Showing papers in "East African Medical Journal in 1997"

Duration of symptoms and case fatality of sleeping sickness caused by Trypanosoma brucei rhodesiense in Tororo, Uganda.

Abstract: Although there have been recent molecular biological studies for evidence of possible changes in trypanosome biochemistry, such studies are not yet complemented by parallel clinical studies to determine the possible implications to the sleeping sickness patient. The study of the duration of symptoms and the case fatality of T. b. rhodesiense showed that the disease progressed to the stage of central nervous system involvement between three weeks to two months of infection. Most (> 80%) deaths occurred within six months of illness. The case fatality rate of treated sleeping sickness patients was 6% of which the rate in the late-stage of sleeping sickness was more than two and a half times that in the early stage. The incidence of melarsoprol encephalopathy was 2.5% and case fatality due to this condition was 1.0% and similar to previous findings. Thus it appears the virulence of T. b. rhodesiense circulating in south east Uganda has not changed during the past decades.

Knowledge and attitude towards voluntary blood donation among Dhaka University students in Bangladesh.

Abstract: This cross sectional descriptive study was conducted among the students of the University of Dhaka, Bangladesh, to assess their knowledge and attitudinal variables towards voluntary, non-remunerated blood donation. Two hundred students were selected to participate in this study and were interviewed face to face on various aspects of blood donation using a structured questionnaire. Eighty two per cent of the participants showed a positive attitude towards blood donation, however, only 16 per cent of the respondents in this study had actually ever donated blood voluntarily. Among the non-donor respondents, physical harm and fear were found to be the common reasons for not donating blood. The results also showed that a high number of respondents (93%) had a negative attitude towards paid blood donation. We suggest that appropriate motivational campaign should be launched immediately among this young section of the population to convert this favourable "attitude" towards blood donation into a regular "practice" in order to increase the voluntary blood donation in Bangladesh.

Assessment of rational drug use and prescribing in primary health care facilities in North West Ethiopia

Abstract: In a study on rational drug use in 9 health centers (HC) and 9 health stations (HS) in Ethiopia prescribing patient care and facility-specific factors were observed and measured through drug use indicators during February-June 1995. With only few exceptions the drug use indicators in HCs and HSs were similar despite differences in manpower and facilities. The average consultation times in minutes in HSs and HCs were 5.1 and 5.8 respectively while the dispensing times were 1.5 and 1.9 minutes respectively. More than 89% of drugs in HCs and 71% in HSs were dispensed from the health facilities and labeling was satisfactory. On average generic brands were prescribed 75% of the time in HCs and 83% of the time in HSs. Key drugs were available but important documents were missing in most facilities or were unpopular for use. When documents were available they needed to be revised and updated. The level of polypharmacy was low. The most often prescribed drugs were anti-infectives and analgesics accounting for more than 76% in HCs and 82% in HSs and probably often prescribed with little justification. 60% of patients in HCs and 65% in HSs were exposed to antibiotics levels too high for the prevailing disease conditions. More than 37% of HS patients received injections.

Prevalence of transmissible blood infections among blood donors at the University of Maiducuri Teaching Hospital, Maiduguri, Nigeria.

Abstract: Before the advent of the Acquired Immune Deficiency Syndrome (AIDS), many countries of the world transfused blood without seriously considering the potential risks of transmission of infectious agents. Even after it was shown that the Human Immunodeficiency virus(HIV) could be transmitted through blood and blood products, many hospitals and clinics in Nigeria still continue to transfuse unscreened blood. This study was therefore initiated to highlight the risks of transmitting infectious agents through blood transfusion and the category of infectious agents which could be transfused in blood in this area. A total of 364 healthy blood donors were counselled, bled and screened for HIV-1, HIV-2, HBsAg, Treponema pallidum, Plasmodium falciparum and microfilaria. The results show that the three most common infections transmissible through blood transfusion are Hepatitis B(14.9%), HIV-1 (5.8%) and P.falciparum (4.1%). Thirteen of the 364 blood donors (3.6%) and antibodies to T. pallidum. There were no donors with HIV-2 or filarial infection. Infection of donors by hepatitis B virus (HBV), T. pallidum and HIV-1 was not significant dependent on promiscuity, polygamy, previous blood transfusion or local surgery. However, there was a significant difference between donors with no risk factors and those with risk factors with regard to seroprevalence to HBV, T. pallidum and HIV-1 (p = 0.0053). The results confirm that transfusion of unscreened blood carries severe risks of transmitting serious infectious agents and that is a need to enforce laws for transfusing blood in Nigeria. Meanwhile, in the absence of screening facilities, proper counselling of blood donors in order to ascertain their risk behaviour should be used to select donors and reduce this risk.

