African Journals OnLine
East African Medical Journal

Volume 80 No.7 July 2003
ABSTRACTS

Reproductive awareness behaviour and profiles of adolescent post abortion patients in Blantyre, Malawi

V.M. Lema, MBChB (Mak), MMed (Nbi), Professor and Head, Department of Obstetrics and Gynaecology, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi

Abstract

Background: Adolescent sexuality and its sequelae are now acknowledged as major public health, social and economic problems in Malawi, for which appropriate programmes and services are being designed and implemented.

Objectives: To identify the profiles of adolescent post abortion patients, their reproductive and contraceptive knowledge and factors related to the index pregnancy.

Setting: Queen Elizabeth Central Hospital, Blantyre, Malawi.

Design: Cross-sectional, descriptive study.

Methods: All adolescents treated for incomplete abortion, January to December 1997 were eligible. Data was collected by means of interviewer-administered questionnaire, one for each, during reproductive health education and/or post abortion contraceptive counseling and service provision. This was subsequently analysed using EPI-INFO 6.0 data analysis packages.

Results: Of the 465 adolescents treated during this period, 446 (95.9%) were enrolled in the study. Their mean age was 17.5 years (SD 1.3), that at menarche and sexual debut 14.3 years (SD 1.4) and 15.7 years (SD 1.75) respectively. The unmarried adolescents formed 43.9%, while students comprised 38.6% of the total. Their level and accuracy of knowledge on reproductive biology was poor. While their contraceptive knowledge was high, its use was very low, 70.9% vs 9.5% respectively. The number of sexual partners one had had ranged from 1 to 10 with a median of 1. The index pregnancy was reportedly unwanted by 45.1 %. The young (< 16 years), more educated, single and students were more likely to have unwanted pregnancy.

Conclusions: Sexual activity starts early in Malawi, with poor contraception, thus predisposing to unwanted pregnancy. Lack of appropriate reproductive awareness appears to be partly responsible for that. These need to be addressed through the national reproductive health programmes and services.

A randomised controlled trial of early initiation of oral feeding after Caesarean delivery in Mulago Hospital

D. Adupa, Obstetrician and Gynaecologist, Mulago Hospital, P.O. Box 7051 Kampala, Uganda, J. Wandabwa, Senior Lecturer and P. Kiondo Lecturer, Makerere Medical School, P.O. Box 7072 Kampala, Uganda

Request for reprints to: Dr. J. Wandabwa, P.O. Box 29524, Kampala, Uganda

Abstract

Background: The concept of early initiation of oral feeding after caesarean delivery is well tolerated by patients, yet not routinely practiced in Mulago Hospital. An effective postoperative dietary management schedule could have major implications on the management of maternal post-caesarean section mothers.

Objectives: To compare the effect of time initiation of oral feeding on acceptability, benefits and gastrointestinal functions in women who had undergone caesarean section in Mulago Hospital.

Design: A randomised controlled study.

Setting: Mulago Hospital.

Subjects: One hundred and ninety two women admitted on the postnatal ward after emergency or elective caesarean section for various indications and who satisfied the eligibility criteria were recruited and randomized into the study. Assignment to the early feeding group or routine feeding group was done randomly using a computer generated numbers. The early feeding group were encouraged to take sips of water within six to eight hours followed by oral soup or milk at least 150 millilitres at a time within 8 to 12 hours post operative under supervision. The routine group were managed by restricting oral intake for twenty four hours and administration of orals sips of water 24 to 48 hours post operative. The outcome measures were rate of ileus symptoms, post operative presence of bowel sounds, maternal pyrexia and acceptability and benefits of early feeding.

Results: The mean age, parity and gravidity were similar in the two groups. The study shows that women of the early feeding group had more rapid return of their bowel function with significant more shorter mean post operative time intervals to bowels sounds (24.2 hours versus 34.2 hours), passage of flatus (51.6 hours versus 62.1 hours) and bowel movement (67.8 hours versus 75.8 hours). The women who fed early, made more rapid recovery and expressed their interest in earlier hospital discharge. The findings significantly indicated that women in the early feeding group got out of bed (patient mobilisation) earlier (p = 0.001) than their control group (15.1 hours versus 17.8 hours). This could probably have been because of the adequate rehydration and improved early energy intake. In comparison those who were fed early required less number of bottles of intravenous fluids (5.0 bottles versus 7.0 bottles). The average hospital stay was similar and not statistically significant in both groups (5.5 days versus 6.0 days).

