African Journals Online
The Central African Journal of Medicine

ABSTRACTS Vol.45. No.5. May 1999

The Central African Journal of Medicine, Vol. 45, No. 5. 1999 pp. 110

ORIGINAL ARTICLES

Trauma and mental health problems of Sudanese refugees in Uganda

K PELTZER

Objectives: To determine the extent of trauma and mental health problems.Design: Screening surveysSetting: Sudanese refugee communities in Northern Ugandan camps.Subjects: 100 adult refugees, 44 ex-soldiers, 60 patients at camp outpatient health facilities, 63 traditional healers' patients and 56 refugee children.

Main Outcome Measure: Rate of trauma.Results: The most common trauma events experienced by 100 adults were forced isolation from others (94%), forces separation from family members (91%) and lack of food or water (83%). Thirty two percent of the adults suffered post traumatic stress disorder (PTSD). Among the 56 children, 12 (20%) suffered from a chronic PTSD. Forty four ex-soldiers scored a median of 74.6 (Q=62.3; Q=79.1) on the depressive scale of the Hopskins Sympton checklist. Out of 60 outpatients at a dispensary, 12 (20%) has psychological disorder. Out of a total of 63 patients attending traditional and faith healers' facilities, 26% suffered from PTSD and 39% from depressive disorder.

Conclusion: High rates of trauma and psychosocial problems were found among Sudanese refugees in Uganda.

The Central African Journal of Medicine, Vol. 45, No. 5. 1999 pp. 114

Non-traumatic paraplegis in a Zimbabwean population – a retrospective survey

O PARRY, E BHEBHE, L F LEVY

Objective: To ascertain the aetiology of non-traumatic paraplegia in a Zimbabwean population and to compare findings with other studies from Africa.

Design: Retrospective survey over a six year period.

Setting: National Rehabilitation Centre, Ruwa, Zimbabwe.

Subjects: 159 patients referred to the National Rehabilitation Centre with non-traumatic paraplegia.

Results: The commonest causes of non-traumatic paraplegia were neoplasms (28% of cases) of which a third were metastatic, followed by tuberculosis (TB) (27%). Transverse myelopathy of unknown aetiology was diagnosed in 11% of cases and 6% had Guillan Barré syndrome. Miscellaneous conditions included: degenerative bone and joint conditions, degenerative cord disorders and infections. In 7% of cases no diagnosis was reached. On admission all patients were confined to wheelchairs. On discharge 49% had regained some degree of mobility. A year after discharge 48% were known to be alive and 18% had died. The fate of 34% was not known.

Conclusions: The aetiology of non-traumatic paraplegia in a Zimbabwean population is similar to that reported from other African countries, with tumours and tuberculosis accounting for over half the cases. Survival appears to be related not only to the primary condition but also to the severity of the disability.

The Central African Journal of Medicine, Vol. 45, No. 5. 1999 pp. 119

Lung function status of some Nigerian men and women chronically exposed to fish drying using burning firewood

E J PETERS, R A ESIN, K K IMMANANAGHA, S SIZIYA, E E OSIM

Objective: To determine the lung function status of some Nigerian men and women chronically exposed to fish drying using burning firewood.

Design: Case control study.

Setting: Ibaka, Utaewa and Ikanga fishing settlements.

Subjects: 183 males and 192 females engaged in fishing, aged 20 to 45 years who have been exposed for a minimum of five years as cases. The control group comprised sex matched male (142) and female (152) Nigerians from the same area who were not exposed to any known air pollutant.

Main Outcome Measures: Lung function indices: FVC, FEV, FEV% and PEFR.

Results: Lung function indices were significantly lower in men engaged in fishing than in their controls: FVC [mean (SD): 2.98 (0.20) vs 3.52 (0.29), p<0.001]; FEV [2.08 (0.18 vs (0.25), p<0.001]; FEV% [69.8 (3.1) vs 80.2 (6.7), p<0.001]; and PEFR [335 (22) vs 592 (99), p,0.001}, respectively. Similarly, lung function indices were lower in females in the fishing industry than in their controls: FVC [2.42 (0.07) vs 3.02 (0.24), p<0.001]; FEV [1.70 (0.09) vs 2.55 (0.21), p<0.001]; FEV% [72.9 (3.2) vs 84.4 (6.7), p<0.001]; and PEFR [298 (22) vs 418 (34), p,0.001].

