African Journals Online
African Health Sciences

Volume 1 Number 1 August 2001

African Health Sciences: the journal that will fill the evidence based practice void in Africa.

Welcome to this maiden issue of African Health Sciences! Well, it has had a very long gestation period! So why this new journal by the Makerere Faculty of Medicine?

There is now urgent need for evidence based practice whether in public health, clinical practice or when tackling pressing development issues such as HIV/AIDS, the tobacco scourge or the health needs of the urban poor. Increasingly health, policy and development practitioners have had to rely on information generated by western researchers and their institutions. Yet this information may have little relevance to conditions in Africa.

Therefore the establishment of a credible medium and data - base for the exchange of the most current health and development information is critical.

Researchers and health, policy and development practitioners attempting to publish their work may be too timid to publish in western journals or these journals may, more often than not, reject work, which is not so relevant to practice in the western countries. Their work therefore may remain unpublished. Such researchers and practitioners get discouraged and they might stop attempting to publish, and eventually they drop out of research altogether!

Another unfortunate trend is for authors and researchers to focus on areas which may not be of national or regional priority but which would find more acceptability in foreign non-African journals. Local health problems may remain unsolved. While there are a couple of regular medical journals in the region, there is no regular multidisciplinary publication putting emphasis on evidence based practice across the fields of health, policy, research and development.

Challenges and unique opportunities:

The new millennium has ushered in new challenges and opportunities. Thus there is more emphasis now on working with the civil society in issues of governance, accountability decentralization and engaging the private sector in resource mobilization and health care provision. Then there is the HIV/AIDS issue, the emergence of new epidemics of malaria, Ebola and others in view of the collapse of the state in many countries.

The issue of conflict and its consequences including gender inequities are all challenges that the traditional health sector never prepared its workers to tackle. Yet innovative approaches such as the effective onchocerciasis work in West Africa pioneered by the WHO AFRO director, Dr. Samba, are examples to be emulated.

Such work whether at local or national level needs to be communicated to the wider audience so that other people have a chance to adapt it to their local situation and to scale it up in country where this is possible.

The documentation and publication of such experiences is a daunting task that challenges the overburdened and often under-resourced health care system. The Makerere Faculty of Medicine has risen to the challenge by starting the publication of the multidisciplinary African Health Sciences.

In order to fulfill its mandate African Health Sciences has clear objectives, which include:

• Advocate for, and promote the growth of a reading culture in the sub Saharan Africa.
• Provide a high quality journal (African Health Sciences) in which health policy and other researchers and practitioners in the region and worldwide, can publish their work
• Promote relevant health system research and publication in the region including alternative means of health care financing, the burden and solution of health problems in marginalized urban and rural communities, amongst the displaced and others affected by conflict.
• Promote research and systematic collection and collation and publication of data on diseases and conditions of inequity and affluence.
• Promote development of evidence-based policies and guidelines for clinical, public health and other practitioners.

Philosophy

African Health Sciences will uphold high standards of professional ethics and practice using scientific merit, originality and relevance as the yardsticks by which to judge articles for publication. We shall, as much as possible, provide constructive guidance and advice and make professional help to those whose command of the English language might not be adequate. We shall not accept any donations from tobacco companies given the deleterious effect of tobacco smoking on health.

In this issue we bring you several original articles.

Dr. Erume and colleagues report results of their study on intranasal administration of measles vaccine while Kiwanuka and Mwanga share their experience with pyogenic meningitis in Mbarara Hopsital in Uganda. Olwa odyek and collaeagues report results of their study on the antimicrobiol effects of an endangered African tree, while Sekirime’ findings on the attitude and sexual behaviour of University students give us another angle of health promotion given the HIV/AIDS pandemic.

There are several case reports on African Histoplasmosis simulating Pott’s disease, use of ultrasonography in the diagnosis of splenic rupture and an interesting case of empty sell syndrome.

Under the’ practice points’ section we bring you current recommendations for cotrimoxazole chemoprophylaxis in adults and children with HIV/AIDS and a review of the value of nevirapine in the prevention and treatment of HIV infection.