Conclusion: Early initiation of oral feeding after caesarean delivery is safe and well tolerated and can be implemented without an increase in gastrointestinal symptoms or paralytic ileus.

Puerperal complications of episiotomies at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

S. T. Sule MBBS, MPH, FWACS, Lecturer I/Consultant, S. O. Shittu, MBBS, FWACS, Dip. Rep. Health (Liv), FICS, Senior Lecturer/Consultant, Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Request for reprints to: Dr. S. T. Sule, Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Abstract

Objectives: To establish the epidemiological variables associated with episiotomies and their puerperal complications at Ahmadu Bello University Teaching Hospital Zaria, in order to institute appropriate management including preventive measures.

Design: A prospective cohort study.

Setting: Ahmadu cello University Teaching Hospital, Zaria, Nigeria.

Methods: A cohort of all consecutive patients that underwent vaginal deliveries during a 12- week period were followed up for six weeks in order to determine the distribution and determinants of episiotomy and its complications.

Results: The episiotomy rate was 35.6% of all vaginal deliveries. Episiotomies were significantly associated with primigravidity being performed in 88.5% of all primigravidae. The mean delivery-repair interval was 60.5 minutes. The most common puerperal complication of episiotomies was perineal pain that lasted an average of 5.5 days. Other complications included asymmetry (32.9%), infection (23.7%), partial dehiscence (14.5%), skin tags (7.9%), haemorrhage (5.3%) and extension of the incision (1.3%). The complications were not significantly associated with any potential risk factor.

Conclusion: In view of the very high episiotomy rate among primigravidae, it is recommended that the episiotomy rate among primigravidae be reduced by re-acquainting accoucheurs with the indications for episiotomy. Attention needs to be given to adequate pain relief for all women who have had an episiotomy and the delivery-repair interval in this unit should be reduced by provision of materials for episiotomy repair in the delivery suite.

Contraceptive practice among married market men in Nigeria

E.O. Orji, FMCOG, FWACS, Senior Lecturer/Consultant Obstetrician and Gynaecologist. and U. Onwudiegwu, FWACS, Professor/Obstesterician and Gynaecologist, Department of Obstetrics, Gynaecology and Perinatology, College of Health Sciences, Obafemi Awololwo University, Ile-Ife, Nigeria

Request for reprints to: Dr. E.O. Orji, Department of Obstetrics, Gynaecology and Perinatology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria

Abstract

Background: Until recently, family planning researchers and service providers had focused almost exclusively on women. Men are often seen as uncooperative and uninterested in family planning or reproductive health.

Objective: To investigate the contraceptive knowledge, attitude and practice among married market men.

Design: A cross-sectional survey.

Setting: llesa Main Market, Osun State, Nigeria.

Subjects: Four hundred and fifty married market men were interviewed between November 2000 and January 2001.

Main Outcome Measures: Level of awareness and utilisation, reasons for non-use, influence of socio-demographic variables.

Results: All the men were aware of family planning and 60.9% are currently using a form of contraception with their spouse. Reasons for non-contraceptive use by 39.1% of the respondents include: family size not yet complete, religious opposition, afraid of contraceptive failure, still searching for a male sex. Christianity and education were significantly associated with contraceptive use and knowledge (p< 0.05).

Conclusion: Men favour contraceptive use in Nigeria. Involving men by family planning providers is a winning strategy with benefits to both men and women.

Measles trends and vaccine effectiveness in Nairobi, Kenya

P. K. Borus DrPH,Senior Research Officer, Centre for Virus Research, Kenya Medical Research Institute, P. Cumberland MSc., Lecturer, London School of Hygiene and Tropical Medicine, S. Sonoiya MMed, Manager, Kenya Expanded Programme on Immunisation, J. Kombich MSc, Assistant Research Officer, P.M. Tukei MD., Chief Research Officer, Centre for Virus Research, Kenya Medical Research Institute and F.T. Cutts MD, Professor of International Health, Medical Research Council, Gambia

Request for reprints to: Dr. P. Borus, Centre for Virus Research, Kenya Medical Research Institute, P.O. Box 54628, Nairobi, Kenya

Abstract

Objectives: To determine morbidity and mortality from measles and to estimate measles vaccine effectiveness among children hospitalised with measles in two hospitals in Nairobi.

Design: A review of hospital records (index cards).

Setting: Kenyatta National Hospital and Mbagathi District Hospitals covering the years 1996-2000.

