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HEPATITIS B VIRUS AND HIV INFECTIONS AMONG PATIENTS IN MULAGO HOSPITAL
No full textObjective: To compare the frequency of exposure to hepatitis B infection among HIVseropositive and HIV seronegative medical outpatients.Design: Case control study.Setting: Mulago hospital medical outpatient clinics.Patients: One hundred and twenty nine consecutive HIV seropositive patients and onehundred and twenty nine HIV seronegative control patients.Results: The frequency of anti-HBc among the HIV seropositive patients was 65.1%compared to 41.9% in the HIV seronegative patients (95% confidence interval: 1.51-4.45; pvalue:0.0002). Of the 84 HIV positive patients with anti-HBc, 52 (61.9%) had more than fivelifetime sexual partners. In comparison, of the 45 HIV positive patients with no anti-HBc,only 18 (40%) had more than five lifetime sexual partners (95% confidence interval: 1.04-1.80; p-value: 0.028). There was no significant difference in the frequency of HBsAg andHBeAg among the HIV seropositives and HIV seronegatives.Conclusion: The frequency of previous exposure to hepatitis B infection was higher amongHIV seropositive patients compared with HIV seronegative patients and was associated witha greater number of lifetime sexual partners. Safe sexual behaviour and reduction in thenumber of sexual partners should continue to be promoted in the community including HIVpositive patients, because it is likely to have the added advantage of reducing coincidentexposure to HBV infection. This is especially important for the immunocompromised HIVpositive patients who are more likely to develop a chronic infectious carrier state and amongwhom HBV control by vaccination is less effective than in the immunocompetent individuals
ANAESTHETIC EXPERIENCE IN FEMALE STERILISATION AT JOS UNIVERSITY TEACHING HOSPITAL, NIGERIA
No full textABSTRACTObjective: To present the trend of anaesthetics used for interval and post-partum femalesterilisation.Design: A retrospective descriptive study.Setting: Jos University Teaching Hospital, Jos, Nigeria from 1985 to 2004.Subjects: All cases of female sterilisation in Jos University Teaching Hospital within the studyperiod.Interventions: Clients were allowed free choice of the method of anaesthesia after appropriatecounseling. Written consent by the patient and her husband was obtained.Results: During the period, 4,313 female sterilisations were performed. The mean (±SD) age and parityof the clients were 36.8 ± 4.8 years, and 7.6 ± 2.4 respectively. Local anaesthesia alone was the mostcommonly used (75.0%), followed by general anaesthesia (15.8%) and local anaesthesia with sedation(9.2%). The use of local anaesthesia alone for minilaparotomy under local anaesthesia for femalesterilisation rose from 0.0% in 1985 to 83.0% in 2004. Majority (79.1%) of the cases were performedas interval procedures, 15.1% performed at Caesarean section and 5.8% as postpartum procedures.There were no serious morbidity and/or mortality associated with the types of anaesthesia used.Conclusion: Minilaparotomy under local anaesthesia for sterilisation has been found to be feasible,and now acceptable in our institution.East African Medical Journal Vol. 84 No. 8 August 2007ANAESTHETIC EXPERIENCE IN FEMALE STERILISATION AT JOS UNIVERSITY TEACHING HOSPITAL,NIGERIAJ.T. Mutihir, MBBS, FWACS, Senior Lecturer, Department of Obstetrics and Gynaecology, Jos University TeachingHospital, Jos, Plateau State, Nigeria, A.O. Aisien, MBBS, FMCOG, Senior Lecturer, Department of Obstetrics andGynaecology, University of Benin Teaching Hospital, Benin-City, Edo State, Nigeria and I.A.O. Ujah, MBBS, FMCOG,FICS, Professor, Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Plateau State,NigeriaRequest for reprints to: Dr. J.T. Mutihir, Department of Obstetrics and Gynaecology, Jos University Teaching Hospital,Jos, Plateau State, NigeriaINTRODUCTIO
QUALITY OF HEALTH CARE AND ITS EFFECTS IN THE UTILISATION OF MATERNAL AND CHILD HEALTH SERVICES IN KENYA
