Pan African Medical Journal

Développement d´un questionnaire d´évaluation des apports calciques journaliers chez le Camerounais (QUEVACC)

Jan René Nkeck — 2024-06-06

L’évaluation des apports calciques est capitale dans la prévention des maladies osseuses en rapport avec le métabolisme phosphocalcique, telles que l’ostéoporose et l’ostéomalacie, qui représentent actuellement dans le monde un problème de santé publique. L’usage d’un questionnaire portant sur l’alimentation est conditionné par les habitudes alimentaires de la population cible. Les différences culturelles au plan culinaire et la diversité alimentaire en Afrique Subsaharienne rendent complexe l’applicabilité de la plupart des questionnaires classiques validés dans la littérature. Nous proposons l’outils QUEVACC (QUestionnaire d’EValuation des Apports en Calcium chez le Camerounais), qui est une adaptation du Calcium Assessment Tools à partir des données locales sur les ressources alimentaires au Cameroun et en Afrique Subsaharienne.

A randomized controlled trial study on effectiveness between tadalafil versus combination mirabegron and solifenacin on treatment of ureteral stent-related symptoms

Tjia Adynata Ciayadi — 2024-06-06

Introduction: ureteral stents have common complications like ureteral stent-related symptoms (SRSs). This study investigated the effectiveness of tadalafil compared to mirabegron and solifenacin combination therapy in patients with ureteral SRSs after double-J (DJ) stent insertion.

Methods: this double-blind, randomized clinical trial used consecutive random sampling in participants with SRSs after double-J stent insertion. The study was conducted at four different hospitals in Makassar, Indonesia, from July to December 2020. Ureteral stent-related morbidity indices which analyzed include urinary symptoms, pain, general health, quality of work, and sex scores. All of the indices were measured by ureteral symptom score questionnaire for the first, second, third, and fourth weeks after drug consumption, either tadalafil 10 mg/day (group A, n=25) and a combination of mirabegron 25 mg/day and solifenacin 5 mg/day (group B, n=28).

Results: before the treatment procedure, the groups were comparable in age, gender, body mass index, DJ stent procedures, type, and indication. In general, the score in all parameters declined over the follow-up time for both groups. Group A had a lower urinary symptom score than group B at week III and week IV (all p-value < 0.001). In addition, group A had a lower pain score, general condition, work activity, and other complaints than group B at week II, week III, and week IV (all p-value <0.001). The sexual activity score is comparable between the group, except in week I.

Conclusion: according to our results, we suggest tadalafil to minimize stent-related urinary symptoms and improve general health in patients with double J stent.

Timeliness and completeness of monthly disease surveillance data reporting, Uganda, 2020-2021

Robert Zavuga — 2024-06-06

Introduction: timely and complete reporting of routine public health information about diseases and public health events are important aspects of a robust surveillance system. Although data on the completeness and timeliness of monthly surveillance data are collected in the District Health Information System-2 (DHIS2), they have not been routinely analyzed. We assessed completeness and timeliness of monthly outpatient department (OPD) data, January 2020-December 2021.

Methods: we analyzed secondary data from all the 15 regions and 146 districts of Uganda. Completeness was defined as the number of submitted reports divided by the number of expected reports. Timeliness was defined as the number of reports submitted by the deadline (15^th day of the following month) divided by reports received. Completeness or timeliness score of <80% was regarded incomplete or untimely.

Results: overall, there was good general performance with the median completeness being high in 2020 (99.5%; IQR 97.8-100%) and 2021 (100%; IQR 98.7-100%), as was the median timeliness (2020; 82.8%, IQR 74.6-91.8%; 2021, 94.9%, IQR 86.5-99.1%). Kampala Region was the only region that consistently failed to reach ≥ 80% OPD timeliness (2020: 44%; 2021: 65%). Nakasongola was the only district that consistently performed poorly in the submission of timely reports in both years (2020:54.4%, 2021:58.3%).

Conclusion: there was an overall good performance in the submission of complete and timely monthly OPD reports in most districts and regions in Uganda. There is a need to strengthen the good reporting practices exhibited and offer support to regions, districts, and health facilities with timeliness challenges.

Experiences and perceptions of health professionals towards the quality of care for people living with HIV in Tunisia: a qualitative study

Mariem Zribi — 2024-06-06

Introduction: human immunodeficiency virus (HIV) infection continues to be a public health issue, especially in low- and middle-income countries, including Tunisia. In 2020, 32% of people living with HIV were on treatment. Management of HIV infection remains a real challenge for both patients and care providers. Our study aimed to describe the perceptions and attitudes of health professionals toward care for people living with HIV (PLHIV).

Methods: a qualitative study was carried out between 2020 and 2021. Interviews with key informants were conducted in order to identify the strengths and weaknesses of the care for PLHIV, as well as their suggestions for improvement. Eight key informants in HIV care from different profiles were interviewed: healthcare providers from a specialized university hospital, the Ministry of Health, and civil society representatives working in the field of HIV. Interviews were transcribed and analyzed thematically using "QDA Miner" software.

Results: the frequency of PLHIV who have interrupted medical follow-up was perceived as worrisome, and increasing. Along with individual factors, non-adherence to treatment was also attributed to systemic factors related to stock shortages, geographical inaccessibility, and shortfall in human resources. Stigmatization of PLHIV in healthcare facilities outside the specialized hospital was also highlighted. This has been linked to gaps in the training of care providers on the modes of the virus transmission.

