African Journals OnLine
East African Medical Journal

PROPHYLACTIC EFFECT OF MULTI-HERBAL EXTRACT ‘AGBO-IBA’ ON MALARIA INDUCED IN MICE

C. Nwabuisi, M.B, BS, MSc, FMCPATK, Department of Medical Microbiology and Parasitology, Faculty of Health Sciences, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria

Objective: To determine the efficacy of a multi-herbal preparation extract of ‘Agbo-Iba’ on rodent malaria induced in mice.

Design: An experimental design in which mice were divided into four groups A,B,C,D representing control, prophylactic, chloroquine and ‘Agbo-Iba’ groups respectively. Each mouse was intraperitonally inoculated with Plasmodium yoelii nigeriensis and treated with oral herbal extract or chloroquine syrup depending on group.

Setting: College of Medicine of the University of Lagos Medical Microbiology and Parasitology Laboratory.

Subjects: One hundred and twenty male and female albino mice aged 10-12 weeks with an average weight of 25 grams.

Main Outcome measures: The herbal extract was effective, preventing the development of parasitaemia in the prophylactic group of mice.

Results: After intraperitoneal inoculation of Plasmodium yoelii nigeriensis, a prepatent period of two days was observed before parasitaemia was established in all but the prophylactic group of mice. Induced infection was promptly aborted with oral chloroquine treatment in group C, while in groups A and D, infection terminated fatally. Group B mice appeared normal throughout the duration of investigation with 100% survival rate.

Conclusion: ‘Agbo-Iba’ extract has some prophylactic action against malaria induced in mice with no apparent significant side effects.

MISSED OPPORTUNITIES AND CARETAKER CONSTRAINTS TO CHILDHOOD VACCINATION IN A RURAL AREA IN UGANDA

F. Tugumisirize, MBChB, MMed, J.K. Tumwine, MBChB, MMed, FRSH, Ass. Professor and E.A. Mworozi, MBChB, MMed, Department of Paediatrics and Child Health, Makerere Medical School, P.O. Box 7072, Kampala, Uganda

Request for reprints to: Prof. J.K. Tumwine, Department of Paediatrics and Child Health, Makerere University Medical School, P.O. Box 7072, Kampala, Uganda

Background: Despite concerted support to vaccination programmes, coverage remains low. While health service reasons for this are known, there is little information on caretaker constraints to vaccination in Africa.

Objective: To establish the prevalence of missed vaccination opportunities and caretaker constraints to childhood vaccinations.

Design: Cross-sectional descriptive study.

Subjects: Caretakers of 408 children aged 12-23 months were interviewed.

Setting: Kiyeyi, a rural area in Eastern Uganda.

Results: Complete vaccination coverage by card was 26.7% while by history and card it was 44.6%. Of the 215 eligible children who sought treatment in a health facility where vaccination could be offered, 59.6% missed an opportunity to be vaccinated while 24.4% of the children missed an opportunity during routine vaccination sessions. Reasons for non-completion of vaccination included caretaker ‘not bothered’, being busy, or illand fear of rude health workers. While most caretakers were aware of vaccination and its benefits, none knew the immunisation schedule. The major caretaker constraints were low level of formal education, fear of vaccine side effects, and perceived contraindications to vaccinations.

Conclusion: Promotion of formal education for girls and educating mothers and health workers on the timing of vaccinations, their side effects and management might contribute to higher vaccination coverage.

PREVALENCE OF VITAMIN A DEFICIENCY AMONG PRE-SCHOOL AND SCHOOL-AGED CHILDREN IN ARSSI ZONE, ETHIOPIA

Y.T. Asrat, BSc, MSc, Ethiopian Health and Nutrition Research Institute, P.O. Box 5654, Addis Ababa, Ethiopia; Applied Nutrition Programme, Department of Food Technology and Nutrition, University of Nairobi, P.O. Box 442, Uthiru, Nairobi, Kenya, A.M. Omwega, BSc., MSc., PhD, and J.W.G. Muita, MBChB, MMed (Paed), MPH, Applied Nutrition Programme, Department of Food Technology and Nutrition, University of Nairobi, P.O. Box 442, Uthiru, Nairobi, Kenya

Request for reprints to: Dr. A.M. Omwega, Applied Nutrition Programme, Department of Food Technology and Nutrition, University of Nairobi, P.O. Box

442, Uthiru, Nairobi, Kenya

ABSTRACT

Objective: To investigate vitamin A status of pre-school and school aged children in the study area.

