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VITAMIN A DEFICIENCY AMONG KENYAN CHILDREN AS DETECTED BY CONJUCTIVAL IMPRESSION CYTOLOGY
No full textABSTRACTObjective: To determine the prevalence of Xerophthalmia among Kenyan children aged(four to seven) years in high risk using Conjuctival Impression Cytology and transfer.Design: A cross sectional community based study.Setting: Mathare slum in Nairobi and Tiva/Ithiani area of Kitui.Subjects: Children aged four to seven years residing in the above areas were assessedfor both clinical and cytological features of vitamin A deficiency.Results: Of the 342 children included in this study, 316 (92.0%) were normal, five (1.5%)had XN, 19 (5.9% had XIA and two (0.6%) had XIB. No signs of corneal Xerophthalmiawere seen in this study. Conjuctival impression cytology and transfer (CICT) was usedto asses for squamous metaplastic changes associated with Vitamin A deficiency (VAD).Seventy five (23.1%) of the children were normal by CICT while 249 (76.9%) wereabnormal. In comparing the two areas of study, only 13.2% of the children in Matharehad normal CICT compared to 50% in Kitui. For each of the age groups studied therewas significant difference between the two areas with children from Mathare being moredeficient than those from Kitui.Conclusion: VAD is a significant health problem in the high risk areas assessed byCICT in this study
ACUTE APPENDICITIS IN A KENYAN RU IAL HOSPITAL
No full textObjectives: The literature on appendicitis in Africa is almost all derived from urban teachinghospitals. As most of Africa's people are from rural areas, we sought to review our experiencefrom a rural hospital in Kenya.Design: Retrospective chart review.Setting: A rural Kenyan church hospital.Subjects: One hundred and twelve cases of acute appendici .is presenting at Kijabe Hospitalover a five year period were reviewed.Intervention: Appendicectomy.Main outcome measures: Sex, age, pre-hospital delay, ope -ative findings, wound infection,post-operative length of stay.Results: The male to female ratio was 1.8:l. The median agt was 29 (4-71 years). Median prehospitaldelays were one day (normal appendix), one and 3 half days (simple appendicitis),three days (perforated appendix) and six and a half days (appendical abscess). Operativefindings were 14% normal appendix, 42% simple apptndicitis, 22% perforated, 21 %abscess. Overall wound infection rate was 22% ; ranging from 11 % for simple appendicitisto 46% for an appendiceal abscess. The mean post-opera tive length of stay was nine and ahalf days.Conclusions: Acute appendicitis in rural Kenya is similar to patterns reported in urbanAfrican centres. The main difference from western data is the high complicated appendicitisrate which is most likely related to prolonged pre-hospit~l delay
PREVALENCE OF ACUTE AND PERSISTENT DIARRHOEA IN NORTH GONDAR ZONE, ETHIOPIA
No full textObjectives: A study was conducted to determine the magnitude of dysentery and persistentdiarrhoea in children aged under-five.Design: A cross-sectional community- based survey was used to enroll the under-fivechiidren. A two-stage random sampling technique was applied to identify the householdswith under-five children.Setting: The study was conducted from March to May 1997 in two districts of North GondarAdministrative Zone that is located in northwest Ethiopia Two urban dwellers associationsand twelve peasant associations were covered by the study.Subjects: A total of 1101 under-five children were involved.Main outcome measures: Bloody diarrhoea and diarrhoea that persisted for fourteen days ormore were the main outcome variables.Results: One hundred and ninety seven (18%) of the under five children had diarrhoealattacks within two-week recall period. Sixty five (33%) of these had persistent diarrhoea.The prevalence of persistent diarrhoea was 6%. Of those who had diarrhoea, forty four(22.3%) had dysentery. Access to protected water source was significantly lower in childrenwith diarrhoeal diseases than without ( ~ 2 = 431, p4.05). Significantly a higher number ofchildren with diarrhoea had recent attacks of diarrhoea than those without diarrhoea(x2=176.82, p4.00001).Conclusions: A particularly high prevalence of dysentery and persistent diarrhoea wasobserved. Establishment of a simple surveillance system and taking of control measures toreduce the burden of dysentery is recommended
PSEUDOXANTHOMA ELASTICUM IN A PATIENT WITH SICKLE CELL DISEASE: CASE REPORT
No full textAn 18 year female sickler (HbSS) presented with repeated history of epistaxis and bleeding gums. Features consistent with pseudoxanthoma elasticum were observed, such as hyper-extensile redundant skin folds in the neck, axilla, inguinal areas and abdomen. The skin biopsy showed swollen, clumped and fragmented elastic fibres and calcium deposits in the deep and mid reticular dermis, consistent with pseudoxanthoma elasticum. This is a well recognised complication of sickle cell disease which has not been described in Kenya
TRADITIONAL REMEDIES IN CHILDREN AROUND EASTERN CAPE, SOUTH AFRICA
No full textABSTRACTObjective: To gauge the views of mothers and other caregivers on the use of traditionalremedies in the community.Design: Descriptive study.Setting: Five health centres affliated to the UNITRA, Faculty of Health Sciences.Methods: Medical students administered a questionnaire to mothers and other caregivers.Areas covered included how commonly traditional remedies are used, experience withtraditional remedies in children, reasons for use, how administered, and problems encountered.Results: There were 103 respondents, 7.8% rated use of traditional remedies non-existent,20.4% rated it as rare and the rest said it was common. 57.3% of the respondents had usedthese remedies in their children, and 83.1% of them said they would use them again. Only20.7% of respondents reported problems with these remedies, including diarrhoea, vomiting,fever and death. The preparations used were known by only 40.7% of respondents. Theremedies were administered by the mother and grandmother in 82.8% of cases; and weremainly given orally, by enema or by scarification. The amount administered varied fromspoonful(s) up to 2.5 l. Children of all ages were given traditional remedies, usually fordiarrhoea, fevers and constipation, or as prophylactics. These remedies were used becausethey are effective, available and safe, or due to customary beliefs and pressure from others.Conclusion: The use of traditional remedies in children is common in communities aroundUmtata. There is need to study the composition and activity profiles of commonly usedpreparations so as to develop appropriate management protocols in case of toxicity
