African Journals OnLine
East African Medical Journal

Volume 79, No 4 April 2002

EDITORIAL - Current Management of Hypertensive Disease in Pregnancy

Z.P. Qureshi

ABSTRACT

Hypertensive disorders occur in 6-8% of all pregnancies with the incidence varying with geographic location. Studies conducted at Kenyatta National Hospital have noted a prevalence of 5.4% of hypertensive disease and 0.56% for eclampsia(1). Pregnant mothers with hypertension are predisposed towards the development of potentially lethal complications, notably abruptio placentae, disseminated vascular coagulation, cerebral haemorrhage, hepatic failure and acute renal failure. The baby may have intra-uterine growth retardation, suffer the consequences of being born too early, or die in utero.Causes of hypertensive disease especially pre-eclampsia remain unknown(2-4).

METHYLDOPA VERSUS NO DRUG TREATMENT IN THE MANAGEMENT OF MILD PREECLAMPSIA

E.M. ELHASSAN, O.A. MIRGHANI, A.B. HABOUR and I. ADAM

ABSTRACT

Objectives: To evaluate the efficacy of methyldopa in the treatment of mild pre-eclampsia, to prevent its progress and to investigate its effect on the pregnancy outcomes.
Designs: Randomised clinical trial.
Setting: Wad Medani Hospital in the central Sudan.
Subjects: Seventy primigravidae with single, alive baby of 28-36 weeks gestational age suffering from true mild pre-eclampsia were enrolled. The patients were randomised in two groups, treatment group who received methyldopa 750- 4000 mg/day (n=34) and a control group who received no treatment (n=36). All the (treatment and control) patients were drug followed as in-patients till the delivery, seen with their babies on the days 7, 42 after the delivery.
Main outcomes measures: The outcomes examined were, rise of the diastolic blood pressure to 110 mm Hg or more, occurrence of imminent eclampsia or the eclampsia, if the maturity could be achieved, occurrence of intrauterine growth retardation, abruptio placentae, mode of delivery, birth weight, placental weight, perinatal death, Apgar score and referral of the babies to the pediatrician.
Results: Three out of 34 (8.8%) of the treatment group had a rise in the diastolic blood pressure of 110 mm Hg, 18/36(50%) of the control had a rise in the diastolic blood pressure of 110 mmHg (p <0.05). Three out of thirty four (8.8%) of the treatment group developed imminent eclampsia, while 10/36 (27.8) of the control group developed imminent eclampsia (p<0.05). The maturity was achieved in 82.3% and 88.8% of the treatment and the control, respectively (p > 0.05). There were ten (14.2%) perinatal deaths, four of them in the treatment group, while six in the control (p > 0.05). There was no difference regarding birth weight, occurrence of intrauterine growth retardation, placental weight, mode of delivery, Apgar score, referral of the babies to the paediatrician. No patient developed eclampsia or abruptio placenta; there was no maternal death in both groups.
Conclusion: Methyldopa can prevent the progress of the mild pre-eclampsia to severe preeclampsia, without affecting the maturity, birthweight or the neonatal outcomes.

SOCIO-DEMOGRAPHIC AND REPRODUCTIVE CHARACTERISTICS OF MOTHERS DELIVERED AT THE KORLE-BU TEACHING HOSPITAL, GHANA

C. A. KLUFIO, A.T. LASSEY and B. D. ANNAN

ABSTRACT

Objectives: To measure selected socio-demographic and reproductive history characteristics of parturients at the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana, and to compute the risk load.
Design: A non-randomised cross-sectional survey.
Setting: Korle-Bu Teaching Hospital, Accra, Ghana.
Subjects: Korle-Bu Teaching Hospital, a tertiary institution delivers about 11000 women annually. From 1st November to 12th December 1994, 961 parturients were studied out of 978 delivered during the study period. Seventeen questionnaires were excluded from analysis because of errors and omissions that could not be corrected before the parturients' discharge from hospital.
Methods: The data sources were the patients' antenatal and delivery records, and a structured interviewer-administered questionnaire.
Results: More than three per cent of the subjects were less than 18 years, and 10.8% were over 35 years of age. Before the index delivery, 5.8% were grand multiparae. Eighteen per cent had never been to school. Seventeen per cent of parous subjects had experienced a perinatal death. The non-educated had significantly more births. The mean birth interval was less than two years in 26.4%. Fifty percent of those who had been previously pregnant had a history of at least one induced-abortion. Only 21.0% of the 961 subjects had ever-used a family planning method. The risk load was 53.0%.
Conclusion: Analysis of the historical factors of parturients surveyed at the KBTH showed a high risk load related mainly to lack of education. Formal education of the female child and family health education of our women are recommended to reduce the high past abortion rate and risk load. Additionally, postpartum tubal ligation for those who have completed their families will further reduce the risk load.