Design: Cross-sectional.

Setting: Arssi, Ethiopia.

Subjects: Four hundred and two children.

Results: Night blindness, Bitots spot, corneal xerosis, corneal ulceration and corneal scar were observed in 7.2%, 2.2 %, 0.2%, 0.5%, and 0.5% of the children respectively. The prevalence of xerophthalmia was higher in school aged children than pre-school children (P< 0.0001). Based on the WHO recommended cut-off level, serum retinol levels were in the “low” range (<20µ1/d1) in 51% of the children.

Conclusion: The results indicate that vitamin A deficiency (VAD) is a public health problem in Arssi, with higher prevalence among school aged children than pre-school children.

IRRITABLE BOWEL SYNDROME IN KENYANS

G.N. Lule, MBChB, MMed, Associate Professor and E.O. Amayo, MBChB, MMed, Senior Lecturer, Department of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya

Request for reprints to: Prof. G.N. Lule, Department of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya

Objective: To study the prevalence and clinical presentation of Irritable Bowel Syndrome (IBS) in Black Africans in Nairobi, Kenya.

Design: A retrospective study.

Subjects: Case files of all patients presenting with abdominal pain.

Main Outcome Measures: Prevalence of IBS using modified Manning’s Symptomatic criteria in 223 consecutive adult patients presenting with abdominal pain and discomfort who had normal clinical findings and normal general and gastrointestinal investigations.

Results: Out of the 3472 patient files screened, there were 281 patients who fitted the diagnosis of Irritable Bowel Syndrome giving an overall prevalence of 8%. The mean age was 40 years with range of 11 to 75 years with a peak prevalence in the 3rd decade. The male to female ratio of 1.4:1 being statistical significant at a p value of 0.010. There was not statistical significant difference between the males and females in constipation and diarrhoea at p value of 0.84 and 0.82 respectively. Fifteen percent of the patients were either on antidepressants or had been seen by a psychiatrist. Nine percent had undergone laparatomy for the abdominal pain.

Conclusion: The Black African patient is equally as exposed to Irritable Bowel Syndrome as is his counterpart in the western world and has similar morbidity patterns. The syndrome may account for over 10% of patients with abdominal pain presenting to gastroenterologists in Africa. Proper attention to symptomatology may lead to clinching the diagnosis without resorting to many unnecessary and expensive investigations.

ANTHRAX REVISITED

K.M. Bhatt, MBChB, MMed, DTM&H, MSc. and S.M. Bhatt, MBChB, MMed, MPh., Department of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya

Request for reprints to: Prof. K.M. Bhatt, Department of Medicine, College of Health Science, University of Nairobi, P.O. Box 19676, Nairobi, Kenya

Background: Anthrax is an ancient disease affecting animals and humans. Sporadic cases of anthrax and small epidemics have been seen from time to time in different parts of the world and in Africa. However many clinicians are not very familiar with the various presentations and management of anthrax. It is relevant for the health care workers to re-familiarise themselves with all aspects of anthrax, with the impending threat of bioterrorism.

Objective: To familiarise healthcare workers on all aspects of anthrax.

Study Selection: To describe epidemiology pathogenesis, clinical features, management and prevention of anthrax including measures to take when weapons grade anthrax is suspected.