No full textObjective: To assess the quality of care provided by the Kisumu Municipal health facilities, with special reference to Maternal and Child health services (MCH). Design. A descriptive cross-sectional survey.Setting: Kisumu Municipal Health facilities. Subjects: Four hundred and eighty two mothers were interviewed in a household survey.Results: A total of 482 mothers were interviewed in the household survey. Out of these, only 40.4%, 53.7% and 45.7% had respectively used Municipal facilities for antenatal services (ANC), immunisation and treatment of their children the last time they required such a service. This translates to by-pass rates for Municipal health facilities of 59.5%, 46.3% and 54.3% respectively for the three services. By-pass was higher for the more central urban catchment areas than the more peripheral ones, a finding that was associated with the socio-economic status of the respondents and the relative location of the municipal facilities vis-a-vis competing facilities, mainly the District and Provincial hospitals. The main reasons cited for by-pass were poor care (21%), lack of drugs and supplies (17%) and lack of/poor laboratory services (12%). From the facility audit, most of the clinics had a reasonable capacity to offer basic health care with only three scoring less than 50% in the scale used. The worst areas were in availability of drugs, equipment and management issues. There was a strongrelationship between the perceived quality of care and utilisation of MCH services as well as by-pass. The capacity of the facilities to offer care was however not associated with utilisation of MCH services or by-pass.Conclusion: There is under-utilisation of Municipal health facilities for MCH services. This is related to the perceived poor quality of care in the facilities. Perception of quality is influenced by a person's socio-economic status especially education
External root morphology of maxillary first premolars in Kenyan Africans
Get PDFObjective: To determine the external root morphology of the maxillary first premolarsin Kenyan Africans.Design: In vitro descriptive cross-sectional study.Setting: School of Dental Sciences, University of Nairobi.Subjects: One hundred and fifty five extracted maxillary first premolar teeth obtainedfrom patients aged between 13-30 years attending dental clinics within Nairobi.Main outcome measures: Number of roots, direction of root curvature and toothlength.Results: A total of 155 maxillary first premolars were studied, 77 from males and 78from females. Overall, there were 83.2% two-rooted teeth (mean tooth length: buccalroot 22.3 mm; lingual root 21.2 mm), 10.3% one-rooted (mean tooth length-22.6 mm)and 6.5% three-rooted. Three roots occurred more commonly in males than femalesand this was a statistically significant gender difference (P<0.05). Males were foundto have larger mean tooth length than females in multirooted teeth. Majority of theroots were straight (57.2%). Distal and “S” curvatures were the commonest (19.1% and10.2% respectively). There were no significant gender differences in direction of rootcurvature (P>0.05).Conclusions: Maxillary first premolars were mostly two-rooted with straight roots.Males presented with two or three roots more often than females and had significantlylarger mean tooth lengths
Nutritional and oral health status of an elderly population in Nairobi
No full textObjective: To determine the nutrition and oral health status of elderly persons in Nairobi, Kenya.Design: A cross-sectional study.Setting: Households in Dagoretti Division of Nairobi.Subjects: Two hundred and eighty nine persons (29.8% males and 70.2% females) aged 45 yearsand above were assessed.Results: The level of malnutrition using the mid upper arm circumference was 18.8% while bybody mass index was 11.4%. Of the population assessed, 46.4% had normal nutritional status while40.9% were overweight, with more females 48.0%) than males (25.9%) being overweight. The studyestablished that many of the elderly persons suffered from dental problems, especially periodontitis with 89.9% having dental plaque, calculus 85.6%, gingival recession 82.5% and bleeding gums 77.4%. The decayed index missing and filled teeth, was 7.173 with 19.7% caries free, 51.9% reported tooth mobility and edentulousness was common.Conclusions: Under-nutrition, obesity and dental problems are issues of concern among the elderly. There is need to develop policies that will look into the nutrition and dental health of the elderly in order to improve their welfare
HAEMATOGENOUS DISSEMINATION OF TUBERCULOUS LYMPHADENITIS
