African Journals Online
African Health Sciences

Volume 3 Number 1 April 2003
Abstracts

Editorial
Its now official: we are on MEDLINE and Index Medicus

Yes it is official! African Health Sciences has now been accepted on MEDLINE/Index Medicus. There is no doubt that this will have a major impact on the future influence and impact of the journal and in the process contribute to the information revolution sweeping across the African continent. Many thanks to our contributors, readers, editorial advisors and well wishers. Without your support this would not have been possible. We greatly appreciate your support. Please keep the torch burning: one good turn deserves another.

In this first issue of 2003 African Health Sciences has a recurring theme: quality of health care. Thus Ogwal Okeng and colleagues’ article on chloroquine on the Uganda market1 sends a clear message: there is need for vigorous pharmacovigilance in view of the fact that 50% of chloroquine injection sample failed the safety test!

In keeping with its international nature, African Health Sciences brings you results of a study on family communication about HIV/AIDS and sexual behaviour among secondary school students in Accra Ghana2. Adu-Mireku found that 1 in 4 students were sexually experienced and of these 64.7% had had their first sexual intercourse by 16 years. Unfortunately more than half had had unprotected sex. However communication with family members, about HIV/AIDS especially between students and parents increased the odds of condom use. Food for thought?

Richard Idro’s article on malaria3 reminds us that malaria is a devastating illness especially when accompanied by the twin complications of severe anaemia and cerebral malaria. While our understanding of malaria pathophysiology increases by the day, there is need for innovative strategies to operationalise malaria control strategies with proven scientific value such as use of insecticide-treated materials.

Returning to the theme of school health, Wandera and Twa-Twa’s study of oral health4 of primary and secondary school pupils in Uganda showed 1 in 3 pupils had dental caries and 1 in 6 had fluorosis. Factors contributing to these disturbing findings need urgent attention.

Also needing attention are blood glucose monitoring systems in Uganda. In their paper on the accuracy of self monitoring blood glucose meter systems in Kampala, Bimenya and colleagues5 report that the systems are poor performers, and call for a quality control system. Perhaps the Uganda Bureau of Standards or the National Drug Authority need to be proactive and take the initiative to save what appears a very disturbing state of affairs.

You talk of innovation! Emily Muga6 of the Tropical Institute of Community Health and Development (TICH) in Kisumu, Kenya reports results of an interesting study of disability in children using the ‘ten questions’ screen. Emily calls for concerted efforts to sensitize parents and communities about disability especially about the need for community based interventions which do not require highly specialized personnel.

In his special article, Prof. Paget Stanfield formerly of the Makerere Medical School in Kampala, now living in retirement in the UK, provides counsel of perfection.7 In a parental style he reminds us of the attributes of good practice.

In our practice points we bring you the Uganda Breast Cancer guidelines whose objective is to foster early detection, harmonize treatment and referral of patients.8 We hope that it will assist in highlighting breast cancer as a very important public health problem. Finally don’t forget. African Health Sciences is now on MEDLINE/Index Medicus. It is your gateway to a large international audience and knowledge. Go for it!

References

1.   Ogwal-Okeng JW, Owino E, Obua C. Chloroquine on the Uganda market fails a quality test: a pharmacolovigilance study. African Health Sciences 2003; 3(1): 2-6

2.   Adu-Mireku S. Family communication about HIV/AIDS and sexual behaviour among senior secondary school students in Accra, Ghana. African Health Sciences 2003; 3(1): 7-14

3.   Idro R. Severe malaria in childhood cerebral malaria is associated with profound coma. African Health Sciences 2003; 3(1):15-18

4.   Wandera M, Twa-Twa J. Baseline survey of oral health and secondary school pupils in Uganda. African Health Sciences 2003; 3(1):19-22

5.   Bimenya GS, Nzarubara GR, Kiconco J, Sabuni S, Byarugaba W. The accuracy of self monitoring blood glucose meter systems in Kampala, Uganda. African Health Sciences 2003; 3(1):23-32

6.   Muga E. Screening for disability in a community: the ‘ten question’ screen for children in Bondo, Kenya. African Health Science 2003; 3(1):33-39