Method: A review of index cards for measles morbility and mortality was undertaken in the two hospitals. Measles data at the Kenya Expanded Programme on Immunisation covering both hospitals was analysed for vaccine effectiveness.

Results: The incidence of measles was unusually high in 1998 between July and November (monthly range 130-305), reflecting on the occurrence of an outbreak at that time. There was no definite monthly incidence trend of measles in 1996, 1997, 1999 and 2000. The median age of cases was 13 months (range 0-420 months) for Kenyatta hospital and 18 months (range 1- 336 months) for Mbagathi Hospital. Significantly, 29.8% of all cases were aged below nine months when routine immunisation for measles had not begun. The median number of days spent in hospital were five days (range 0-87 days) for Kenyatta and four days (range 1-13 days) for Mbagathi. The overall case fatality rate was 5.6% and was similar for both males and females. The overall measles vaccine effectiveness among measles cases admitted to Kenyatta and Mbagathi Hospitals was 84.1%.

Conclusion: The case admissions in Kenyatta and Mbagathi Hospitals suggest measles was prevalent in Nairobi over the latter half decade of the 1990’s. Apart from 1998 when there was an outbreak, the seasonality of measles was dampened. The 1998 outbreak suggests a build up of susceptible children the majority of whom were born in the last quarter of 1996. The high mortality may have had to do with the majority of cases presenting late when symptoms were already complicated and severe.

Prevalence of trachomatous trichiasis in the community of Alaba District, southern Ethiopia

A. Wondimu, MD, Certificate of speciality in Ophthalmology (AAU), Department of Ophthalmology and A. Bejiga, MD, Certificate of speciality in Ophthalmology (AAU), Diploma in Clinical Epidemiology and Biostatistics (Australia), Department of Ophthalmology, Faculty of Medicine, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia

Request for reprints to: Dr. A. Bejiga, Department of Ophthalmology, Faculty of Medicine, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia

Abstract

Background: Until the burden of active trachoma is reduced for a sustained period, trachomatous trichiasis (TT) will remain one of the major causes of blindness in Ethiopia. The magnitude of trichiasis as well as knowledge, attitude and practice of people with this condition in Alaba District is not known.

Objectives: To assess the prevalence of trachomatous trichiasis in the community and evaluate the knowledge, attitude and practice (KAP) of these cases.

Design: A community based cross-sectional study.

Setting: Alaba District, 365 Km from Addis Ababa, Ethiopia.

Results: Out of 3850 people who were screened, 104 (2.7%, 95% confidence interval (Cl): 2.2- 3.2) cases were found to have trichiasis of which females and males accounted for 79.8% (83/ 104) and 20.2%,(21/104) respectively. While all cases didn’t know the cause and risk factors for trichiasis, nearly all of them, 102 (98.1%), knew that surgical treatment could prevent blindness from trichiasis. Previously operated patients were reported to be the most important source of information regarding its management. Eighty two (78.8%) of them epilate the misdirected cilia. The cost of surgery and distance from eye care service were found to be the two main barriers preventing the cases from having surgery.

Conclusion: The prevalence of trichiasis greater than 1%, according to WHO, indicated that the community of Alaba District is facing a blinding trachoma. An increased public awareness regarding this common blinding disorder is required through health education. In addition, affordable and accessible surgical facility for trichiasis is needed in the area in order to prevent blindness.

Cryptosporidium oocysts in Ghanaian AIDS patients with diarrhoea

A. Adjei, PhD, Asociate Professor, Department of Pathology, M. Lartey, MBChB, FWACP, Lecturer, Department of Medicine, T.K. Adiku, PhD, Consultant, Department of Microbiology, University of Ghana Medical School, Korle-Bu, Accra, O. Rodrigues, MBChB, FWACP, Consultant, Department of Child Health, Korle-Bu Teaching Hospital, Korle-Bu, Accra, L. Renner, MBChB, FWACP, Consultant, Department of Child Health, Korle-Bu Teaching Hospital, Korle-Bu, Accra, E. Sifah, MBChB, FWACP, Specialist, Department of Child Health, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana, J.D. Mensah, MBChB, FWACP, Principal Medical Officer, Korle- Bu Polyclinic, Korle-Bu, Accra, Ghana, B. D. Akanmori, PhD, Asociate Professor, J. Otchere, Principal Medical Technician, B.K. Bentum, BSc, Research Assistant and K.M. Bosompem, PhD, Senior Research Fellow, Noguchi Memorial Institute for Medical Research, Legon, Accra, Ghana

Request for reprints to: Dr. K.M. Bosompem, Noguchi Memorial Institute for Medical Research, P.O. Box LG581, Legon, Accra, Ghana

Abstract

Background: Although Cryptosporidium spp. infections in acquired immunodeficiency syndrome patients (AIDS) with chronic diarrhoea have been reported in several African countries, there is no information regarding cryptosporidial diarrhoea in Ghanaian AIDS patients.