No full textABSTRACTObjective: To determine whether Mycobacterium tuberculosis infection spreads through the bloodto different lymph-node groups in patients with tuberculous lymphadenitis.Design: Prospective analytical study.Setting: The patients were recruited, managed and followed at the lymphodenopathy clinic, CentralPolice Hospital, Burr, Khartoum, Sudan.Subjects: Fifty two sequential patients were enrolled. Thirty patients with FNAC diagnosisof tuberculous lymphadenitis and positive PCR for M. tuberculosis complex had a mean ageof 26.9±11.2 years and similar male, female affection. Nine patients with FNAC tuberculouslymphadenitis, but negative PCR had a slightly higher mean age (32.6±18.2 years) with similarmale : female proportions. Patients with reactive lymphadenopathy (9/52) were older than patientswith tuberculous lymphadenitis with a mean age of 45±24.6 years.Results: None of the patients were positive for HIV or had clinical or radiological evidence ofpulmonary tuberculosis. M.tuberculosis DNA was detected in the blood samples of 30/39 (77%)patients with tuberculous lymphadenitis, but in none of the cases with reactive or malignantlymphadenopathy. The presence of M.tuberculosis DNA correlated strongly to multiple lymphnodeinvolvement [OR (odds ratio) = 96.7, 95% confidence interval (CI) 9.0 – 1,039] and to caseatinggranulomatousand predominantly necrotic cytomorphological categories [OR = 70, 95% confidenceinterval (CI) 7.0 – 703].Conclusion: M.tuberculosis most probably disseminates through the blood from one node groupto the other in patients with tuberculous lymphadenitis.East African Medical Journal Vol. 84 No. 1 January 2007HAEMATOGENOUS DISSEMINATION OF TUBERCULOUS LYMPHADENITISG.S. Sharafeldin, MSc, National Health Laboratory, Federal Ministry of Health, Khartoum, Sudan, E.A.G. Khalil, MBBS,FRCPath, Institute of Endemic Diseases, University of Khartoum, P.O. Box 45235, Khartoum, Sudan, I.A. El Hag,MBBS, PhD, PARAS Central Hospital, Sakaka Al-jouf, Saudi Arabia, K.E. Elsiddig, MBBS, MCS, FRCS, Departmentsof Surgery and Pathology, Faculty of Medicine, University of Khartoum, P.O. Box 45235, Khartoum, Sudan, M.E.M.O.Elsafi, MBBS, PhD, MD, Central Police Hospital, Khartoum, Sudan, A.S.A Aijafari MSc, A.A. Elnour MSc, Institute ofEndemic Diseases, University of Khartoum, P.O. Box 45235, Khartoum, Sudan, A.M. Hussein, MBBS, MD, Central PoliceHospital, Khartoum, Sudan, I.M. Elkhidir, MBBS, PhD, Department of Microbiology, Faculty of Medicine, University ofKhartoum, P.O. Box 45235, Khartoum, Sudan and A.M. El-Hassan, DKSM, PhD, FRCPath, Institute of Endemic Diseases,University of Khartoum, P.O. Box 45235, Khartoum, SudanRequest for reprints to: Prof. E.A.G. Khalil, Department of Clinical Pathology and Immunology, Institute of EndemicDiseases, University of Khartoum, P.O. Box 45235, Khartoum, SudanINTRODUCTIONTuberculosis remains one of the major healthproblems worldwide with 8.7 million new casesevery year and an estimated 1.7 million annualdeaths (1). Tuberculosis is a systemic diseaseaffecting almost all organs with two clinical forms;pulmonary and extra-pulmonary. The incidenceof extra-pulmonary tuberculosis is dramaticallyrising, largely because of HIV/AIDS pandemic (2).Tuberculous lymphadenitis is the most commontype of extra-pulmonary tuberculosis (3-6). Lymph4E A S T A F R I C A N M E D I C A L J O U R N A L January 2007nodes are usually involved as a component ofa primary complex. Less often lymphadenitis isseen in secondary tuberculosis but the nodes areusually smaller and firmer than in primary disease.Tuberculous lymphadenitis may involve a singlediscrete lymph-node, multiple lymph-nodes ormultiple sites of lymph-nodes and could even begeneralised. Nevertheless, the most commonlyaffected lymph-nodes are those of the cervicalregion (7,8). Since tuberculous lymphadenitis ispredominantly a primary disease, the question of howthe infection spreads from the primary lymph-nodeto other nodes arises. Using blood culture techniques,circulating M. tuberculosis has been found to be oneof the frequent causes of bloodstream infections(BSI) among febrile adults with advanced HIVinfection in sub-Saharan Africa. These patients haveradiological, microbiological or clinical evidence foractive pulmonary disease. Recently, non-tuberculousmycobacteria was detected by culture technique inimmunocompetent individuals (9-13).In this communication we provide evidenceto the probable route of M. tuberculosis spreadin peripheral tuberculous lymphadenitis bydemonstrating circulating M. tuberculosis DNA inimmune-competent Sudanese patients who had nosigns of pulmonary disease, using a highly sensitivemolecular technique (PCR).MATERIALS AND METHODSThe study proposal was scientifically and ethicallyreviewed by the Ethical Committee of the Instituteof Endemic Diseases, University of Khartoum. Fiftytwo sequential patients with lymphadenopathywere enrolled in this prospective study followinginformed consent. FNAC was performed onall patients as a routine diagnostic procedure.Following thorough clinical examination; bloodcell count, ESR, Mantoux test, HIV ELISA testand a chest X-ray were performed. Five millilitersof EDTA-blood were collected from all patientsand DNA was extracted from the mononuclearblood cells (PBMCs) using the phenol-chloroformiso-amyl alcohol (PCI) method. Peripheral