Conclusion: health professionals face many challenges in the care of PLHIV. There is an urgent need to improve treatment availability and accessibility, strengthen social assistance for PLHIV and fight against stigmatization, especially in healthcare settings.

Analyse de la gestion et des aspects épidémiologiques de l’épidémie COVID-19 au Sénégal à un an d’évolution

Abdoulaye Bousso — 2024-06-06

Introduction: après une année d´évolution, la pandémie COVID-19 continue d´être un fardeau pour le monde. Le continent Africain, malgré qu´il ne soit pas touché comme on le pensait souffre des conséquences sanitaires et économiques. Le Sénégal, à l´instar des autres pays africains continue de faire face à cette pandémie. L´objectif de ce travail est d´analyser la stratégie de gestion et le profil épidémiologique de l´épidémie au Sénégal après un an d´évolution.

Méthodes: nous avons répertorié tous les patients testés COVID-19 positifs par RT-PCR au cours de la première année de l´épidémie, du 2 mars 2020 (date du premier cas) au 1^er mars 2021 sur l'ensemble du territoire national. Une analyse des données épidémiologiques a été réalisée.

Résultats: il a été diagnostiqué 34 732 cas positifs, enregistrés en une année, avec un taux de létalité à 2,5%. Toutes les régions administratives du pays sont touchées, avec Dakar, la capitale, comme l'épicentre de l´épidémie. La prédominance masculine est notée sur le nombre de cas positifs et de décès. La moyenne d´âge était de 47 ans et le taux de guérison était de 83,5%. Les personnes de plus de 60 ans étaient les plus vulnérables, en particulier avec des comorbidités cardiovasculaires.

Conclusion: la stratégie du Sénégal dans la gestion de la COVID-19 a été soulignée sur le plan international. Elle a été dynamique, tirant des expériences de la gestion antérieure d´évènements de santé publique comme Ebola. La pandémie du COVID-19 a mis à rude épreuve nos systèmes de santé fragiles. Cependant, la réaction et les résultats obtenus mettent en évidence les progrès importants réalisés par notre pays, contribuant à assurer la résilience du système de santé.

Research for Health Care and Policy on HIV/AIDS: proceedings of the third edition of the Cameroon HIV Research (CAM-HERO) 2022, Kribi, Cameroon, from 1st to 3rd December 2022

Anastase Dzudie — 2024-06-06

Cameroon is committed to reaching HIV epidemic control through coordinated efforts by the Ministry of Public Health, the National AIDS Control Committee, bilateral/multilateral institutions and implementing partners. The third edition of the Cameroon HIV Research Forum (CAM-HERO) was held in Kribi from December 1^st to 3^rd, 2022, with the theme "Research for Health Care and Policy on HIV/AIDS." The conference brought together local and international scientists and clinicians, policymakers, and regulatory authorities to 1) disseminate HIV research findings and HIV policy; 2) foster operational research collaboration; 3) build research capacity through training on basics of research methods and CAM-HERO young investigator Awards; and 4) initiate a guideline for promoting HIV/AIDS research in Cameroon. The main activities included training on research methodology and basic principles in bioethics, presentations of selected abstracts, and awards for top research. A total of 35 abstracts (16 oral presentations, 16 posters, and 3 late-breaker-abstracts) were selected for presentation following a rigorous review. The conference ended with evidence-based recommendations and a way-forward statement for the development of a National Guide for HIV/AIDS research in Cameroon, with the aim of improving the quality and quantity of research agenda and projects nationwide.

HIV and AIDS-related knowledge, HIV risk perception, uptake of HIV testing and its predictors among prison inmates in Bauchi State, Nigeria: a cross-sectional study

Peter Okpeh Amede — 2024-06-06

Introduction: globally, HIV infection among prison inmates is significantly higher than in the general population. Therefore, it is important to identify inmates-living-with-HIV, through HIV-testing, in keeping with the target of UNAIDS vision 90-90-90. We assessed HIV/AIDS-related knowledge, HIV-risk perception and predictors of HIV-testing-uptake in Bauchi Prison.

Methods: we conducted a cross-sectional study among 310 inmates selected with 2 stage sampling. Data was collected using a pretested, structured, interviewer-administered questionnaire. Inmates that consented to HIV-test were tested. We estimated inmates' knowledge about HIV/AIDS, the level of HIV testing uptake and predictors of HIV testing-uptake using multiple logistic regression at 5% significant level.

Results: the mean age (SD) was 32.3 (±9.4) years and 94.8% were males, 47.1% (95% CI: 41.6-52.7) of the respondents had good knowledge of HIV/AIDS. Fifty-five percent (95% CI: 49.9-60.9) felt they were not at risk of contracting HIV. Uptake of HIV-testing was 58.1% (95% CI: 52.5-63.4). Independent predictors for the uptake of HIV-testing were age 35-44 years (aOR= 3.3; 95% CI: 1.4-7.7), positive risk perception (aOR= 3.3; 95% CI: 1.8-6.2), good knowledge of HIV (aOR= 9.6; CI: 5.1-18.0) and knowing someone who had died of AIDS (aOR= 4.1; 95% CI: 1.9-6.4).