Evaluation of the efficacy of thiamine and pyridoxine in the treatment of symptomatic diabetic peripheral neuropathy

Abstract: The clinical response to therapeutic doses of two vitamins were determined in diabetic patients with symptomatic peripheral neuropathy. Of 200 consecutive patients, 100 were randomly allocated to treatment with both thiamine (25 mg/day) and pyridoxine (50 mg/day) group A and the rest group B to treatment with an identical tablet containing 1 mg/day each of thiamine and pyridoxine. Pain, numbness, paraesthesia and impairment of sensation and ankle in the legs were graded into none, mild, moderate or severe. Blood thiamine levels were measured using HPLC fluorimetry. Four weeks after starting treatment the grade was less than on the first visit in 88.9%, 82.5% and 89.7% of those whose worst symptoms were pain, numbness and paraesthesia respectively for group A compared with 11.1%, 40.5% and 39.4% respectively for group B. The severity of signs of peripheral neuropathy decreased in 48.9% of patients in group A compared with 11.4% in group B. The mean (s.e.) pre-treatment whole blood thiamine levels decreased with increasing severity of symptoms: 64.2 (2.81), 57.7 (3.25) and 52.2 (2.14) micrograms/l for those with mild, moderate and severe symptoms respectively (analysis of variance, p = 0.03). Diabetic peripheral neuropathy in Dar es Salaam is associated with thiamine deficiency. Dietary guidelines for diabetic patients should emphasize a balanced diet.

Treatment of hyperkalaemia by altering the transcellular gradient in patients with renal failure: effect of various therapeutic approaches

Abstract: Ten patients with acute and 60 with chronic renal failure (both groups having hyperkalaemia), were managed at Kenyatta National Hospital in the medical wards and Renal Unit between August, 1995 and January, 1996. They were divided into seven different treatment groups, each consisting of ten patients. Treatment A glucose 25g i.v. with insulin 10 units i.v., treatment B 50 mmol of 8.4% sodium bicarbonate infusion, treatment C 0.5mg of salbutamol i.v. in 50mls 5% dextrose, treatment D was a combination of treatments A and B, treatment E was a combination of treatment B and C, treatment F was a combination of treatments A and C while treatment G was a combination of treatments A and B and C. Serum potassium was measured, 30 minutes, 1 hour, 2 hours, 4 hours and 8 hours after treatment. Plasma glucose concentration was measured before treatment was given and 1 hour after in all patients. Electrocardiography was done before treatment on all patients and repeated 30 minutes and 1 hour after treatment for the patients with hyperkalaemic changes on the initial recording. All treatment modalities had satisfactory potassium lowering effects. Of the single therapeutic approaches, treatment A and C were equieffective, but better than treatment B (P < 0.001). Amongst the two regimen combinations, treatment D and F were more efficacious than treatment E and all the single therapeutic approaches (P < 0.001). Treatment G was the most efficacious in lowering serum potassium in this study. All treatment modalities had maximum serum potassium lowering effect at 1-2 hours. A fall in plasma glucose concentration was a notable feature of treatments A and D, but significant hypoglycaemia occurred in 20% of patients receiving treatment A and in none on treatment D. The ECG changes of hyperkalaemia did not correlate with serum potassium levels. The normalisation of hyperkalaemic ECG alteration occurred within the first 30 minutes after treatment. In conclusion, combination therapies for hyperkalaemia appear to be more efficacious than single therapeutic approaches. Inclusion of salbutamol seems to protect against insulin induced hypoglycaemia. The maximum potassium lowering effect is observed 1-2 hours of administration of either agents. The potassium reducing effect remains significant compared to baseline values even after 8 hours. If dialysis cannot be instituted early enough it seems reasonable to repeat treatment every 4-6 hours to sustain the effect. Repeated administration of glucose with insulin may not be safe because of the hypoglycaemic effect. Other single and combination therapies can theoretically be repeated regularly until dialysis is initiated although this requires further clinical evaluation.

Parasitic infections in Pemba Island schoolchildren.

