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INDUCTION OF LABOUR USING LOW AND HIGH DOSE REGIMENS OF PROSTAGLANDIN E2 VAGINAL TABLETS
No full textABSTRACTObjective: To compare the efficacy of low dose prostaglandin E2 vaginal tablets withthat of high dose in induction of labour.Design: A retrospective study.Setting: Abha Maternity Hospital, a teaching hospital in the southern region of SaudiaArabia.Patients: The outcome of induction of labour in 73 women induced with 1.5 mgprostaglandin E2 vaginal tablets was compared with those in 168 women induced with3 mg vaginal tablets.Results: There were no statistical significant differences in the success rate, inductiondeliveryinterval, caesarean section rate and Apgar scores between the two groups. Therewere two incidences of uterine hyperstimulation and two of uterine rupture in the highdose group. These were not statistically significant. Logistic regression analysis showedthat the success rate of induction of labour was dependent only on maternal age(P=0.0025) and Bishop score (P=0.0403) and not on parity, gestational age, birthweightor dose of prostaglandin.Conclusion: The low dose regimen of 1.5 mg is as efficacious as the high dose regimenof 3mg. prostaglandin E2 vaginal tablets in inducing labour. This implies that usingthe low dose regimen reduces the cost of induction of labour effectively. Largerprospective randomized studies are needed to confirm this finding
Comparison of maternal satisfaction following epidural and general anaesthesia for repeat Caesarean sec
Get PDFObjective:To assess maternal satisfaction following two anaesthetic techniques (generaland epidural anaesthesia) for repeat Caesarean section.Design: Prospective study.Setting: University of Port Harcourt Teaching Hospital, Nigeria.Subjects: One hundred and twenty parturients scheduled for elective Caesareansection.Results: The demographic data and mean satisfaction scores obtained from questionnaireand visual analogue scale (VAS) were subjected to analysis using the Student’s t-testwith the computerised statistical calculator SPSS Windows 10.0. The mean satisfactionscore of the parturients in the epidural anaesthesia population using the questionnairewas 149.0±10.65 while that in the general anaesthesia population was 105.3±12.42.The mean satisfaction score from the VAS was 9.0±1.50 for those who had epiduralanaesthesia while it was 2.6±0.70 in the general anaesthesia population. The differencesin the mean satisfaction scores from both instruments of measurement were statisticallysignificant at P<0.05. Ninety eight patients (89.09%) of the total study populationwho completed the study, desired to have a repeat Caesarean section under epiduralanaesthesia while 12 patients representing 10.91% still desired further surgery undergeneral anaesthesia.Conclusion: It is concluded that patients are more satisfied with Caesarean sectiondone under epidural anaesthesia
PURULENT PERICARDITIS COMPLICATING SEPTICAEMIA: REPORT OF TWO CASES
No full textABSTRACTIntrapericardial (Pericardial) abscess is quite rare as a complication of sepsis and asa cardiac complication of typhoid septicaemia. It is rapidly fatal if untreated. We reporttwo cases of a schoolboy eight years old with septicaemia from pyomyositis of the rightthigh and another of nine and a half years with typhoid perforation and typhoidsepticaemia that developed pericardial abscesses. In well-developed centres, computerisedtomography, ultrasonography and other radiological investigations are employed forboth diagnosis and therapy. We emphasise that these can be accomplished by goodclinical examination, radiography of chest and the use of 18-G intra-venous cannulafor percutaneous pericardiocentesis without aggressive surgical intervention
PREVALENCE OF VISUAL IMPAIRMENT AND BLINDNESS IN A NAIROBI URBAN POPULATION
No full textObjective: To determine the prevalence and causes of visual impairment and blindness among Kibera slum dwellers.Design: Population based Survey.Setting: Kibera Slums, Kibera Division, Nairobi, Kenya.Subjects: One thousand four hundred and thirty eight randomly selected slum dwellers.Results: The prevalence of blindness and visual impairment was 0.6% (95% CI: 0.21 to 1.0), and 6.2% (95% CI: 4.95 to 7.15) respectively. 37.5% of those found blind were due to cataract followed by refractive errors 25.0%. 58.1% of those with visual impairment had refractive errors while 35.5% had cataracts. Females had a higher prevalence of visual impairment compared to males but the difference was not statistically significant (P = 0.104).Conclusions: Prevalence of blindness in Kibera slums is slightly lower than the estimated national average (0.7%) while that of visual impairment is almost three times higher. The leading causes of blindness are cataract followed by refractive errors. For visual impairment, refractive error was the leading cause followed by cataract.Recommendation: Kibera slum dwellers are in need of comprehensive eye care services offering cataract surgery and low cost spectacles
NOSOCOMIAL INFECTION IN A NIGERIAN RURAL MATERNITY CENTRE: A SERIES OF NINE CASES
No full textBackground: An outbreak of urinary tract infection in a rural maternity hospital near Enugu, Nigerialed to bacteriological assessment which identified Serratia marcescens as the causative organism.An epidemiological investigation was done to trace the source of this organism.Objective: To investigate an outbreak of urinary tract infection in a rural maternity centre.Design: A descriptive study.Setting: Maternity centre in a rural community near Enugu run by local midwives assisted byauxillary nurses trained by the midwives.Subjects: Nine patients at term with symptoms of urinary tract infection.Results: In all nine cases, the pigmented form of Serratia marcescens was found to be the cause ofthe urinary tract infection and the source of this organism was traced to the auxillary nurse whoshaved the patients and the instrument she used.Conclusion: Since the causative organism of the outbreak of urinary infection in these women wastraced to the shaving instruments used and the fingers of the auxillary nurse who shaved them,there is the need for better hygiene practices in the health centre and the use of properly trainedstaff to attend to pregnant and parturient women. It is recommended that the practice of shavingparturient women should be discarded
