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.
|