Abstract: Intestinal helminths schistosomiasis and malaria have been recognized for decades to be major public health problems in Zanzibar Tanzania. During the evaluation of the impact of the Zanzibar Helminth Control Programme baseline parasitological data on 3605 school children were collected in Pemba Island. Prevalence of intestinal helminth infections was 72% 94% and 96% for Ascaris lumbricoides Trichuris trichiura and hookworm respectively. 31% of children tested positive for hematuria a reliable indicator of urinary schistosomiasis in the study area. Malaria parasites were found in 61% of children. Hookworm infections and hematuria were more prevalent in boys. 67% of the children were infected with all the three helminths and 28% harbored double infections. No association was found between intestinal helminths and schistosomiasis or malaria. Children living in rural areas were more heavily infected with hookworms schistosomiasis and malaria compared to children in towns. Results from this study provided relevant information for designing a "plan of action" for the integrated control of filariasis intestinal helminths malaria and schistosomiasis in Zanzibar. (authors)

Shigella serogroups identified from adult diarrhoeal out-patients in Addis Ababa, Ethiopia: antibiotic resistance and plasmid profile analysis.

Abstract: Fifty shigella strains were isolated from 700 diarrhoeal samples collected from adult diarrhoeal out-patients in Addis Ababa. Among the isolates, serogroup A comprised 28%, B 44%, C 18% and D 10%. Among all shigella serogroups, highest resistance was encountered to tetracycline (74%), ampicillin (70%), cephalothin (64%), trimethoprim-sulfamethoxazole (52%) and chloramphenicol (50%) while least resistance was observed to gentamicin (0%), polymyxin B (10%) and nalidixic acid (14%). Gentamicin, polymyxin B and nalidixic acid were found to be the drugs of choice for cases of shigellosis. All drug resistant isolates analysed for plasmids contained multiple plasmids ranging from 1.8 to greater than 21 Kilobases.

Cardiovascular risk factors in middle aged Nigerians.

Abstract: Ischaemic heart disease (IHD) contributes very little to mortality figures in Nigerians. In this study of 146 middle aged Nigerians (110 males and 36 females) aged 50-54 years, the cardiovascular risk factors of smoking, alcohol ingestion, history of diabetes mellitus, obesity, hypertension and high serum total cholesterol were assessed seeking to confirm the postulated reason for the low prevalence rate of IHD. Prevalence of the risk factors in this random sample population in males and females were as follows respectively: cigarettes 0%; alcohol intake 5.4% in males, 2.8% in females; self reported diabetes 1.8%, 2.8%; obesity 21%, 28%; hypertension 16.4%, 25% and cholesterol > 200 mg/d 6.4%, 13.9%. None of the subjects smoked more than 10 cigarettes a day. Multiple risk factors occurred infrequently in individual subjects. Only five men (4.5%) exhibited two risk factors and only one (0.9%) exhibited three risk factors apart from the gender. Of particular relevance, mean total cholesterol was 148.7 mg/dL (SD +/- 37.9) for the entire group, 143.5 mg/d (SD +/- 36.0) for men, and 153.6 mg/dl (SD +/- 35.3) for women. In the whole group, mean total cholesterol was higher in the hypertensive than the normotensive subjects (P < 0.05). Compared to similar age population from Japan and the United States, the prevalence of the risk factors was generally low. Attention should be on controlling obesity, hypertension and the diet to keep the prevalence low.

Antibiotic resistance of prevalent Salmonella and Shigella strains in northwest Ethiopia.

Abstract: Salmonella and Shigella strains were isolated prospectively from in- and outpatient specimens of the Gondar College teaching hospital over a two year period, from June 1994 to May 1996 Of 7993 miscellaneous specimens cultured, 80 yielded Salmonella and 147 Shigella Serogroup B dominated among the salmonella, accounting for 61% of isolates, followed by S typhi (21%) S flexneri (585%) and S dysenteriae (367%) were the most frequently isolated species among the Shigella Results of sensitivity testing to five commonly used antibiotics in the area: ampicillin, chloramphenicol, gentamicin, tetracycline and cotrimoxazole, showed multiple drug resistance among the isolates of both salmonella and shigella Only 4% of shigella were sensitive to all five antibiotics screened for in the study Overall sensitive of shigella isolates to individual antibiotics was 88% to tetracycline, 10% to ampicillin, 28% to co-trimoxazole and 98% to gentamicin No resistance was observed to nalidixic acid among 108 shigella strains tested for this antibiotic The continued sensitivity of S typhi to chloramphenicol, cotrimoxazole, ampicillin and the other commonly used antibiotics is noted It is recommended that nalidixic acid be introduced into the area under strict regulation for treatment of severe cases of shigella dysentery, an illness which is highly endemic in the region and the cause of occasional epidemics with high mortality

Antibiotic resistance pattern of Vibrio cholerae and Shigella causing diarrhoea outbreaks in the eastern Africa region: 1994-1996.