Conclusion: good knowledge of HIV/AIDS and HIV-testing-uptake was low among the inmates. We recommended the development and implementation of targeted HIV-testing interventions that cater to the specific needs of different age-groups within the prison population. The prison authority should develop prison-specific health education programme and awareness campaigns aimed at promoting accurate HIV-risk perception, improving their knowledge and help inmates make informed decisions that will prevent them from contracting HIV.

Relationship between psychological stress with functional constipation in children: a systematic review

Ferry Suganda Gozali — 2024-06-06

Introduction: constipation affects up to 29.6% of children worldwide, making it one of the most common gastrointestinal illnesses in the pediatric population. As a functional disorder, the development of constipation is mostly influenced by a child´s psychosocial condition, even considered as one of important contributing factors. This systematic review aims to evaluate the relationship between psychological stress with constipation in the pediatric population.

Methods: three online databases were searched as study sources, including PubMed, the Cochrane Library, and Google Scholar. Study selection was carried out using the PRISMA diagram. Studies that met the eligibility criteria were then included in the data extraction and synthesis. The study quality assessment was done using the Joanna Briggs Institute's (JBI) critical appraisal checklist.

Results: eleven studies are included in this systematic review, consisting of four cross sectional studies, four case control studies and three cohort studies. The included studies have good quality based on the assessment. Majority of the studies showed a significant relationship between psychological stress and constipation in children. Psychological stress in children can be classified into family-related stressors, school-related stressors, exposure to stressful life events, stress related to psychological disorders, and other factors.

Conclusion: psychological stress and burden are associated to constipation in children. To overcome functional constipation in children, a collaborative effort is required between parents, children, and the healthcare professional.

Le cancer de la thyroïde chez l´enfant et l´adolescent: à propos de 22 cas

Said Anajar — 2024-06-06

L´objectif de notre étude était de mettre en relief les particularités du cancer de la thyroïde chez l´enfant et l´adolescent, et d´évaluer nos résultats par rapport à la littérature internationale à travers une série de cas la plus représentative au Maroc: 22 cas. Une étude rétrospective descriptive des patients atteints de cancer différencié de la thyroïde, hospitalisés au Service d´Oto-Rhino-Laryngologie et Chirurgie Cervico-faciale, Hôpital 20 Août, Casablanca, Maroc, sur la période qui s´étend de janvier 1995 à mars 2015. Nous avons recueilli les données relatives à 22 cas, qui répondaient à nos critères d´inclusion. L´âge moyen de nos patients était de 14 ans, avec une sex-ratio de 3,4, la plupart de nos patients ont consulté pour un nodule thyroïdien, associé dans 22,7% des cas à une adénopathie cervicale, et dans 9,1% à des signes de compression. L´ensemble des patients ont bénéficié d´une thyroïdectomie totale, suivie d´un curage ganglionnaire dans 31,82%. Le diagnostic de cancer thyroïdien a reposé sur l´examen anatomopathologique de la pièce opératoire, qui a objectivé un carcinome papillaire dans 95,4% des cas, et un carcinome vésiculaire dans 4,5%. Le traitement par l´iode radioactif 131 a été réalisé dans 100% des cas. Par la suite tous nos patients ont été mis sous hormonothérapie thyroïdienne. Une surveillance étroite et régulière a permis de détecter des métastases ganglionnaires chez 3 patients, et les métastases à distance chez 4 patients. Le cancer différencié de la thyroïde de l´enfant et l´adolescent est une entité rare mais agressive, son traitement se base sur la chirurgie, associée à l´irathérapie donnant un pronostic excellent.

A case of a 55-year-old female with uterine prolapse grade IV: a rare clinical image

Switi Jawade — 2024-06-06

In the female reproductive system anatomical abnormality is uterine prolapse and it developed when uterus dropped into the vagina. It may cause obstructive uropathy with unilateral or bilateral mild hydronephrosis. The more risk for women who increasing aged and decreasing oestrogen level and it can diagnose by pelvic examination. Treatment for prolapse is severe surgical treatment include uterine suspension or hysterectomy. Here we reported patient came to the hospital with chief complaint of something coming out of her vagina, it was progressive in nature and progressed to current size, increase frequency urgency, frequent micturition (5 to 6 time/day), backache. There is significant past history of hypertension since 2 years and she is taking Tab. Amlo 5 mg BD. On the pelvic and physical examination and ultrasound sonography abdomen and pelvis done that revealed grade IV hydro-uretero nephrosis right kidney: 12.5x6 cm and left kidney: 10x8.5 it shows severe dilatation of right renal pelvic congestion syndrome and liver calcific focus of size 2.3x2.7 mm present in segment 4 of left lobe. After diagnosing uterine prolapse grade IV, the patient underwent surgical treatment of vaginal hysterectomy.

Task shifting and task sharing in the health sector in sub-Saharan Africa: evidence, success indicators, challenges, and opportunities

Brenda Mbouamba Yankam — 2024-06-06

This review explores task shifting and task sharing in sub-Saharan African healthcare to address workforce shortages and cost-effectiveness. Task shifting allocates tasks logically, while task sharing involves more workers taking on specific duties. Challenges include supply chain issues, pay inadequacy, and weak supervision. Guidelines and success measures are lacking. Initiating these practices requires evaluating factors and ensuring sustainability. Task shifting saves costs but needs training and support. Task sharing boosts efficiency, enabling skilled clinicians to contribute effectively. To advance task shifting and sharing in the region, further research is needed to scale up effective initiatives. Clear success indicators, monitoring, evaluation, and learning plans, along with exploration of sustainability and appropriateness dimensions, are crucial elements to consider.