Dr. Weeks reviews that important organ: the placenta, while Susan Rifkin who is a world expert on community participation has reviewed ten best readings in community participation and health. Our people are the most valued resource! We must find innovative ways to enable us contribute to making their health better. African Health Sciences will be your partner in this process.

Editor

1. Erume J, Partidos H: Evaluation of the adjuvant effect of Escherichia coli heat-labile enterotoxin mutant (LTK63) on the systemic immune responses to intranasally co-administered measles virus nucleoprotein. Part I: Antibody responses. African Health Sciences 2001: 1(1): 3-8.
2. Kiwanuka JP, Mwanga J Childhood bacterial meningitis in Mbarara Hospital, Uganda: antimicrobial susceptibility and outcome of treatment. African Health Sciences 2001: 1(1): 9-11.
3. Olila, D, Opuda-Asibo J, and Olwa-Odyek Bioassay-guided studies on the cytotoxic and in vitro trypanocidal activities of a sesquiterpene (Muzigadial) derived from a Ugandan medicinal plant (Warburgia ugandensis). African Health Sciences 2001 1(1): 12-15
4. Sekirime WK, Tamale J, Lule JC, Wabwire-Mangen F: Knowledge, attitude and practice about sexually transmitted diseases among university students in Kampala. African Health Sciences 2001; 1(1): 16-22
5. Makoba IG: Splenic injury following trauma: The role of ultrasonography. African Health Sciences 2001: 1(1): 23-25.
6. Luutu I, Empty sella syndrome: incidential findings at computerised tomography. African Health Sciences 2001; 1(1): 26-27.
7. Musoke F, Spinal African histoplamosis simulating tuberculous spondylitis: A case report. African Health Sciences 2001; 1(1): 28-29.
8. Provisional WHO/UNAIDS Secretariat Recommendations on the Use of Cotrimoxazole Prophylaxis in Adults and Children Living with HIV/AIDS in Africa. [World Health Organization/UNAIDS] Geneva, October, 2000. African Health Sciences 2001; 1(1): 30-31.
9. Nevirapine: An Option For Preventing as Well as Treating Paediatric HIV Infection. African Health Sciences 2001; 1(1): 32-35
10. Weeks AD, The Retained Placenta, African Health Sciences 2001; 1(1): 36-41.
11. Rifkin SB: Ten Best Readings on Community Participation and Health. African Health Sciences 2001; 1(1): 42-45.
12. Neurosurgery in the tropics: A practical approach to common problems By Jeffrey V. Rosenfeld MBBS, MS, FRACS, FRCS (Ed), FACS, FACTM and David A.K Watters ChM, FRACS, FRCS (Ed) Macmillan Education LTD 2000, Price $ 50 US ISBN 0-333-68412-5. Book Review by Owor G and Lett R. African Health Sciences 2001; 1(1): 46.
13. Kibirige MS, Paediatric and Neonatal Resuscitation. African Health Sciences 2001; 1(1): 47-49
14. Instructions to Authors. African Health Sciences 2001; 1(1): 49
15. Subscription information. African Health Sciences 2001; 1(1): 50.

1 Mbarara University of Science and Technology, Mbarara, Uganda

ABSTRACT

The recommended antibiotic treatment of bacterial meningitis has come under scrutiny following frequent reports of in-vitro resistance by the common causative organisms to penicillin and chloramphenicol.

The study recorded the causative organisms, antibiotic sensitivity patterns and outcome of treatment of bacterial meningitis in children and examined the impact of various factors on the recorded outcome.

This was a retrospective review of all case records of patients treated for bacterial meningitis over a one-year period.

The study was set in the paediatric wards of Mbarara University Teaching Hospital, in south western Uganda.

