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RHEUMATIC DISORDERS IN SUB-SAHARAN AFRICA
No full textObjective: To review prevalence of rheumatic disorders in Sub-saharan Africa and in thecontext of current medical practice in the region assess the need for service and educationalprovision.Data sources: Medline, (English, French). Pre-medline literature review from the 1950’s(Current contents). Various conference reports including attendance at all three AFLAR(African League Against Rheumatism) congresses in the 1990’s. Author’s personal database.All cited references read in full.Conclusions: The evidence shows rheumatoid arthritis and systemic lupus erythematosus tobe increasing in frequency in the indigenous populations of East, Central and South Africabut remaining rare in West Africans. Gout is now more prevalent than ever throughout thesubcontinent. HIV has spawned a variety of previously rare spondyloarthropathies (reactivearthritis, psoriatic arthritis, enthesopathy) and changed the epidemiology of pyomyositisand osteomyelitis. Osteoarthritis is a universal problem. Juvenile chronic arthritis is not rareand rheumatic fever is common. Acute and chronic locomotor problems associated withdiverse entities such as leprosy, brucellosis, meningococcus, alpha viruses, parasites, fluorosis,rickets and haemoglobinopathies enhance diagnostic diversity and therapeutic and educationalrequirements. Suggestions made to address the challenge posed by the burden of rheumaticdisorders
NASOPHARYNGEAL STREPTOCOCCUS PNEUMONIAE AMONG UNDER-FIVE YEAR OLD CHILDREN AT THE MOI TEACHING AND REFERRAL HOSPITAL, ELDORET, KENYA
No full textObjectives: To determine the prevalence, risk factors and antibiotic sensitivity of streptococcuspneumoniae carried in the upper respiratory tract of children.Design: A cross-sectional study on consecutive clients.Setting: Maternal Child Health Clinic (MCH) at Moi Teaching and Referral Hospital (MTRH) inwestern Kenya.Subjects: Seventy eight of children attending Maternal Child Health Clinic between March 10th2003 and July 11th 2003.Main outcome measures: Upper airway carriage status, ventilation, housing, age, illness, sensitivitypatterns.Results: Fifty six percent were boys; the median age was six months (range 1-42 months).Streptococcus pneumoniae carriage rate was in 28 (35.9%) cases. Fifty two percent of S. pneumoniaewere resistant to penicillin, 25% to ampicillin and 78% to cotrimoxazole. There was signifi cantassociation between the type of fl oor with pneumococcal carriage (p = 0.009) with people living inearth fl oor houses being fi ve times more likely to be pneumococcal carriers as compared to thoseliving in cement fl oor houses.Conclusions: A signifi cant resistance of S. pneumoniae to penicillin, ampicillin and cotrimoxazole wasfound. Earth fl oored houses may increase susceptibility to upper airway S. pneumoniae carriage.Recommendation: Similar studies should be conducted in other parts of Kenya in order to learnabout susceptibility patterns and associated risk factors, including fl oor type, in the country andtailor better treatment regimens
EPIDEMIOLOGY OF POLIOMYELITIS IN NORTHWESTERN ETHIOPIA
No full textObjectives: To determine the magnitude of poliomyelitis and assess its epidemiologicalfeatures.Design: A cross-sectional community based, house-to-house survey.Setting: Six urban and ten rural villages in Gondar Zuria district, north-western Ethiopia.Subjects: Twelve thousand children aged 1-15 years residing in the randomly selected areaswere ended in the study to identify children with walking abnormality. Paralytic poliomyelitisis considered as flaccid paralysis in one or both legs with normal sensations and acute onsetwithout progression.Results: Out of 12,000 children aged 1-15 years enrolled, 20 were found to have paralyticpoliomyelitis. The prevalence of residual poliomyelitis was found to be 2.1 per 1000 childrenaged 1-15 years with the estimated annual incidence rate of 7.7 per 100,000 population. Sixtypercent of the cases were from urban areas and 55% of the cases were males.Conclusions: The magnitude of paralytic poliomyelitis is high in the study area, thusexpanding the expanded programme of immunisations with a strong surveillance system issuggested
SEPTICAEMIA IN HIGH RISK NEONATES AT A TEACHING HOSPITAL IN ILE-IFE, NIGERIA