Abstract: Between March 1994 and December 1996, 1797 rectal swabs were transported to the AMREF laboratory from sites in six countries in the eastern Africa region: 1749 were cultured for Vibrio cholerae and 48 for Shigella/Salmonella Culture, isolation, identification and antibiotic susceptibility testing were performed using standardized techniques The isolates were categorized as sensitive or resistant based on standardized zones of inhibition The rate of isolation of V cholerae from rectal swabs increased progressively from less than 20% to more than 45% between 1994 and 1996, 80-100% of isolates of V cholerae from Kenya and south Sudan, and 65-90% from Somalia were sensitive to tetracycline, although in 1995 isolates from Mogadishu showed only 44% sensitivity All isolates from Tanzania and Rwanda were 100% resistant to tetracycline In Kenya and Somalia, the percentage of isolates sensitive to chloramphenicol and cotrimoxazole reduced markedly from 85% in 1994 to 70% of isolates were sensitive Nalidixic acid and erythromycin retained > 75% sensitivity in all areas Shigella dysenteriae and Shigella flexneri were recovered from dysentery specimens in northern Kenya Both species showed similar antibiotic sensitivity patterns and were sensitive only to nalidixic acid and furazolidone Due to variations of resistance patterns within countries in the region, antibiotic sensitivity testing should be performed at the start of an outbreak, and antibiotic use should be restricted to severe cases of V cholerae and Shigella infection

Prevalence of adult diabetes in Ibadan, Nigeria.

Abstract: Within the framework of an international collaborative network, we measured the prevalence of diabetes mellitus in a traditional Yoruba community in the city of Ibadan, Nigeria. Using a random sampling technique we enrolled a community sample of 247 men and women. Fasting blood glucose (FBG) was measured at the community clinic from a fingerstick using the Companion2 Medisense blood glucose meter. The mean FBG was 4.7 mmol/L and 4.9 mmol/L for men and women, respectively. Using the 1985 WHO criteria, the prevalence of diabetes was 2.8%. There was no significant rise in FBG with age. Compared to the lowest quartile of the body mass index (BMI), there was about a 1.5 fold increased risk of developing elevated FBG. The test of trend between FBG and BMI was however not statistically significant. Despite a modest hypertension rate (22.3%), there was no significant difference in the FBG for hypertensives compared to normotensives. The findings of this study show that the prevalence of diabetes mellitus in this West African community remains low compared to nations in Western societies. However, in comparison to previous estimates from sub-Saharan Africa, the prevalence of adult onset diabetes seems to be on the increase.

Antibiotic sale behaviour in Nairobi: a contributing factor to antimicrobial drug resistance.

Abstract: A survey of antibiotic sale behaviour in retail chemist shops in Nairobi revealed that about 64% of chemists sell antibiotics without prescriptions from doctors Most shops sold underdose drugs according to the request of the patient The practice is more common in peri-urban than city centre chemists Out of the 128 chemist shops visited, 82 sold the antibiotic, 33 sent the patients to go and see the doctors while 13 did both Sixty eight per cent of the chemists in the city centre recommended the taking of full antibiotic course to the patients while only 46% in peri-urban centres did so Even after the recommendation, some of the chemists still sold under dose drugs Some of the drugs were sold in envelopes without any instruction at all and none of the drugs sold were fully labelled Only seven chemists sold septrin, the brand of co-trimoxazole requested by the patients, the rest sold various brands of the drug some of whom still labelled the brands 'septrin'

Prevalence and epidemiological characteristics of hepatitis B and C infections among doctors and dentists in Nigeria