CHEILITIS GLANDULARIS PROGRESSING TO SQUAMOUS CELL CARCINOMA IN AN HIV-INFECTED PATIENT: CASE REPORT
No full textSUMMARYCheilitis glandularis (CG), is a rare inflammatory minor salivary gland diseaseaffecting the lower lip. The hallmarks of which include progressive enlargement andeversion of the lower labial mucosa resulting in the obliteration of the mucosalvermillioninterface. A case is presented of a 47-year-old HIV-infected woman whoinitially manifested clinical features of CG with a typical histopathology picture ofa non-specific sialadenitis while a second biopsy performed six months later revealedwell differentiated squamous cell carcinoma (S C C). She is symptom free one yearfollowing excision and radiotherapy treatment
MEASLES SERO-SURVEILLANCE DURING MASS IMMUNISATION CAMPAIGN IN MALAWI
No full textObjective: To determine age-specific measles antibody prevalence and serological responseto vaccination during the first mass campaign against measles in Malawi.Design: Cross-sectional study using a questionnaire and a serological particle agglutination(PA) test.Setting: Two health centres in Salima district, central Malawi during the national measlesimmunisation week, 1998.Pa,rticipants: Two hundred forty six under-five year old t hildren.Results: Seventy four per cent of enrolled children (95 % crmfidence interval, 69-80%) weremeasles PA antibody positive at the vaccination. The antibody positive rate was 17.490 inchildren aged 8-12 months and gradually increased up to 90% by four years-old, while theage-specific geometric mean titers (GMTs) in 48-59 months-old group were significantlylower than those in 24-35 months-old group, suggesting antibody waning after previousvaccination (p=0.0047). Two hundred and thirty follow up specimens were obtained eightweeks after the vaccination. The sero-conversion rate was 100% in 58 children sero-negativeat the vaccination and the GMTs in 172 children seropositive at the vaccination weresignificantly increased (p<0.001).Conclusion: These results indicated that the first national measles immunisation campaignsuccessfully immunised the enrolled children or gave a booster response of antibody levels.It was also confirmed that the PA test was easy to perform and most suitable for the fieldcondition in developing countries
GENDER DIFFERENCES IN THE HOUSEHOLD-HEADSHIP AND NUTRITIONAL STATUS OF PRESCHOOLER
No full textBackground: In genera self declared female headed-households in most developing countries tend to be poorer, own less and have less access to job opportunities.Objective: To assess the nutritional status of preschoolers by gender differentiation of heads of households.Design: A cross-sectional descriptive study carried out during February 2003.Setting: Four benefi ciary villages registered under the Ethio-Danish joint community development programme in North Ethiopia.Subjects: A total of 144 heads of random systematically selected households regrouped as male-headed (n=96) and female-headed households (n=48) with their respective preschoolers.Main outcome measures: Nutritional status of two groups of children categorised by gender of the head of household.Results: The number of preschoolers from male-headed households was 1.54 as opposed to the female-headed households (1.08). The proportion of stunted and underweight preschoolers was signifi cantly higher in female headed-households than in the maleheaded households while the prevalence of wasting was practically similar. The proportion of vaccinated and breastfed children, although not statistically signifi cant, was higher in male headed households while the practice of colostrums feeding, giving water and butter, Vitamin A and appropriate weaning was better in femaleheaded households. The difference noted in prevalence of feeding colostrums was signifi cant. The energy, protein and vitamin A intake in almost all of the households was below the recommended daily allowances; showing a nutrient adequacy ratio of 50.2%, 48.8% and 17.9% respectively whereas iron intake exceeded 100%. The energy, protein, vitamin A and iron intake was better in the male-headed households than in female-headed households. The difference, however, was statistically signifi cantfor energy only.Conclusion: This study delineated that chronic child under-nutrition is not only higher among female children but also in female headed households and hence the implication of gender biased violation of the right to nutrition security. Other important implication of this study is that apart from gender issues alternative livelihood options that promote healthy behaviours, such as, improving the provision of health services and curbing the harmful traditional practices that may have a dual impact on the well being of mothers and children is recommended
POST-PARTUM MENTAL DISORDERS IN SAGAMU
No full textBackground: Pregnancy and labour are suffi ciently stressful to precipitate mental disorders in women after delivery. This may arise newly, as a recurrence or an exacerbation of previously existing mental illness in the individual woman. Postpartum mental disorders are under reported in our practices.Objective: To determine the incidence of post-partum mental disorders in our practice, pattern of presentation and the commonly associated factors.Design: A retrospective descriptive study.Results: During the study period there were a total of 9085 deliveries and 27 cases of puerperal mental illness. This gave an incidence of 2.9 per 1000 births. The mean age and mean parity of patients were 27.3 (+ 7.9 SD) and 2.3 (+ 1.8 SD) respectively. The mean delivery-presentation interval and mean length of hospitalisation were 11.5 (+ 7.15 SD) and 12.4 (+ 5.8) respectively.Conclusion: Incidence of post-partum mental illness in our practice is 2.9 per 1000 births. There were preponderance of primiparity and young maternal age in the study group. Family history of psychiatric disorders and marital disharmony appear to play major role in the aetiology of these disorders in our practice