African Journals Online
The Central African Journal of Medicine

ABSTRACTS (Vol.45. No.7)

The Central African Journal of Medicine, Vol. 45, No.7, 1999 pp: 169-173

Risk factors for neonatal mortality: Harare Central Hospital Neonatal Unit- Zimbabwe

RA KAMBARAMI, P MATIBE, D PIRIE

Objective: To assess risk factors for neonatal mortality in a tertiary level neonatal unit.
Design: Case control analysis of routine neonatal data for 1998.
Setting: Harare Central Hospital Neonatal Unit.
Subjects: All neonates delivered at Harare Maternity Hospital and admitted to the neonatal unit for care between January and December 1998.
Main Outcome Measure: Neonatal mortality in hospital.
Results: A total of 5 305 neonatal admissions were studied of which 19.3% died in hospital. The median age at death was two days (Q₁=1, Q₃=3) and the median age at hospital discharge was 3 days (Q₁=1,Q₃₌6). Risk factors for mortality were un-booked mother odds ratio (OR) 2.36 (95% CI= 1.98 to 2.81), breech delivery OR: 1.76 (95% CI= 1.39 to 2.22), low birth weight OR: 4.67 (95% CI=3.92 to 5.57), prematurity OR: 2.36 (95% CI= 2.09 to 2.66), congenital malformations OR: 2.80 (95% CI=1.72 to 4.53) and birth asphyxia OR: 1.79 (95% CI=1.51-2.12).
Being admitted for respiratory distress was associated with better survival OR: 0.22 (95% CI=0.17 to 0.28). Having a Caesarean section was also protective OR: 0.60 (95% CI= 0.47 to 0.76). Mother's age, parity, time of delivery and sex were not significantly associated with mortality odds ratios (95% CI) of 1.07 (0.86 to 1.3 4), 0.94 (0.78 to 1.13 ), 1.10 (0.93 to 1.30) and 0.89 (0.78 to 1.03 ) respectively. On regression analysis birth weight greater than 2 500 g, being un booked and breech delivery were predictive of mortality with OR (95% CI) of 0.99 (0.99 to 0.99), 1.31 (1.12 to 1.61) and 1.15 (1.04 to 1.28) respectively.
Conclusion: Low birth weight is the highest risk factor for mortality in this tertiary level hospital. Strategies targeted at low birth weight infants such as antenatal corticosteroid use, improved intrapartutn care, appropriate antibiotic use, improved efficiency and access to neonatal intensive care will have the most impact on neonatal mortality.

The Central African Journal of Medicine, Vol. 45, No.7, 1999 pp: 173-176

Highlights of extranodal lymphomas in Ibadan, Nigeria

JO THOMAS, BO OGUNSANWO, AO OGUNBIYI

Objective: To find out the pattern, trend and site distribution of extranodal lymphomas in Ibadan.
Design: Case series.
Setting: Department of Pathology, University College Hospital.
Subjects: All cases of malignant lymphomas with extranodal manifestations between 1981 and 1998.
Main Outcome Measures: Frequency and distribution of primary extranodal lymphomas.
Results: Extranodal lymphomas constituted 9.8% of non-Hodgkin's lymphomas (NHLs) during the period, increasing from 8.5% of NHLs from 1980 to 1990 to 12.4% from 1991 to 1998. During the entire 18 year period the nasal/nasopharynx, gastro-intestinal tract (GIT), tonsils and skin were the most commonly affected sites constituting 20.2%, 19.3 %, 14.3 % and 13.4%, respectively of all extranodal lymphomas. However, between 1980 and 1991 the GIT was the most commonly affected site (26.1%) followed by the nasal/nasopharyngeal region (11.6%). The involvement of the nasopharyngeal area during the second period of the study accounted for 32.0%.
Conclusion: The reasons for this changing trend are unknown and the significance of HIV infection in this regard is uncertain.

Central African Journal of Medicine, Vol. 45, No. 7, 1999, pp 176-178

Laparoscopic cholecystectomy in Black patients at Ga-Rankuwa hospital: a feasibility study

J MUYANGA, FO GHOOR, MCM MODIBA

Objective: To determine feasibility and outcome of laparoscopic cholecystectomy for Black patients in Ga-Rankuwa Hospital and to analyse the type of stones harvested.
Design: Cross sectional description study.
Setting: Ga-Rankuwa Hospital/Medunsa, South Africa.
Subjects: 79 patients who presented with cholelithiasis over a six year period.
Main Outcome Measures: Successful performance of laparoscopic cholecystectomy on the subjects.
Results: 39 laparoscopic cholecystectomies were performed with seven conversions (18% conversion rate). Forty open cholecystectomies were also performed. Post operative stay after laparoscopic cholecystectomy averaged 3.5 days and that of the open converted group 6.9 days (p<0,001).
Two patients returned with persistence of symptoms following laparoscopic cholecystectomy.
Twenty gall stones were analysed; 17 were of the cholesterol type and three of the black pigment type.
Conclusions: Laparoscopic cholecystectomy is feasible in the Black populace of Ga-Rankuwa Hospital. The majority of gallstones are of the cholesterol type.

