African
Journals Online
African Health Sciences
Volume 2 Number 3 December 2002
Abstracts
EDITORIAL
In
this X-mas bumper issue we bring you six original research articles,
three case reports and a few practice points. They are very
informative and worth reading: making an important contribution to
professional development and continuing medical (read health)
education.
The
diagnosis of tuberculosis especially among HIV infected children
remains a big challenge. Thus Dr. Kiwanuka’s paper in to day’s African
Health Sciences1 is a
welcome addition to the literature on the diagnosis and treatment of
TB in this region. In a study of 128 children in western Uganda,
Kiwanuka has established that HIV positive patients with TB are more
likely to be wasted, have digital clubbing, lymphadenopathy and lower
frequency of positive tuberculosis test.
As Road
Traffic Accidents, become important causes of morbidity, mortality and
disability in the developing countries, their prevention will need to
be planned through evidence-based policy changes and interventions. In
their innovative study of the effect of an overpass on pedestrian
injuries in Uganda’s capital city, Mutto, Kobusingye and Lett2 demonstrate that despite costly interventions, such as road
bye-passes, will remain largely unused unless there are practical
steps to involve stakeholders before putting such interventions into
place.
Thinking of
primary health care, one is reminded of the role of the private sector
as an important player in health care provision in a country with
liberal approach to privatization and liberalization of many aspects
of life. Tumwesigire and Watson’s study of health seeking behaviour
of families with children suspected to have malaria in Kabale district
where the so called “high-land malaria” is rampant has shocking
news3. A staggering 53% of
respondents sought treatment from private drug shops/vendors despite
the fact that only 25% would afford to pay for a full course of
treatment for malaria. Worse still 90% knew at least one method of
prevention yet only 21% used any of the known methods.
Odong-Aginya
et al4 have found that over
80% of the residents of the two fishing villagers in the West Nile
region along the Albert Nile were excreting Schistosoma mansoni
eggs in their schools. Just under 50% had evidence of periportal
thickening in the liver on ultrasonography indicating a serious
complication of this ancient parasite. Urgent studies into the most
cost effective and feasible prevention strategies are needed.
Swedish5
researchers report on their interesting findings of a study of the
views and experiences of sex advice of the youth in a health center in
Kampala. Most of the youth had been told to abstain from sex or use
condoms if abstinence was impossible and remain faithful to one
partner. Familiar territory? Well most of the respondents thought this
was good advice and helpful but not free of obstacles. The youth were
concerned about the risks of being HIV positive and theexpected lack
of support, if the test is positive, was a common reason for refusing
HIV testing.
Adome and
colleagues show that the spectrophotometric method depends on optimum
pH which, in their study, ranges from 4 to 5. Useful stuff for
pharmacologists/pharmasts wishing to further their research in this
field.
Despite the
adage that “common things occur more
commonly” we have decided to break with tradition and publish
rare but interesting case reports: one of a 26 year old woman, who has
been suffering with bone pains for 20 years. Clinical as well as
radiological evaluation led to a diagnosis of Engelmann’s disease
with good response to steroids and analgesics.
The next case report is that of a 2 months old infant who
presented in severe respiratory distress unresponsive to antibiotics!
Imaging confirmed the diagnosis of congenital lobar emphysema and the
patient improved dramatically after surgery. The last case comes from
Port Harcout in Nigeria where Onwuchekwa et al report idiopathic
intracranial hypertension.
Business,
HIV/AIDS or the government? Familiar words? Well, Kironde and Lukwago
propose a conceptual framework to assist private companies tackle the
issues raised by the HIV/AIDS pandemic in a developing country
setting. They argue that well planned comprehensive interventions by
the private sector would bring in financial returns. Food for thought.
For those
interested in bioethics, there is some good news! The Wellcome Trust
has set aside 4 million pounds sterling for
biomedical research in developing countries. The fund supports
research, studentship seminars and capacity building initiatives. If
you are short of research/capacity building money like most of us are,
please read the article carefully.
We have
submitted copies of our journal for review for MEDLINE/PUBMED. We
should let you know of the results in the April 2003 issue. In the
meantime I wish you enjoyable reading of Africa Health Sciences
over a Merry Christmas!
