African
Journals Online
Malawi Medical Journal
The Journal of the College of Medicine
and Medical Association of Malawi
Volume 15 No.
1 2003
ABSTRACTS
Behavioural
characteristics, prevalence of Chlamydia trachomatis and antibiotic susceptibility of Neisseria gonorrhoeae in men with urethral discharge in Thyolo,
Malawi
Zachariah R, Harries AD, Nkhoma W, Arendt V , Nchingula
D, Chantulo A, Chimtulo F, Kirpach
P
A study was
carried out in a rural district of Malawi among men presenting with urethral
discharge, in order to a) describe their health seeking
and sexual behaviour b) determine the prevalence of Neisseria gonorrhoeae
(N. gonorrhoeae) and Chlamydia trachomatis (C. trachomatis),
and c) verify the antibiotic
susceptibilityof N
.gonorrhoeae. A total of 114 patients were entered into the study. 61% of
study subjects reported having taken some form of medication before coming to
the Sexually Transmitted Infections (STI) clinic. The most frequent alternative source of care was the traditional
healer.
68 (60%) patients reported sex during the
symptomatic period the majority (84%) not using condoms. Using ligase chain
reaction on urine, N. gonorrhoeae was detected in 91 (80%) and C.
trachomatis in 2 (2%) of urine
specimens. 45 of 47 N gonorrhoeae isolates produced penicillinase, 89%
showing multi-anti-microbial resistance. This study emphasises the need to
integrate alternative care providers and particularly traditional healers in
STI control activities, and to encourage their role in promoting safer sexual
behaviour. In patients presenting with
urethral discharge in our rural setting, C. trachomatis was not found to
be a major pathogen. Antimicrobial susceptibility surveillance of N.gonorrhoeae
is essential in order to prevent treatment failures and control the spread of
resistant strains.
Ocular disease in patients with TB and
HIV presenting
with fever in Malawi
Beare NAV, Kublin JG, Lewis DK,
Schijffelen MJ, Peters RPH, Joaki G, Kumwenda J, Zijlstra EE
Aims. To
investigate ocular disease in Malawian patients with tuberculosis (TB) and HIV
in presenting with fever, and to determine if indirect ophthalmoscopy is useful
in the diagnosis of mycobacteraemia. Methods.
A prospective study of all adult patients admitted with fever to Queen
Elizabeth Central Hospital, Blantyre.
All recruited patients had an ophthalmic examination, HIV tests, chest
x-ray, sputum examinations, bacterial and mycobacterial blood cultures and malaria
slide. Results. 307 patients were recruited; 109 (36%) had TB, including 53
(17%) with mycobacteraemia; 255 (83%) had HIV and 191 (62%) had AIDS. Of the patients with TB 102 (94%) had HIV.
Choroidal granulomas were found in four patients, all of whom had AIDS; three
had disseminated TB with mycobacteraemia, and one had persistent fever but no
other evidence of TB. Among the
patients with AIDS, 32 (17%) had retinal microangiopathy manifest by cotton
wool spots; one (0.5%) had signs of active cytomegalovirus (CMV)
retinitis. The presence of
microangiopathy was not related to TB. Conclusions. In Malawian patients with
TB presenting acutely with fever, choroidal granulomas were found in 2.8%, and
were concurrent with mycobacteraemia and AIDS.
Ophthalmoscopy was not a useful aid in the diagnosis of mycobacteraemia.
CMV retinitis is rarely seen in African AIDS patients. This may be due to mortality early in the
disease course, or differences in race, HIV sub-type or co-morbidity.
High frequency of tuberculosis in
households of patients with pulmonary tuberculosis in Mzimba, Malawi
Mwale A, Harries AD,
Hargreaves NJ, Salaniponi FM
A case-control study was carried out in
Mzimba district to determine whether household members of a patient with
pulmonary tuberculosis (PTB) had an increased frequency of TB compared with
households where no TB had been previously diagnosed. There were 79 patients
with PTB (66 with smear-positive PTB and 13 with smear-negative PTB) and 79
controls, matched by age and sex. Household compositions were similar. During a
mean period of observation of 35 months, 8 household members from PTB patient
households developed TB compared with no household members from control
households (RR 1.99, 95% CI 1.81 - 2.18).
The case notification rate of TB in household members from patients with
all types of PTB was calculated at 1221 / 100,000/ year: the rates were 1233 /
100,000 / year for household members from patients with smear-positive PTB and
1127 for household members from patients with smear-negative PTB. The frequency
of TB in households of TB patients is significantly higher than in households
of control persons who have not suffered from TB.
Perceptions about the aetiology,
treatment and prevention of convulsions in under-five children in Rumphi
Munthali AC
This paper, based on an ethnographic study
carried out in western Rumphi, examines people’s perceptions about the
aetiology, treatment and prevention of convulsions in under-five children. Both
old and young women attributed convulsions to the eating of eggs by under-five
children and acts of witchcraft. However, young women, probably because of
their higher level of educational attainment and their attendance of the health
education sessions conducted by health surveillance assistants, also
interpreted convulsions as serious forms of malaria. As regards prevention of
convulsions, informants mentioned traditional methods such as the use of
incisions and wearing of amulets, and that children should not eat eggs.
Because of the attribution of convulsions to witchcraft and such other
culturally related-causes, most informants said that treatment for this illness
is first sought from traditional healers, and biomedicine is only sought when
the situation worsens. The delay in seeking therapy for convulsing children
from modern medical facilities (mainly because of culturally perceived causes
and modes of prevention) diminishes chances of the survival of such children.
The knowledge of such community perceptions about convulsions is necessary as
it can better inform the design and implementation of health education
programmes.
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