bloodmononuclear cells (PMBCs) were collected usingdensity gradient centrifugation with FicolHypaque.The quality of the extracted DNA was checked by1.2% agarose gel electrophoress.Oligonucleotide primers: A single set of oligonucleotideprimers was used (MOL BIOL, Berlin, Germany®).The lyophilised primers were reconstituted asdescribed by the manufacturer. The target for PCRamplification was IS6110 (size 123bp), an insertionlikeelement found in Mycobacterium tuberculosiscomplex strains. The oligonucleotides primers usedwere:E1 (20 mer)(5’-CCTGCGAGCGTAGGCGTCGG-3’)E2 (5’ -CTCGTCCAGCGCCGCTTCGG-3’)DNA amplification: Following strict StandardOperating Procedures, DNA extraction andPCR were carried in separate rooms to reducecross contamination. PCR for the specimens wasperformed in a total volume of 50μl of the reactionmixture containing 10X PCR buffer, 2.25μM.Magnesium Chloride, dNTPs mixture (dATP, dGTP,dCTP & dTTP) 100 each (Boehringer Mannheim,Germany), E1 and E2 oligonucleotide primers 0.2μMeach and 2 U/μL of Taq polymerase (Finnzmes®,Vienna, Austria). The reaction mixture was overlaidwith mineral oil. The tubes were then subjected to40 thermal cycles in a programmable heat block(Biometra®, Göttingen, Germany). The cycle wasas follows: denaturation at 95ºC for five minutes,annealing at 65ºC for one minute, extension at 72ºCfor one minute and final extension at 72ºC for tenminutes.Detection of amplified DNA: The PCR products wereanalysed by ethidium bromide-stained agarosegel electrophoresis on 1.5% agarose gel. Positive,negative controls and a 100 bp DNA marker wereincluded with every electrophoresis run.Statistical analysis: Odds ratio were computed onAcaStat statistical software. If any of the four valuesin the contingency table were zero, one is added toall values before calculating the odds ratio. RESULTSBaseline characteristics, laboratory findings, FNACand PCR results were summarised in Table l.Cervical lymph nodes were the most commonlyaffected group and were seen in 91% of patientswith lymphadenopathy. The cytological diagnosiswas; tuberculous lymphadenitis in 39 cases (75%),reactive in nine (17.3%) and malignant in four casesJanuary 2007 E A S T A F R I C A N M E D I C A L J O U R N A L 5(7.7%). Based on the cytological findings, cases oftuberculous lymphadenitis were categorised intothree groups; necrotising-granulomatous (21/39;54%), predominantly necrotic (6/39; 15.3%) andgranulomatous (12/39; 30.7%). Multiple lymphnodeswere seen in 28 cases, but a single discrete nodewas seen in 11 cases of tuberculous lymphadenitis. Allcases in the caseating-granulomatous (21/21) and thepredominantly necrotic (6/6) categories had multiplelymphnodes. Single lymph-node presentation wasmainly associated with granulomatous lesion(11/12). An ear, nose, throat examination revealedno abnormalities.None of the patients were HIV positive or hadradiological or clinical evidence of pulmonary ormiliary disease.The ESR was high in the tuberculous groupespecially the granulomatous type, while it wasvariable in patients with reactive and malignantgroups. A significant Mantoux reactivity (> l 5mm) was seen in all patients with tuberculouslymphadenitis, while it was < 10 mm in the reactiveand the malignant groups.Circulating M. tuberculosis DNA was detectedin 30 out of 39 cases (77%) with tuberculous lymphnodes, but in none of the cases with reactive ormalignant nodes. The PCR positive rates variedamong tuberculous patients with different smearfinding, while it was 100% (27/27 cases) in thecaseating-granulomatous and the predominantlynecrotic categories; the positivity rate was 25%(3/12 cases) among patients with granulomatouslesions. The computed odds ratio was 70 with a95% confidence interval CI between 7.0 and 703.Circulating M. tuberculosis DNA was detected inall of the 28 patients (100%) with multiple lymphnodes, but in 2 out of 11 cases (18%) with single nodeinvolvement. The odds ratio was 96.7 with a 95%confidence interval CI between 9.0 and l,039.DISCUSSIONTuberculous lymphadenitis is characterisedby painless enlargement of lymph nodes andoccasional constitution symptoms like nocturnalfever and sweating. The cervical group is the mostcommonly affected group. Peripheral tuberculouslymphadenitis usually develops as a part of a primarycomplex i.e. a primary focus and regional glands.Involvement of lymph-nodes as a manifestation ofa generalised tuberculous infection is rather rare(14). For tuberculous lymphadenitis of the neck,the primary focus would be mainly in the tonsilsand mouth, however recent or previous seedingof the lymph nodes from an occult site cannot beruled out. None of our cases had shown