African Journals OnLine
East African Medical Journal

Volume 79, No 2 February 2002

EDITORIAL - OBESITY: WHAT LIES BENEATH?

M. M. Warshow

ABSTRACT
Obesity is a chronic disease that is associated with an excess mortality in a relationship that is best described as a "J"- shaped curve(1). As body mass index (BMI) increases, there is a curvilinear increase in mortality mostly attributable to increased deaths from heart disease(1,2), diabetes, hypertension and some forms of cancer in both men and women(1). The cardiovascular mortality is mediated through decreased levels of high-density lipoprotein (HDL) cholesterol, elevated triglycerides (TG) and hypertension(1). Increased levels of highly atherogenic, small dense low density lipoprotein (LDL) particles(2), elevation of plasminogen activator inhibitor-1, a proinflammatory state and insulin resistance(3) may co-exist as part of the "metabolic syndrome". Weight loss studies show that all of these derangements revert towards normal with successful weight reduction(1).

OBESITY AND LIPID PROFILES IN MIDDLE AGED MEN AND WOMEN IN TANZANIA

M. A. NJELEKELA, H. NEGISHI, Y. NARA, T. SATO, M. TOMOHIRO, S. KUGA, T. NOGUCHI, T. KANDA, M. YAMORI, Y. MASHALLA, L. JIAN LIU, K. IKEDA, J. MTABAJI and Y. YAMORI

ABSTRACT

Objective: To examine the relationship between obesity and lipid profiles and to compare the effects of total obesity and central adiposity on lipids in three locations in Tanzania.
Design: Cross-sectional epidemiological study.
Setting: Three areas in Tanzania: Dar es Salaam (urban), Handeni (rural) and Monduli (pastoralists), in August 1998.
Subjects: Five hundred and forty five men and women from a random sample of 600 people aged 46-58 years.
Main outcome measures: Mean BMI, waist circumference, WHR, TC, HDL-C, LDL-C, TG and LDL/HDL ratio. Prevalence rates of overweight, obesity, central obesity and dyslipidaemia.
Results: As compared to men, women had higher BMl (24.7 versus 22.5 kg/m², p<0.0001), waist circumference (92.4 versus 89.1 cm, p< 0.05), TC (4.9 versus 4.2 mmol/L, p<0.0001) and LDL-C (3.3 versus 2.6 mmol/L, p<0.0001). The urban population demonstrated higher levels of lipid factors than the rural population (TC, men 4.8 mmol/L; women 5.3 mmol/L, p<0.0001; TG, men 3.6 mmol/L; women 3.7 mmol/L, p<0.0001, LDL-C, men 2.8 mmol/L, p<0.0001). BMI and waist circumference correlated positively with serum TC, TG, and LDL-C in both genders. Stepwise regression analysis showed that BMI predicted triglyceride concentration in men (p<0.05) and women (p<0.0001). Waist circumference predicted levels of TC in women only (p<0.0001) and of LDL-C in both genders (men p<0.05, women p<0.0001). The prevalence of overweight, obesity and central obesity were significantly higher in urban than in rural areas in both men and women. Compared to lean subjects, obese men and women had significantly higher mean serum TC, TG, LDL-C and a higher prevalence of dyslipidaemia. The mean levels of TC, TG and LDL cholesterol increased across successive increases in BMI and waist circumference quintiles in both genders.
Conclusion: Subjects from the urban area had greater lipid abnormalities related to obesity than those from the rural area and that, central adiposity had a greater effect on total cholesterol and LDL cholesterol among women than was BMI.

SUPRAPUBIC TRANSVESICAL PROSTATECTOMY IN A RURAL KENYAN HOSPITAL

A. G. HILL and P. NJOROGE

ABSTRACT

Objective: To evaluate the effectiveness, safety and complications of suprapubic transvesical prostatectomy in a rural Kenyan hospital.
Design: A prospective audit of suprapubic transvesical prostatectomy.
Setting: Africa Inland Church, Kijabe Hospital, Kijabe, Kenya.
Subjects: One hundred and six men with lower urinary tract obstruction, clinically due to benign prostatic hyperplasia, undergoing suprapubic transvesical prostatectomy.
Interventions: Suprapubic prostatectomy.
Main outcome measures: Age, presentation, comorbidity, type of anaesthesia, pathology, bladder irrigation time, Foley time, post-operative stay, complications-mortality, blood transfusion rate, return to theatre for bleeding, incontinence, urine leak, urinary retention.
Results: One hundred and six men entered the study with a mean age of 72.8 years. Seventy eight per cent were in retention and 25% had significant medical problems. Spinal anaesthesia was used in 94%. The mean prostate weight was 70.4g and 11% had carcinoma. The Foley's catheter was removed at a mean of 4.2 days after surgery and the mean post-operative stay was 6.0 days. The 30 day mortality was 0.9%, the blood transfusion rate was 4.7%, the return to theatre for bleeding rate was 0.9% and 4.7% of patients developed a urine leak.
Conclusion: Suprapubic transvesical prostatectomy, performed under spinal anaesthetic, by general surgeons in rural Kenya, is a safe and effective way of managing benign prostatic hyperplasia and its complications.