Data synthesis: Three forms of the disease are recognised, cutaneous, inhalational and intestinal. Cutaneous anthrax is the most common form. Inhalation anthrax is the most severe form of anthrax. The treatment of anthrax in most cases is penicillin, however with the threat of bioterrorism, intentional releases of anthrax spores in the environment has caused much concern. Weapons grade anthrax of more virulent strain and resistant to commonly used antibiotics is possible.

Conclusion: In view of the different clinical presentations and outcomes it is important that health care workers re-familiarise themselves with the disease and in the event of bioterrorism are able to take appropriate measures.

REVIEW OF EIGHT CASES OF INSULIMONA

H. Besim, MD., A, Korkmaz, MD., Asoociate Professor, O. Hamamci, Department of 6th Surgery and S. Karaahmetoglu, Department of Endocrinology, Ankara Numune Teaching and Research Hospital

Request for reprints to: Dr. H. Besim, Kennedy Caddesi 128/7, GOP 06700-Ankara, Turkey

Objective: To review patients records operated with the diagnosis of insulinoma and to discuss their clinical presentations, diagnostic and therapeutic modalities.

Design: Retrospective review of patients records.

Setting: Ankara Numune Teaching and Research Hospital, Turkey.

Subjects: Eight cases were operated in the Department of 6th Surgery, Ankara Numune Teaching and Research Hospital between 1994 and 2000. All patients had neuroglycopenic symptoms. Six patients had blood glucose levels of lower than 50 mg/dL during the admission. The other two patients had hypoglycaemia in the prolonged fasting test. Serum insulin/glucose ratio was diagnostic in all patients except one. Abdominal ultrasonography and computerised tomography could successfully localise the tumour in one case. In six patients tumours could be localised by endoscopic pancreatic ultrasonography. In one patient none of the studies could localise the tumour. Three tumours were located at the pancreatic head, one in the neck, two at the body and two at the tail. All tumours except one were palpable. Enucleation was the procedure of choice in four cases and distal pancreatectomy was the procedure of choice in four.

Results: Post-operative course was uneventful in seven patients. One patient died due to intra-abdominal sepsis. Hypoglycaemia was controlled in all patients after the surgery.

Conclusion: Surgery is the mainstay of treatment of insulinoma. Enucleation should be the procedure of choice if possible. Endoscopic pancreatic ultrasonography has promising results and may replace invasive angiographic studies in the future.

SURGICAL ADMISSIONS TO THE RIFT VALLEY PROVINCIAL GENERAL HOSPITAL, KENYA

N. Masiira-Mukasa, MBChB (Muk), MMed (Surg), Consultant Surgeon, Rift Valley Surgical Consultation Clinic, P.O. Box 10178, Nakuru and B.R. Ombito, MBChB (UoN) MMed (Surg), Consultant Surgeon, Rift Valley Provincial General Hospital, P.O. Box 71, Nakuru, Kenya

Request for reprints to: Dr. N. Masiira-Mukasa, Consultant Surgeon, Rift Valley Surgical Consultation Clinic, P.O. Box 10178, Nakuru, Kenya

Objective: To describe the pattern of surgical admissions to the Rift Valley Provincial General Hospital and in particular the epidemiologic characteristics of trauma admissions.

Design: Retrospective study (1st January 1998 – 31st December 1999).

Setting: Rift Valley Provincial General Hospital, Nakuru.

Subjects: All patients admitted to the various surgical wards (excluding eye-patients) during the stated period and whose medical records were available and complete.

Methods: Medical records (files) of all surgical patients admitted during the period of study were retrieved using admission data from casualty, surgical out-patient and Annex Hospital registers. Further medical data was obtained from wards admission registers, nurses report books and records from theatre and radiology books. A special data-form was used to collect the required information. The data was subjected to simple statistical analysis.

Results: There were 5907 surgical admissions of whom 3411 cases seventy three point five percent were trauma admissions, 1499 cases (25.4%) were non-traumatic emergency surgical admissions and 997 cases (16.8%) were elective surgical admissions. 73.5% of all trauma admissions were males and 57.6% were in the 21-60 year age-group. The most common injuries were soft-tissue injuries, fractures, burn injuries and head injuries, while the leading causes of trauma were road traffic accidents (32.7%), assaults (23.8%), falls (15.5%) and burns (13%). Fifty one point seven percent of all performed surgical operations were trauma-related. The mean length of hospital stay for trauma patients was 10.4 days. Trauma was the leading cause of death (6.6%) among all surgical admissions.