Objective: To investigate the occurrence of C. parvum and other gastrointestinal parasitic agents in Ghanaian AIDS patients with chronic diarrhoea.

Design: Prospective study of HIV/AIDS patients with diarrhoea over a nine month period.

Setting: Korle-Bu Teaching Hospital and Korle-Bu Polyclinic Accra, Ghana.

Results: Analysis of stool specimens from clinically diagnosed HIV/AIDS (n=2I; mean CD4 count was 288 cells per microliter, 95% confidence interval of 237 to 340 cells per microliter) and HIV-seronegative (n=27) patients revealed C. parvum in six (28.6%) of HIV/AIDS and 10 (37.0%) of the HIV-seronegative patients, respectively. Three other HIV/AIDS cases had other infections involving Strongyloides stercoralis 4.8% (l/21) and Salmonella spp. 9.5% (2/21). There was no concomitant association between C. parvum and any other parasites found. Also, no enterobacteria was found in the HIV-seronegative patients.

Conclusion: This study demonstrates the prevalence of Cryptosporidium sp. in both HIV/ AIDS and HIV-seronegative individuals in Ghana. However, there was no statistical association between cryptosporidiosis and HIV/AIDS (p>0.05).

A new classification of osteomyelitis for developing countries

B.A. Solagberu, MBBS, FWACS (Ortho), Consultant Orthopaedic and Trauma Surgeon, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria, P.O. Box 4377, Ilorin 240001, Nigeria

Abstract

Background : The term osteomyelitis (OSM) was first coined by Nelaton in 1844. Waldvogel et al, Cierny-Mader, May et al classifications of OSM from developed countries and Meier et al’s from Nigeria have been described.

Objective:This new classification was developed to highlight significant pathology seen in developing countries not covered by existing classifications.

Design: A prospective study.

Setting: University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Subjects: All OSM patients treated from January 1998 to June 2000.

Main outcome measures: Age, sex, clinical features, radiographs and treatment offered were analysed. Five stages were recognised: stage 0 (potential OSM with bone contamination), stage I (early or acute OSM), stage II (intermediate OSM with subperiosteal abscess), stage III (late or chronic OSM with sequestrum and subdivided into IIIa ‘curable’, IIIb ‘controllable’, IIIc ‘complicated’). Stage IV (compound OSM) with joint involvement: IVa, if anatomical and IVb if physiological. Patients’ haemoglobin (Hb) status is added to the staging, for example stage II (Hb SS).

Results: All 271 patients comprising 198 males and 73 females (M: F= 2.7: 1) with age range 2-48 years (mean 29.4 ± 12.2) were studied. Only 93 patients had Hb genotype done; only 42 had Hb S. The stage O had 184 patients (120 open fractures and 64 bone operations). Stage I had nine patients, stage II 19 patients, stage III 51 patients and stage IV eight.

Conclusions: This new staging incorporates pre-emptive OSM seen in developing countries where certain practices, if unchecked lead to OSM. The severity of OSM featuring florid disease not common in the developed world, and for which existing classifications did not accommodate, is included.

Ten-year mortality review in a pioneer psychiatric hospital in West Africa

I.O. Malomo, MBBS, DPM, FMCPsy, FWACP, Consultant Psychiatrist/ Medical Director, Psychiatric Hospital, Yaba, Lagos, Nigeria, O. F. Aina, MBBS, FWACP, Lecturer/Consultant Psychiatrist, Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria, H. T. O. Ladapo, MD (Ukraine), FMCPsych, FWACP, Consultant Psychiatrist/ Director of Clinical Services, Psychiatric Hospital, Yaba, Lagos, Nigeria, and A. O. Owoeye, MBChB, Senior Registrar in Psychiatry, Psychiatric Hospital, Yaba, Lagos, Nigeria

Request for reprints to: Dr. O. F. Aina, Department of Psychiatry, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria

Abstract

Objective: To determine the mortality among admitted patients in the study centre, a pioneer psychiatric facility in the West African sub-region.