clinical orradiological evidence of another primary complexor military disease and the lymph-nodes werelarge and soft. These findings probably support theprimary nature of the disease in our cases. Therefore,the demonstration of circulating mycobacteria insuch cases would suggest spread by blood stream.Patients with multiple nodes were considered ashaving bulky disease.Table 1Baseline characterisitics, cytomorphological patterns and circulating mycobacterial DNA of the study patientsCytomorphological typeof lymphadenopathy M: F Mean age Mean ESR Mean TBCs Mean mantouxmm mmPCR positive (n = 30) 1:1.5 26.9 ± 11.2 87 ± 31 5.3 ± 1.6 22 ± 6Necrotising Tb (n = 6) 1:5 23 ± 8.6 69 ± 24.9 6.8 ± 2.3 19.2 ± 5.5Granulomatous Tb (n = 3) 1:2 43.7 ± 15.1 113 ± 25.1 4.6 ± 0.7 36.3 ± 7.6Necro/Granul.Tb (n = 21) 3:4 25.1 ± 9.2 69.3 ± 32.4 4.6 ± 0.6 21.4 ± 6PCR negative (n = 22) 2:1 34.6 ± 21.6 77 ± 30 5.9 ± 3.2 13 ± 10.8TB lymphadenitis (n=9) 2:1 32 ± 18.2 90.4 ± 27.8 7.3 ± 4.5 19.3 ± 8.2Reactive (n = 9) 2:1 45 ± 24.6 76 ± 35.1 5.3 ± 1.7 5.3 ± 9.2Malignancy (n = 4) 1:0 26.8 ± 25.5 56.7 ± 23.1 4.3 ± 0.6 8.5 ± 6.6Continuous variables are expressed as means ±SD6 E A S T A F R I C A N M E D I C A L J O U R N A L January 2007For the detection of circulating M. tuberculosis,a highly sensitive molecular technique (PCR)was used in this study. PCR has proven to bemore sensitive compared to the conventionalmicrobiological methods (LJ culture and ZNstaining for acid fast bacilli in smears) in theidentification of mycobacterium (15-19). However,PCR is known to be associated with high falsepositive results, with rates ranging from 3 – 20%,mainly due to cross-contamination (20, 21). Toprevent cross-contamination we followed strictlythe manufacturer instructions, DNA extraction andamplification were carried out in different roomsand the sequences of the process were adequatelymonitored. Positive and negative controls wereincluded as extra quality assurance measure withevery run. We have recently shown that, over 96%of cases of tuberculous lymphadenitis in Sudanare caused by M. tuberculosis (18). This made theuse of a single primers set that amplifies a 123bp sequence common to all M. tuberculosis moreappropriate for this study. Circulating M. tuberculosisDNA could be demonstrated in most patientswith tuberculous lymphadenitis in this study. Thehighest positive rate was reported among cases withcaseating-granulomatous or predominantly necroticchanges. The positive rate among patients withgranulomatous lesion was low. This agrees well withprevious studies demonstrating lower mycobacterialload in granulomatous lesions which was reflectedin scantier mycobacteria in ZN smears and lowerpositive rates in LJ culture (22,23). Althoughcirculating M. tuberculosis DNA was seen in patientswith multiple lymph-node involvement or showingcaseating-granuloma tous or predominantly necroticcytological pictures, the confidence intervals werewide probably indicating weak association. Thegranulomatous pattern is associated with singlenode involvement (91.6%) and a low positive rate(25%) for circulating M. tuberculosis DNA. Manystudies showed that bloodstream infections (BSI) byM. tuberculosis do occur. However, it affects mainlyimmuno-compromised adults with advanced HIVinfection with radiological, microbiological and/or clinical evidence of pulmonary tuberculosis.The demonstration of circulating M. tuberculosisDNA in immuno-competent patients, mainly inassociation with multiple lymph node involvementprobably suggests haematogenous spread. Lack ofmultiple organ involvement by the disease in-spiteof haematogenous spread can be explained bycompartmentalisation of mycobacterial infection.Garcia de Viedma et al (24), demonstrated thatinfection by more than one mycobacterial strains isvery rare and when occurs, the co-infecting strainsare not equally distributed at pulmonary andextra-pulmonary sites. Circulating M. tuberculosisDNA in our patients could explain the nocturnalfever that was reported by more than 80% of ourpatients (unpublished data). The pattern of thefever could be explained by episodic release of themycobacteria and its antigens into the blood stream.Demonstration of circulating M. tuberculosis DNAwas previously shown by Mirza et al (25).It has long being claimed that the mantouxtest can help to differentiate between tuberculousand non-tuberculous lymphadenitis (26,27). Allour patients with tuberculous lymphadenitishad strongly positive mantoux test (induration>15mm).We conclude that the presence of circulatingM. tuberculosis DNA in the blood of most patientswith tuberculous lymphadenitis, especially thosewith multiple lymph node involvement