Predictors of cessation of exclusive breastfeeding according to the Cox regression model: survey of mothers of children aged 6-12 months, Thiès, Senegal

Mouhamadou Faly Ba — 2024-06-06

Introduction: even though exclusive breastfeeding (EBF) for up to six months is recognised as essential infant care, it is still insufficiently practiced. The objective of this study was to identify predictors of EBF cessation in Thiès.

Methods: this was a survival analysis of data collected using a cross-sectional procedure. Data collection took place from 2^nd December 2019 to 21^st January 2020. The study population consisted of mothers of children aged 6 to 12 months residing in Thiès and seen at the reference health centre of the Thiès Health District during infant vaccination sessions. The number of subjects was 400 mothers recruited using a systematic survey, with a sampling interval equal to two. Data were collected through a face-to-face interview. Predictive factors were identified using the Cox regression model. The adjusted hazard ratio (AHR) and its 95% confidence interval (95% CI) are calculated.

Results: the average age of the mothers was 27.08 ± 6.34 years. The proportion of mothers who breastfed their child within one hour of birth was 29.25%. The proportion of those who practiced EBF was 41.50%. The incidence density of EBF cessation was 14 person-months per 100 breastfeeding mothers. The median duration of EBF was 5 months. Lack of advice on EBF during antenatal care (AHR=1.42; 95% CI =1.08-1.85), sources of information other than health professionals (AHR =1.51; 95% CI =1.05-2.19), late initiation of EBF, i.e. breastfeeding beyond 24 hours after birth (AHR =1.53; 95% CI =1.02-2.28) and low level of knowledge about EBF (AHR =1.46; 95% CI =1.11-1.92) were significantly associated with early termination of EBF.

Conclusion: the promotion of EBF for up to six months will necessarily involve the promotion of prenatal consultations during which professionals should raise awareness among future mothers.

Plasma IL-33 levels and immune activation in HIV-TB coinfection: a cross-sectional study in Yaoundé, Cameroon

René Ghislain Essomba — 2024-06-06

Introduction: HIV-1 and Mtb are characterized by immune activation and unbalances production of cytokines, but the expression of IL33 in HIV/TB coinfection remain understudied. This study aimed to evaluate the level of IL-33 in plasma of HIV and M.tuberculosis (HIV/TB) coinfected patients compared to patients with respective mono infections in Yaoundé.

Methods: a cross-sectional study was conducted among patients attending the pneumology service and HIV treatment center of the Yaoundé Jamot Hospital. Plasma samples of 157 HIV/TB coinfected patients (n =26, 50% males and 50% females, mean age 39), HIV-1 monoinfected patients (n = 41, 41% males and 59% females, mean age 35), TB monoinfected patients (n = 48, 56% males and 44% females, mean age 37) and healthy controls (n = 42, 29% males and 71% females, mean age 32) were examined by enzyme-linked immunoassay (ELISA) to detect the levels of IL-33 cytokine.

Results: plasma level of IL-33 were higher in HIV/TB coinfected (33.1±30.9 pg/ml) and TB monoinfected individuals (15.1±2.9 pg/ml) compared to healthy controls (14.0±3.4 pg/ml) and could not be detected in most of the HIV-1 monoinfected individuals (12.6±8.7 pg/ml). Interestingly, the increased plasma level of IL-33 in HIV/TB coinfected patients showed a statistically significant difference between healthy controls (33.1±30.9 pg/ml vs 14.0±3.4 pg/ml, P<0.0001) and HIV-1 monoinfected patients (33.1±30.9 pg/ml vs 12.6±8.7 pg/ml, P=0.0002). We further found that IL-33 was higher in patients with high viral load group (40.6±59.7 pg/ml vs 12.6±1.8 pg/ml), P= 0.47) whereas patients under highly active antiretroviral therapy (HAART) showed decreased level of IL-33 concentration as the number of years under ART increased. Our data showed a positive association between plasma IL-33 and viral load in the context of HIV/TB coinfection in our study population with a positive Pearson coefficient of r=0.21.

Conclusion: this study indicates that plasma level of IL-33 differs among HIV/TB coinfected patients and respective monoinfections patients. The increased level of plasma IL-33 reveals that IL-33 measurement in HIV-1 monoinfected patients may represent an early predictor of development of tuberculosis.

Osteogenesis imperfecta: an unusual presentation

Hardik Patel — 2024-06-06

Osteogenesis imperfecta (OI), also known as brittle bone disease or "glass bone disease," is a genetic disorder that affects the production of collagen and causes bones to be fragile and easily fractured. It is very rare condition, with varying degrees of severity, and present from birth. Its estimated incidence is around 1 in 100,000 live births. Here, we report a rare presentation of osteogenesis imperfecta type IV. A 7-year-old male child was brought to the orthopedics OPD with complaints of old malunited femur fracture and associated bony deformity, and unable to walk and multiple bony fracture without no history of trauma. On examination there were deformity present in lower limb and old malunited femur fracture left side present. His sclera was normal in color, with no hearing deficit and no rhizomelia. The child's bones were weak, and the cortex was thin, so the child was treated with intravenous zoledronate. The child was planned for surgical intervention based on the work of Sofield and Millar, involving multiple osteotomies, realignment of fragments, and medullary nail fixation for long bones such as the femur, tibia. The Fassier-Duval telescoping rod is designed for children with osteogenesis imperfecta to prevent and stabilize fractures and correct deformities of long bones during growth. The advantage of this expandable rod is its easy placement and better fixation in the physis of long bones.