Editor
ORIGINAL
ARTICLES
Tuberculosis
in children at Mbarara University Teaching Hospital, Uganda: diagnosis
and outcome of treatment
Julius P. Kiwanuka 1
1
Department of Paediatrics, Mbarara University of Science and
Technology, Mbarara, Uganda
ABSTRACT
Background:
The diagnosis of
tuberculosis in children is difficult particularly in HIV infected
children. The poor outcome following antituberculosis treatment
usually reported in HIV infected children might be due, in part, to
other HIV-related chronic diseases wrongly diagnosed as TB.
Objective:
The study
examines the impact of HIV infection on the clinical features and
diagnosis of children presenting with suspected tuberculosis in
Mbarara University Teaching Hospital. It also examines the effect of
various factors on the outcome of anti-TB treatment.
Methods: Children presenting with suspected TB were prospectively
enrolled. Clinical data were recorded and investigations included
Mantoux test, chest X-ray, HIV test and Z-N staining of various
specimens for AAFBs where available. Patients were treated with
standard, short-course anti-TB therapy, and followed-up for six
months. They were then classified as “good outcome” if they
improved and “poor outcome” if they deteriorated or died whilst on
treatment.
Results:
A total of 128
children were enrolled over an 18-month period. Four patients (3.1%)
had a diagnosis of confirmed TB, 82 (64.1%) with “probable TB” and
42 (32.8%) with “suspected TB”. Of 88 patients tested 43 (48.9%)
were HIV positive. HIV positive patients had a higher frequency of
failure to thrive, digital clubbing, enlarged lymph nodes and
hepatomegaly; and a lower frequency of positive Mantoux tests. HIV
positive patients were less likely to be classified as “ confirmed
or probable TB” (c2 =
5.02, p = 0.025). Fifty six patients had a good outcome, 12 had a poor
outcome and 60 defaulted before completing six months of treatment.
HIV positive children were more likely to have a poor outcome
(relative risk = 9.58, 95% CI 1.32 – 69.46). A diagnosis of “
confirmed or probable TB” was associated with a good outcome
(relative risk for poor outcome = 0.14, 95% CI 0.05 – 0.36).
Conclusion:
HIV positive
children with suspected TB frequently have signs that suggest the
presence of other diseases such as Lymphocystic Interstitial
Pneumonitis (LIP) and chronic bronchiectasis; and are less likely to
have a diagnosis of “probable or confirmed TB” after
investigations. Patients with an uncertain diagnosis of TB are less
likely to improve on anti-TB therapy.
Keywords:
Childhood tuberculosis; HIV infection; diagnosis; outcome of
treatment, Uganda.
African
Health Sciences 2002: 2(3): 82-88
The
effect of an overpass on pedestrian injuries on a major highway in
Kampala – Uganda
Milton Mutto1,
Olive C Kobusingye1,
Ronald R Lett2
1Injury
Control Centre-Uganda, Makerere Medical School
2The
Canadian Network for International Surgery
ABSTRACT
Objectives:
To describe the pedestrian population, their use of an overpass,
and to assess pedestrian perceptions and responses to the risk of
traffic crashes, determine pedestrian injuries in relation to traffic
flow, and compare traffic crash and pedestrian injury rates before and
after the overpass construction.
Setting: The
study was conducted in Nakawa trading center approximately six
kilometers from the center of Kampala city on a major highway. The
trading center has a busy market, small retail shops, industries, a
sports stadium, offices, low cost housing estates, schools, and an
estimated population of 6,226 residents, 15.1% of them students.
Methodology:
Pedestrian road behavior and traffic patterns were observed, and
police traffic crash records reviewed, one year before and one year
after overpass construction. A convenient sample of overpass and
non-overpass users was interviewed to assess their perceptions of
risk.
Results: A
total of 13,064 pedestrians were observed (male: female ratio= 2.2:1).
The overall prevalence of pedestrian overpass use was 35.4%. A bigger
proportion of females (49.1%) crossed on the overpass compared to
males (29.2%). More children (79.7 %) than adults (27.3%) used the
overpass. The majority of pedestrians (77.9%) were worried about their
safety in traffic but only 6.6% thought of the overpass as an
appropriate means to avoid traffic accidents. Traffic was not
segregated by vehicle type. Mean traffic flow varied from 41.5
vehicles per minute between 0730-0830 hours, to 39.3 vehicles per
minute between 1030-1130 hours and 37.7 vehicles per minute between
1730-1830 hours. The proportion of heavy vehicles (lorries, trailers,
tankers, and tractors) increased from 3.3% of total vehicle volume in
the morning to 5.4% in the evening (t = 2.847, p <0.05);
44.0% of the collisions occurred in the evening with 35 pedestrian
casualties before and 70 after the overpass intervention.