Design: A detailed retrospective study of the records of all deaths among the inpatients during the ten-year period of January, 1991 to December, 2000.

Setting: Psychiatric Hospital Yaba, Lagos, Nigeria; established in 1907 with present bed status of 535 and patronage from Lagos and it’s environ, including the neighbouring Benin Republic.

Subjects: Ninety six patients that died while on admission in the centre during the study period.

Results: A total of 96 patients died over the ten-year period, giving an annual rate of 9.6. The age range was 14-87 years, and mean of 44.4 (SD ±16.8) years. The male: female ratio was 1:1.6. Schizophrenia (26%) and major depression (25%) constituted the main psychiatric diagnoses at the time of admission among the cohort. The commonest cause of death included infections/infestations, most especially malaria and septicaemia (44% of the cohort).

Conclusion: It is concluded that the major psychotic disorders, schizophrenia and depression continue to constitute the highest psychopathologies diagnosed psychiatric mortality study. Finally, infections/infestations still continue to play leading role as major causes of death in the West African sub-region.

Sickle cell disease in Uganda: a time for action

G. R. Serjeant, MD, FRCP, Professor Emeritus, University of the West Indies, 14 Milverton Cresent, Kingston 6 Jamaica and C. M. Ndugwa, MD, FRCP, Department of Child Health and Paediatrics, Makerere University Medical School, P.O Box 7062, Kampala, Uganda

Request for reprints to: Prof. C.M. Ndugwa, Department of Paediatrics and Child Health, Makerere University Medical School, P.O. Box 7062, Kampala, Uganda

Abstract

Objectives: To draw attention to the extent of homozygous sickle cell (SS) disease as a public health problem in Uganda where a mean 20% frequency of the sickle cell trait implies that 25,000 babies with SS disease are born each year. To highlight the dangers of applying interventions developed in non-malarial areas to regions where malaria may change the natural history and outcome of sickle cell disease.

Data Sources: The published literature from Africa and from the US and Caribbean in populations of African ancestry.

Study Selection: The world literature especially, that derived from the US, Caribbean, and equatorial Africa.

Data Extraction and synthesis: In non-malarial areas, simple interventions applied early in life have significantly improved survival and the quality of life. Two well documented interventions are pneumococcal prophylaxis and the early parental diagnosis of acute splenic sequestration. The available literature from Africa suggests that neither of these may be appropriate in malarial areas.

Conclusions: Manifestations of SS disease differ in malarial areas and it is questionable whether interventions developed in non-malarial areas apply. There is an urgent need to document the causes of death so that locally appropriate interventions may be developed to improve survival. Equally urgent is the need to define the pattern of clinical problems so that models of care may be evolved for use in malarial areas. Without this knowledge, health care planners will not have the information necessary to develop strategies and limited resources may be inappropriately deployed.

Unusual bladder outflow obstruction: case report

P.L.W. Ndaguatha, MBChB, MMed (Surg), Senior Lecturer, Department of Surgery, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya

Summary

Hydatid disease, the parasitic infestation caused by the cestode, echinococcus granulosus involves mainly the liver and the lungs though no organ is immune. Genito urinary involvement has been found mainly in the kidneys and rarely in other structures such as, bladder and epididymis. Isolated retrovesical location of the hydatid cyst is a very rare condition whose manifestations appears after a long course of the disease and are due to compression of bladder, causing the bladder out flow obstruction. Such rare case of bladder out flow obstruction is presented.

Midline lethal granuloma complicating pregnancy: case report

B.D.O. Saheeb, BDS, FWACS, FICS, FDS, RCS (Edin) Senior Lecturer/Consultant, and M.A. Ojo, BDS, MMed Sc, Dip Maxfac Rad, Associate Professor/Consultant Department of oral and Maxillofacial Surgery and Pathology, University of Benin Teaching Hospltal, Benin City, Nigeria.

Request for reprints to: Dr. B.D.O. Saheeb, P.O Box 2799, Benin City, Edo State, 300-001, Nigeria

Abstract

A case of midline lethal granuloma in a 28-year- old female Nigerian patient is reported. Oral, ocular and nasal lesions were present and these preceded a spontaneous abortion of a three month old pregnancy. The clinical course of the disease and its similarity to other granulomatous diseases, which are generally classified as midline granuloma syndrome, are highlighted. The prognosis is poor but early diagnosis and treatment appears to improve a patient’s condition