No full textObjectives: To determine the incidence, predisposing factors,clinical features, bacteriologicalpattern and antibiotic sensitivity in septicaemia in high-risk newborns.Design: A prospective study.Setting: Neonatal unit, Ife State Hospital, a unit of the Obafemi Awolowo UniversityTeaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria.Subjects: All newborns admitted with clinical features and/or risk factors suggestive ofneonatal septicaemia from February 1994 to March 1995.Main outcome measures: Culture results and mortality rates.Results: The incidence of neonatal septicaemia among new born was 22.9 per 1000 livebirths.The predisposing perinatal factors were low socio-economic status, lack of antenatal care,maternal peripartum pyrexia and congenital malformations. Gram-positive bacteria werefound to be the most prevalent causative organisms (59.4%). Staphylococcusaureus (36.2%),Pseudomonas aerugirzosa (18.8%) and Coagulase negative Staphylococcus (15.9%) were thecommonest causes of septicaemia. Meningitis and UTI were associated diagnoses in 16.7%and 18.2% of the septicaemic babies, respectively. The bacterial isolates showed a highdegree of in-vitro antimicrobial resistance. However, all the isolates were sensitive toofloxacin. Amongst the commonly used antibiotics, gentamicin had the lowest resistance.The overall mortality rate was 33.3%.Conclusion: Improvement in the socio-economic status of the populace and availability ofaffordable antenatal care would reduce the incidence of neonatal septicaemia in Nigeria.Continuous surveillance in every unit, as well as close attention to preventive strategieswould be necessary to reduce morbidity and mortality from neonatal septicaemia. Werecommend the inclusion of gentamicin in the initial treatment of septicaemia in the neonatalunit of OAUTHC, Ile-Ife, Nigeria
A NEW CLASSIFICATION OF OSTEOMYELITIS FOR DEVELOPING COUNTRIES
No full textABSTRACTBackground : The term osteomyelitis (OSM) was first coined by Nelaton in 1844. Waldvogelet al, Cierny-Mader, May et al classifications of OSM from developed countries and Meieret al’s from Nigeria have been described.Objective:This new classification was developed to highlight significant pathology seen indeveloping countries not covered by existing classifications.Design: A prospective study.Setting: University of Ilorin Teaching Hospital, Ilorin, Nigeria.Subjects: All OSM patients treated from January 1998 to June 2000.Main outcome measures: Age, sex, clinical features, radiographs and treatment offered wereanalysed. Five stages were recognised: stage 0 (potential OSM with bone contamination),stage I (early or acute OSM), stage II (intermediate OSM with subperiosteal abscess), stageIII (late or chronic OSM with sequestrum and subdivided into IIIa ‘curable’, IIIb ‘controllable’,IIIc ‘complicated’). Stage IV (compound OSM) with joint involvement: IVa, if anatomicaland IVb if physiological. Patients’ haemoglobin (Hb) status is added to the staging, forexample stage II (Hb SS).Results: All 271 patients comprising 198 males and 73 females (M: F= 2.7: 1) with age range2-48 years (mean 29.4 ± 12.2) were studied. Only 93 patients had Hb genotype done; only 42had Hb S. The stage O had 184 patients (120 open fractures and 64 bone operations). StageI had nine patients, stage II 19 patients, stage III 51 patients and stage IV eight.Conclusions: This new staging incorporates pre-emptive OSM seen in developing countrieswhere certain practices, if unchecked lead to OSM. The severity of OSM featuring floriddisease not common in the developed world, and for which existing classifications did notaccommodate, is included
TEMPOROMANDIBULAR JOINT DISLOCATION IN NAIROBI
No full textBackground: Despite the diverse conservative and surgical modalities for the management of temporomandibular joint (TMJ) dislocation and the controversy that surrounds them, very little has been done within the East-African setup in terms of highlighting and provoking greater interest in the epidemiology and management of TMJ dislocation.Objective: To audit the pattern of occurrence, demographics, aetiology and enumerate the treatment modalities of TMJ dislocation at the oral and maxillofacial surgery division (OMFS) of the University of Nairobi Dental Hospital.Design: Descriptive cross-sectional study.Setting: University of Nairobi Dental Hospital (UNDH) from January 1995 to July 2005.Results: Twenty nine patients had been diagnosed and managed for TMJ dislocation.Twenty (69%) were females and nine (31%) were