Conclusions:
The prevalence of pedestrian overpass use was low with adult males
least likely to use it. Pedestrians had a high perception of risk,
which did not seem to influence overpass use. Pedestrians were more
likely to be injured during slow traffic flows. There were more
traffic crashes, and pedestrian injuries, but fewer fatalities after
the construction of the overpass.
Key
words: Overpass, Pedestrian Injuries, Urban Uganda, Accidents.
African
Health Sciences 2002: 2(3): 89-93
Health
seeking behavior by families of children suspected to have malaria in
Kabale, Uganda
*
Sam Tumwesigire1
and
Sharon Watson2
1Kabale
Regional Hospital, P.O. Box 7, Kabale, Uganda
2
Development Studies and Social Anthroplogy, University of Notre Daine,
USA
51270
Mayflower Road South Bend, I N 46628 United States
ABSTRACT
Background:
Malaria is common among communities of Kabale district, and many
young children die of the illness. Despite a good distribution of
health facilities, able to handle malaria patients, families and
individuals tend to depend on self-treatment, or private clinics where
drugs used may be of doubtful quality.
Objective:
To establish the health seeking behaviour by families with
children suspected to have malaria.
Methodology:
A community-based, cross-sectional survey among 209 rural peasant
families living in 12 villages, chosen from the 5 most
malaria-affected sub-counties was done. Using a questionnaire,
respondents’ reactions to the disease and what decisions they took
were recorded. Reasons
for choices such as drugs used, location of treatment and malaria
control methods were recorded.
Results: Ninety
seven percent lived within easy reach of a public health facility.
Over 2/3 knew how malaria was transmitted and how it presented. They
believed it was best treated at public heath facilities using western
type of medicine. Fifty percent of the children, who attended public
health units, were treated within 24 of illness. Thirty eight percent
of the caretakers knew how to correctly use chloroquine. The caretakers relied on fever, vomiting and refusal to feed
as the main symptoms for their diagnosis of malaria. Only 31% of the
families sought treatment from government health facilities.
Fifty three
percent of the families sought treatment from drug shops/vendors.
Unfortunately only 38% of the families knew the correct regimen of
chloroquine, 4.3% for sulpha-doxine pyrimethamine and 0.5% for
quinine. One quarter could afford malaria treatment, and one out of
five missed treatment because of poverty. Concerning prevention, 90%
stated at least one method but only 21.2% used them.
Conclusions:
Despite reasonable knowledge for diagnosis of malaria, awareness
of correct treatment is limited. Paradoxically government health units
appear to play a minor role in the treatment of malaria.
Key
words: Malaria, health seeking, behaviour, Uganda
African
Health Sciences 2002; 2(3): 94-98
High
prevalence and morbidity of Schistosoma mansoni along the
Albert Nile in Uganda
Emmanuel I. Odongo-Aginya1,
Lorenz Grigull2,
Ulrich Schweigmann2,
Tom Loroni-Lakwo1,
Jochem HH Enrich3,
Bruno Gryseels4,
Ekkehard Doehring2,
1Uganda
Virus Research Institute, Entebbe, Uganda.
2Rosa
Luxemburg Str. 3 16 816 Neuruppin Germany [email protected]
Tel: 0049 - 33 91 - 65 95 51
3
Herzzentrum leizig, Leipzig, Germany.
4
Laboratory of Parasitology, State University
of Leiden, Leiden, The Netherlands.
ABSTRACT
An
epidemiological cross sectional study of Schistosoma mansoni
was conducted in two hyper endemic fishing villages of Rhino Camp and
Obongi both in West Nile district in northern Uganda in 1991 and 1992.
People with various water contacts were registered. A small group of
civil servants and clergies with less water contact in the river Nile
were studied for control of infection and morbidity. An overall
prevalence of 81.5% of the 1367 people studied in both fishing
villages of Rhino Camp and Obongi were excreting from 100 to ³ 500 Schistosoma
mansoni eggs per gram (epg). 253 (18.5%) did not have Schistosoma mansoni
eggs in their faeces. The influence of socioeconomic factors on
infections in the study population was high among poorer illiterates
who have frequent water contact activities with River Nile.
