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TRADITIONAL MENTAL HEALTH PRACTITIONERS IN KWARA STATE, NIGERIA
No full textObjectives: To assess the knowledge, practice and attitude of traditional mental healthpractitioners (TMHPs) in four 1,ocal Government Areas (L.GAs) in Kwara State, Nigeria, onmental health care; to organise training sessions aimed at ~mproving their knowledge base,practice and; to evaluate such training after allowing for a period of practice.Study design/intervention: Pre-training evaluation phase: 'I'MHPs were assessed in the areaof knowledge, attitude and practice of mental health, with the use of a questionnaire. Theywere then trained in the coricepts of normality and abnormality, types of mental illness,treatment of mental illrles5 including follow up, after-care, relapse prevention, otherprimary preventive measures, and some introductory talks on some sub-specialties ofpsychiatry, for example, child psychiatry, old age psychiatry, forensic psychiatry, drug andalcohol abuse and; after a free-practice period of two months, the TMHPs were again reassessedfor the impact of the training.Results: Pre-intervention phase: TMHPs could easily recognise most symptoms of mentalillness except undue sadness. The TMHPs also expressed 5trong belief in the supernaturalfactor as a cause of mental illnes.;. Some of them beat their patients for therapeutic reasonsand; Post-intervention phase: there was a widening of the sense of recognition of TMHPs ofimportant mental symptom5 such as undue sadness, social withdrawal and elation. Therewas a better understanding of the aetiological concepts of mental illness. There was also areduction in the habit of beating their patients as a form crf treatment.Conclusions: The use of information, education and communication intervention techniquescould lead to more positive and less hazardous forms of practice among TMHPs and; Thehigh level of cooperation achieved in this study would indicate a bright chance for futurecollaborative activities between orthodox and traditional healthcare providers
QUALITY OF RECORD KEEPING IN THE INTRAPARTUM PERIOD AT THE PROVINCIAL GENERAL HOSPITAL, KAKAMEGA, KENYA
No full textABSTRACTObjective: To assess the quality of recording critical events in the intrapartum period in KakamegaProvincial General Hospital (PGHK).Design: Retrospective comparative study.Setting: Provincial General Hospital, Kakamega, the referral hospital for Western Province,Kenya.Participants: Two hundred women admitted at the labour ward during the six-month periodbetween 1st September 2000 and 28th February 2001 were compared to two hundred women admittedbetween 1st July 2001 and 31st December 2001.Intervention: The Safe Motherhood Demonstration Project (SMDP) was introduced in fourdistricts of Western Province, Kenya, in which PGHK is located. It included on job training inSafe Motherhood which emphasised, among others, collection and utilisation of maternal healthcare services data.Main outcome measures: Comprehensiveness of recording of biodata, history taking and examinationfindings were assessed for women in labour before and during the implementation of the SMDP.The proportion of cases in labour managed by use of partograph and its appropriate use were alsodetermined.Results: Retrieval rate of patients’ notes was 86.9% and 89.6% before and during SMDP respectively.Information on sociodemographic characteristics, history taking, general and obstetric examinationhad a near universal recording in both groups but data on alcohol consumption, smoking, menarche,previous pregnancies and contraceptive use was poorly recorded. There was a significant improvementin recording of diagnosis and plan of management during the SMDP (p=0.037). The partograph wasused in only 11% of patients before SMDP as compared to 85% during SMDP (p=0.000). Record onfoetal condition and progress of labour were significantly improved during the SMDP (p=0.000).Records on summary of labour likewise significantly improved during the SMDP (p=0.02).Conclusion: The quality of record keeping in the intrapartum period at the PGHK greatly improvedduring the implementation of the SMDP. It would be worthwhile to assess the sustainability ofquality of intrapartum records and care a year or so after the SMDP ended
MORPHOLOGICAL AND FUNCTIONAL TRAITS OF MALOCCLUSION IN 3-5 YEAR-OLDS IN MOSHI, TANZANIA