HEPATITIS B VIRUS AND HIV INFECTIONS AMONG PATIENTS IN MULAGO HOSPITAL

F.N. NAKWAGALA and M.M. KAGIMU

ABSTRACT

Objective: To compare the frequency of exposure to hepatitis B infection among HIV seropositive and HIV seronegative medical outpatients.
Design: Case control study.
Setting: Mulago hospital medical outpatient clinics.
Patients: One hundred and twenty nine consecutive HIV seropositive patients and one hundred and twenty nine HIV seronegative control patients.
Results: The frequency of anti-HBc among the HIV seropositive patients was 65.1% compared to 41.9% in the HIV seronegative patients (95% confidence interval: 1.51-4.45; pvalue: 0.0002). Of the 84 HIV positive patients with anti-HBc, 52 (61.9%) had more than five lifetime sexual partners. In comparison, of the 45 HIV positive patients with no anti-HBc, only 18 (40%) had more than five lifetime sexual partners (95% confidence interval: 1.04- 1.80; p-value: 0.028). There was no significant difference in the frequency of HBsAg and HBeAg among the HIV seropositives and HIV seronegatives.
Conclusion: The frequency of previous exposure to hepatitis B infection was higher among HIV seropositive patients compared with HIV seronegative patients and was associated with a greater number of lifetime sexual partners. Safe sexual behaviour and reduction in the number of sexual partners should continue to be promoted in the community including HIV positive patients, because it is likely to have the added advantage of reducing coincident exposure to HBV infection. This is especially important for the immunocompromised HIV positive patients who are more likely to develop a chronic infectious carrier state and among whom HBV control by vaccination is less effective than in the immunocompetent individuals

IMMUNITY TO TETANUS IN MALE ADULTS IN DAR ES SALAAM, TANZANIA

S. ABOUD, E.F. LYAMUYA, E.K. KRISTOFFERSEN and R. MATRE

ABSTRACT

Objective: To determine immunity to tetanus in male blood donors with previous diphtheriapertussis- tetanus (DPT)/tetanus toxoid (TT) vaccination.
Design: A cross sectional study, conducted in September 1999.
Setting: Blood bank, Muhimbili Medical Centre, Dar es Salaam, Tanzania.
Methods: Using an antigen competition ELISA technique, serum tetanus anti-toxin levels in two hundred male blood donors were determined.
Results: Vaccination history was absent in 43 (21.5%) blood donors, whereas 60 (30%) and 97 (48.5%) reported childhood DPT and TT vaccination, respectively. Tetanus anti-toxin was undetectable in 47 (23.5%) blood donors and the levels were below that considered protective (>>0.1 IU/ml) in 25 (12.5%). Among those with undetectable level, 43 (91.5%) had no vaccination history. Time after last DPT/TT vaccination correlated significantly with tetanus anti-toxin levels (r²=-0.331, p=0.001). In multivariate analysis, TT doses received and time after last vaccination explained 4.8% and 29.4%, respectively, of the variations in tetanus anti-toxin levels.
Conclusion: Seventy two (36%) male blood donors were susceptible to tetanus and the susceptibility was highest from 48 years. A regular TT booster dose at 10 yearly intervals is recommended to provide adequate and long lasting immunity in male adults. Proper keeping of vaccination records is emphasised.