Brain computed tomography perfusion analysis in HIV-seropositive adults with and without neurocognitive impairment in Nigeria: outcomes and challenges of a pilot study

Godwin Ogbole — 2024-06-06

Introduction: the significance of cerebrovascular disease in HIV-associated neurocognitive disorder (HAND) in a homogeneous black population has not yet been determined. This incident case-control study used CT perfusion imaging to quantify and compare regional cerebral blood flow parameters in neuro-cognitively impaired and unimpaired HIV+ participants of the Ibadan Cohort on Neuro AIDS (ICON) in Nigeria.

Methods: this was an incident case-control study consisting of twenty-seven HIV+ adults, classified based on Frascati criteria into neurocognitive impaired (n=18) and unimpaired (n=9) groups, who had brain computed tomographic perfusion (CTP) with a 64-slice Toshiba CT scanner. The standard deviation (SD) of regional mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV) values were calculated for bilateral basal ganglia (BG), frontal, parietal, temporal, and occipital regions from CT perfusion maps. The regional mean values and variability (SD) in the CTP measures were compared in the groups using an independent student t-test.

Results: differentially higher variability in the bilateral CBF measures in the parietal (right; OR = 1.14, x̅ =5.61, p=0.041, CI=0.27-11.35/left; OR = 1.16, x̅=7.01, p=0.03, CI=5.6-13.47) and time to peak (TTP) measures in the basal ganglia (right; OR = 3.78, x̅=0.88, p=0.032, CI=0.081-1.67/left; OR = 2.44, x̅=1.48, p=0.020, CI=0.26-2.71) and occipital (right; OR = 2.18, x̅=1.32, p=0.018, CI=0.25-2.38/left; OR = 1.93, x̅=1.08, p=0.034, CI=0.086-2.06) regions were observed in the cognitively impaired group compared to the unimpaired group.

Conclusion: the study evidence suggests that alterations in cerebral perfusion implicated in HIV-associated neurocognitive disorder may be possibly demonstrated using CTP, a readily available resource in most African countries saddled with the highest burden of HIV.

Influence of social factors on adoption of sanitation practices in rural areas: a mixed methods study in Nzaui, Kenya

Grace Kasiva Eliud — 2024-06-06

Introduction: provision of adequate sanitation is among the common strategies of preventing sanitation-related diseases. However, provision of sanitation facilities may only be a sustainable solution if the population´s behavior changes and positive perception is embraced. This paper highlights the influence of social factors on adoption of sanitation practices.

Methods: convergent mixed methods designs was employed. Quantitative data was gathered using structured questionnaires from 100 household heads selected using cluster and simple random techniques. Logistic regression analysis was performed to explore factors that influenced adoption of sanitation practices. Qualitative data was gathered from a purposively selected focus group and analyzed thematically.

Results: many (57%) of the participants were males. The average age for participants was 39 years, standard deviation (SD)=0.20. From the multivariable regression analysis with adjusted odds, household heads being aged 18-33 years (OR 1.76, 95% CI: 0.62-3.02, p=0.015) was associated with increased open defecation chances; whereas being a female (OR 0.16 95% CI: 0.06-1.81, P=0.01), availability of open spaces near households (OR 0.12, 95% CI: 0.05-1.13, p=0.30), and mason skills (OR 0.29, 95% CI: 0.13-1.65) and safety of latrines (OR 1.72, 95% CI: 0.70-5.15, p<0.001) was associated with reduced likelihood of open defecation practices. Further, being a female (OR 1.06, 95% CI: 0.18-3.16, p=0.043), having knowledge on safe sanitation (OR 1.01, 95% CI: 0.74-3.08, p=0.02), engaging skilled masons for toilet construction (OR 1.299, 95% CI:1.01-8.95, p=0.005) and financial stability (OR 1.95, 95% CI: 0.98-23.40, P=0.032<0.001) were positively associated with adoption of improved toilets.

Conclusion: the sanitation status in the study area was mainly poor due to the influence of multiple factors like gender, absence of toilets, knowledge on safe sanitation, poverty, mason skills and toilet location in relation to safety. The findings showed the need for innovative planning approaches based on the social aspects of communities for progress in sanitation standards in rural areas. Such approaches should adhere to the sanitation hardware versus software components of communities to promote active utilization of the available toilets, construction of improved toilets and reduction of open defecation.

Improving health information system for malaria program management: Malaria Frontline Project lessons learned from Kano and Zamfara States, Nigeria, 2016-2019

Adefisoye Adewole — 2024-06-06

The U.S. Centers for Disease Control and Prevention in collaboration with the National Malaria Elimination Program and the African Field Epidemiology Network established the Malaria Frontline Project to provide innovative approaches to improve the malaria program implementation in Kano and Zamfara States, Nigeria. Innovative approaches such as malaria bulletin, malaria monitoring wall chart, conduct of ward level data validation meetings and malaria dashboard have helped improve the use of data for decision making at all levels. Innovative approaches deployed during the project implementation facilitated data analysis and a better understanding of malaria program performance and data utilization for decision making at all levels. These innovative approaches may improve malaria control program performance in Nigeria and other resource limited countries.