No full textObjective: To assess the morphological and functional traits of malocclusion.Design: Cross-sectional study.Setting: Moshi Municipality, Kilimanjaro region, Tanzania.Subjects: Examination for occlusal traits was done on 372 randomly selected 3-5-yearolds (157 males and 215 females).Results: The overall prevalence of malocclusion was 26.9%. Females had significantlymore occlusal anomalies than males. The flush terminal plane (93.8%) was the commonestanteroposterior relation. Excessive maxillary overjet and deep-bite occurred in 5.1%and 21.5% of the children respectively. Reverse overbite (1.9%), frontal open-bite(1.6%), lateral open-bite (0.8%) and posterior cross-bite (0.3%) were relatively rare.Harmful oral habits were uncommon in this population. The sample mean for intercanine width in the maxilla was 31.1mm (SD ±2.72) and for the mandible 25.3mm (SD±2.46). Lack of natural spacing in the anterior segment of the maxilla occurred in 34.4%of the children and 33.6% in the mandible.Conclusion: Generally, females had significantly more occlusal anomalies than males.The flush terminal plane was the commonest anteroposterior finding. Lack of naturalspacing in the anterior segments and deep bite were common
FRONTO-ETHMOIDAL TERATOMA: CASE REPORT
No full textA one-month old baby was referred to the neurosurgical unit, Kenyatta National Hospital,Nairobi, Kenya, with history of being born with a bony outgrowth from the right side of herface which resembled an undeveloped twin. A computerised tomography scan of the brainand the extracranial mass confirmed a defect in the anterior cranial fossa and extension ofthe mass intracranially. Total surgical excision of the mass was done and facial reconstructionachieved. Histology of the excised mass confirmed a mature (benign) teratoma. Except forlocation, fronto-ethmoidal teratoma resembles its counterpart in the sacro-coccygeal area.It may arise over the nasion, or within the nose, orbit, or mouth and frequently extendsintracranially. Like other teratomatous tumours, malignant changes tend to occur withincreasing age. Calcification within the mass is often evident on plain skull x-rays. Treatmentconsists of early total excision
OUTCOME AND HAEMATO-TOXICITY OF TWO CHEMOTHERAPY REGIMENS FOR CHILDHOOD NON-HODGKIN’S LYMPHOMA IN A KENYAN HOSPITAL
No full textBackground: Effectiveness and toxicity of childhood cancer treatments have never beenevaluated in Kenya since introduction of structured care in the early seventies.Objective:To evaluate effectiveness and toxicity of two treatment protocols for Non-Hodgkin’s lymphoma (NHL).Design: Historical cohort study using medical records.Setting: Kenyatta National Hospital, a tertiary care and medical teaching hospital.Subjects: Children ≤ 15 years with diagnosis of non-Hodgkin’s Lymphoma.Main outcome measures: Primary outcomes were median survival, event free survivaland toxicity.Results: Out of 101 records, only 26 (25.7%) met inclusion criteria. Baseline characteristicswere similar in the two treatment arms. Median survival was 0.75 months (95%CI=0.54-0.96) and 1.0 months (95% CI=0.29-1.71) for short and long arm groups. There was nodifference in event free survival and haematological toxicity.Conclusion: No clear difference in effectiveness and toxicity between the intensiveshortand the less aggressive long course chemotherapy regimens was evident. Thoughlack of difference may be attributed to the small sample size, suboptimal supportivecare for intensive treatment would increase risk of toxic deaths. As the short courseprotocol did not demonstrate obvious deterioration of median and event free survival,a strong case may be made for a randomised clinical trial within a context of improvedsupportive care
RISK FACTORS FOR PLACENTA PRAEVIA IN SOUTHERN NIGERIA
No full textObjective: To determine the risk factors for placenta praevia in Ile-Ife, southern Nigeria.Design: A prospective case control study.Setting: A tertiary center - Obafemi Awolowo University Teaching Hospital, Ile-Ife,southern Nigeria.Subjects: One hundred and thirty six patients with confirmed placenta praeviaconstituted the cases. Controls consisted of one hundred and thirty six patients whodelivered at term immediately after each indexed case and did not have placenta praevia.Results: Cases and controls were similar in terms of twin deliveries (P=0.72) and pasthistory of uterine surgery (P=0.47). After adjusting for confounders, factors associatedwith risk of placenta praevia were history of retained placenta [OR=6.7(95% CI 1.2-36.6)], previous caesarean section [OR=4.7, (95% CI 1.9-11.4)], previous abortion[OR=2.9 (95% CI 1.1-5.1)], grand multiparity [OR=2.1 (95% CI 1.6-7.1)] and age over35 years [OR=1.4 (95% CI 1.2-6.6)].Conclusions: From our study, the risk factors for placenta praevia are a history ofretained placenta, previous caesarean section, previous abortion, grand multiparity andmaternal age over 35 years