Abstract: A random sample of seventy five doctors and dentists at the University College Hospital, Ibadan, Nigeria, was surveyed. They were offered anonymous testing for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), antibodies to hepatitis B core antigen (anti-HBc) and to hepatitis C virus (anti-HCV) by enzyme immunoassay. The results suggest a high prevalence of hepatitis B virus (HBV) with a high potential of transmissibility, as well as a high prevalence of HCV infection. Most of the doctors and dentists use universal precaution for protection against viral hepatitis less than 50% of the occasions when they carry out procedures on their patients. Infection with HBV was associated with type of specialty (surgeons and dentists) and lack of HBV vaccination (p < 0.05). After logistic regression, these factors were independently associated with HBV infection (p < 0.05). Sixty (80%) of these health care workers had not received prior HBV vaccination. The unvaccinated personnel were more likely to be surgeons, dentists, less than 37 years of age and have fewer years of professional activity (p < 0.05). After logistic regression, only the fewer years of professional activity remained independently associated with lack of vaccination (p < 0.05). We conclude that to reduce the occupational exposure of HBV, universal precautions must be rigorously adhered to when doctors and dentists carry out procedures on their patients. It is necessary that these health care workers are vaccinated with HBV vaccine and the currently anticipated HCV vaccination, if not immune. No recent study exists that exclusively addresses this problem in health care workers in tropical Africa.

STD services for women at truck stop in Tanzania: evaluation of acceptable approaches

Abstract: AIDS continues to be the commonest cause of death in Tanzania among those aged between 15 and 45 years. Both ulcerative and non-ulcerative sexually transmitted diseases have been identified as major co-factors in HIV transmission. Certain groups including long distance truck drivers and their sexual partners have been reported as having a disporportionate effect on the transmission dynamics of STD including HIV, in a population. In 1993 African Medical and Research Foundation decided to add an STD component to their HIV/AIDS prevention programme along the Tanzania-Zambia highway which had been targeting truck drivers and their sexual partners through peer education and condom distribution since 1989. A study to evaluate the acceptability and feasibility of four different approaches of delivering STD services, was conducted over a period of one year. The approaches for delivering STD services were: special STD services offered twice a week at a site and at hours of the women's choice, special outreach services once every three months, or STD services integrated into the nearest Primary Health Clinic. Drugs were provided at three of the four interventions. 1,330 women at seven truckstops, participated in the evaluation study. The women were generally satisfied with all approaches that included the provision of drugs. The most expensive and ineffective way of treating STD was by not providing drugs. These findings confirm the fact that it is feasible to provide STD services to women at high risk in HIV high transmission areas. These women would utilise STD services provided in a manner that suits them if mobilised and encouraged by their peer educators.

HIV infection and antituberculosis drug resistance among pulmonary tuberculosis patients in Harar Tuberculosis Centre, Ethiopia.

Abstract: A cross-sectional study was conducted to estimate HIV seroprevalence among infectious (smear positive) cases of pulmonary tuberculosis and to describe the relation between antituberculosis drug resistance and infection with human immunodeficiency virus. A total of 418 smear positive pulmonary tuberculosis patients who attended the out patient departments of Harar Tuberculosis Centre and two general hospitals were studied from October 1994 through January 1995. The majority (94%) of these patients were from the tuberculosis centre. Sputum cultures were positive for 338/418 (80.9%) patients. HIV seroprevalence was 92/418 (22.0%) among smear positive and 69/338 (20.4%) among culture positive patients. HIV positive patients were more likely to be from urban than rural areas (p < 0.001). Initial resistance was not affected by HIV seropositivity. Secondary drug resistance was significantly higher in HIV positive patients than HIV negatives (p < 0.05). Although not significant, HIV positive patients were more defaulters than HIV negatives. Significantly higher numbers of HIV positive pulmonary tuberculosis patients were cases of relapse and treatment failure (p < 0.05). Other studies are required in order to assess the impact of HIV infection on the spread of anti-tuberculosis resistance. Supervised and appropriate treatments with follow up are required in order to minimise the spread of drug resistant tubercle bacilli among HIV infected patients.