Prooxidant effects of high dose ascorbic acid administration on biochemical, haematological and histological changes in Cavia porcellus (Guinea pigs): a Guinea pig experimental model

Oladunni Omolabake Otanwa — 2024-06-06

Introduction: Ascorbic acid (AA) is a water-soluble vitamin that is well known for its antioxidant and immune-boosting properties. Owing to the wide-range application of AA in the treatment of numerous ailments and its sweet taste, it is usually abused i.e. overused. However, the effect of the abuse has rarely received attention. Therefore, this study was designed to assess the effect of oral administration of high-dose ascorbic acid on biochemical and haematological parameters as well as the effects on the kidney, liver and lungs.

Methods: adult guinea pigs were divided into four (4) groups where group 1 served as the untreated control group and groups 2-4 were dosed with 29 mg, 662 mg and 1258 mg of ascorbic acid per day, respectively for 28 days.

Results: the result revealed that administration of high dose ascorbic acid significantly (P<0.05) increased serum creatinine from 50.0 ± 7.09 (NC) to AA29- 73.8 ± 4.5, AA-662-89.7 ± 3.3 and AA1258- 79.9 ± 5.7mmol/L and urea levels in the treatment group AA-1258 -18.3 ± 0.5 µmol/L compared to the normal group (NC-2.15 ± 0.6 µmol/L). Disturbance in electrolyte balance was observed with a significant (P<0.05) increase in Na+ from NC- 131.3 ± 3.5 mmol/L to 135.7 ± 3.6 mmol/L in the AA-1258 treatment group, Cl- ( NC- 67.1 ± 1.6 mmol/L in creased to AA29- 92.1 ± 0.83, AA662- 95.3 ± 1.3 and AA-1258- 95.6 ± 0.4 mmol/L), and Ca2+ (NC- 2.66 ± 0.03 to AA1258- 3.36 ± 0.03 mmol/L) and a significant (P<0.05) decrease in serum K+ in the AA29-5.0 ± 0.2, AA662-5.2 ± 0.3 and AA1258-5.6 ± 0.3 mmol/L treatment groups compared to the normal group 6.6 ± 0.3 mmol/L. There was also a significant (P<0.05) increase in the differential blood count in the animals with a significant (P<0.05) increase in red blood count ( NC-5.11 ± 0.13 ×10⁶/µL to AA1258- 5.75 ± 0.11×10⁶/µL ), haematocrit count (NC 39.90 ± 0.52% to AA-29-42.08 ± 0.24 and AA1258-46.13 ± 0.86%), white blood count (NC 10.15 ± 1.01 ×10³/µL to AA1258- 15.18 ± 1.65×10³/µL ), total lymphocytes (NC 3.5 ± 0.51×10³/µL to AA29-5.28 ±0.43×10³/µL), monocytes (NC 0.45 ± 0.07×10³/µL to AA1258 0.80 ± 0.07×10³/µL), eosinophils (NC 0.23 ± 0.03×10³/µL to AA12580.40 ± 0.03×10³/µL), basophils (NC0.68 ± 0.10×10³/µL to AA12581.20 ± 0.10×10³/µL) and neutrophil count (NC 4.73 ± 0.68×10³/µL to AA1258 8.36 ± 0.71×10³/µL). The histopathological indices indicate cellular necrosis in the AA662 and AA1258 treatment groups of the kidney and liver respectively compared to the normal control which has normal cells.

Conclusion: high dose of ascorbic acid can therefore be suggested to cause damage to the cells by causing cellular necrosis as observed in the histopathology results and has effect on the blood cells as observed in the increase compared to the normal control, and the consequences are possibly triggered through inflammatory responses.

Implementation of direct health facility financing in the rural District of Kigoma in Western Tanzania

Flora Joram — 2024-06-06

The adoption of decentralization by devolution in Tanzania has enabled the implementation of a Direct Health Facility Financing (DHFF) program in the facilities. While copious gains have been reported under DHFF, there are also notable failures to improve health service provision. This study aims to explore the experience of implementing the DHFF program in the rural areas of the Kigoma District Council. An exploratory qualitative study was conducted in Primary Health Care (PHC) facilities of the Kigoma District Council. A purposive sampling technique was used to draw 21 key informants including leaders of health facilities and members of the Health Facility Governing Committees (HFGC). Key Informant Interviews (KII) were used to solicit information from the study participants. Content analysis technique was used to analyze data collected from study participants. Our findings present enablers and barriers in the implementation of DHFF. Successful implementation of DHFF was enabled by the availability of formal training and supportive supervision, adherence to DHFF guidelines, availability of planning guidelines at the health facility, functionality of the HFGC, and adherence to the procurement process. A low sense of ownership of the program, delays and insufficient fund disbursement, shortage of health workers, and inadequate knowledge of DHFF program implementation emerged as the barriers that impeded successful program implementation. Evaluating the implementation experience of the DHFF program requires policymakers at the national level to devise a mechanism for the timely disbursement of funds, reinforcing capacity building to increase the autonomy of health facilities in their daily operations. Furthermore, structural and operational barriers warrant further operational and implementation research.