HIV/AIDS AND PREGNANCY-RELATED DEATHS IN BLANTYRE, MALAWI
No full textBackground: HIV/AIDS epidemic is one of the major factors affecting women’shealth and impeding national efforts to improve it especially in sub-Saharan Africa.Current evidence indicates that HIV/ AIDS is increasingly becoming a major cause orcontributing factor to pregnancy-related deaths, almost overtaking the “traditional”causes and factors.Objectives: To survey the contribution of HIV infection and AIDS to pregnancy-relateddeaths in Blantyre, Malawi.Design: A retrospective, descriptive, facility-based survey.Setting: The Queen Elizabeth Central Teaching Hospital, Blantyre, Malawi.Subjects: All women recorded to have had pregnancy-related deaths between January1, 1999 and December 31, 2000.Results: There were 204 maternal deaths, 154 (75.5%) direct, the top five causes beingpuerperal sepsis (39.0%), postabortion complications (31.2%), obstetric haemorrhage(14.3%), eclampsia (8.4%) and ectopic pregnancy (3.9%). At least 38 (18.6%) of thetotal were HIV positive or had AIDS. The main causes of deaths amongst these weremeningitis (23.7%), pneumonia (18.4%), puerperal sepsis (13.2%), postabortal sepsis(10.5%), severe anaemia (10.5%) and pulmonary tuberculosis (10.5%) Of those who diedof puerperal and postabortal sepsis in the whole study group 8.3% had HIV/AIDS. Ofthe indirect maternal deaths, 50 (58%) were HIV positive or had AIDS.Conclusion and recommendations: HIV/AIDS contributes to both direct and indirectmaternal deaths in Malawi. National strategies to realise MDG5 targets should includeaddressing the HIV/AIDS epidemic within the entire population as well as scalingup contraceptive uptake and utilisation, especially amongst the most vulnerablegroups.INTR
AN UNUSUAL ABDOMINAL MASS: CASE REPORT
No full textThe causes of intra-abdominal masses associated with chronic abdominal pain range from thebenign to malignant; common to bizarre and some raise major medical-legal issues. We presenta case of a 40-year old African lady who presented with chronic right-sided abdominal pain withan associated mass on the right mid-abdomen. She had had a Caesarian section one year prior topresentation. Antecedent history of surgery and typical imaging features enabled a preoperativediagnosis of abdominal mass secondary to retained surgical gauze. The case illustrates the fallibilityof the men and women in the operating theatres and the vital role of correct instrument and spongecounts
AETIOLOGY AND PRESENTATION OF HIV/AIDS-ASSOCIATED PULMONARY INFECTIONS IN PATIENTS PRESENTING FOR BRONCHOSCOPY AT A REFERRAL HOSPITAL IN NORTHERN TANZANIA
No full textABSTRACTObjectives: To determine the aetiological agents of pulmonary infections in HIV-infected Tanzaniansand to correlate the causative agents with clinical, radiographic features, and mortality.Design: A prospective study.Setting: Kilimanjaro Christian Medical Centre (KCMC), Tanzania.Subjects: Bronchoalveolar lavage fl uid (BAL) were obtained from 120 HIV infected patients withpulmonary infections. BAL for causative agents was analysed and correlated with clinical andradiographic features, and one-month outcome.Results: Causative agents were identifi ed in 71 patients (59.2%) and in 16 of these patients, multipleagents were found. Common bacteria were identifi ed in 35 patients (29.2%), Mycobacteriumtuberculosis in 28 (23.3%), Human Herpes Virus 8 (HHV8) in 12 (10%), Pneumocystis jiroveci in nine(7.5%) and fungi in fi ve (4.2%) patients. Median CD4 T cell count of the patients with identifi edcauses was 47 cells/μl (IQR 14-91) and in the 49 patients with undetermined aetiology was 100 cells/μl (IQR 36-188; p=0.01). Micronodular chest radiographic lesions were associated with presenceof M. tuberculosis (p=0.002). The one-month mortality was 20 (16.7%). The highest mortality wasassociated with HHV8 (41 .7%) and