The
sonomorphological abnormalities of periportal thickening (PT) due to Schistosoma
mansoni were performed using ultrasound. 664 patients were found
to have various stages of (PT stages 0, I, II and III). A total of 703 (51.4%) patients did not
have any periportal thickening (PT 0) in their livers despite the fact
that 450 (32.9%) of them had Schistosoma. mansoni eggs in the
faeces. The gravities of schistosomiasis in the two villages were
similar showing greater morbidity in the younger adults.
Key
words: epidemiology; sonomophological; morbidity; Schistosoma
mansoni; infection; northern Uganda.
African
Health Sciences 2002; 2(3): 99-106
“Safe
sex advice is good – but so difficult to follow”: views and
experiences of the youth in a health centre in Kampala.
Eva-Britta Råssjö1
and
Elisabeth Darj2
1Department
of Obstetrics and Gynecology, Falun Hospital, S-791 82 Falun, Sweden
2Department
of Women’s and Children’s Health, International Maternal and Child
Health, Akademiska Hospital, University of Uppsala, Sweden
ABSTRACT
Background:
Young people in Uganda are advised by the Ministry of Health and other
authorities to abstain from sex in order to avoid the human
immunodeficiency virus (HIV), other sexually transmitted diseases
(STD) and early pregnancies. If they cannot abstain they should use
condoms and they should stay faithful to their partner.
Objective:
To find out how young people perceive
this advice and if they find it possible and realistic to follow.
Method:
In May and June 2000 twenty informants were selected by purposeful
sampling and were interviewed in English. Given items were discussed.
The interviews were recorded on tape, transcribed, extracted and
sorted into categories in a qualitative research method.
Results:
Most of the interviewed youth claimed that the advice is good and
helpful but there are many obstacles. The results showed that
information given in schools about condom use and safer sex behaviour
is not always adequate. However, despite lack of clear health
education messages, the risk of being HIV positive is of major concern
to many youth. In addition, the expected lack of support if the test
is positive is a common reason for abstaining from HIV testing.
Conclusions:
More discussions in society are needed to create consensus on safe sex
messages presented to young people. HIV infection is a major concern
but many young people abstain from testing, as they expect to receive
inadequate support.
African
Health Sciences 2002; 2(3): 107-113
The
optimum pH for the derivative spectrophotometric determination
of co-trimoxazole in binary
mixtures.
R.O. Adome1
and
S. Balyejjusa
Department
of Pharmacy, Makerere University, Faculty of Medicine,
P.O. Box 7072, Kampala, Uganda.
ABSTRACT
Background:
Although the experimental assessment of co-trimoxazole by use of
derivative spectrophotmetry underscores the usefulness of this method
due to its relative simplicity with which it can be carried out over
the official United States Pharmacopoeia (USP), high pressure liquid
chromatography (hplc) methods for this drug, suitable optimum
conditions ought to be refined for its universal acceptability.
Objective:
The objective of the present work was to obtain the optimum pH level
for the UV assessment of co-trimoxazole.
Methods:
The aqueous solutions of the individual drugs and their binary
mixtures were buffered with Sodium Acetate-Acetic Acid buffer in the
pH ranges 2-7 and scanned on zero order and on first-order derivative
at the wave length between 200- 300nm
Results:
At the same drug solution concentrations, spectral shifts occurred
with change in pH, especially between the wavelengths 200 and 240nm,
only seeming to converge from approximate wavelength 260nm onwards.
Absorbance fluctuations were also observed at the same drug
concentrations in the pH range 2 to 3.5 and 5 to 7 when the solutions
were scanned, even at the wavelength where the spectra seem to
converge. However there were no absorbance differences between pH 4
and 5.
Conclusion:
The UV spectrophotometric method is dependent on the optimum pH and
this has been found to range from 4 to 5.