NEONATAL SURVIVAL OF INFANTS LESS THAN 2000 GRAMS BORN AT KENYATTA NATIONAL HOSPITAL

F.N. WERE, B.O. MUKHWANA and R.N. MUSOKE

ABSTRACT

Background: Survival of patients is regularly used as a measure of the level and appropriateness of medical care provided by institutions. Newborn services have been evaluated in this manner since the 1960s. Though Kenyatta National Hospital has provided neonatal services for over 25 years, no survival data for the low birth weight infants has been published since 1978.
Objective: To determine the birthweight specific neonatal survival of infants born weighing less than 2000 grams at Kenyatta National Hospital.
Design: A cross sectional survey.
Setting: Newborn Unit, Kenyatta National Hospital, Nairobi.
Main outcome measures: The proportion of infants surviving the first 28 days of life grouped in the following birthweight categories; below 1000 grams (extremely low birthweight), 1000 - 1499 grams (very low birthweight) and 1500 - 1999 grams (low birthweight).
Results: The overall neonatal survival of 163 infants born below 2000 grams was 62.6%. None of the 23 infants born less than 1000 grams survived the neonatal period. Bigger infants fared much better with 68% (n=73) of the 1000 - 1499 and 78% (n=67) of the 1500-1999 gram groups surviving. Survival based on gestational age was also determined. Sixty nine per cent of infants born between 32 and 35 weeks survived while only 27% and 9% of the 28 - 31 weeks and those less than 28 weeks survived respectively. When the patients were analysed for age at death, it was found that over 28% of the deaths occurred within the first day and by the seventh day, more than 70% had died. Less than 30% of the deaths occurred after the first week. The commonest clinical syndromes seen were infection (41%) and respiratory distress (43%).
Conclusion: Neonatal survival rates of low birthweight infants are still much lower than those observed in developed countries as far back as the early 1970's. The big proportion of deaths occurring during the first week, and in particular the first day, is due to lack of neonatal intensive care facilities and inadequate obstetric services.

JOINT HYPERMOBILITY SYNDROME AMONG UNDERGRADUATE STUDENTS

B.C. DIDIA, D.V.B. DAPPER and S.B. BOBOYE

ABSTRACT

Objective: To assess the prevalence of joint hypermobility syndrome among undergraduate students of the University of Port Harcourt, Nigeria using the Beighton's criteria.
Design: Cross- sectional prospective study of 550 randomly selected undergraduate students.
Setting: Departments of Anatomy and Human Physiology, College of Health Sciences, University of Port Harcourt, Nigeria.
Main outcome measures: The overall prevalence, and the male/female prevalence of joint hypermobility syndrome.
Results: Five hundred and fifty subjects (250 males and 300 females) were assessed. Seventy one (12.91%) subjects consisting of 20 (8.0%) males and 51 ( 17.0%) females, had features of joint hypermobility syndrome, suggesting a higher female prevalence. Knee joint, back and wrist joint pains, in descending order were found to be the commonest type of joint complaints.
Conclusion: The study indicates that joint hypermobility syndrome is not rare in Nigerians and suggests that it should attract the attention of Nigerian medical practitioners.

VERBAL AUTOPSY IN ESTABLISHING CAUSE OF PERINATAL DEATH

N. IRIYA, K. P. MANJI and R.L MBISE

ABSTRACT

Introduction: Perinatal mortality is a sensitive indicator of health status of a community and is also highly amenable to intervention. The causes of perinatal deaths in developing countries are often difficult to establish. Verbal autopsy has been used in several countries for children and adults, but seldom for perinatal cause.
Objective: To establish the cause of perinatal deaths using verbal autopsy.
Design: Community-based cross-sectional, retrospective study to identify perinatal death over a one year period from July 1996-June 1997. Comparison was made with hospital records. An algorithm of signs and symptoms was used by trained personnel to identify the cause of perinatal death. The duration of collection of data was six months (August 1996- January 1997).
Setting: Hai district of Kilimanjaro region in Tanzania.
Subjects: All perinatal deaths within one year.
Results: The perinatal mortality was 58 per 1000 (121 deaths and 2088 live births). Verbal autopsy could establish the cause of death in 105 of the 121 deaths. Hospital records showed 79 deaths indicating that 42 deaths probably occurred at home. Among the 79 available hospital records, the cause of death could be established in only 30 (38%). The causes of postnatal death were compared between the verbal autopsy and hospital records. There was a good correlation between the same, however only 18 records were available from hospital among the total 31 postnatal deaths. The specificity of determining cause of death using verbal autopsy was 100% and sensitivity 61%.
Conclusion: The commonest causes of perinatal deaths were related to obstetric care, therefore interventions to curb perinatal mortality should be directed to improvement of obstetric care. Verbal autopsy is a simpler and more sensitive tool in establishing the cause of perinatal death than hospital records in a rural district of Tanzania. Large-scale studies are needed to validate this.