A total of 77 patients were treated. Among 56 patients with available CSF results the frequency of bacterial causes was as follows: H. influenzae 13(23.2%), coliforms 7(12.5%), uncultured Gram-negative bacilli 7(12.5%), S. pneumoniae 5(8.9%) and

N. meningitidis 3(5.4%). Most isolates tested were resistant to both penicillin and chloramphenicol, but all were sensitive to ciprofloxacin and perfloxacin. Twenty eight(36.8%) patients died, 22(28.9%) survived with sequelae and 15(19.7%) improved without sequelae. 14/18 who received perfloxacin and/or ciprofloxacin survived compared with 23/47 who did not: p=0.04).

The high case-fatality rates and the high frequency of resistance to penicillin and chloramphenicol make a case for a review of the currently recommended antibiotic treatment of bacterial meningitis in this region. Fluoroquinolones need further evaluation as potential alternatives to chloramphenicol in the treatment of bacterial meningitis.

Olila, D.^a* Opuda-Asibo, J^b.and Olwa-Odyek^c

Departments of Veterinary Physiological Sciences, Veterinary Public Health and Epidemiology, Pharmacy, Makerere University, P.O. Box 7062, Kampala, Uganda.

ABSTRACT

Trypanosomosis is arguably the most important disease of man and his domesticated animals in the tropics. There are few compounds available for its treatment. This has exacerbated the development of drug resistance. There is therefore urgent need to search for newer compounds to treat this important disease. Medicinal plants represent a potential source of the drugs. This paper reports a bioassay-guided study to search for possible biological activity (cytotoxic and trypanocidal) in two Ugandan medicinal plants. The methodology adopted was the so-called ‘ping-pong’ approach, involving phytochemical purification (column chromatography and preparative thin layer chromatography), alongside biological studies (cytotoxicity, antibacterial, trypanocidal and antifungal studies). Phytochemical investigations of Zanthoxylum chalybeum (seed) yielded a pure crystalline compound, 27-135D, which was characterized by ¹HNMR as the alkaloid skimmianine. Studies on stem bark yielded three alkaloids 27-165A, 27-173A and 27-173B. All the above pure isolates, and the crude extracts of Z. chalybeum had neither biological activity nor cytotoxicity in the brine shrimp assay. A cytotoxic sesquiterpine, characterized as muzigadial, was isolated from W. ugandensis. It was highly toxic in the brine shrimp assay and also had in vitro trypanocidal activity against IL 3338 as well as IL1180; reference drug-resistant and drug-sensitive trypanosome strains respectively, comparable to diminazene aceturate and Geneticin (G418). Muzigadial also had antifungal activity against Candida albicans. It was concluded that the brine shrimp assay might be a useful predictor of trypanocidal activity of plant extracts and that muzigadial may be potentially valuable in the treatment of drug-resistant trypanosomosis.

African Health Sciences 2001 1(1): 12-15

Wilberforce Kigongo Sekirime¹, Jerome Tamale¹, John C Lule¹, Fred Wabwire-Mangen²

1. Department of Obstetrics and Gynaecology, Makerere Medical School, P. O .Box 7072

Kampala, Uganda.

2. Institute of Public Health, Makerere University, P. O. Box 7072 Kampala

Sexually transmitted diseases (STDs) remain an important cause of morbidity and mortality among women in the child-bearing age. In order to institute appropriate preventive measures there is need to establish the profile of knowledge of the predisposing factors and causation of STDs, attitude to sexual practice and sexual patterns among the susceptible young people, such as university students.

Study population:

Non medical university students, Makerere University

Design:

Descriptive cross sectional study

A detailed questionnaire identifying socio-demographic characteristics, sexual patterns, knowledge of STDs as well as attitudes towards prevention of STDs was administered to 400 non-medical university students of Makerere University.

Knowledge of the clinical features of gonorrhoea and AIDS was high; most knew the predisposing factors for STDs (multiple sexual partners 90%; unprotected sexual intercourse 93%; rape 81%; sex outside marriage 78%, and sex under the influence of alcohol 73%) but not so for syphilis. Males were three times more likely to contract STDs (27%) than their female (9%) counterparts. Whereas knowledge on methods of prevention was high (>90%) it was not followed by appropriate behavioural patterns. More female (33.5%) students had heard about Trichomonas vaginalis than males (23%); (C ² = 17.1; < 0.0001). This study has shown that more female than male students got information from their parents (C ² = 25.3; p < 0.001) while more male students had their source of information from previous sexual intercourse (C ² = 12.9; p = 0.001).