M. tuberculosis (32.1%). Mortality in patients with undeterminedaetiology was 11.3%. No death occurred in patients with PCP.September 2007 EA S T AF R I C A N ME D I C A L JOURNAL 421INTRODUCTIONSub-Saharan Africa is the region of the world mostaffected by HIV/AIDS, more than 70% of HIVinfected individuals live in this African sub-continent,(1) and the HIV pandemic is still increasing. Despitethis, data pertaining to the disease presentation fromthis region compared to the developed world areinsuffi cient and require regular updating. The clinicalpresentation of HIV/AIDS and the occurrence ofopportunistic infections depend on different factorssuch as the presence of endemic diseases, qualityof health services, availability of and access to antiretroviraltreatment, and levels of education of thepopulation. Pulmonary infections are the leadingcauses of morbidity and mortality in HIV-infectedindividuals (2,3). A microbiological diagnosis is ofcrucial importance in HIV infected patients withpulmonary infections because of atypical clinicaland radiographic manifestations and high mortality(4). Because in these settings resources are limited,treatment is largely empirical, but to be effective,it should be tailored to locally prevailing causativeorganisms. Therefore health facilities equipped withadvanced diagnostic techniques should monitor thetrend of diseases and obtain data on aetiologicalpathogens, so that empirical treatment regimenscan be improved.The aim of this study was to fi nd the aetiologicalpathogens of pulmonary infections in HIV/AIDSpatients who presented with features of pulmonaryinfection for bronchoscopy.Furthermore, we correlated the pathogensidentified with clinical and radiographicpresentations, level of immunity, and outcomeafter one month.MATERIALS AND METHODSAt Kilimanjaro Christian Medical Center (KCMC)in northern Tanzania we enrolled 120 HIV infectedpatients aged 18 years and above, who presentedwith features of chest infection such as cough(dry or productive) and/or chest pain, dyspnoea,fever and chest radiographic abnormalities. Thesepatients were recruited at the endoscopy unitwhere bronchoscopic procedures are done. Thepatients were referred by their attending cliniciansfor bronchoscopy as part of patient’s managementafter failing to establish the causative agent by othermethods and/or following failure to respond toempirical treatment. Pregnant women and patientswith oxygen saturation less than 90% under 61/mmof oxygen were excluded from the study.Bronchoscopy and bronchoalveolar lavage (BAL)was performed by standard procedure using fl exiblefi beroptic bronchoscope. Briefl y, the bronchoscopewas wedged in one of the heavily involved segmentalbronchi as seen on the chest radiograph. In case ofdiffuse lung involvement, the scope was wedgedin one of the segmental bronchi of the right middlelobe. Then aliquots of 50 ml or less of sterile saline atbody temperature, up to a maximum of 150 ml, wereinstilled and at least 40 ml was sucked back into asterile container. The sediments of BAL fl uid obtainedby centrifugation at 1500 g for 10 minutes were usedfor laboratory tests to identify the aetiological agentof the chest infection.For identifi cation of M. tuberculosis, BAL sampleswere decontaminated with 4% NaOH, centrifugedand cultured using in-house made Lowenstein-Jensen (LJ) solid medium, with a maximum of eightweeks incubation. Diagnosis of M. tuberculosis wasbased on positive culture results showing acid fastbacilli (AFB) in ZN stain.Diagnosis of pneumocystis pneumonia (PCP)was based on identification of Pneumocystis (P)jiroveci with at least one of the following techniques:Giemsa stain, Gomori methenamine silver (GMS)stain or immunofl uorescence test (IFT). Also realtime PCR was performed for detection of P. jiroveciDNA in the BAL fl uid, using 40 as the cycle threshold(CT) cut off value (5).Conventional PCR was used for the diagnosis ofHuman herpes virus 8 (HHV8) as described by Changand collaborators (6).Fungi were diagnosed by direct smear andculture for seven days using Sabouraud dextroseConclusion: In this population of severely immunosuppressed HIV-infected patients withpulmonary infection a variety of causative agents was identifi ed. Micronodular radiographiclesions were indicative of TB. High mortality was associated with M. tuberculosis or HHV8. Nodeath occurred in patients with P. jiroveci infection