indicatesthat heamatogenous spread is the probable routeof mycobacterial dissemination in tuberculouslymphadenitis.REFERENCES1. World Health Organisation. (2002). Global TuberculosisControl: Surveillance, Planning, Financing. WHO report,Geneva, Switzerland, 2000 WHO/CDC/TB/; 295.2. Fanning A. Tuberculosis: Extrapulmonary disease. CMAJ.1999; 160: 1597-1603.3. Jha B.C., Dass A., Nagarkar N.M., Gupta R. and Singhal S.Cervical tuberculous lymphadenopathy: changing clinicalpattern and concepts in management. Postgrad. Med. J. 2001;77: 185-187.4. Chao S.S., Loh K.S., Tan K.K. and Chong S.M. Tuberculousand nontuberculous cervical lymphadenitis: a clinical review.Otolaryngol. Head Neck Surg. 2002; 126: 176-179.5. Shenoy R., Kapadi S.N., Pai K.P., et al. Fine needle aspirationdiagnosis in HIV-related lymphadenopathy in Mangalore,India. Acta. Cytol. 2002; 46: 35-39.6. El_Hassan A.M. and Tag El Deen M. Primary intestinaltuberculosis in the Sudan. Ann. Trop. Med. Parasitol. 1982; 76:317-322.7. Bandapat M.C., Mishra B.M., Dash S.P. and Kar P.K.Peripheral lymph-node tuberculosis: A review of 80 cases.Brit. J. Surg. 1990; 77: 911-912.January 2007 E A S T A F R I C A N M E D I C A L J O U R N A L 78. Yassin M.A., Olobo J.O., Kidane D., et al. Diagnosis oftuberculous lymphadenitis in Butjira, Rural Ethiopia. Scand.J. Infect. Dis. 2003; 35: 240-243.9. Archibald L.K., den Dulk M.O., Pallangayo K.J. and PellerL.B. Fatal Mycobacterium tuberculosis bloodstream infectionsin febrile hospitalised adults in Dar es Salaam, Tanzania. Clin.Infect. Dis. 1998; 26: 290-296.10. Archibald L.K., McDonald L.C., Nwanyanwu O., et al. Ahospital-based prevalence survey of bloodstream infectionsin febrile patients in Malawi: Implications of diagnosis andtherapy. J. Infect. Dis. 2000; 181: 1414-1420.11. Waddell R.D., Lishimpi K., von Reyn C.F., et al. Bacteraemiadue to M. tuberculosis or Mbovis, Bacille Calmette Guerin(BCG) among HIV-positive children and adults in Zambia.AIDS. 2001; 15: 55-60.12. Lai C.C., Lee L.N., Ding L.W., Yu C.J., Hsueh P.R. andYang P.C. Emergence of disseminated infections due tonontuberculous mycobacteria in non-HIV-infected patients,including immunocompetent and immunocompromisedpatients in a university hospital in Taiwan. J. Infect. 2005;[Epub ahead of print].13. MacGregor R.R., Hafner R., Wu J.W., et al. ACTG Protocol341 Team. Clinical, microbiological, and immunologicalcharacteristics in HIV-infected subjects at risk for disseminatedMycobacterium avium complex disease: an AACTG study.AIDS Res. Hum. Retroviruses. 2005; 21: 689-695.14. Miller F.J.W. and Cashman J.M. The natural history ofperipheral tuberculous lymphadenitis associated with avariable primary focus. Lancet. 1955; 268: 1286-1289.15. Singh K.K., Muralidhar M., Kumar A., et al. Comparisonof in house polymerase chain reaction with conventionaltechniques for the detection of Mycobacterium tuberculosisDNA in granulomatous lymphadenopathy. J. Clin. Pathol.2000; 53: 355-361.16. Goel M.M., Ranjan V., Dhole T.N., et al. Polymerase chainreaction vs. conventional diagnosis in fine needle aspirationof tuberculous lymph nodes. Acta. Cytol. 2001; 45: 333-340.17. Hirunwiwatkul P., Tumwasorn S., Chantranuwat C. andSirichai U. A comparative study of diagnostic tests fortuberculous lymphadenitis: polymerase chain reaction vshistopathology and clinical diagnosis. J. Med. Assoc. Thai.2002; 85: 320-326.18. Aljafari A.S., Khalil E.A., Elsiddig K.E.G., et al. Diagnosisof tuberculous lymphadenitis by FNAC, microbiologialmethods and PCR: A comparative study. Cytopathol. 2004;15: 44-48.19. Jain A., Verma R.K., Tiwari V. and Goel M.M. Dot-ELISA vs.PCR of fine needle aspirates of tuberculous lymphadenitis: aprospective study in India. Acta. Cytol. 2005; 49: 17-21.20. Noordhoek G.T., Kolk A.H., Bjune G., et al. Sensitivityand specificity of PCR for detection of mycobacteriumtuberculosis: A blind comparison study among sevenlaboratories. J. Clin. Microbiol. 1994; 32: 277-284.21. Noordhoek G.T., Mulder S., Wallace P. and Van LoonA.M. Multicentre quality control study for the detection ofmycobacterium tuberculosis in clinical samples by nucleicamplification methods. Clin. Microbiol. Infect. 2004; 10: 295-301.22. Gupta S.K., Chagh T.D., S.heikh Z.A. andal-Rubah N.A. Cytodiagnosis of tuberculous lymphadenitis.A correlative study with microbiological examination. Acta.Cytol. 1993; 37: 329-332.23. Prasson D. Acid fast bacilli in fine needle aspiration smearsfrom tuberculous lymph-nodes. Where to look for them. Acta.Cytol. 