DESCRIPTIVE CASE SERIES OF PATIENTS PRESENTING WITH CANCER OF THE PROSTATE AND THEIR MANAGEMENT AT KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textABSTRACTObjective: To study clinical prostate cancer in this locality with particular interest inincidence, clinical presentation and treatment.Design: A descriptive prospective study.Setting: Kenyatta National Referral and Teaching Hospital affiliated to College ofHealth Sciences of the University of Nairobi between November 1998 and October1999.Patients: Sixty five patients with clinical prostate cancer were included in the study.Results: Age was reliably confirmed in 64 out of the 65 patients. 87.5% of the patientswere aged over 61 years with a peak incidence in the 66-70 year age group and a meanage of 67 years. Crude hospital incidence of 76.5 patients per 100,000 patients anda crude hospital death rate of 5.8 patients per 100,000 patients is reported. Themajority of patients (87.5%) presented late with advanced disease stages III(C) andIV(D) prostate cancer.Conclusion: The crude hospital incidence of cancer of the prostate is on the increasein this locality with a finding of 76.5 per hundred thousand patients, higher than thatreported by earlier researchers in this locality and elsewhere. This study suggeststhat prostate cancer incidence and the magnitude of risk in our locality must havebeen grossly underestimated in the past. The prostate cancer rate in Kenyans maybe as great as noted in black men in the United States, Jamaica, Nigeria andCameroon which may suggest some common enhancing genetic predisposition.There is need to further investigate this phenomenon. Cancer of the prostate in thislocality presents late with clinically advanced disease
Reclaiming the Promise of Sociological Imagination in Africa
Get PDFI have carefully chosen the theme of this paper as 'Reclaiming the Promise of Sociological Imagination in Africa because I believe this is one area where African sociokgists have played an insuuficient, relevany and transformed role. The important message in this paper is that it not too late to reclaim our relevance as sociologists and to map out the terrain of our enterprise in relation to the challenges we face in a country like Kenya and in Africa as a whole. As my contribution to the re-launching of the African Journal of Sociology Why is it important that we have journals of sociology? Is it only to provide us with a medium of academic expression, erudition and mobility? Or is it so that we can, as African sociologists, be interpreters of our own sitjations and conditions?of the University of Nairobi I want to pose following questions: Why do we research and publish?
Globalization and State in Africa: A paradox
Get PDFGlobalization as a meltdown offreer flows of trade; direct foreign investment and finance, the liberalization of trade and investment policies have had both positive and negative effects on national economies. Positively, globalization has created and opened hidden opportunities for some people, groups and countries. At the same time, globalization has negatively impacted on economies through increased impoverishment, inequality, and work security, a weakening of institutions and social support systems and the erosion of established identities and values. Globalization is transforming trade, finance, technology, employment, environment, social systems and patterns of governance. This paper analyses the implications of these trends for global development
RISK FACTORS FOR CARDIAC DYSFUNCTION IN CHILDREN ON TREATMENT FOR CANCER AT KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjective: To determine the point prevalence of abnormal cardiac function and to assessthe risk factors for cardiac dysfunction in paediatric oncology patients on treatmentat Kenyatta National Hospital.Design: Descriptive cross-sectional study with a nested case control.Setting: Kenyatta National Hospital between February and April 2006.Main outcome measures: Left ventricular dysfunction if ejection fraction (EF) <55% orfractional shortening (FS) <29% defined cases. Controls had EF >55% or FS >29%.Results: One hundred and eleven patients were enrolled of whom 32 had abnormalcardiac function and were classified as cases while 79 had normal cardiac function. Abouta third, point prevalence 29% (95% CI 21.2-37.9), had cardiac dysfunction. Cumulativeanthracycline dose was a risk factor for cardiac dysfunction in this population. Above200mg/m2 the attributable risk percentage of cardiac dysfunction was 77%.Conclusions: Serial echocardiography should be performed to identify patients at risk.Alternative treatment protocols should be used when the cumulative anthracycline doseexceeds 200mg/m2 due to the high attributable risk. Studies to further assess the otherassociated risk factors and long term effects of anthracycline are recommended
INFORMED CONSENT FOR CLINICAL TRIALS: A REVIEW
Get PDFObjective: To identify and highlight challenges related to informed consent processfor clinical trials in sub-Saharan Africa.Data sources: Published original research findings and reviews in the English literature,together with anecdotal information from our current professional experiences withclinical trials.Design: Review of peer-reviewed articles.Data extraction: Online searches were done and requests for reprints from correspondingauthors and institutional subscription.Data synthesis: Information categorised accordingly.Results: Informed consent for clinical trials conducted in sub-Saharan Africa (SSA) isnot always “truly informed” or “truly voluntary”. Guidelines for obtaining informedconsent are often difficult to implement because of low literacy levels, socio-economicand cultural factors. The local ethics committees, whose role is critical in informedconsent, are weak, ill-equipped or non-existent in some countries. Many participantsmay have incomplete understanding of the various aspects of the clinical trials due tolanguage barriers, the way information is disclosed or terms used for informed consentdocuments. In some settings, clinical trials are the only access to health care servicesfor the local population. Further, participants may enroll with perceived notion ofcure of their conditions, for monetary or material benefits.Conclusions: There is need for national guidelines on clinical research including ethicsreview, compensation of subjects, requirements for research investigators, facilitiesand ethics committees as well as budgetary allocation. These guidelines must not onlyaddress specific and unique local circumstances but also meet minimum internationalclinical research standards. Local bioethics and research capacity should be developedand strengthened with research sponsors contributing towards this. Local research isneeded on the validity and reliability of informed consent for clinical trials and factorsinfluencing that in different socio-cultural settings in SSA