HAEMORHEOLOGICAL CHANGES DURING THE MENSTRUAL CYCLE

D.V. B. DAPPER and B.C. DIDIA

ABSTRACT

Objective: To determine changes in some haemorheological parameters: haematocrit (Hct), Whole Blood Relative Viscosity (WBRV), Erythrocyte Sedimentation Rate (ESR) and Fibrinogen Concentration (FC) during the menstrual cycle.
Design: Cross-sectional prospective study.
Subjects: Three hundred and fifty randomly selected female undergraduate students of the University of Port Harcourt, Port Harcourt, Nigeria.
Setting: Departments of Human Physiology and Anatomy, Faculty of Basic Medical Sciences, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria.
Main outcome measures: Significant variation (p< 0.05) were found in the values of all four haemorheological parameters assessed in the various phases of the menstrual cycle.
Results: Both haematocrit (Hct) and Whole Blood Relative Viscosity (WBRV) showed a similar trend, being highest in the ovulatory phase, followed by the luteal phase and follicular phase, and lowest in the menstrual phase. The Erythrocyte Sedimentation Rate (ESR) however, showed a pattern opposite to both Hct and WBRV, being highest in the menstrual phase followed by the luteal phase, and the follicular phase, and lowest in the ovulatory phase. The Fibrinogen Concentration (FC) was highest in the menstrual phase, followed by the ovulatory phase, the luteal phase and was lowest in the follicular phase.
Conclusion: The study shows that significant variation could occur in some haemorheological parameters during the phases of the normal menstrual cycle.

UTILISATION OF ANTENATAL AND MATERNITY SERVICES BY MOTHERS SEEKING CHILD WELFARE SERVICES IN MBEERE DISTRICT, EASTERN PROVINCE, KENYA

P.K. MWANIKI, E. W. KABIRU and G.G MBUGUA

ABSTRACT

Background: Utilisation of antenatal and maternity services is an important maternal health indicator. Increasing the proportion of mothers who are cared for in health facilities during pregnancy, childbirth and puerperium reduces the health risks to mothers and their children.
Objective: To determine the utilisation of antenatal and maternity services by mothers of Mbeere District bringing their children to the child welfare clinic.
Design: Cross-sectional, descriptive study.
Setting: Four rural health centres in Mbeere district.
Subjects: Two hundred mothers bringing their children aged one year and below to the child welfare clinic between September and December 2000.
Results: The proportion of mothers who utilised health facilities for antenatal and maternity services was 97.5% and 52%, respectively. Utilisation of health facilities for maternity services was significantly influenced by number of children and distance to health facility in that, as number of children increased, utilisation of maternity services reduced (~2=8.99; p=0.027; df=1). Mothers living less than 5km to a health facility utilised the services better than those living 5 km and beyond (~2=7.57; p=0.0059; df=1). Among the reasons given by the mothers (individual respondents and through Focus Group Discussions) regarding dissatisfaction with the services offered included shortage of drugs and essential supplies, lack of commitment by staff, poor quality of food and lack of cleanliness in the health facilities.
Conclusion: Coverage for antenatal services was high among mothers during their last pregnancy. However, only about half of the mothers interviewed utilised health facilities for maternity services (labour and delivery). The major constraints experienced by the mothers as they sought for the services (as reported by individual respondents and through Focus Group Discussions) included lack of transport, lack of money for transport and hospital fee and delay in admission to health facility once mothers report in labour. Lack of satisfaction with quality of care given could be the major demotivating factor in the use of health facilities for maternity services.