7.   Stanfield P. The complete Paediatrician: attributes of good practice. African Health Sciences 2003; 3(1):40-46

8.   The Breast Cancer Working Group. Proposed breast cancer guidelines for Uganda. African Health Science s2003; 3(1):47-50

ORIGINAL ARTICLES
Chloroquine in the Ugandan market fails quality test: a pharmacovigilance study

Jasper W. Ogwal-Okeng, Erisa Owino, and Celestino Obua

Department of Pharmacology and Therapeutics, Faculty of Medicine, P. O. Box 7072 Kampala, Uganda

ABSTRACT

Background: Antimalaria treatment failure has been partly attributed to poor quality antimalarials in the drug market. A 1998 survey in Kampala showed that 55 % of tablets and 62 % of injection forms of chloroquine failed the quality test.

Objective: This study was carried out as a follow-up to establish the quality of chloroquine tablet and injection dosage forms in the Ugandan drug market from June - November 2001.

Methods: Chloroquine tablets and injection dosage forms, randomly purchased from pharmacies and drug shops in the four regions of Uganda, were assayed for content of the active ingredient according to the USP standard, using the HPLC method.

Results: Of the tablets samples surveyed, 39 % failed the content test with 11 % having sub-normal and 28 % having supra-normal amounts, whilst 51 % of the injection samples failed with 40 % and 11 % having sub-normal and supra-normal amounts respectively.

Conclusion: There was overall improvement in the quality of chloroquine in Uganda compared with the 1998 figures, but the failure rates are still unacceptably high. The variations in the chloroquine amounts in both the tablet and injection forms may contribute to chloroquine toxicity or poor response during treatment. More vigorous pharmacovigillance on drugs entering the Ugandan drug market is needed.

African Health Sciences 2003: 3(1): 2 - 6

Family communication about HIV/AIDS and sexual behaviour among senior secondary school students in Accra, Ghana

Samuel Adu-Mireku

Department of Social Sciences, Fayetteville State University, 1200 Murchison Road, Fayetteville, NC 28301, USA

Abstract

Background: Sexually active adolescents in Ghana are increasingly at risk of HIV and other sexually transmitted infections. As a primary agent of socialization, the family can exert a strong influence on adolescent sexual behaviour. Therefore, to aid in the design and implementation of effective prevention programmes, it is important to understand the role of the family in influencing sexual behaviour among school-going adolescents.

Objectives: To evaluate the relationship between family communications about HIV/AIDS and sexual activity and condom use among school-going adolescents in Accra, Ghana.

Method: A sample of 894 students (56.9% girls, 43.1% boys; mean age = 17.4 years, SD = 1.40) at two senior secondary schools in Accra completed a modified version of the Youth Risk Behavior Survey (YRBS) questionnaire, a self-administered instrument developed by the Centers for Disease Control and Prevention. Analytical techniques utilized included logistic regression and chi-square.

Results: Twenty-five percent of the participants reported being sexually experienced, and 73.6% had talked about HIV/AIDS with parents or other family members. Of the sexually experienced students, 64.7% initiated first sexual intercourse by age 16; and 55.7% did not use a condom at last sexual intercourse. Bivariate analysis showed significant gender differences in sexual activity, condom use, and family communication about HIV/AIDS. Logistic regression analysis showed that student-family communication about HIV/AIDS was not associated with sexual activity. However, communication about HIV/AIDS between students and parents or other family members increased the odds of using a condom at last sexual intercourse.

Conclusions: The findings of this study suggest that prevention programmes that seek to educate Ghanaian school-going adolescents about sexual risk behaviour must strongly encourage communication about HIV/AIDS between students and family members.

Key words: Ghana, adolescent health, risky sexual behaviour, condom use, gender differences.

African Health Sciences 2003; 3(1): 7 - 14

Severe anaemia in childhood cerebral malaria is associated with profound coma.

Richard Idro

Department of Paediatrics and Child Health, Mulago Hospital, P.O Box 7051, Kampala – Uganda.

Abstract

Background: Severe anaemia in children with cerebral malaria has been associated with respiratory distress secondary to lactic acidosis and/or hypoxia. The ensuing metabolic derangement may further depress the level of consciousness culminating in presentation with profound coma. This association has poorly been studied.