Conclusion:

The level of knowledge about STDs and their prevention is not matched by sexual behavioural patterns, and male students undertake more risky sexual behaviour. Sexual education should be introduced at the university as a means of increasing students' awareness about the problem and prevention of sexually transmitted diseases including HIV/AIDS.

Splenic injury following trauma: The role of ultrasonography Innocent Gerald Makoba

Abstract

The spleen is the most commonly injured abdominal organ and this may follow accidental or non-accidental trauma. Three cases are presented of adult males who presented with pain in the left hypochondrium following trauma. Traumatic injury to the spleen was suspected and ultrasound confirmed this suspicion in the 3 patients. The patients did well after splenectomy. Hence ultrasound evaluation of patents with history of trauma and left hypochondrial pain should be performed urgently in order to detect possible splenic rupture.

African Health Sciences 2001: 1(1): 23-25.

Israel Luutu

Department of Radiotherapy
Mulago Hospital
P. O. Box 7051
Kampala, Uganda

Abstract

A case is presented of a 43-year old female patient who presented with severe dizziness, neck pain and headache. Clinical examination revealed diplopia with a horizontal gaze.

Plain skull radiographs showed an enlarged sella turcica with no abnormal intracraial calcifications. Pre and post contrast axial and post contrast coronal computerised tomography scans through the sella turcica were done. An enlarged sella turcica filled with cerebrospinal fluid was demonstrated.

Florence Musoke

Makerere University Hospital
P. O. Box 7062 Kampala, Uganda

Spinal histoplasmosis is a rare disease condition that must be differentiated from other common inflammatory lesions of the spine such as tuberculosis. A case is presented of a pathologically proven African spinal hisptoplasmosis in a 39-year old female.

Paraplegia and fever were the patient clinical fingings. Cervical plain radiography demonstrated a lytic destructive process of the lower cervical spine with radiographic signs similar to tuberculosis. The surgical management and chemotherapy of histoplasmosis are briefly discussed.

Practice Points

Provisional WHO/UNAIDS Secretariat Recommendations on the Use of Cotrimoxazole Prophylaxis in Adults and Children Living with HIV/AIDS in Africa

[World Health Organization/UNAIDS] Geneva, October, 2000.

Prophylactic treatment with cotrimoxazole can potentially enhance essential HIV care programmes in Africa by preventing several secondary bacterial and parasitic infections in people living with HIV/AIDS (PLHA). This intervention has been discussed at a UNAIDS/WHO consultation held in Harare, Zimbabwe on 29-31 March 2000. In view of the urgent need to preserve the health and well-being of HIV-infected individuals in Africa, where the HIV epidemic has its largest impact, WHO and the UNAIDS secretariat endorse the following as provisional recommendations:

From Drug & Ther Perspect 17(10):1-5, 2001 With permission from Adis International Limited

Nevirapine belongs to the class of non-nucleoside reverse transcriptase inhibitors (NNRTI) of HIV. It reduces perinatal HIV transmission when administered as a 2-dose regimen, 1 dose to pregnant women during labour and 1 dose to the new born infant within 72 hours of birth. This nevirapine regimen was more effective than a short course of intrapartum and neonatal zidovudine in a randomised trial in breastfeeding women in Uganda. The 2-dose mother-infant nevirapine regimen is well tolerated and is more cost effective and easier to administer in resource-poor settings than zidovudine. In the US, guidelines for the prevention of perinatal HIV transmission suggest the use of the 2-dose nevirapine regimen as one of the possible treatment options for pregnant women who have received no previous antiretroviral therapy and whose infection is diagnosed late in pregnancy or during labour.

Data concerning the use of nevirapine for the treatment of children with established HIV infection are still limited. It should only be used in combination with at least 2 other antiretroviral agents. In small numbers of patients nevirapine-containing triple antiretroviral combination regimens have produced reductions of HIV RNA both in plasma and the CSF.