Twelve months antiretroviral therapy retention among clients newly enrolled to care and treatment services in Geita region, Tanzania: does universal test and treat matter?

Rachel Masuke — 2024-06-06

Introduction: sustaining high rates of retention is critical for management of HIV clients, newly initiated antiretroviral therapy (ART). In low resource settings including Tanzania, retention among clients on ART was challenging due to inaccessible infrastructure, gender-based violence, inadequate skilled staff and socio-economic disparities. Low retention leads to increased morbidity and mortality. Tanzania adopted universal test and treat (UTT) strategy in mid of 2016 as recommended by Joint United Nations Program on HIV/AIDS (UNAID) that set goals for HIV epidemic control globally. Studies demonstrated controversial findings on whether UTT strategy improves retention, until now there is limited information on the effect of UTT on retaining HIV patients in our settings.

Methods: a retrospective cohort study was conducted between July 2014 to June 2015 and July 2017 to June 2018 to determine 12 months ART retention among clients newly initiated ART prior and during universal test and treat (UTT) strategy in Geita Region, Tanzania. A total of 13,649 newly clients-initiated ART were extracted from the National AIDS control care and treatment database (CTC2 database). Among these clients 4,624 initiated ART prior the UTT strategy and clients 9,025 start ART after the rollout of UTT strategy. Chi-square test was deployed to determine the significant difference of proportion within categories for each UTT group. Kaplan-Meier curve and long rank test were used to determine significant differences of retention rate prior and during UTT program. Cox regression models were used to estimate the association between exposure variables and ART retention with 95% confidence intervals and p-value of p<0.05.

Results: the overall mean age at ART initiation was 38 years (SD=11.6) with observed significant mean difference between two cohorts (prior UTT, mean=41, SD=11.7 Vs during UTT, mean=37, SD=11.3). The cumulative retention was 83.1% among newly initiated ART clients in both cohorts with significant difference observed between two cohorts (69.7% for prior UTT and 89.9% during UTT, p-value<0.001). The overall person year of follow up was 127,209.3 with an incidence rate of ART retention of 86 per 1000 person-year. It was significantly higher among clients enrolled during UTT strategy than clients enrolled prior UTT strategy (95.1 per 1000 PY Vs 69.6 per 1000 PY, p-value<0.001). The log rank test and Kaplan-Meier survival curve demonstrated clients enrolled in the UTT program had greater probability of retention than clients enrolled prior UTT treatment program (log rank X² test = 599.2, p value < 0.001). Newly HIV clients who initiated ART after the rollout of UTT strategy had 27% higher likelihood to be retained in care and treatment as compared to clients who were enrolled prior UTT strategy, (HR=1.27; 95% CI [1.21 -1.33], p value < 0.001). Sex, District councils, World health Organisation (WHO) stage and client's visit type were significant factors associated with retention among clients newly initiated to care for both arms.

Conclusion: this results, showed that probability of ART retention increased after the rollout of UTT strategy. There is a need to promote universal test and treat strategy in line with other intervention to control HIV epidemic in Geita, Tanzania.

Comparative analysis of SARS-CoV-2 detection methods using stool, blood, and nasopharyngeal swab samples

Marceline Adhiambo Oloo — 2024-06-06

Introduction: as a public health policy, the ongoing global coronavirus disease 2019 vaccination drives require continuous tracking, tracing, and testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diagnostic testing is important in virus detection and understanding its spread for timely intervention. This is especially important for low-income settings where the majority of the population remains untested. This is well supported by the fact that of about 9% of the Kenyan population had been tested for the virus.

Methods: this was a cross-sectional study conducted at the Kisumu and Siaya Referral Hospitals in Kenya. Here we report on the sensitivity and specificity of the rapid antigen detection test (Ag-RDT) of SARS-CoV-2 compared with the quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) using stool and nasopharyngeal swab samples. Further, the mean Immunoglobulin M (IgM) and Immunoglobulin G (IgG) antibody levels among symptomatic and asymptomatic individuals in western Kenya were evaluated.

Results: the sensitivity and specificity of Ag-RDT were 76.3% (95% CI, 59.8-88.6%) and 96.3% (95% CI, 87.3-99.5%) with a negative and positive predictive value of 85% (95% CI, 73.8%-93.0%) and 93% (95% CI, 78.6%-99.2%) respectively. There was substantial agreement of 88% (Kappa value of 0.75, 95% CI, 0.74-0.77) between Ag-RDT and nasopharyngeal swab RT-qPCR, and between stool and nasopharyngeal swab RT-qPCR results (83.7% agreement, Kapa value 0.62, 95% CI 0.45-0.80). The mean IgM and IgG antibody response to SARS-CoV-2 were not different in asymptomatic individuals, 1.11 (95% CI, 0.78-1.44) and 0.88 (95% CI, 0.65-1.11) compared to symptomatic individuals 4.30 (95% CI 3.30-5.31) and 4.16 (95% CI 3.32 -5.00).

Conclusion: the choice of an appropriate SARS-CoV-2 diagnostic, screening, and surveillance test should be guided by the specific study needs and a rational approach for optimal results.

