV/AIDS epidemics.The author declares that they have no competing interests.


Nigeria is home to more people living with HIV than any other country in the world, except South Africa and India-where an estimated 2.9 million [1.7 million – 4.2 million] people were living with the virus in 2005. A systematic assessment of recent HIV/AIDS research output from Nigeria is not available. Without objective information about the current deficiencies and strengths in the HIV research output from Nigeria, it is difficult to plan substantial improvements in HIV/AIDS research that could enhance population health. The aim of this study was to analyse the trends in Nigeria's SCI publications in HIV/AIDS from 1980 to 2006. Special attention was paid to internationally collaborated works that were identified based on the countries of the authors' affiliation.A bibliometric analysis regarding Nigerian HIV/AIDS research was conducted in the ISI databases for the period of 1980 to 2006. An attempt was made to identify the patterns of the growth in HIV/AIDS literature, as well as type of document published, authorship, institutional affiliations of authors, and subject content. International collaboration was deemed to exist in an article if any co-author's affiliation was located outside Nigeria. The impact factors in the 2006 Journal Citations Reports Science Edition was arbitrarily adopted to estimate the quality of articles.Nigeria's ISI publications in HIV/AIDS increased from one articles in 1987 to 33 in 2006, and the articles with international collaboration increased from one articles in 1980 to 16 in 2006. Articles with international collaboration appeared in journals with higher impact factors and received more citations. A high pattern of co-authorship was found. Over 85% of the articles were published in collaboration among two or more authors. The USA, as the most important collaborating partner of Nigeria's HIV/AIDS researchers, contributed 30.8% of articles with international collaboration.Nigeria has achieved a significant increase in the number of SCI publications and collaborations in HIV literature from 1987 to 2005. There is need to challenge the status, scientists from Nigeria should forge multiple collaborations beyond historical, political, and cultural lines to share knowledge and expertise on HIV/AIDS. Nigeria is home to more people living with HIV than any other country in the world, except South Africa and India-where an estimated 2.9 million [1.7 million – 4.2 million] people were living with the virus in 2005 -9. The a®  on the Internet  were in English language. Only one article was published in French. Nigeria's ISI publications in HIV/AIDS increased from one articles in 1987 to 33 in 2006, and the articles with international collaboration increased from one articles in 1980 to 16 articles in 2006. No records were found for the period of 1980 to 1986; and only one record was retrieved for 1987 and 1989 . Table Based on the journal listed on the journal impact factors in 2006, only 17 (6.7%) articles were published in journals with impact factor equal to or greater than five Table . The proIn Table All articles were indexed into 84 subject categories. Table This study was a purely descriptive analysis about Nigeria's SCI publications in HIV/AIDS research for over two decades and arbitrarily adopted co-authorship as an indicator of collaboration. The results showed a continuous increases and reassuring trends in the number of HIV literature production from Nigeria. However, no records were found for period between 1980 and 1986. This finding is consistent with data from other study  that hasContrary to previous study , the stuIt is important to note that United States institutions formed most of institutional contributors; result that is congruent with the finding of previous studies ,18. EchoA high pattern of co-authorship was found. Over 85% of the articles were published in collaboration among two or more authors. This finding is consistent with an earlier study from Haiti . The res® presented in each ISI record. One journal with its articles might be indexed with several subject categories. Absolute country counting was adopted in accrediting an article to countries and might have overlooked the indirect collaboration relationships. Research collaboration might exist in several forms and levels: individual, group, department, institution, sector, and nation [Potential limitations of the study are related to the database used to retrieve articles. ISI databases do not represent all scientific and biomedical journals published. Many articles of importance appear in journals other than those indexed in ISI database. Other limitations include the incorrect or multiple citations of the subject category that was generally used in compilation of the annual Journal Citation Reportsd nation . As noted nation , adoptinIn summary, Nigeria achieved a significant increase in the number of SCI publications and collaborations in HIV literature from 1987 to 2005. As noted by Katz et al , researcThe author(s) declare that they have no competing interests.OAU conceived the study, extracted the data, did the analyses and interpretation, and wrote the first and final draft of the manuscript.The pre-publication history for this paper can be accessed here: