African
Journals OnLine
East African Medical Journal
Volume 79, No 10, October 2002
Abstracts
CLEFT
LIP AND PALATE: THE JOS EXPERIENCE
K.S.
Orkar, FMCS, FWACS, B.T. Ugwu, FWACS, FICS and J.T. Momoh, FWACS, FRCS
(C), Department of Surgery, Jos University Teaching Hospital, P.M.B.
2076, Jos-Nigeria
Request for reprints to: Dr. B.T.
Ugwu, Department of Surgery, Jos University Teaching Hospital, P.M.B.
2076, Jos-Nigeria
ABSTRACT
Objective:
To determine the pattern of occurrence of cleft
lip/palate and the factors that may have influenced treatment outcome.
Design:
Descriptive Study.
Setting:
Jos University Teaching Hospital, Jos, Nigeria.
Subject:
This study included 107 consecutive patients with cleft
lip/palate managed between January 1991 and June 1997.
Main
outcome measures: The
pattern of occurrence of cleft lip/palate, the peculiarities of the
malformation in this environment as well as factors that influenced
treatment outcome.
Results:
The 107 patients were aged between one day and twenty-six
years at presentation. There were three adults aged between 18 and 26
years with a mean of 22.3 years and 104 children with a mean age of
9.5 months. The male/female ratio was 1. 1:1, the anomaly was 2.4
times commoner on the left and the cleft lip alone was the most
frequent mode of presentation (52%). The incidence was higher in the 3rd
and 4th siblings. In 13% of these patients, there were other
associated congenital anomalies such as Van der Woudes Syndrome,
Downs Syndrome and congenital heart disease. Complications were
noted in 16(14.9%) patients and these included dehiscence after repair
in 8(7.5%) patients, oronasal fistulae in 2(1.9%), nasal speech in
4(3.7%) and hypertrophic scar in 2(1.9%). Eighty nine percent of these
repairs were satisfactory to the parents of the affected children. All
the adult patients were satisfied with their repair.
Conclusion:
The low incidence of this anomaly in our environment may be
due to underreporting in the rural areas. Public enlightenment
programs should help improve early presentation.
PREVALENCE OF
ASTHMA, ALLERGIC RHINITIS AND DERMATITIS IN PRIMARY SCHOOL CHILDREN IN
UASIN GISHU DISTRICT, KENYA
F. Esamai, MBChB, MMed CTM, MPH,
PhD; Associate Professor, S. Ayaya MBChB, MMed CTM; Fderm, Lecturer,
W. Nyandiko, MB ChB, MMed. CTM; Lecturer, Department of Child Health
and Paediatrics, Faculty of Health Sciences Moi Universty P.O. Box
4606 Eldoret, Kenya
Request for reprints to: Prof. F.
Esamai, Department of Child Health and Paediatrics, Faculty of Health
Sciences, Moi Universty, P.O. Box 4606 Eldoret, Kenya
ABSTRACT
Objective;
To establish the relative increase in the prevalence of
asthma, allergic rhinitis and eczema in primary school children aged
13-14 years over a six year interval.
Design:
Cross sectional comparative study.
Setting:
Primary schools in three rural divisions at Uasin Gishu
district in the Rift Valley Province of Kenya.
Methods:
Three thousand two hundred and fifty eight children aged
13-14 years from seventy two primary schools in Uasin Gishu district
were studied using the International Study of Asthma and Allergies in
Childhood (ISAAC) questionnaire. All children in the selected schools
in this age range whose parents gave consent were included.
Results:
There were 47.4% males and 52.6% females as compared to 48.7%
and 51.3% respectively in 1995. The cumulative prevalence for
wheezing, rhinitis, itchy eyes and dermatitis was 23.6%, 43%, 24.1%
and 28.5% respectively which were higher than for 1995 which were
21.2%, 32.4%, 11.8% and 13.8% respectively (p=0.001). The period
prevalence rates for wheezing, rhinitis and eczema were 13.8%, 31.4%
and 21.3% respectively as compared to 10.2%, 25.3% and 14.4%
respectively for 1995 (p=0.001). The prevalence of asthma, allergic
rhinitis and eczema was 12.6%, 38.6% and 28.5% respectively in 2001
compared to 6.6%, 14.9% and 13.9% respectively in 1995 (p=0.001).
Conclusion:
There was a significant increase in the prevalence of asthma,
allergic rhinitis and eczema in children in the study population over
the last six years.