males. Their ages ranged from 10-95 years with a mean of 42 years. The cases managed were primarily chronic in nature.The most common form being anterior TMJ dislocation, accounting for twenty-five (86.2%) cases. Trauma was implicated as an aetiology in only five (17%) of the cases while the remaining majority of twenty four (83%) cases were spontaneous. Amongst the causes of spontaneous TMJ dislocation, yawning was the most common accountingfor fourteen cases (48.3%). Dislocations caused by trauma were found to be 12.6 times more likely to be associated with other injuries than spontaneous dislocations. Anterior TMJ dislocations were found to be 1.3 times more likely to be associated with absence of molars than posterior TMJ dislocations. Anatomical aberrations, as predisposingfactors, were not a significant finding in this research. Eight (28%) of the cases were managed conservatively. Twenty one (72%) of the cases were managed surgically. The eminectomy was the most common technique with a 75% success rate. The highest incidence of TMJ dislocation occurs in the 3rd-5th decade with a female preponderancewith bilateral anterior TMJ dislocation being the most common. Most of the cases were managed surgically with eminectomy being the preferred technique with the highest success rate. A study needs to be undertaken to determine reasons’ why conservative modalities are least employed in the management of TMJ dislocation in our setupand what can be done about it
FORENSIC FINDINGS FROM THE NAIROBI U.S. EMBASSY TERRORIST BOMBING
No full textBackground: The 1998 terrorist bombing of the US-Embassy in Nairobi resulted in the highest number of civilian deaths ever recorded from a single urban terrorist bombing in global history.Objective: To present forensic findings from the Nairobi terrorist bombing and discuss some contributory factors to the high-fatality witnessed.Design: Desriptive retrospective study.Setting: Office of the Chief Government Pathologist of Kenya.Results:A total of 211 persons were confirmed to have died as a direct result of the bomb blast. Out of the 201 cases examined in this paper, 198 (99%) died on the day of the blast. Sixty percent of the deceased were males and 85% were aged between 21 and 50 years. Most of the deceased were visually identified (95%). The rest required fingerprinting (3%), DNA testing (2%), and forensic odontology (1%). Ninety six percent of the victims (194 cases) had primary blast injuries. The typical triad of blast fragmentation injuries was found in only 47% of the cases. Eighty nine percent (179 cases) had injuries in multiple anatomical regions. The most common cause of death was head injury (30%).Conclusion: The anatomical pattern of injuries and other pathological findings among fatalities from this terrorist bombing are similar to those recorded from other bombing incidents worldwide. Contributory factors to the high fatality include the collapse of a densely populated building, the TNT-equivalent force of the bomb, the confined site of detonation, and probably the lack of a proper disaster response system
CRYPTOSPORIDIOSIS AMONG ANIMAL HANDLERS AND THEIR LIVESTOCK IN BASRAH, IRAQ
No full textObjective: To investigate the prevalence of cryptosporidiosis among groups at risk(animal handlers) and among domestic animals.Design: Comparative study with zoonotic aspect.Method: Stool samples were collected from 60 animal handlers, 175 nonanimal handlersand 198 domestic animals (60 cows, 45 sheep, 45 goats, 25 horses and 23 camels). Directsmear method and then formalin-ether sedimentation method were carried out for stoolsamples to detect intestinal parasites. Faecal smears were prepared from the sedimentand stained by the modified Ziehl-Neelsen method for the recovery of red-pink oocystsof Cryptosporidium.Results: Out of the 60 animal handlers, 30 (50%) were found to be positive for intestinalparasites compared to 26 (14.8%) of non-animal handlers (P<0.01). Cryptosporidiumoocysts were found to be excreted by three (5%) animal handlers and two (1.14%) ofthe non-animal handlers (P>0.05). Cryptosporidiosis was also diagnosed in 20%, 13.3%,17.7% and 12% of cattle, sheep, goats and horses respectively. No single positive casewas detected among the examined camels.Conclusion: Veterinarians, butchers and breeders should be aware of the diseaseamong farm animals in order to avoid great losses and to prevent its transmissionto humans