RELAPSING FEVER IN GONDAR, ETHIOPIA

K. MITIKU and G. MENGISTU

ABSTRACT

Objective: To determine the magnitude of relapsing fever, the rate of Jarisch-Herxheimer reaction (JHR) and its outcome and compare these parameters between adults and children in the same setting, time period and more or less similar management.
Design: A retrospective descriptive record analysis.
Setting: Gondar College of Medical Sciences (GCMS) hospital, paediatric ward and medical wards, northwest Ethiopia.
Subjects: Clinical records of 262 patients discharged with confirmed diagnosis of primary relapsing fever admitted between September 1995 and August 2000.
Results: Of the 13177 patients admitted during the study period, 262 (1.99%) had a primary diagnosis of relapsing fever of which 70.6% were males. Children below 14 years of age comprised 41.2%. Of the total admissions, 83.6% were from Gondar town and the rest from outside. JHR was observed in 31.7% of the patients. The overall case fatality rate was 4.6%. Bad outcome was observed more frequently in adult patients.
Conclusions and recommendations: Relapsing fever is still a public health problem. Because of the potential danger of the epidemic and its outcome it should not be neglected. Preventive programmes must be integrated with other services. Though the JHR is the most feared part of the management of relapsing fever, if health personnel are trained and competent, the management of relapsing fever can be delegated to the peripheral health workers, especially when it occurs in children. Moreover, the reason for bad outcome in adult patients than in children needs to be established.

HIV PREVALENCE AND DEMOGRAPHIC RISK FACTORS IN BLOOD DONORS

R. ZACHARIAH, A. D. HARRIES, W. NKHOMA, V. ARENDT, M-P. SPIELMANN, L. BUHENDWA, C. CHINGI and J. MOSSONG

ABSTRACT

Objectives: To estimate HIV prevalence in various blood donor populations, to identity sociodemographic risk factors associated with prevalent HIV and to assess the feasibility of offering routine voluntary counselling services to blood donors.
Design: Cross-sectional study.
Setting: Thyolo district, Malawi.
Methods: Data analysis involving blood donors who underwent voluntary counselling and HIV testing between January 1998 and July 2000.
Results: Crude HIV prevalence was 22%, while the age standardised prevalence (>15 years) was 17%. Prevalence was lowest among rural donors, students and in males of the age group 15-19 years. There was a highly significant positive association of HIV prevalence with increasing urbanisation. Significant risk factors associated with prevalence for both male and female donors included having a business-related occupation, living in a semi-urban or urban area and being in the age group 25-29 years for females and 30-34 years for males. All blood donors were pre-test counselled and 90% were post test counselled in 2000.
Conclusions: HIV prevalence in blood donors was alarmingly high, raising important concerns on the potential dangers of HIV transmission through blood transfusions. Limiting blood transfusions, use of a highly sensitive screening test, and pre-donation selection of donors is important. The experience also shows that it is feasible to offer pre and post test counselling services for blood donors as an entry point for early diagnosis of asymptomatic HIV infection and, broader preventive strategies including the potential of early access to drugs, for the prevention of opportunistic infections.

ANTI-TYPHOID AGGLUTININS IN SCHOOL AGED AFRICAN CHILDREN

M.O. IBADIN and A.O. OGBIMI

ABSTRACT

Objectives: To determine baseline antibody responses to H and O antigens of Salmonella typhi and Salmonella paratyphi (A, B and C) in school aged Nigerian children.
Design: Cross-sectional study involving 175 children. Using both rapid slide and tube agglutination techniques in dilutions of sera (1:20 to 1:320), agglutination reactions with various antigens were determined.
Setting: Community based study involving primary school pupils in Benin City.
Subjects: Apparently healthy school children (5-16 years) selected systematically, using multistage sampling technique.
Results: No subject demonstrated agglutination to any of antigens at 1: 320 dilution. Two (1.1%), 26 (14.9%), 85 (33.1%) and 51 (29.1%) pupils respectively had reactions to either antigens of Salmonella typhi at dilutions of 1:160, 1:80, 1:40 and 1:20. At 1:40 dilution 1 (0.6%) and 3 (2.3%) each had reactions to HB, OB and HC respectively. Sixteen per cent had reactions at higher dilutions of _ 1:80 and this occurred more significantly in older children ( ~_y² = 15.50; p < 0.001), those with low maternal socio-economic status ( ~_y² = 22.06, p< 0.001), those from poor apartments (~² = 4.49; p < 0.05) and those who used predominantly none pipe-borne water ( ~² = 5.40; p < 0.02). Against OD and HD, about 50.0% seroconverted at 1:40 dilution with antibodies against H being more prevalent.
Conclusion: Interpretation of single widal reaction in endemic areas must take into cognisance age, clinical and socio-cultural characteristics of the child