Conclusion: Trauma, particularly due to road traffic accidents and violence is a growing public health problem in this region that urgently calls for specific intervention measures. Further studies of disability levels as well as costs of trauma care are recommended.

EVALUATION OF 25-GAUGE QUINCKE AND 24-GAUGE GERTIE MARX NEEDLES FOR SPINAL ANAESTHESIA FOR CAESAREAN SECTION

C.O. Imarengiaye*, MBBS, FWAC, Lecturer and Honorary Consultant and N.P. Edomwonyi, MD, FMCA, Lecturer and Honorary Consultant, Department of Anaesthesiology, University of Benin Teaching Hospital, P.M.B. 1111, Benin City, Nigeria

*Now a Clinical Fellow in Obstetric Anaesthesia, Mount Sinai Hospital/University of Toronto, Toronto, Ontario, Canada

Request for reprints to: Dr. C.O. Imarengiaye, Department of Anaesthesiology, University of Benin Teaching Hospital, P.M.B. 1111, Benin City, Nigeria

Objective: To compare the insertion characteristics and rate of complications between 25-gauge Quincke and 24-gauge Gertie Marx needles.

Design: Prospective, randomized.

Setting: University of Benin Teaching Hospital; a university-affiliated tertiary centre.

Subjects: Parturients (ASA 1 and 2) scheduled for elective caesarean section. They were randomly assigned to receive spinal anaesthesia with either 25-gauge Quincke needle or 24-gauge Gertie Marx needle. The patients with abnormal spaces, coagulopathy, infection, pre-eclampsia/eclampsia or obesity were excluded.

Main Outcome Measures: The number of attempts at successful identification of the spinal space, intraoperative complications, incidence of postdural puncture headache (PDPH), non-postdural puncture headache (NPDPH) and backache.

Results: Sixty women were studied. The 24-gauge Gertie Marx needle resulted in more successful location of the spinal space on the second attempt (P<0.05). Non-postdural puncture headache was seen in 43% of the study population. PDPH was seen in 10% of the Quincke group and none in the Gertie Marx group. There was no difference in the incidence of backache in both groups.

Conclusion: The ease of insertion and low incidence of PDPH with the Gertie Marx needle may encourage trainee anaesthetists to use this needle for caesarean section.

RHINOCEREBRAL MUCORMYCOSIS: CASE REPORT

J. F. Onyango, BDS, MSc, FDSRCS, Senior Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, J. K. Kayima, MBChB

, MMed, Senior Lecturer, Department of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi and W.O. Owen,

MBChB MMed, Senior Consultant, Department of Ophthalmology, Kenyatta National Hospital, P.O. Box 20723, Nairobi, Kenya

Request for reprints to: Dr. J. F. Onyango, Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, University of Nairobi, P.O. Box

19676, Nairobi, Kenya

Rhinocerebral mucormycosis is a rare, fulminating opportunistic fungal infection caused by a fungus of the order mucorales. These fungi are ubiquitous, subsisting on decaying vegetation and diverse organic material. Although the fungi and spores of mucorales show minimal intrinsic pathogenicity towards normal persons, they can initiate aggressive and fulminating infection in the immune compromised host. Because rhinocerebral mucormycosis occurs infrequently it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation. We present a patient with classical presentation of rhinocerebral mucormycosis involving the paranasal sinuses, the orbit and cranial base who, was treated by a combination of aggressive surgical and medical therapy and subsequently had surgical repair of the oral defect. The purpose of this presentation is to draw attention to the clinical presentation and pathogenesis of rhinocerebral mucormycosis and to emphasise the need for high index of suspicion in its diagnosis and management.