Criteria for better detection of brucellosis in the Narok District of Kenya

Abstract: Monthly disease summary sheets from 1986-1992 of 60 dispensaries, clinics and hospitals in Narok district, Kenya were reviewed for the occurrence of brucellosis and other diseases with "flu-like symptoms" Diseases with these symptoms accounted for about 52% of the 1,037,875 cases reported for the time period These were classified as malaria (793%), rheumatism (71%), PUO (24%), and brucellosis (08%) Brucellosis was diagnosed by a positive Rose Bengal (RB) test routinely conducted in seven out of the 60 health units In these units, 55% of flu-like cases were classified as malaria and 212% as brucellosis Individual case records of patients at four dispensaries using the RB test during 1991-92 were assessed for specific predictor symptoms For 625 RB tested patients, a positive test result was associated with joint pain, headache, and the combinations of joint pain with headache and lameness with headache A logistic regression model correctly predicted the RB test result in 623% of the time For the 465 patients examined by the blood smear examination, identification of malaria parasites was associated with, headache, joint pain and combinations of emesis with pale mucous membranes This regression model correctly predicted positive results 672% of the time Both models indicate that selected clinical predictors represented significantly increased odds of being positive to the respective tests However, for both diseases, clinical signs alone appear insufficient for reliable diagnosis and differentiation probably due to resemblance in symptomatology between these two and other diseases

HIV infection in malnourished children in Harare, Zimbabwe.

Abstract: The HIV epidemic in Zimbabwe has increased the prevalence of child malnutrition. This descriptive study compared sociodemographic features the nutritional profile and clinical features of 140 HIV-positive and HIV-negative children 15 months of age and older with malnutrition admitted to Harare Hospital in 1993-94. 68 children (48.6%) were HIV-infected. There were no significant differences between infected and non-infected children in terms of sociodemographic factors such as area of residence maternal education caretaker and breast feeding status. HIV-infected children were most likely to have marasmus and marasmic kwashiorkor; 64% of children in the HIV-negative group had kwashiorkor. Pneumonia lymphadenopathy chronic ear discharge and oral thrush were significantly more prevalent among HIV-infected children. Four factors were predictive of HIV infection: marasmus (odds ratio (OR) 2.72; 95% confidence interval (CI) 1.04-8.10) generalized lymphadenopathy (OR 2.77; 95% CI 1.16-6.64) oral thrush (OR 2.72; 95% CI 1.16-6.37) and ear discharge (OR 6.05; 95% CI 1.89-19.42). 32 children (22.8%) died during their hospitalization. Mortality was significantly greater among children less than 60% of expected weight (severe malnutrition) but was not significantly related to HIV status.

Mosquito vectors of bancroftian filariasis in Kwale District, Kenya.

Abstract: A total of 2,906 female mosquitoes were collected over a period of one year using pyrethrum spray-sheet and human bait methods, and dissected for filaria larvae in three hinterland villages of coastal Kenya. The dominant species, Anopheles gambiae and Anopheles funestus were also found to be the main vectors. From the spray catch collections 0,9 and 1 Cx. quinquefasciatus, An. gambiae and An. funestus out of 491, 708 and 403 respectively were infective. In the same order, 4, 2 and 2 out of 512, 196 and 180 from human bait collections were infective. The results indicate that Cx.quinquefasciatus is also an important vector in this area contrary to some previous findings that it played no important role in rural hinterland areas. Differences in the results from the human bait and spray catch methods have been pointed out and the advantage of using both methods in filarial surveys indicated.

Non infective colitis in infancy: evidence in favour of minor immunodeficiency in its pathogenesis.

Abstract: Forty two infants below the age of two years presenting with chronic non infective diarrhoea and shown to have histologically proven colitis were investigated over a five year period at this hospital. Allergic colitis was the most common cause of colitis accounting for sixty two percent of the cases. Other colitides diagnosed included: non specific colitis, autoimmune enterocolitis and ulcerative colitis accounting for 9.5% each, severe combined immunodeficiency 7.1% and Crohn's disease 2.8%. A positive family history and a personal history of atopy was obtained in 47.6% and 28.6% of the cases. Serum immunoglobulin A, IgG2 and IgG4 were very low in over 50% of the infants with colitis. Sixty six percent of those with severe combined immunodeficiency, autoimmune enterocolitis and ulcerative colitis (n = 11) had low CD3 and CD4 T lymphocytes with an accompanying elevated CD8 in 2/3 of those with severe combined immunodeficiency. T lymphocytes were normal in those with allergic colitis. We conclude that infants with proven non infective colitis show as a group a high prevalence of IgA, IgG2 and IgG4 deficiency. It is likely that this minor deficiency of mucosal associated immunoglobulin production have a role in the pathogenesis of the colitic process.