HEADACHE ASSOCIATED
DISABILITY IN MEDICAL STUDENTS AT THE KENYATTA NATIONAL HOSPITAL,
NAIROBI
E. O. Amayo, MBChB, MMed(Medicine),
Senior Lecturer, Department of Medicine, College of Health Sciences.
University of Nairobi, P.o. Box 19676 Nairobi, J.O. Jowi, MBChB,
MMed(Medicine), Dip. Neurology, Consultant Neurologist, Kenyatta
National Hospital, P.O. Box 20723, Nairobi and E.K. Njeru, B.Sc., MSC
(Biostatistics), Lecturer, Department of Community Health, College of
Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya
Request for reprints to: Dr. E.O.
Amayo, Department of Medicine, College of Health Sciences, University
of Nairobi, P.O. Box 19676, Nairobi, Kenya
ABSTRACT
Objective:
To study headache associated disability in a group of medical
students at the Kenyatta National Hospital.
Study
design: Cross sectional survey.
Results:
Between October 1994 and January 1995 we conducted a survey
on headache characteristics on medical students at both the Kenya
Medical Training Centre and the Medical School of the University of
Nairobi. Six hundred and twenty-five (87%) of the 711 students
surveyed admitted having had at least one episode of headache in the
last six months. Using the International headache society (IHS) case
criteria 314 students (50%) had tension type headache, 240 (38%)
migraine headache and 71 (12%) unclassified headache. Eighty-six
percent of the students with headache had their working ability
disturbed to various degrees. Eighty-five percent of the students
reported that their social activities were interfered with by
headache. Migraine headaches had the greatest impact on both the
working and social activities at a p-value of 0.0005 and 0.0004
respectively. One hundred and forty-one students (23.6%) had missed at
least one day of work or school in the last one-year as a direct
result of the headache. There was an association between headache
severity with working ability and social effect. There was no
association between the days students missed work or classes with the
severity of the headache. No gender difference was found in the
headache associated disability.
Conclusion:
Headache is a prevalent condition with disability both in
working and social activities.
CHILD
CARE PRACTICES AND NUTRITIONAL STATUS OF CHILDREN AGED 0-2 YEARS IN
THIKA, KENYA
F. Kamau-Thuita, BEd., MSc,
Department of Community Health, College of Health Sciences, University
of Nairobi, P.O. Box 19676, Nairobi, A.M. Omwega, BSc, MSc, PhD,
Applied Nutrition Programme, Department of Food Technology and
Nutrition, University of Nairobi, P.O. Box 442, Uthiru, Nairobi and
J.W.G. Muita, MBChB, MMed(Paed), MPH, Applied Nutrition Programme,
Department of Food Technology and Nutrition, University of Nairobi,
P.O. Box 442, Uthiru, Nairobi, UNICEF Kenya Country Office, P.O. Box
44145, Nairobi, Kenya
Request for reprints to: F.
Kamau-Thuita, Department of Community Health, College of Health
Sciences, University of Nairobi, P.O. Box 19676, Nairobi,
Kenya
ABSTRACT
Objective:
To assess time allocation for child care and the nutritional
status of children aged 0-2 years.
Design:
Cross sectional descriptive survey using a structured
questionnaire and taking of anthropometric measurements to determine
the nutritional status of children aged 0 to 2 years. In addition, two
day (10 hour) observations were conducted in a subsample of households
to assess time allocation for the main child care activities.
Setting:
A low-income peri-urban section of Thika town (in Makongeni
estate), Kenya.
Subjects:
A random sample of 150 mothers and their 0-2 year old
children.
Results:
Mothers knowledge about child care influences the amount
and type of care that is given to children. Time taken to perform
various activities was also found to vary with the mothers
education level, her occupation, number of children less than five
years in the house and the childs age and birth order.
Comparatively, children who were malnourished (stunted) had less time
devoted to them for breastfeeding, food preparation and feeding.
Although mothers were the primary caregivers, the responsibility of
care giving was shared with other household members as well as with
neighbours.
Conclusion:
The amount and type of care that a child receives is
determined to a large extent by the mother and caregivers knowledge.
PAIN
RELIEF USING PARACERVICAL BLOCK IN PATIENTS UNDERGOING MANUAL VACUUM
ASPIRATION OF UTERUS
Tekle G. Egziabher, MMed (Obs/Gyn),
Consultant, Kenyatta National Hospital, J.K. Ruminjo, MMed, (Obs/Gyn),
FCTR, Senior Lecturer, Department of Obstetrics and Gynaecology and C.