All the lung function indices (expect FEV%) of the fishermen and women declined significantly (p<0.001) with their duration of exposure. The results showed a predominantly mixed pattern (restrictive and obstructive) of respiratory defect. There were higher prevalences of respiratory and other symptoms among the cases than the controls. The respiratory symptoms included cough with sputum, chest pain, dyspnoea catarrh and sneezing and unproductive cough. Other symptoms were eye and skin irritation, internal heat and headache.

Conclusions: Chronic exposure to fish drying using burning firewood can impair lung function and cause respiratory and other symptoms.

The Central African Journal of Medicine, Vol. 45, No. 5. 1999 pp. 124

Radical radiotherapy for carcinoma of the cervix – the Zimbabwean experience

N NDLOVU

Objective: Carcinoma of the cervix accounts for over 30% of all female malignancies in Zimbabwe. Patients treated with radiotherapy tend to have to have advanced disease. This study examines some presentation patterns, radiotherapy treatment parameters, outcomes of treatment and identifies some prognostic factors in this set up.

Design: Retrospective study.

Setting/Subjects: The study was undertaken on all patients (273) who presented to the Parirenyatwa Hospital Radiotherapy Centre (RTC) between November 1990 and December 1991 and diagnosis of cervical carcinoma. Of these patients 93 were suitable for radical treatment and they were studied.

Main Outcome Measures: Complete remission rates in relation to total dose given and stage of disease, incidence of acute complications, local recurrence and development of metastases.

Results: Of 93 patients studied 72 (77.4%) were Stages I and II and 21 (22.6%) were stage III. Fifty nine percent of the patients gave a history of three to eight months symptom duration and 21.5% symptom duration longer one year. The mean length of follow up time was 13.4 months. The overall complete remission (CR) rate 49%. Ninety seven percent of patients achieving a CR had received 70 Gy or more as total dose to Point A. Patients with both pelvic wall and lower one third vaginal involvement (Stage A+B) did more poorly than other Stage III patients. Acute complications were mainly and seen in patients whose overall treatment time was under seven weeks. Most recurrences and metastases occurred within one year of completion of treatment.

Conclusion: It is only a minority of patients (34.1%) that present to the Radiotherapy Centre with cervical carcinoma who are suitable for radical treatment. These are patients who become aware of their symptoms early. Treatment achieves a good complete remission rate. Follow up of treated patients is poor. The sub group of patents with Stage III A+B must be recognised for their poorer response compared to other patients with Stage III disease.

The Central African Journal of Medicine, Vol. 45, No. 5. 1999 pp. 127-8

CASE REPORT

Pneumocystic carinii Pneumonia (PCP) at Gs-Rankuwa Hospital

P P SEIN, M O MZILENI, A A HOOSEN

Pneumocystis carinii is recognised as one of the leading caused of death in AIDS patients in developed countries but its role in this regard in developing countries appears to be less prominent. Sub-Saharan African countries, in spite of their high HIV prevalence, have hardly recorded any cases. We report the first microbiologically proven case of PCP in an adult patient at Ga-Rankuwa Hospital.

A 37 year old African woman was referred to Ga-Rankuwa Hospital from the local clinic for chest infection with a non productive cough that had not responded to conventional treatment. On admission, she was febrile, emaciated and in respiratory distress with oral thrush. Chest radiography showed diffuse bilateral infiltrations and a preliminary diagnosis of a typical pneumonia and tuberculosis was made. The patient was begun on penicillin, gentamicin, cotrimoxazole and anti-tuberculosis therapy.

Laboratory investigations revealed a low haemoglobin, positive HIV test (after counselling) and Pneumocystis carini trophozoites and cytes in the vronchoalveolar larvage specimen. In spite of appropriate treatment the patient died with three days.

One wonders whether the outcome for this middle aged woman with advanced HIV infection would have been different had appropriate cotrimoxazole therapy been administered at the primary health care centre. It must be noted that PCP may no longer be a rare disease in sub-Saharan countries and intensive investigations should be carried out to avoid losing patients with treatable infectious diseases.

The Central African Journal of Medicine, Vol. 45, No. 5. 1999 pp. 129

CASE REPORT

Partial atrioventriculae septal defect causing confusion with rheumatic heart disease in children in Harare – case reports

I-E PAZVAKAVAMBWA

Four cases of partial atrioventricular septal defect (ATSD) which had been confused with rheumatic heart disease are presented. The need for a full clinical and echocardiographic assessment to reduce this confusion and avoid potentially harmful therapy is highlighted in the report.