2000; 44: 297-300.24. Garcia de Viedma D., Martin M., Ruiz Serrano M.J., Alcala L.and Bouza E. Polyclonal and compartmentalised infection byMycobacterium tuberculosis in patients with both respiratoryand extra-respiratory involvement. J. Infect. Dis. 2003; 187:695-699.25. Mirza S., Restrepo B.I., McCormick J.B. and Fisher-Hoch S.P.Diagnosis of tuberculous lymphadenitis using a polymerasechain reaction on peripheral blood mononuclear cells. Amer.J. Trop. Med. Hyg. 2003; 69: 461-465.26. Margileth A.M. The use of purified protein derivativemycobacterial skin test antigens in children and adolescents:purified protein derivative skin test results correlated withmycobacterial isolates. Pediat. Infect. Dis. 1983; 2: 225-231.27. Margileth A.M., Chandra R. and Altman R.P. Chroniclymphadenopathy due to mycobacterial infection. Clinicalfeatures, diagnosis, histopathology and management. Amer.J. Dis. Child. 1984; 138: 917-922
Anti-Diabetic Drugs In The Private And Public Sector In Dar Es Salaam, Tanzania
Get PDFObjectives: To compare availability, cost, affordability and sources of anti-diabeticdrugs between private and public health facilities in Dar es Salaam, Tanzania.Design: Cross sectional descriptive study.Setting: Diabetic clinics in private and public health facilities in Dar es Salaam,Tanzania.Subjects: Eighty patients randomly selected and 45 health facility personnel staffworking in the diabetic clinics. Semi-structured questionnaires and a checklist wereused to collect the information.Results: Oral hypoglycaemic agents were available in all seven private and three publicfacilities that were studied. Private facilities stocked more types of oral hypoglycaemicagents than public facilities, which stocked only chlorpropamide and tolbutamide,based on the National Essential Drugs List. The cost of chlorpropamide was five timeshigher in private facilities compared to public facilities. Insulin was also available inall the facilities. The price of animal insulin in private health facilities was ten timesthat in public health facilities. Human insulin, which is generally more expensive thananimal insulin, was only available in private facilities. Although prices were muchlower in public facilities, affordability emerged as a common issue in both privateand public facilities.Conclusions: Urban private health facilities offer a wider choice for the needs ofdiabetic patients but this advantage is compromised by higher prices as compared topublic facilities as well as inconsistent supply across facilities. Public health facilitiesoffer only a limited selection of essential oral hypoglycaemics and insulin but at alower price and across all facilities. Twenty six per cent and 10% of patients in publicand private facilities respectively are unable to afford anti-diabetic drugs. The needfor intervention to increase affordability of anti-diabetic drugs is evident. Financingand cost of drugs needs to be addressed, either by means of health insurance orother mechanisms, in this era of increasing prevalence of diabetes mellitus amongdeveloping countries
TOTAL LYMPHOCYTE COUNT AS A SURROGATE MARKER FOR CD4+ T CELL COUNT IN INITIATING ANTIRETROVIRAL THERAPY AT KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textABSTRACTObjective: To evaluate the utility of Total Lymphocyte Count (TLC) as a surrogate marker for CD4+ T cell count in antiretroviral (ARV) treatment initiation in a Kenyan population of HIV seropositivepatients at Kenyatta National Hospital.Design: Cross-sectional descriptive study.Setting: Kenyatta National Hospital, HIV treatment and follow-up outpatient facility; ComprehensiveCare Centre, Nairobi, Kenya.Subjects: Two hundred and twenty fi ve HIV Elisa positive, ARV naive patients visiting theComprehensive Care Centre between january 2006 to March 2006.Results: A signifi cant linear correlation was found between TLC and CD4 cell count for the wholegroup with a Spearman rank correlation of 0.761 ( p < 0.01); and was also independently observedin the four WHO clinical stages. The classifi cation utility of TLC 1200 cells/mm3 cut-off was suboptimal;sensitivity 37% specifi city of 99% and the NPV of 56%. The receiver operator characteristics(ROC) curve generated an optimal TLC cut-off of 1900cells/mm3 cut-off to be of greatest utilitywith a sensitivity of 81.1%, specifi city of 90.3%, PPV of 90.8% and NPV of 80.2%. This implies thata TLC cut-off of 1900cells/mm3 correctly classify eight out of ten HIV positive patients as havinga CD4 < 200 cells/mm3 and only misclassify two such patients. Serial CD4 testing can then beperformed on the minority of patients who despite a TLC≥1900 cells/mm3 are, on basis of clinicaldata, suspect of more advanced disease warranting ARV therapy. This would reduce the numberof patients tested for and focus the application of CD4 testing and thus reduce attendant cost incare provision in CD4 resource poor settings.Conclusion: Our data showed a good positive correlation between TLC and CD4 cell count, howeverthe WHO recommended TLC cuto-ff of 1200/mm3 was found to be of low sensitivity in classifyingpatients as having a CD4 counts < 200 cells/mm3. This would result in underestimation of advancedstage of disease and to withholding ARVs treatment to persons who need treatment. We recommenda TLC cut-off of 1900 cells/mm3 for our population to classify patients as either above or below theCD4 count cut-off of 200 cells/mm3 as an indicator of when to start antiretroviral therapy