SEXUAL VIOLENCE AMONG FEMALE HIGH SCHOOL STUDENTS IN DEBARK, NORTH WEST ETHIOPIA

A.WORKU and M. ADDISIE

ABSTRACT

Objectives: To assess the prevalence, outcome and awareness of sexual violence among high school female students .
Design: A school-based cross-sectional survey .
Setting: Debark Town, north-west Ethiopia .
Subjects: Two hundred and sixteen female high school students, grade 9-11 were included for the quantitative study. For the qualitative data, 16 individuals for the focus group discussion (10 well-recognised female figures in the town and six high school students) and head of the police department for in-depth interview were enrolled .
Results: Sixty two per cent of the respondents had heard of sexual violence committed on young females. Sexual violence was reported by 65.3% of the respondents. The prevalence of performed and attempted rape were 8.8% and 11.5%, respectively. The age range of performed rape victims was between 12 and 21 years. Of the 19 (8.8%) who reported rape being performed on them, unwanted pregnancy, suicide attempt, vaginal discharge and abortion were the consequences in 21%, 15.8%, 10.5% and 5.3%, respectively .
Conclusion: Sexual violence is a major public health problem with high rates of underreporting .Sex education should be given on a regular basis and policy making bodies and the police be well aware of this high magnitude and take strong measures to reduce it.

HAEMATOLOGICAL ALTERATIONS IN LEPROSY PATIENTS TREATED WITH DAPSONE

N.K.D. HALIM and E. OGBEIDE

ABSTRACT

Objective: To evaluate the haemoglobin concentration (Hb); total white blood cell count (WBC), differential WBC count; platelet count and reticulocyte count in leprosy patients already treated with dapsone .
Design: A case-control study .
Setting: Specialist Hospital Ossiomo, which is a Leprosarium and Haematology laboratory, University of Benin Teaching Hospital (UBTH), Nigeria .
Subjects: Seventy six leprosy patients (forty males and thirty six females) age range 13-40 years on single dose dapsone .
Results: The haemoglobin concentration showed a marked decrease while the reticulocyte count was markedly elevated which was suggestive of haemolytic anaemia. There was also lymphocytosis in patients during pre and post dapsone therapy .
Conclusion: Leprosy patients on a dosage of 100mg dapsone, are prone to haemolytic anaemia. Leprosy patients should routinely have their Hb, WBC, platelet count and reticulocyte count determined, while on dapsone therapy in order to ascertain the presence of haemolysis .

ALCOHOLISM AND DIABETES MELLITUS: CASE REPORT

C. F. OTIENO, M. M. O. OKONJI and I. S. O. ODONGO

ABSTRACT

Two male patients with diabetes mellitus and alcohol dependence syndrome are presented. Both were married and in middle age. MI stayed alone in the city while his spouse and two children lived in the rural home. He showed no obvious underlying psychiatric morbidity. FWK was living with his family in the city. He was an alcoholic receiving psychiatric care for alcoholism. They both presented separately at different hospitals with decompensated diabetes following heavy alcohol consumption. The history and clinico-laboratory picture of both patients are presented and brief management programme and outcome are also given. Review of literature on alcoholism and its potential impact on the course and management of diabetes is presented.

FRONTO-ETHMOIDAL TERATOMA: CASE REPORT

N.J. M. MWANG'OMBE, G. KIRONGO and W. BYAKIKA

ABSTRACT

A one-month old baby was referred to the neurosurgical unit, Kenyatta National Hospital, Nairobi, Kenya, with history of being born with a bony outgrowth from the right side of her face which resembled an undeveloped twin. A computerised tomography scan of the brain and the extracranial mass confirmed a defect in the anterior cranial fossa and extension of the mass intracranially. Total surgical excision of the mass was done and facial reconstruction achieved. Histology of the excised mass confirmed a mature (benign) teratoma. Except for location, fronto-ethmoidal teratoma resembles its counterpart in the sacro-coccygeal area. It may arise over the nasion, or within the nose, orbit, or mouth and frequently extends intracranially. Like other teratomatous tumours, malignant changes tend to occur with increasing age. Calcification within the mass is often evident on plain skull x-rays. Treatment consists of early total excision.

PRESS RELEASE - LAUNCH OF GLAXOSMITHKLINE IN KENYA

N.J. M. MWANG'OMBE, G. KIRONGO and W. BYAKIKA

ABSTRACT

Nairobi, 12th January, 2002 .... GlaxoSmithKline (GSK), the pharmaceutical company that was the result of the merger between Glaxo Wellcome PLC and SmithKline Beecham PLC that was completed late December 2000 was formally launched in Kenya.