Dr Andrew D Weeks

Visiting Lecturer, Dept of Obstetrics and Gynaecology,
Makerere University,
Kampala,
Uganda

The retained placenta is a significant cause of maternal mortality and morbidity throughout the developing world. It complicates 2% of all deliveries and has a case mortality rate of nearly 10% in rural areas.

Ultrasound studies have provided fresh insights into the mechanism of the third stage of labour and the aetiology of the retained placenta. Following delivery of the baby, the retro-placental myometrium is initially relaxed. It is only when it contracts that the placenta shears away from the placental bed and is detached. This leads to its spontaneous expulsion. Retained placenta occurs when the retro-placental myometrium fails to contract. There is evidence that this may also occur during labour leading to dysfunctional labour. It is likely that this is caused by the persistence of one of the placental inhibitory factors that are normally reduced prior to the onset of labour, possibly progesterone or nitric oxide.

Presently, the only effective treatment is manual removal of placenta (MROP) under anaesthetic. This needs to be carried out within a few hours of delivery to avoid haemorrhage. For women in rural Africa, facilities for MROP are scarce, leading to high mortality rates. Injection of oxytocin into the umbilical vein has been suggested as an alternative. This method relies on the injected oxytocin passing through the placenta to contract the retro-placental myometrium and cause its detachment. Despite several placebo controlled trials of this technique, no firm conclusion have been reached regarding its efficacy. This may be due to inadequate delivery of the oxytocin to the placenta. Further trials are in progress to assess the optimal dose of oxytocin as well as the efficacy of a new technique designed to improve delivery of the oxytocin to the placental bed.

Susan B. Rifkin

This article reviews, in the opinion of the author, the 10 most influential reading on community participation and health development. The introduction notes that some of the articles do not address health directly but still do bring crucial interpretations to the topic. All articles view community participation as an intervention by which the lives of people, particularly the poor and marginalised can be improved. In addition, they all address the issue of the value of participation to equity and sustainability. The article considers the readings under four heading: concepts and theory; advocacy; critiques and case studies. It highlights the important contributions each reading makes to the understanding of participation in the wider context of health and health development. In conclusion, the article argues that participation has not met the objectives of planners and professionals, in good part, because it is questionable as to whether viewing participation as an intervention enables them to make correct assessments of its contribution to development. The bottom line is that participation is always about power and control, an issue planners and professionals do not want explicitly to address.

Key Words: community participation, health and development, participation as an intervention, empowerment

African Health Sciences 2001; 1(1): 42-45.

NEUROSURGERY IN THE TROPICS

A practical approach to common problems By Jeffrey V. Rosenfeld MBBS, MS, FRACS, FRCS (Ed), FACS, FACTM and David A.K Watters ChM, FRACS, FRCS (Ed) Macmillan Education LTD 2000, Price $ 50 US ISBN 0-333-68412-5

Neurosurgery in the Tropics is a book, aimed at the general surgeon in a remote setting. As a surgical trainee in East Africa, the possibility of practicing in a remote setting is real. It is with this background that together with a surgeon who has worked in remote areas of Western Africa, we write this review.

M S Kibirige

Consultant Paediatrician, South Cleveland Hospital
Marton Road, Middlesbrough, TS4 3BW England.
Phone 01642 854869 Fax 01642 854636
Email: [email protected]

Saving lives is the primary responsibility of secondary care services. Many patients arrive in hospitals when they are acutely ill and are hoping for rescue treatment that will save their lives, but also deal with the primary cause of the acute illness. It is therefore important that all staff involved in the care of such patients is adequately trained and proficient in delivering that service.

Resuscitation can be defined as the act of reviving. Many of our patients who are acutely ill do require resuscitation, if further treatment is to be effective and successful. Thus, the necessity for resuscitation is not questionable.

In Mulago teaching hospital many children are admitted via the acute care unit (assessment unit) and babies in the maternity unit as well as those in special care baby unit do require resuscitation. In this paper I have tried to discuss the various components of resuscitation, provide experience of the training programme, that has recently been performed and the results.