Sekadde-Kigondu, PhD Associate Professor, Department of Clinical
Chemistry, College of Health Sciences, University of Nairobi, P.O. Box
19676, Nairobi, Kenya
Request for reprints to: Dr. J.K.
Ruminjo, Department of Obstetrics and Gynaecology, College of Health
Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya
ABSTRACT
Objective:
To evaluate pain relief using paracervical nerve block with
1% lignocaine injection in patients undergoing uterine evacuation by
Manual Vacuum Aspiration (MVA) for the treatment of incomplete
abortion.
Design:
A randomized double blind clinical trial.
Setting:
Marie Stopes Health Centre, Nairobi.
Methods:
One hundred and forty two patients were recruited between
September and October 1997. The intervention was random assignment to
the study group (paracervical block with 1% lignocaine) or the placebo
group (paracervical block with sterile water for injection). Intra and
post operative assessment of pain was made using McGills and facial
expression scales.
Results:
The untreated group experienced significantly more pain than
the treated group, especially lower abdominal pain and backache. The
pain was especially marked intraoperatively, less so 30 minutes
post-operatively.
Conclusion:
Based on the findings of this study, any patient going for
manual vacuum aspiration for the treatment of incomplete abortion
should be given Paracervical block as it is cost effective, easy to
perform and with less side effects.
RISK FACTORS FOR
PLACENTA PRAEVIA IN SOUTHERN NIGERIA
A.O.
Eniola, FWACS, FMCOG, MRCOG, Department of Obstetrics and Gynaecology,
North Tyneside General Hospital, Northshields, NE29 8NH, England, A.U.
Bako, FWACS, FMCOG, Department of Obstetrics and Gynaecology, Leighton
Hospital, Crewe, CW1 42J, England and D.O. Selo-Ojeme, FWACS, FMCOG,
MRCOG, Department of Obstetrics and Gynaecology, Barts and the Royal
London NHS Trust, London, N1 1BB, England
Request for reprints to: Dr. D.O.
Selo-Ojeme, 13 Wingrave Crescent, Brentwood, Essex, CM14 5PA, England
ABSTRACT
Objective:
To determine the risk factors for placenta praevia in
Ile-Ife, southern Nigeria.
Design:
A prospective case control study.
Setting:
A tertiary center - Obafemi Awolowo University Teaching
Hospital, Ile-Ife, southern Nigeria.
Subjects:
One hundred and thirty six patients with confirmed placenta
praevia constituted the cases. Controls consisted of one hundred and
thirty six patients who delivered at term immediately after each
indexed case and did not have placenta praevia.
Results:
Cases and controls were similar in terms of twin deliveries
(P=0.72) and past history of uterine surgery (P=0.47). After adjusting
for confounders, factors associated with risk of placenta praevia were
history of retained placenta [OR=6.7(95% CI 1.2- 36.6)], previous
caesarean section [OR=4.7, (95% CI 1.9-11.4)], previous abortion
[OR=2.9 (95% CI 1.1-5.1)], grand multiparity [OR=2.1 (95% CI 1.6-7.1)]
and age over 35 years [OR=1.4 (95% CI 1.2-6.6)].
Conclusions:
From our study, the risk factors for placenta praevia are a
history of retained placenta, previous caesarean section, previous
abortion, grand multiparity and maternal age over 35 years.
MORBIDITY
AND OUTCOME OF LOW BIRTHWEIGHT BABIES OF ADOLESCENT MOTHERS AT
KENTATTA NATIONAL HOSPITAL, NAIROBI.
A.
Wasunna, MBChB, MMed(Paed), Fell Neunat. Med(UK), Associate Professor,
Department of Paediatrics and Child Health, Faculty of Medicine,
College of Health Sciences, University of Nairobi, P.O. Box 19676,
Nairobi and K. Mohammed, MBChB, MMed (Paed), Formerly Registrar,
Department of Paediatrics, Aga Khan Hospital, P.O. Box 30270, Nairobi,
Kenya
Request for reprints to: Prof. A.
Wasunna, Department of Paediatrics and Child Health, Faculty of
Medicine, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya
ABSTRACT
Objective:
To compare the morbidity and outcome of low birthweight
babies (birthweight < 2000gm) of adolescent (age < 20 years) and
older mothers.
Design:
Cross sectional descriptive study.
Setting:
The newborn Unit of the Kenyatta National Hospital.