GUNSHOT INJURIES AS SEEN AT THE AGA KHAN HOSPITAL, NAIROBI, KENYA

H. S. SAIDI, J. NYAKIAMO and S. FAYA

ABSTRACT

Objective: To determine the prevalence, injury patterns, offender-victim characteristics, treatment and outcome of firearm-related injuries at the Aga Khan Hospital, Nairobi.
Design: Retrospective descriptive study.
Setting: The Aga Khan Hospital, a major private hospital in Nairobi.
Subjects: One hundred and seven patients who presented at the Aga Khan Hospital Accident and Emergency Department (January 1993- December 1998) with firearm injuries and were subsequently hospitalised. There were 97 males and 10 females aged four to 94 years. The mean age was 39 years.
Results: The peak incidence was in the 40-49 year age group. The male to female ratio was 10:1. The victim offender was a thug, thief or robber in 74.7% of cases. Law enforcement officers were responsible for 9.4% of the injuries. The Injury Severity Scores (ISS) ranged from one to 32 with mean score of 8.25. Injuries involving the extremities were the most prevalent. There were 31 major operations performed. The complication rate was 35.5%. Six (6.5%) of these patients died.
Conclusion: Gunshot injuries cause profound morbidity and significant mortality. A wider and larger study needs to be undertaken to elucidate the true nature of firearm injuries.

PATTERN OF CANCER IN MBARARA, UGANDA

H. R. WABINGA

ABSTRACT

Objective: To determine the pattern of cancer in Mbarara region.
Design: Retrospective descriptive study
Setting: Mbarara University of Science and Technology (MUST), Mbarara, southwestern Uganda.
Subjects: A total of 585 cancer patients diagnosed between 1995 and 1999 formed the basis of the analysis.
Results: The most frequent cancers observed among males in their descending order were Kaposis sarcoma (KS), stomach, Non Hodgkin Lymphoma (NHL), prostate and penis while in females cancer of cervix, breast, NHL, stomach and KS were found most frequent.
Conclusion: This pattern was different from that of Kyadondo county, Uganda in which stomach and penila cancer were found to be rare whereas oesophageal cancer was one of the commonest cancer in Kyadondo but rare in Mbarara. These differences which are discussed in detail could be attributed to both environmental and genetic factors.

CONTROL OF SCHISTOSOMA MANSONI BY THE SOAPBERRY ENDOD (PHYTOLACCA DODECANDRA) IN WOLLO, NORTHEASTERN ETHIOPIA: POST-INTERVENTION PREVALENCE

B. ERKO, F. ABEBE, N. BERHE, G. MEDHIN, T. GEBRE-MICHAEL, T. GEMETCHU and S. G. GUNDERSEN

ABSTRACT

Objectives: To record the effect of Endod soap and spraying of soaked Endod suspension on the prevalence of human schistosomiasis.
Design: A cross-sectional epidemiological study in which pre- and post-intervention parasitological results were compared.
Setting: Kemise, Bati and Harbu towns in northeastern Ethiopia.
Subjects: The study subjects included all members of the five per cent households systematically selected from the three towns.
Results: In Kemise town, where suspension of ground Endod was sprayed on the stream containing infected snails, the prevalence of the disease was reduced from 59% to 53% and the mean intensity of infection was reduced from 239 eggs per gram (EPG) of faeces to 99 EPG (p < 0.05). In Bati town where Endod soap approach was used, the respective reduction in the prevalence and intensity of infection was from 51% to 43% and from 195 EPG to 162 EPG (p<0.05). There was also a significant reduction of the disease in the control town probably due to the effects of praziquantel treatment and other factors.
Conclusion: The reduction achieved in the prevalence and intensity of schistosomiasis after an intervention period of four years was limited. This observation corroborates the fact that molluscicides must always be considered as supplementary to chemotherapy in the control of schistosomiasis. Although both approaches can be used, the spraying approach appears to be simpler and more feasible because two or three times yearly application of Endod suspension would suppress snail population and reduce transmission. Nevertheless, the choice as to what approach to use must be made on the basis of community preference, and for some soap-effect of Endod would be attractive