PREVALENCE AND DETERMINANTS OF LOW BIRTH WEIGHT IN JIMMA ZONE, SOUTHWEST ETHIOPIA
No full textObjectives: To assess the prevalence and determinants of low birth weights (LBW).Design: A cross-sectional descriptive study.Setting: Four health centers (Jimma, Agaro, Asendabo and Shebe) within 5-50 km radius from Jimma University and Jimma University hospital from September 1, 2002 to March 30, 2003.Subjects: Mothers with newborns delivered in the above institutions and those delivered at home and received care within the first 24 hours after delivery in the above health care settings.Results: A total of 145 (22.5 %) of the newborns were LBW. Mothers residing in the urban setting had higher risk of delivering LBW babies and the difference was statistically significant (p = 0.00). Analysis of maternal obstetric history revealed that those mothers who delivered before 37 weeks of gestation, had weight loss, and who did not receive additional diet during pregnancy had higher risk of delivering LBW babies and the difference was statistically significant (p = 0.01, 0.00, 0.00) respectively. Similarly, those who had multiple gestations had a higher risk of delivering LBW babies and the difference was statistically significant (p = 0.00).Conclusions: Despite the fact that the method of sampling used in this study has its own limitation, the prevalence of LBW in this study was relatively higher than the reported current estimate of LBW in Ethiopia. Therefore, it is recommended that special attention should be given to adequate rest and additional diet during pregnancy and making antenatal services available and accessible to all pregnant women
MORBIDITY AND MORTALITY OF NEONATES ADMITTED IN GENERAL PAEDIATRIC WARDS AT KENYATTA NATIONAL HOSPITAL
No full textABSTRACTBackground: Neonatal morbidity and mortality is high in developing countries. Facilitiesfor specific neonatal care are limited in Kenya with no neonatal intensive care unitin the public health institutions. The new born unit at Kenyatta National Hospital (KNH)cannot accommodate all neonates so a number of these are admitted to the generalpaediatric wards.Objectives: To establish the morbidity and mortality of neonates admitted to the generalwards at KNH and to review the medical interventions applied in the management andmake recommendations that will improve on this.Design: A retrospective study.Setting: Kenyatta National Hospital general paediatric wards-Nairobi, Kenya.Subjects: All babies who were admitted to the general paediatric wards at KNH fromJanuary to December 2000.Results: A total of 308 records of neonates admitted to the general paediatric wardsat KNH in the year of study were found and retrieved. The mortality was 315/1000neonates admitted. Of the 308 admissions, 33.4% were low birth weight (LBW), 5%being very low birth weight (VLBW). The common diagnoses at admission or dischargewere suspected sepsis 71% (confirmed sepsis 8.4%), jaundice 35%, pneumonia 32%,omphalitis 28%, dehydration 14%, apnoec attacks 13%, and hypothermia 6%. Eightynine (29%) of the infants were not investigated at all. The mean duration of stay wasnine days for those who lived to discharge and four days for those who died. Of thosewho died, 49% died within 24 hours of admission. The frequently cited cause of deathwas suspected sepsis, pneumonia, dehydration and hypothermia. There were only sixadmissions to the general purpose intensive care unit referred from the wards. Theindependent predictors of mortality were low birth weight, apnoec attacks, hypothermiaand dehydration(p<0.05).Conclusion: The mortality rate for neonates admitted to the general paediatric wardsis high with almost half the deaths occurring in the first twenty four hours of admission.While the wards are doing commendable work, they need support by improvinglaboratory back up for improved diagnostic ability and to improve supportive care suchas maintenance of fluid electrolyte balance, temperature regulation and access tointensive care facilities