1. From the Muhimbili University College of Health Sciences (Y.M.M., K.L.R., A.B.M.S., D.G.M), University of Dar es Salaam, Tanzania; Shree Hindu Mandal Hospital (K.L.R.), Dar es Salaam, Tanzania; and Department of Medicine (K.G.M.M.A.), University of Newcastle on Tyne, UK.