Objective: To determine the relationship between profound coma at presentation and the presence of severe anaemia in children with cerebral malaria.

Methods: This cross-sectional study involved 100 children with cerebral malaria who were consecutively recruited at admission in the Paediatric emergency unit of Mulago hospital in Uganda from July to December 2000. Clinical and laboratory evaluation was done using the hospital’s guidelines for the management of severe malaria. The exposure factor of interest was severe anaemia (Hb < 5.0 g/dl) and occurrence of profound coma (Blantyre coma Scale 0) was the outcome measure.

Results: Severe anaemia and profound coma were seen in 20% and 9% of the children respectively. Severe anaemia was independently associated with profound coma, adjusted OR 1.34 (CI 1.17 – 1.95), p = 0. 002 and age < 3 years, adjusted OR 1.42 (CI 1.13 – 1.54), p = 0.001). Thirty percent of those with severe anaemia had deep sighing (acidotic) breathing compared to only 15% of those with haemoglobin (Hb) > 5 g/dl, OR 1.21 (CI 0.90 – 1.64), p = 0.118. There was no association between the malaria parasite density and severe anaemia. A similar proportion of those with severe anaemia regained consciousness within 24 hours compared to those with Hb > 5 g/dl (30 vs 42.5 %), OR 1.56 (0.65 – 3.71), p = 0.307.

Conclusions: The findings suggest that profound coma in cerebral malaria may not only result from primary malaria encephalitis but possibly also from a metabolic dysfunction due to severe anaemia.

African Health Sciences 2003; 3(1): 15 - 18

Baseline survey of oral health of primary and secondary school pupils in Uganda.

Margaret Wandera1 and J Twa-Twa2

1-University Hospital, Makerere University Kampala, Uganda.

2-School Health Section, Ministry of Health, Uganda.

Abstract

Background: Among the issues that determine the performance of a child at school is health. In recognition of this, the Uganda government has embarked on a school health program for the success of universal primary education. Although dental health is an important component of school health there is little information on it.

Objective: This study aimed at collecting information on dental health of pupils in school for evaluation and planning.

Design: A cross-sectional study using a multistage cluster sampling technique was used to select 685 children attending schools in 5 districts. Children were clinically examined for common illnesses/conditions. The oral examinations were done using simplified versions of Decayed, Missing, and Filled teeth (DMFT) index and Community Periodontal Index (CPI). Oral examinations also assessed presence of fluorosis.

Results: The pupils attending school were aged from 5 to 22 years. Sixty six percent (456) were found to be caries free with a group DMFT of 0.7. The D-component (decay) accounted for approximately 70% of the cases. Fifty nine percent of the pupils were found to have a healthy periodontium. Sixteen percent of the pupils were found to have some degree of fluorosis of whom the majority were from the highland districts of Kabale and Mbale. Urban school pupils were more likely to have caries (OR 1,69; 95% CI 1.21-2.37) than the rural.

Conclusion: There is an upward trend in the caries prevalence when compared to studies done earlier. This study revealed a need to develop preventive programs alongside improvement of dental health services.

African Health Sciences 2003; 3(1): 19 - 22

The accuracy of self monitoring blood glucose meter systems in Kampala Uganda

G. S. Bimenya1, G.R. Nzarubara2, J. Kiconco3, S. Sabuni3, and W. Byarugaba1

1. Pathology Department, Faculty of Medicine, Makerere University, P. O. Box 7072 Kampala, Uganda

2. Anatomy Department, Faculty of Medicine, Makerere University P. O. Box 7072 Kampala, Uganda

3. Kololo Polyclinic and X-ray Services

ABSTRACT

Back ground: Many blood glucose self-monitoring systems are privately and publicly used by people in Uganda and technical and human errors may occur during their operation. Many patients were referred to Kololo polyclinic laboratory to have their blood glucose checked because the values obtained on the patients’ glucose meter systems did not tally with familiar clinical signs and symptoms. This prompted an experimental set up to check glucose meter systems using a larger number of patients.