PATHOGENIC AGENTS OF CHRONIC SUPPURATIVE OTITIS MEDIA IN ILORIN, NIGERIA

C. NWABUISI and F.E. OLOGE

ABSTRACT

Objective: To determine the type and pattern of antibiotic susceptibility of the pathogenic micro-organisms causing chronic suppurative otitis media (CSOM) in our environment.
Design: A retrospective study of ear discharges from patients presenting consecutively with chronic suppurative otitis media.
Settings: University of Ilorin Teaching Hospital, a major referral centre in the Middle Belt region of Nigeria.
Main outcome measures: Bacterial isolates and their sensitivity patterns.
Subjects: Three hundred and seventy five patients aged between eight months and 70 years referred to the ear, nose, and throat clinic of The University of llorin Teaching Hospital were enrolled in the study.
Results: About 95.5% and 4.5% of the specimens were culture positive and negative respectively. The commonest bacterial aetiologic agents were Pseudomonas aeruginosa (26.0%) and Proteus spp (21.8%). Peak prevalence of 30.5% occurred among the 0-5 years age group. Seventy five per cent of isolates were gram-negative bacteria. Ofloxacin produced 100% sensitivity in both gram positive and gram-negative organisms tested. Colistin, ceftazidime and cefuroxime were highly active ( _80%) against the gram-negative bacteria while erythromycin and cloxacillin were very effective ( _80%) against the gram-positive isolates.
Conclusion: Chronic suppurative otitis media is still highly prevalent in our environment, affecting mainly children. The antibiotic susceptibility pattern of pathogenic isolates is different from those of other regions of Nigeria with increasing resistance recorded for some organisms. Hence, where possible and available, susceptibility tests should guide the management of CSOM in this environment, otherwise, ofloxacin if indicated and cloxacillin/ erythromycin may provide relief and delay emergence of resistant strains.

BURDEN OF MENTAL ILLNESS ON FAMILY MEMBERS, CARE-GIVERS AND THE COMMUNITY

Z. NYATI and M. B. SEBIT

ABSTRACT

Objective: To determine the burden of mental illness in the family/caregiver and the community.
Design: A cross-sectional descriptive study.
Setting: Rehabilitation centres, community day centres, resettlement villages and in the community in three provinces (Harare, Bulawayo and Masvingo), Zimbabwe.
Subjects: A sample size comprising sixty six care-givers and 126 patients were consecutively interviewed for the study.
Results: The care-givers had a mean ± s.d. age of 48.8 ±15.7 years. The majority were females (80.3%), married males, 76.9% (p=0.073), unemployed females, 94.3% (p=0.0004) and parents of the patients accounted for 51.5%. Many respondents believed that the cause of mental illness was witchcraft (31%), they experienced financial constraints (63.6%), and spent a lot of money on food (56.1%). Patients were younger than their caregivers, with a mean ± s.d. age of 37.7 ± 12.8 years and mostly on medications (91.3%).
Conclusion: The caregivers were mainly women and unemployed, whereas patients were mostly male. Caregivers were faced with multiple problems, but they were more tolerant to patients' behaviour than the community at large.

EFFECTS OF HYPOKINESIA ON CYCLIC NUCLEOTIDES AND HORMONAL REGULATION OF CALCIUM METABOLISM IN RATS

J.B.L CHEK and A.I. LANIKO

ABSTRACT

Objective: To study the dynamic of changes in the level of parathyroid hormone (PTH), calcitonin (CT), cyclic nucleotides (cAMP, cGMP) and calcium in the blood of rats, while in urine - phosphate, calcium and cyclic nucleotides
Design: Laboratory based experiment.
Setting: Laboratory in the Department of Biochemistry, Faculty of Medicine, University of Nairobi, Nairobi, Kenya and in the Department of Biochemistry, Kharkov State University, Ukrain Republic.
Results: Correlation between the changes in the parameters of study was shown. This supports the theory about the relationship between branches of hormonal systems (cyclic nucleotides - calcium), which perform the central role in the regulation of homeostasis. The results show that daily excretion of calcium and phosphate is age dependent in rats during the pathogenesis of hypokinesia: the values are higher in control groups. Changes in calcium in the blood and phosphaturia in the experimental animals of all ages were attributed to changes in the intensive re-absorption process within the bones during the readaptation period of hypokinesia.
Conclusion: Old rats have a higher ability to adaptation than younger experimental counterparts during hypokinesia.

MULTIPLE SUPERNUMERARY TEETH IN ASSOCIATION WITH MALOCCLUSION: REPORT OF TWO CASES

P.M. NG'ANG'A, S. W. GUTHUA and R.N. NG'ANG'A

ABSTRACT

Although multiple supernumerary teeth without any associated syndromes are rare, their occurrence can create a variety of clinical problems such as derangement of the occlusion, prevention of eruption of permanent teeth, damage to adjacent teeth, cystic degeneration and root resorption. Hence, clinical and radiographic evaluation of patients should always be thorough in order to detect their presence. Furthermore, because the clinical management of multiple supernumerary teeth pauses a great challenge to clinicians, timely, appropriate consultation and interdisciplinary approach to treatment is extremely important. We report two cases, a 14 year-old boy with eight and a 13-year-old girl with seven supernumerary teeth not associated with syndromes. In the boy, the teeth were bilaterally distributed in all quadrants in the premolar regions, and in the girl they were distributed bilaterally in the premolar regions in the mandible and bilaterally distal to the upper third molars. The clinical implications and management are discussed.