Survey of antibiotic prescribing pattern in government health facilities of the Wassa west district of Ghana.

Abstract: Antibiotic prescribing patterns was studied from 700 retrospective outpatient clinical records from seven government health facilities in the Wassa West district of Ghana. Prescribing patterns were compared between the district hospital and six health centres. The percentage of patients receiving one or more antibiotics was significantly more at the health centres(60.7%) than at the hospital(41.0%) (chi 2 = 13.6; p < 0.001). The average number of antibiotics prescribed per patient was 1.4 and 1.1 respectively. The commonest antibiotics prescribed were procaine penicillin, cotrimoxazole, benzylpenicillin, metronidazole and amoxycillin. Malaria, upper respiratory infections, soft tissue infections and diarrhoeal diseases were the commonest indications for antibiotic use. Factors such as the availability of diagnostic facilities, type of prescriber, lack of refresher training and patient demand were considered to significantly influence antibiotic prescribing.

Sexual abuse of minors: emerging medical and social problem in Malawi.

Abstract: Sexual abuse is one of the most dehumanising human offenses. There has been an increasing public concern and outcry regarding the escalating wave of sexual abuse of young girls in Malawi, in the recent past. Four young girls, aged between two and seven years who were sexually abused by adult males aged between 20 and 70 years seen and managed in the department within the past two years, are presented to illustrate the problem. Their physical injuries, varied reactions and those of their immediate families to the abuse; possible predisposing factors to the abuses; the related medical, psychosocial as well as legal management of such incidents, in the light of limited public awareness, and lack of adequately and appropriately trained personnel and facilities in Malawi are discussed. With the scare of AIDS and an increasing disintegration of the traditional family fabric, there is a high potential for an increase, not only of the prevalence of sexual abuse of minors in Malawi, but also the variety and severity of sequelae. It is therefore recommended that there is need to create public awareness about sexual abuse, train and equip the relevant personnel to appropriately manage such cases, as well as enact and enforce the relevant legal provisions, so as to curb the menace, for the well-being of the society.

Apolipoprotein E polymorphism in elderly east Africans.

Abstract: Current advances have shown the apolipoprotein E (APOE)-epsilon 4 allele to be highly associated with late-onset familial and sporadic Alzheimer's disease (AD) in Western populations. The association of APOE allele frequencies and dementia remain unknown in populations from developing countries. We recently initiated a project to examine APOE frequencies in non-demented and demented elderly East Africans. Blood DNA collected from two hospital-based populations showed that the APOE allele frequencies in a group of non-demented 67 Tanzanians over the age of 65 years were found to be 14% for epsilon 2, 61% for epsilon 3 and 25% for epsilon 4. By comparison, the frequency of APOE-epsilon 4 in an age-matched demented group was also 25%. Assessment of APOE genotypes in the group of elderly Kenyan subjects from Nairobi also revealed high frequencies of the epsilon 4 allele with no clear difference in frequency between demented and non-demented subjects. Our preliminary observations suggest that elderly East Africans with no apparent clinical AD possess relatively high APOE-epsilon 4 allele frequencies compared to normal ageing subjects from Western countries including African-Americans. These results appear similar to those reported in a recent study in Nigerian Africans where a lack of correlation between APOE-epsilon 4 allele frequency and Alzheimer type of dementia was noted, and imply that APOE-epsilon 4 allele may not necessarily be a risk factor in some populations of Africa.

Treatment of chloroquine-resistant malaria using pyrimethamine in combination with berberine, tetracycline or cotrimoxazole.

Abstract: Two hundred and fifteen patients with chloroquine-resistant malaria were randomised into three groups. The first group of 82 patients were given pyrimethamine and berberine (berberine group), the second group of 64 patients, pyrimethamine and tetracycline (tetracycline group) and the third group of 69 patients were given pyrimethamine and cotrimoxazole (cotrimoxazole group). In the berberine group, the clearance, rate of asexual parasitaemia was 74.4% after treatment, while in the tetracycline group it was 67.2% and in the cotrimoxazole group 47.8%. These results indicate that berberine is more effective in clearing the parasite than both tetracycline and cotrimoxazole, and that the combination of pyrimethamine and berberine gives the best results for chloroquine resistant malaria.

Symptomatology and chest roentgenographic changes of pulmonary tuberculosis among diabetics.