Objective: The objective was to collate the technical conditions and standing operational procedures of four common glucose meter systems; observe the time, ambient temperature and humidity at which the meter systems operate locally; and compare the performance of three meter systems A, B, and C with the Sensorex glucose meter system on a number of capillary blood samples.

Setting: Kololo polyclinic laboratory – a privately run facility in Kampala, Uganda.

Design: An experimental set up to compare four glucose meter systems.

Methods: Instruction manuals of the four glucose monitoring systems were studied and used to familiarize with the meter operations. One hundred and fourteen capillary blood specimens were assayed for blood glucose. Blood glucose values were instantly read off the four randomly set meter systems A, B, C, and Sensorex, noting the time, ambient temperature and humidity. Results from meter systems A, B, and C were regressed against those of Sensorex using Epi-Info computer program.

Results: Blood glucose concentration levels on meter system A tallied with those on Sensorex meter system. However, those on meter system B and C were significantly lower and different. Temperature and humidity adversely affected the analytical performance of meter systems B and C in the Kampala environ.

Conclusion: Some of the blood glucose monitoring systems in Kampala, Uganda are poor performers and may lead to the mismanagement of patients. There is need for a system to ensure national quality control of blood glucose monitoring systems.

African Health Sciences 2003; 3(1): 23-32

Screening for disability in a community: the ‘ten questions’ screen for children, in Bondo, Kenya.

Emily Muga

Partnerships Department, Tropical Institute of Community Health and Development (TICH) in Africa. P.O Box 2224 Kisumu-Kenya,

ABSTRACT

Background: Although the need for early identification and interventions of disabilities is evident, the current state of routine screening practice in Kenya needs intensive training of screeners before more rigorous techniques are introduced.

Objective: To compare the precision and practical utility of the ‘ten questions’ and EARC screens among the 2 – 9 year olds in a community setting.

Method: In this analytical comparative cross-sectional survey of two disabilities screening methods. multiphase sampling and multistage data collection procedures were employed. Quantitative research utilizing structured interview checklist was used for data collection. It described the prevalence rates of different types of disabilities using both methods. It analyzed the precision and practical utility of the two methods in a community setting.

Results: 64 of the 399 children under study were disabled (50.5 % male and 49.5 % female). The ‘ten questions’ picks up only those problems that are of great concern to families. EARC services are a more definite case defining process of measuring the existence and degree of disability in children. It screens the children who are severely disabled leaving out the mildly disabled and medical conditions which, when left untreated, could lead to possible disablement.

Conclusion: Parents need to be sensitized about symptoms requiring the ten questions that can be used to screen out the potentially disabled children and the Education Assessment and Resource Centres (EARC) be used to diagnose the type and degree of the disability and refer the ill children for treatment. The basic needs of disabled children could be met in the community and do not require highly specialized personnel. They need to be localized and accessible.

African Health Sciences 2003; 3(1): 33-39

SPECIAL ARTICLE
The complete paediatrician: attributes of good practice

J. Paget Stanfield,

Inverlussa, Bridgend, Callander, Perthshire, UK

Abstract

The attributes which the author considers help to make up good paediatric practice are discussed. Some of the problems associated with their achievement are examined. All of these ingredients can never be possessed by any one of us though each of us should have them as our aim. Their full spectrum, to be evident in practice, needs us to be members of a team.

African Health Sciences 2003; 3(1): 40 – 46

PRACTICE POINTS
Breast cancer guidelines for Uganda

The Uganda Breast Cancer Working Group

INTRODUCTION

Breast cancer in Uganda is the third commonest cancer in women coming only next to cancer of the cervix and Kaposi’s sarcoma. The incidence of breast cancer in Uganda has doubled from 11:100,000 in 1961 to 22:100,000 in 1995. Unfortunately the cases are often seen in late stages thus the outcome of treatment is inevitably unsatisfactory. The present day knowledge of this disease does not have any effective primary prevention. It is thus imperative that efforts should be made to detect the disease in its early stages. Mammography has been found to be useful but it is not applicable as a means of mass screening in Uganda (there are only 2 mammography units in Uganda. Public education towards Breast Self Examination (BSE) should be propagated because it is practical and affordable.