RHEUMATIC DISORDERS IN SUB-SAHARAN AFRICA

P. E. McGILL and G. O. OYOO

ABSTRACT

Objective: To review prevalence of rheumatic disorders in Sub-saharan Africa and in the context of current medical practice in the region assess the need for service and educational provision.
Data sources: Medline, (English, French). Pre-medline literature review from the 1950's (Current contents). Various conference reports including attendance at all three AFLAR (African League Against Rheumatism) congresses in the 1990's. Author's personal database. All cited references read in full.
Conclusions: The evidence shows rheumatoid arthritis and systemic lupus erythematosus to be increasing in frequency in the indigenous populations of East, Central and south Africa but remaining rare in West Africans. Gout is now more prevalent than ever throughout the subcontinent. HIV has spawned a variety of previously rare spondyloarthropathies (reactive arthritis, psoriatic arthritis, enthesopathy) and changed the epidemiology of pyomyositis and osteomyelitis. Osteoarthritis is a universal problem. Juvenile chronic arthritis is not rare and rheumatic fever is common. Acute and chronic locomotor problems associated with diverse entities such as leprosy, brucellosis, meningococcus, alpha viruses, parasites, fluorosis, rickets and haemoglobinopathies enhance diagnostic diversity and therapeutic and educational requirements.'suggestions made to address the challenge posed by the burden of rheumatic disorders.

SIZE, COURSE, DISTRIBUTION AND ANOMALIES OF THE MIDDLE CEREBRAL ARTERY IN ADULT NIGERIANS

O. E. IDOWU, M. T. SHOKUNBI, A. O. MALOMO and J. O. OGUNBIYI

ABSTRACT

Objective: To determine the size, course, distribution and anomalies of the middle cerebral artery in adult Nigerians.
Design: A retrospective study.
Setting: Department of pathology, University College Hospital, Ibadan between April and September 1999.
Subjects: One hundred middle cerebral arteries from patients' asymptomatic for central nervous system lesions, obtained at autopsy from fifty adult Nigerians were examined.
Results: The MCA arose as the wider of the two terminal branches of the internal carotid artery (ICA). Its mean diameter was 3.49 mm (CI = 3.39 - 3.59mm), while the mean predivision length was 15.43 mm (CI = 14.59 - 16.27mm). In 92% of specimens, the first branches were perforators. The early branches were destined solely to the temporal lobe pole in most hemispheres (85%). In most specimens, (81%) the main trunk bifurcated while in 13% it trifurcated. One accessory MCA, and the early branches were given off before the perforators in two middle cerebral arteries, making an incidence of anomalies of 3%. There was no aneurysm.
Conclusion: These results are similar to what has been described in the literature for Caucasians. It buttresses the assertion that anatomical anomalies of the MCA are rare. The rarity at autopsy of aneurysms of the MCA in asymptomatic Nigerian Africans is not explained by the gross morphology of this vessel.

Letter to the Editor-in-Chief - RE: EXPERIENCE OF ROAD TRAFFIC ACCIDENT VICTIMS AT THE NAIROBI HOSPITAL, SAIDI AND KAHORO

A. Gregori, P.K. Oroko, P.O'Connor

ABSTRACT

Dear Sir,

We were extremely interested to read the evaluation of the pre-hospital and initial care of the injured from road traffic accidents at the Nairobi Hospital It is unfortunate that this experience is the same as we have found throughout the Continent at many well known teaching hospitals as well as mission hospitals.

Scientific Letter to the Editor-in-Chief - RE: RHEUMATOLOGY IN KENYA: 2000 AND ONWARDS

G. O. Oyoo

ABSTRACT

Dear Sir,

In February 2000 at the invitation of the Kenya Association of Physicians, Paul McGill, consultant rheumatologist and Elizabeth McIvor, Rheumatology nurse specialist from Glasgow in Scotland and Girish Mody, professor of Rheumatology from Durban, Natal and Gill Brown Rheumatology nurse specialist from Cape Town South Africa travelled to Nairobi to conduct/participate in a series of postgraduate medical and nursing lectures and seminars culminating in a one day rheumatology symposium