Main
outcome measures: All
babies weighing less than 2000gm at birth whose mothers consented to
the study had their gestational age verified using the Dubowitz
scoring system. They were then followed up by daily clinical
assessment untill discharge, death or up to one month in the ward. The
babies were divided into two groups according to their mother's age
and then compared with respect to episodes of illness, duration of
hospital stay, and overall outcome.
Results:
One hundred and forty two babies were studied. Of these, 64
were born to adolescent mothers. Babies of the adolescent mothers
tended to be more premature (p=0.0174), be lower in weight (p=0.0078),
had more occurrences of respiratory distress and anaemia (probably
reflecting their increased prematurity) and had frequent multiple
morbidity events. They also had longer hospital stay and they were
more likely to die (57.7% compared to 42.3% of babies of older
mothers).
Conclusion:
Low birthweight babies of the adolescent mothers were found
to be more likely to have increased morbidity and adverse outcome
compared to similar babies of older mothers.
LOW
BIRTHWEIGHT BABIES: SOCIO-DEMOGRAPHIC AND OBSTETRIC CHARACTERISTICS OF
ADOLESCENT MOTHERS AT KENYATTA NATIONAL HOSPITAL, NAIROBI
A.
Wasunna, MBChB, MMed(Paed), Fell. Neunat. Med(UK), Associate
Professor, Department of Paediatrics and Child Health, Faculty of
Medicine, College of Health Sciences, University of Nairobi, P.O. Box
19676, Nairobi and K. Mohammed, MBChB, MMed (Paed), Formerly
Registrar, Department of Paediatrics, Aga Khan Hospital, Nairobi, P.O.
Box 30270, Nairobi, Kenya.
Request for reprints to: Prof. A.
Wasunna, Department of Paediatrics and Child Health, Faculty of
Medicine, College of Health Sciences, University of Nairobi, P.O. Box
19676, Nairobi, Kenya
ABSTRACT
Objective:
To compare some socio-demographic and obstetric factors
between adolescent mothers (aged below 20 years) and older mothers of
low birthweight (birthweight <2000gm) babies.
Design:
Cross sectional descriptive study.
Setting:
The Newborn Unit of the Kenyatta National Hospital.
Results:
Sixty nine adolescent mothers and 73 older mothers were
studied. Adolescent mothers were more likely to be unmarried (p =
0.0001) have less formal education (p<0.0001) be unemployed and be
primigravida (76.5% compared to 36% of older mothers). Although the
obstetric factors of antenatal clinic attendance, premature rupture of
the membranes, pre-eclamptic toxaemia, infections and interventronal
delivery tended to be more frequent among the adolescent mothers, non
of these differences were significant probably due to the small
numbers of patients studied.
Conclusion:
This study does suggest mothers of very low birthweight
babies tend to have unfavourable socio-demographic and obstetric
factors like being single parents having less formal education, being
unemployed and having obstetric risks for poor pregnancy outcome.
PREVALENCE
OF TARDIVE DYSKINESIA AMONG PSYCHIATRIC IN-PATIENTS AT MATHARI
HOSPITAL, NAIROBI
N.
Gatere, MBChB, MMed (Psych) (Nrb), Consultant Psychiatrist, Mathari
Hospital, P.O. Box 40663, Nairobi, Kenya, C.J. Othieno MBChB,
MMed(Psych) (Nrb), Lecturer, and D.M. Kathuku MBChB (Makerere), MMed
(Psych) (Nrb), Av Med (USA), Lecturer, Department of Psychiatry,
College of Health Sciences, University of Nairobi, P.O. Box 19676,
Nairobi, Kenya
Request for reprints to: Dr. N.
Gatere, Consultant Psychiatrist, Mathari Hospital P.O. Box 40663,
Nairobi, Kenya.
ABSTRACT
Objective:
To determine the prevalence of tardive dyskinesia among
psychiatric in-patients.
Design:
A cross-sectional survey.
Setting:
Mathari Hospital, Nairobi, the main psychiatric referral
hospital in Kenya.
Subjects:
Two hundred and two randomly selected in-patients seen in the
hospital between January and April 2000.
Results:
The prevalence of tardive dyskinesia was 11.9%. Neither the
psychiatric diagnosis nor the sex was significantly associated with
tardive dyskinesia. The antipsychotic dosage was also not associated
with tardive dyskinesia but an increase in age was significantly
associated with the abnormal movements.
Conclusion:
The prevalence rate of tardive dyskinesia among patients at
Mathari Hospital is much lower than that found in western countries
but similar to that from Asian studies. These findings indicate the
possibility of racial differences in the aetiology of TD. Prospective
cross- racial studies are necessary to confirm these findings.