Abstract: Symptoms and chest x-ray findings in 28 diabetics and 38 non diabetics with pulmonary tuberculosis were compared. The two groups of patients were age and sex-matched. There was no statistical difference in respiratory or constitutional symptoms between the two groups. Distribution of chest x-ray involvement including cavitary disease was again similar in the two groups of patients. These findings are contrary to previous reports and beliefs that diabetics were less symptomatic and that x-ray findings were more frequent in lower lung fields.

Childhood burns in south eastern Nigeria

Abstract: In a ten year retrospective study of burns in children in University of Calabar Teaching Hospital (UCTH), Calabar, the main causes were hot water, hot soup or oil (56.6%) involving children mostly in the one to three year age group. The relative safety of the home environment seen in other forms of paediatric trauma is not observed in burns in children. A changing pattern of burns in children has emerged within the region with naked flames/bush fire coming second and affecting 22.7% of the children. Chemical burns hitherto a rare occurrence is now frequent because of the storage of caustic soda and acids in living rooms by soap making parents. Burns affecting the perineum, axilla and buttocks are difficult to keep clean and frequently lead to infections, with associated increased morbidity. Causes of childhood burns are largely preventable requiring active social/medical education and public enlightenment campaigns on the various methods of prevention. Language: en

Impact of user charges on government health facilities in Tanzania.

Abstract: Utilisation of outpatient services in government owned district hospitals in Dar es Salaam, declined by more than 50% following the introduction of user charges in these health facilities in mid July 1993 Outpatient attendances in the private health facilities studied remained constant throughout the year although these charged higher fees Education and employment status were found to be major factors influencing utilisation of public versus private health facilities Public facility users (628%) had five to eight years of formal education Private facility users with five to eight years of education were 455% and those with more than years of education were 471% While 686% of public facility users paid for their own healthcare, more than a quarter (273%) had their costs met by relatives or friends The employer paid for 72% of private facility users, 492% of whom stated that this was the reason why they used private facilities Despite introduction of charges in public hospitals, availability of prescribed medication was poor Drugs were reported to be always available by only 273% of public health facility users compared to 80% of private health facility users

HIV seroprevalence rate and incidence of adverse skin reactions in adults with pulmonary tuberculosis receiving thiacetazone free anti-tuberculosis treatment in Yaounde Cameroon.

Abstract: To determine the HIV seroprevalence in adult patients with pulmonary tuberculosis in Yaounde and to compare the incidence of adverse skin reactions in patients with and without HIV infection receiving thiacetazone-free antituberculosis treatment, we studied 235 consecutive patients aged 15 years or more admitted into the Chest Clinic of Hospital Jamot in Yaounde with a diagnosis of pulmonary tuberculosis from July 1 to December 31, 1994. HIV testing was done using two ELISAs and confirmed by Western blot. Each patient was monitored for adverse skin reactions to antituberculosis treatment during the two month initial phase of therapy in hospital. Of the 235 patients studied, 156 (66%) were males (mean age: 33 years) and 79 were females (mean age: 30.3 years). Overall, 16.6% (39 cases) of the 235 patients were HIV seropositive. The prevalence of HIV infection was significantly higher in women (24%) than in men (12.5%) (p = 0.02). Adverse skin reactions to antituberculosis treatment were observed in eleven (4.7%) of the 235 patients. The incidence of the reactions was significantly higher in HIV seropositive (23.1%) than in HIV seronegative patients (1.0%) (p < 10 - 7). Two HIV seropositive patients who developed Stevens-Johnson syndrome died. The drugs incriminated for adverse skin reactions in the nine patients who survived were pyrazinamide (four cases) and rifampicin (five cases).

Thyroidectomy with and without drains.

Abstract: Drainage after thyroid surgery has been widely used to prevent life-threatening complications. However, it is well known that drains do not always prevent haematoma formation. In this retrospective study, we reviewed our experience with 1057 thyroidectomies with and without drains in order to assess this issue. Between 1983 and 1993, 520 patients were closed with drains and 537 patients without drains after thyroid surgery. The indications for drainage of the selective period included wet operative field and large areas of dead space at the conclusion of the operation. Reoperation for bleeding was done in twelve patients in the drainage group and two patients in the non-drainage group (p < 0.05). Wound infection was seen in seven patients in the drainage group and none in the no-drainage group (p < 0.05). This study suggests that routine drainage after thyroid surgery is not necessary and a selective policy can be applied safely.