Key
words: hypsochromic shift, auxochromes,
sulphamethoxazole, trimethoprim, spectroscopy, pH, UV, pyridines
African
Health Sciences 2002; 2(3): 114-117
Case
Reports
Camurati-Engelmann’s
disease: a case report
Rosemary Kusaba Byanyima and
Jennifer Batuuka Nabawesi
Department
of Radiology, Faculty of Medicine, P. O. Box 7072 Kampala, Uganda
Abstract
Camurati-Engelmann’s
disease is a rare condition worldwide. No cases have been documented
in Uganda. A 26 year old
female presented with a history of grinding pain in the limbs for over
20 years. Strong
painkillers would temporally relieve the pain.
She had an asthenic stature with generalised reduction in
muscle bulk. Plain x-rays
revealed the characteristic symmetrical thickening and sclerosis of
the diaphyses of the appendicular skeleton and skull base, which is
pathognomonic of Camurati-Engelmann’s disease. Involvement of the metaphyses of these long bones as well as
the metacarpal bones makes this an unusual case.
African
Health Sciences 2002;
2(3) 118-120
Congenital
lobar emphysema: a diagnostic challenge and cause of progressive
respiratory distress in a 2 month-old infant.
Richard I. Idroa,
Harriet Kisembob, Didas
Mugisac Alfred Bulamub
Department
of Paediatrics and Child Health, Mulago Hospitala
Department
of Radiology, Mulago Hospitalb
Department
of Surgery, Mulago Hospitalc
Abstract
Congenital
lobar emphysema (CLE) is a rare congenital abnormality characterized
by over inflation of a pulmonary lobe.
It often presents a diagnostic and therapeutic dilemma.
No case has been described in Uganda in the previous 10 years. We describe a case of a 2 months old infant who presented
with severe respiratory distress.
A diagnosis of congenital left upper lobar emphysema was
established on diagnostic imaging.
Both his vascular anatomy and the bronchial wall were normal.
He improved dramatically after surgery.
The SaO2 normalized
within 12 hours of Surgery (lobectomy) and the postoperative period
was uneventful.
African
Health Sciences
2002; 2(3): 121-123
A
14-year-old Nigerian female with idiopathic intracranial hypertension
(Pseudotumor cerebri or benign intracranial hypertension)
A.C Onwuchekwa*,
C.N. Nwankwo**,
E.N. Chapp-Jumbo*
*
Neurology Unit, Department of Medicine, University of Port
Harcourt & University of Port
Harcourt Teaching Hospital, Port Harcourt, Nigeria.
**
Department of Radiology, University of Port Harcourt
& University of Harcourt
Teaching Hospital, Port Harcourt, Nigeria.
PRACTICE
POINTS
Corporate
response to the HIV/AIDS epidemic in uganda
– time for a paradigm shift?
Samson
Kirondea and
John Lukwagob
7 Sandown
Hills 103 Katherine Street Sandown, Sandton 2196 South Africa
Axios
International Consultants LTD P.O.Box 6560 Kampala Ugandab
ABSTRACT
The HIV/AIDS
epidemic is likely to remain the pre-eminent global health concern for
the foreseeable future. In Uganda, while significant progress has been
made by the government over the past decade in bringing down the rate
of new infections, the HIV/AIDS burden in the country remains huge and
vigilant efforts must be continued if this burden is to further
decrease.
Traditionally
the government, supported by its international partners as well as
local non-government organizations and the community has borne the
brunt of the costs of containing the epidemic in Uganda. While the
corporate sector in the country has financially contributed towards
the costs of some of the interventions that are currently in place to
combat the HIV epidemic, there is largely a paucity of sustained and
systematic corporate leadership in providing comprehensive HIV/AIDS
programmes for their employees.
A survey
done by the authors reveals that most programmes undertaken in the
private sector are of limited scope. We argue that there is more the
corporate sector can do to more equitably share the HIV/AIDS burden,
without necessarily jeopardizing its primary role – namely to
maximize returns to shareholders.
This paper
proposes a conceptual framework of how companies can approach the
issue of HIV/AIDS within their workforce and suggests that providing
more comprehensive interventions may in some instances result in
substantial cost savings through the prevention or at least delay of
HIV/AIDS related consequences such as: frequent absences from work,
erosion of company skills and knowledge through key employee deaths,
and the costs of hiring and training replacements etc. This ultimately
could result in positive financial returns to those companies that
choose to pursue work place led HIV/AIDS control and prevention
programmes.
African
Health Sciences 2002; 2(3) 127-135
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