African Journals Online
The Central African Journal of Medicine

ABSTRACTS (Vol.45. No.9)

The Central African Journal of Medicine, Vol. 45, No.9, 1999 pp. 231-4

ORIGINAL ARTICLES

Plasma HIV-1 RNA quantitation in HIV infected adult Zimbabweans

WS CHAKA, EN SIBANDA

Abstract

Objectives: To determine HIV-1 RNA levels in plasma of HIV infected Zimbabwean adults and to correlate these with CD4+ cell counts.

Design: Prospective observational study.

Setting: Specialist Immunology Laboratory, Harare, Zimbabwe.

Subjects: 49 consecutive HIV infected patients.

Main Outcome Measures: CD4+ cell counts and plasma HIV- 1 RNA levels.

Results: Based on the CDC HIV classification system five patients were in early stage infection, 15 in middle, 17 in late and 12 in advanced stage of infection. The median CD4+ cell count was 165/m L (Q₁= 4; Q₃= 866). The median HIV-1 RNA levels were 73097 RNA copies/ml (Q₁= 753; Q₃= 750 000). Eighty percent of the patients had HIV- 1 RNA levels > 10 000 copies/ml and 49% had > 100 000 RNA copies/ml. Median viral loads among the four categories of infection were found to be highly significant (p<0.001). The correlation between CD4+ cell counts and HIV-1 RNA copies for the 49 patients was highly significant (r= -0.76; p< 0.001).

Conclusions: High treatment HIV-1 RNA levels were determined in the majority of patients. A highly significant correlation was obtained between plasma HIV-1 RNA levels and CD4+ cell counts.

The Central African Journal of Medicine, Vol. 45, No.9, 1999 ,pp. 234-9

Post natal maternal morbidity patterns in mothers delivering in Gweru City (Midlands Province)

C ZISHIRI, LK SHODU, M TSHIMANGA, L NYIRONGO

Abstract

Objectives: To determine morbid conditions suffered by mothers during the first six weeks post delivery and risk factors associated with them in Gweru district.

Design: A cross sectional survey.

Setting: Gweru district hospital, Monomotapa, Mkoba 1 and Mkoba polyclinic.

Subjects: A consecutive sample of 201 mothers residing in Gweru district who delivered in these facilities during the month of June 1997.

Main Outcome Measures: Morbid conditions, magnitude and the risk factors.

Results: During follow up checks on recruited mothers, turn up rates were 82% and 63% at two and six weeks respectively. Fifty eight percent (58%) of the mothers reported at least one morbid condition within the first 24 hours post delivery and pain was a dominant feature. At two weeks, 56% of those who turned up predominantly presented with sepsis in areas of the reproductive tract. The figure fell to 35% among mothers who turned up at six weeks and a mixture of pain and sepsis were the predominant complaints.

Episiotomies caused a lot of pain post operatively and the risk of subsequent sepsis was high, (OR: 9; 95% CI 1.16<OR<69.7; p = 0.020). Statistically significant associations were found between backache and multiparity (O: 1.89; 95% CI: 1<OR<3.4; p = 0.040) and also between Caesarean section and some morbid conditions (O: 4.14; p = 0.002; 95% CI 2.05 < OR < 10.91). The prevalence rate of HIV was 29.4%. HIV positivity was associated with marriage below the age of 19 years (OR: 2.4; 95%CI 1.21 <OR<3.8; p = 0.024). There was no association between HIV serostatus and maternal morbidity. Use of traditional medication during pregnancy was reported by 42% of mothers, but it did not have any immediately observable intrapartum or postpartum effects. Similarly the place of delivery was not associated with post natal maternal morbidity.

Conclusion: The first two weeks post delivery were the most critical for the mother in terms of post natal maternal morbidity. Sepsis associated pain was the predominant condition. To improve the effectiveness of post natal care, a review within the first two weeks post delivery is an essential intervention, in addition to the routine six weeks check.

The Central African Journal of Medicine, Vol. 45, No.9, 1999 ,pp. 239-44

Abortion: attitudes and perceptions of health professionals in Zimbabwe

J KASULE, MT MBIZVO, V GUPTA

Abstract

Objective: To determine the attitudes of professional health workers (doctors, nurses, matrons, social workers and hospital administrators) to medically supervised abortion. Design: Cross sectional study.

Setting: Randomly selected health institutions - urban as well as rural in the eight provinces of Zimbabwe.