Central African Journal of Medicine, Vol. 45, No. 7, 1999, pp 178-182

Beliefs about sexual relationships and behaviour among commercial farm residents in Zimbabwe

J CHIKOVORE, MT MBIZVO

Objectives: To describe beliefs of farm residents about sexual relationships and sexual behaviours within these relationships, as a basis for understanding how these beliefs may influence sexual behaviour; and to document gender differences in these beliefs.
Design: Cross sectional descriptive study.
Setting: Three commercial farms in Mashonaland Central Province, Zimbabwe.
Subjects: Purposive convenience sample of 218 adult (age 18+, or ever-married) residents on the commercial farms.
Main Outcome Measures: Views towards celibacy, wife inheritance, condom use, infertility, extra- marital affairs.
Results: 85% of respondents felt marriage was a cushion against HIV/AIDS. The majority (87.6%) viewed wife inheritance as improper; 37.6% felt that it facilitated the spread of HIV. Sixty two percent viewed condom use in marriage as unacceptable, and the majority of respondents felt that infertility was a problem in a person's life, with men being less likely than women to indicate this (OR: 0.26; 95% CI: 0.10 to 0.67). Male respondents expressed greater ability than their female counterparts to take protective steps in the event of suspecting STD/HIV/AIDS in their spouse. More male than female respondents felt they could leave marriage against perceived risk of infection with HIV from their partner (OR: 2.20; 95% CI: 1.22 to 4.00)
Conclusion: Perceptions of wife inheritance are positive when viewed against known ways of HIV transmission. There is need for further work to allow women to express their integrity as individuals in their relationship with men, as a strategy to promote their reproductive health. Determinants of condom acceptance need further understanding because condom use is one of the effective "ways of curbing the spread of HIV/AIDS.

Central African Journal of Medicine, Vol. 45, No. 7, 1999, pp 182-184

CASE REPORT

Sporadic Peutz-Jeghers syndrome in a Nigerian

SNC ANYANWU

Peutz-Jeghers syndrome is a rare condition of muco-cutaneous pigmentation and polyposis of the gut. Reports of its occurrence from the Black world have been infrequent.

A case is presented of an 18 year old Nigerian girl with pigmentation of the inner lips and soles of both feet, and recurrent attacks of abdominal pain necessitating two surgical procedures for intestinal obstruction with removal, in both cases, of polyps. Problems of complications and therapeutic modalities are discussed.

Central African Journal of Medicine, Vol. 45, No. 7, 1999, pp 184-186

CASE REPORT

Images in cardiovascular medicine: ruptured aneurysm of the sinus of Valsava

K BHAGAT, S MOMBESHORA, K NAIK, J HAKIM

A 27 year old woman presented with a two year history of cardiac symptoms. Echocardiographic examination revealed a ruptured aneurysm of the sinus of Valsava. Of note the patient was known to be HIV positive.

Central African Journal of Medicine, Vol. 45, No. 7, 1999, pp 187-189

REVIEW ARTICLE

Why beta blockers should be used in heart failure

K BHAGAT, JG HAKIM

Beta blockade may be beneficial for most patients with congestive cardiac failure (CCF) whether due to ischaemic or idiopathic dilated cardiomyopathy (DCM), although they are more effective if the CCF is idiopathic. Beta blockers are additive to angiotensin converting enzyme (ACE) inhibitors in their effects on CCF. Beta blockers have been shown in most studies to increase ejection fraction, cardiac output, and exercise capacity and are sometimes capable of resolving almost all the symptoms of heart failure. Treatment should begin with the smallest possible dose and this should be gradually increased to the maximum tolerated level.

Central African Journal of Medicine, Vol. 45, No. 7, 1999, pp 189-190

BOOK REVIEW and LETTER TO THE EDITOR

BOOK REVIEW

District laboratory practice in tropical countries

BY M CHEESBROUGH

This paperback book is very comprehensive. It deals with aspects of Medical Microbiology that are very essential to medical laboratory scientists.

The book is well designed and is presented in a very easy to understand manner, giving detailed pertinent information on laboratory diagnosis. The author carefully outlines information on specimen collection, processing and examination. Further, the author deals with safety procedures and equipment maintenance.

What is of great importance is that the author made sure that medical laboratory scientists will have adequate knowledge from this book. It is worth noting that several books on the topic lack some information on certain aspects of laboratory practice.

This book is easy to read and is suitable for both physicians, nurses and medical laboratory scientists, and I highly recommend this work to all practitioners in this field.

LETTER TO THE EDITOR

Informed consent for blood transfusion

Dear Sir,
The term informed consent achieved medical and legal currency in 1957 in a California case. A patient who became paralysed as a complication of a translumbar aortography, charged his physicians with negligence not only in the performance of the procedure but in failing to inform him of the risks involved.