CRYPTOSPORIDIOSIS
AMONG ANIMAL HANDLERS AND THEIR LIVESTOCK IN BASRAH, IRAQ
N.K. Mahdi, MSc, PhD and N.H. Ali,
MSc, Department of Microbiology, College of Medicine, University of
Basrah, Basrah, Iraq
Request for reprints to: Dr. N.K.
Mahdi, Central Post Office - 42001, P.O. Box 1565, Basrah, Iraq
ABSTRACT
Objective:
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 handlers and 198 domestic animals (60 cows, 45 sheep, 45
goats, 25 horses and 23 camels). Direct smear method and then
formalin-ether sedimentation method were carried out for stool samples
to detect intestinal parasites. Faecal smears were prepared from the
sediment and stained by the modified Ziehl-Neelsen method for the
recovery of red-pink oocysts of Cryptosporidium.
Results:
Out of the 60 animal handlers, 30 (50%) were found to be positive for
intestinal parasites compared to 26 (14.8%) of non-animal handlers
(P<0.01). Cryptosporidium oocysts were found to be excreted
by three (5%) animal handlers and two (1.14%) of the 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 case was detected among the examined camels.
Conclusion:
Veterinarians, butchers and breeders should be aware of the disease
among farm animals in order to avoid great losses and to prevent its
transmission to humans.
PERSISTENT
HYPERINSULINAEMIC HYPOGLYCAEMIA OF INFANCY: CASE REPORT
S. Semiz, MD, Associate Professor,
Department of Paediatrics, I. Bircan, MD, Professor, S. Akçurin, MD,
Associate Professor, E. Mihçi, MD, Department of Paediatric
Endocrinology, M. Melikoglu, MD, Professor, G. Karagüzel, MD,
Associate Professor, Department of Paediatric Surgery, B. Kiliçaslan,
MD Associate Professor and G. Karpuzoglu, MD, Professor, Department of
Pathology, Pamukkale University, School of Medicine, Denizli, Turkey;
Akdeniz University School of
Medicine, Antalya, Turkey
Request
for reprints to: Prof. S. Semiz, Camlaralti Mah. 6018 Sok. No: 8 Kat:
2 20020 Denizli, Turkey
SUMMARY
Hyperinsulinism,
although rare, is the most common cause of persistent
hyperinsulinaemic hypoglycaemia in infancy. Because of persistent
hypoglycaemia, serious difficulties are encountered in the long term
management of this condition. A male neonate, after an uncomplicated
full-term pregnancy, had been admitted to another hospital with
convulsions on the third post-natal day. Meningitis had been suspected
at that time and treated with phenobarbital and he had been discharged
from the hospital. At threemonths old he was referred to our
department for persistent convulsions and lethargy. His parents were of 1st degree consanguinity. His blood
glucose level was found to be 24 mg/dl (1.33 mmol/L). Because of the
dangerously high insulin level during hypoglycaemia (insulin/glucose
>0.3), the absence of ketonuria, and the need for a high dose of
glucose infusion (> 15 mg/kg/min) to achieve normoglycaemia and a
glycaemic response to glucagon despite the hypoglycaemia, a diagnosis
of persistent hyperinsulinaemic hypoglycaemia of infancy was made.
Since maximal doses of prednisone, glucagon, diazoxide, octreotide and
high infusion of glucose were ineffective in achieving normoglycaemia,
a subtotal (80%) pancreatectomy was done. Postoperatively intermittent
hypoglycaemic episodes continued. These were controlled with low doses
of octreotide. Histology revealed diffuse adenomatous hyperplasia
(nesidoblastosis). The boy is now in the sixth post-operative month
and developing normally.
LEIOMYOMA
OF THE URINARY BLADDER: CASE REPORT
Y.H. Elshebiny, MD, Department of
Surgery, S.D. Ashebu, FWACS, Department of Radiology, H.M. Hussein,
FRCS (Edin), Department of Surgery and
A.M.A. El-Naser, MSc, Department of
Radiology, Al-Adan Hospital, Kuwait
Request for reprints to: Dr. S.D.
Ashebu, P.O. Box 43721, 32052, Hawally, Kuwait
SUMMARY
A
case of leiomyoma of urinary bladder, a rare benign tumour, is
presented. The patient was a 42 year old female who presented with
dysuria and frequency of micturition. The radiological features,
diagnosis and management are discussed and the literature on this
subject is briefly reviewed.
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