Subjects: Males and females - age range 18 to 70 years.

Main Outcome Measures: Perception of the problem of abortion by health professionals, their knowledge of the present abortion law and desire for change.

Results: The majority of doctors were supportive of medically supervised abortion (61.2% ) while the nurses were divided 43.2% for and 42.0% against but 14.8% were undecided. The administrators and social workers were supportive. Of the doctors 75% felt that the present abortion law was restrictive and 55.6% supported change. All health professionals agreed that the majority of women who present for abortion treatment are single. The surprising finding was that it is knowledge of the dire complications of unsafe abortion that determines one's attitude to abortion rather than religion.

Conclusion: By increasing single women's and adolescents' access to family planning services the incidence of unintended pregnancies which result in unsafe abortion with life threatening complications will be reduced. The present restrictive abortion laws which foster backstreet unsafe abortion need to be revised.

The Central African Journal of Medicine, Vol. 45, No.9, 1999 ,pp. 244-6

Patient acceptance of outpatient treatment for inguinal hernia in Jos, Nigeria

VM RAMYIL, BC OGNONNA, D IYA

Abstract

Background: Patient acceptability constitutes an important component of outpatient treatment for hernias. It is essential that patients are properly selected so that only those who need admission are admitted and cared for with the limited available resources. It is also equally important that those who qualify for outpatient care are adequately informed that there is no added risk attributable to outpatient treatment and that they are free to accept or reject such treatment.

Objective: To determine the acceptability of day care treatment for inguinal hernia in our environment.

Design: Prospective cross sectional study.

Setting: Jos University Teaching Hospital.

Subjects: 121 selected patients were randomized to undergo elective inguinal hernia repair either as outpatients (61 ) or inpatients (60).

Main Outcome Measures: Six weeks after operation, an assessment of patients' opinion was made as to their preferred method.

Results: 52 of 61 day cases and 24 of 60 inpatients preferred outpatient treatment, while two daycare patients and 36 inpatients preferred hospital admission (p< 0.001). Altogether, acceptability rate for outpatient treatment was 68.6%.

Conclusion: In carefully selected and adequately informed patients, outpatient elective inguinal hernia repair is readily acceptable.

Central African Journal of Medicine, Vol. 45, No. 9, 1999, pp 246-7

CASE REPORT

Non-pharmacological termination of a supraventricular tachycardia

K BHAGAT

Abstract

Patients with re-entrant supraventricular tachycardias frequently attend casualty departments for termination of their rhythm. With the advent of adenosine in the physician's pharmaceutical armoury, the ease and effectiveness of vagal stimulation is being forgotten.

Introduction

This report describes an occurrence when standard physiological techniques were ineffective in reverting the rhythm of a patient with rapid but haemodynamically stable tachycardia. Firm pressure in the right hypochondrium by the attendant physician during the relaxation phase of the Valsava manoeuvre was successful in ending the tachycardia.

Central African Journal of Medicine, Vol. 45, No. 8, 1999, pp 248-50

LETTERS TO THE EDITOR and CONTINUED HEALTH EDUCATION FOR THE PRACTITIONER

Low CD4 count in HIV negative malaria cases and normal CD4 count in HIV positive and malaria negative patients

DR JOCONIAH CHIRENDA

Dear Sir,
Six HIV patients who were malaria negative had their CD4 cell counts done. All the six patients had normal CD4 counts. However, seven HIV negative patients who had slide positive malaria were found to have very low CD4 lymphocyte counts of less than 100. A total of 101 malaria patients had their CD4 lymphocyte tests done (six were clinical malaria and 95 were slide positive malaria). A total of 58 (57.4%) of these patients had CD4 cell counts of less than 300. Patients who had CD4 lymphocyte counts of less than 300 and had dual infection with malaria and HIV were 47 (46.5%), (Table I).

CONTINUED HEALTH EDUCATION FOR THE PRACTITIONER
Hypertension in Pregnancy- 2 - eclampsia

K MAHOMED

Abstract

Eclampsia is a grand mal convulsion associated with pregnancy-induced hypertension. It is caused by cerebral hypoxia from intense vasospasm combined with cerebral oedema. CT scans show cerebral ischaemia from thrombosis and oedema. ¹

Introduction

Over one third of women who convulse have a record of normal blood pressure when last seen. Although in the UK convulsions occur antepartum (38%), intrapartum (18%) and post partum (44%), in developing countries the majority are antepartum.