An exceptional case of a huge pseudoaneurysm caused by an epicardial electrode

Yassine Morjane — 2024-06-06

Our patient had a history of aortic valve replacement 18 years ago with a mechanical valve. After sternotomy, there is a huge pseudoaneurysm measuring 70 mm of the aortic root (A, B), totally adhering to the right atrium, which is pushed back and compressed. The aorta will be opened vertically downwards, allowing to see this enormous pseudoaneurysm encompassing the right coronary sinus (C). At this level, it exists a perforation of the aorta by an epicardial electrode and caused this pseudoaneurysm (D), which we had left in place 18 years ago to stimulate the right atrium. We finished the operation with a segment replacement by a Dacron tube.

A long-term complication of clitoral cyst after female genital mutilation

Özgür Şahin — 2024-06-06

Female genital mutilation (FGM) was seen in 30 countries, especially in Africa and also in Asia and the Middle East. According to WHO data, Somalia is where FGM is performed most frequently. Our study aimed to evaluate the recordings of patients with FGM who were diagnosed with a traumatic clitoral cyst. We identified the clitoral cyst cases between February 2015 and August 2020. We collected clinical, surgical, sociodemographic, and histopathological details such as age, marital status, patient resume, age at which FGM was performed, complaints, size of the cyst consultation reasons, FGM procedural long-term complications, sexual function, husband polygamic relationship status, and histological findings. A total of 21 patients diagnosed with clitoral cysts were included in the study. The technique was easily applied in every patient, and the cysts were removed intact, except in 2 patients. There were no intraoperative complications; only minimal bleeding was seen. Except for one patient, all had unilocular cysts, and the final pathological examination revealed an epidermal inclusion cyst. We observed a neuroma developed due to genital trauma due to FGM in one of our patients. Female circumcision and its consequences are not familiar to many healthcare professionals in the developed world. We want to increase awareness of female circumcision and its long-term complication of clitoral cysts among healthcare professionals worldwide.

Estimation of shedding time in laboratory-confirmed COVID-19 cases in South Africa: a population-based record linkage study, March-December 2020

Carroll Tshabane — 2024-06-06

Introduction: in South Africa, COVID-19 cases are notifiable and hospitalized cases are reported on a dedicated platform. It is crucial to estimate the duration of SARS-CoV-2 shedding to inform public health interventions. We aimed to estimate viral shedding time among laboratory-confirmed COVID-19 cases in South Africa.

Methods: we analyzed COVID-19 PCR results from 5 March to 31 December 2020. We included cases with at least 2 consecutive positive PCR tests and a subsequent negative test. We performed multiple linear regression to determine the association between shedding time and predictor variables (age, sex, admission status and province). We included 2752 cases that met the inclusion criteria.

Results: about 39.9% (1099/2752) of participants were inpatients and 60.1% (1653/2752) were outpatients. The median shedding time was 17 days (range: 1-128). There was no difference in shedding time between males and females and between hospitalized patients and outpatients. Individuals aged 0-4 years had the lowest shedding time (median: 14 days, range: 1-72). After adjusting for age, sex and province, shedding time was shorter for hospitalized patients compared to outpatients (co-efficient: -0.14, CI: -0.24 - -0.03, P-value: 0.014). Six provinces (KwaZulu-Natal, Gauteng, Limpopo, North West, Mpumalanga, and Western Cape) had a significant association with shedding time.

Conclusion: the duration of viral shedding within our population varies from 1-128 days. Although prolonged shedding might not necessarily indicate infectiousness, individual patient monitoring and management are needed for patients with prolonged shedding. Further studies are required to explore the association between comorbidities and SARS-CoV-2 shedding time.

Presentation and challenges in management of COVID-19 in sickle cell disease: case report

Sheliza Parvez Thaver — 2024-06-06

Sickle cell has predominantly been a disease in the sub-Saharan Africa. There is scanty data in Africa and none in Tanzania regarding patients with sickle cell disease infected with COVID-19 especially in the paediatric group. This is concerning because a large population of children living with sickle cell disease are found in this part of the world where scarcity of resources also prevail. This is the first paediatric case of sickle cell disease and COVID-19 reported in Tanzania; highlighting the presentation and challenges faced in management. It is also the first case in literature describing secondary infection in a child with COVID-19 and underlying sickle cell disease. Our patient was a female child of African origin with underlying sickle cell disease who had recurrent admissions. She presented with cough, fever, chest and abdominal pain and was managed for acute chest syndrome and vaso-occlusive crisis. During the second admission, she developed respiratory distress, infection with COVID-19 was confirmed and managed accordingly. However, she was re-admitted due to bilateral arm pain and physical findings were suggestive of secondary respiratory bacterial infection. She was then started on a different treatment plan. Despite challenges faced in the management of the patient, the outcome was favourable. It is important to recognize the presentation of COVID-19 in children with sickle cell disease and challenges faced in management so that the epidemiologic characteristics, spectrum of the disease and its outcomes can be understood better in the context of sub- Saharan Africa.

Bilateral symmetric dry gangrene of the feet in a newborn

Renu Bharat Rathi — 2024-06-06

Gangrene is extremely rare in neonates caused by the sudden loss of arterial blood supply to usually distal tissue like limbs/feet and toes. There are three types of gangrene-dry, wet and gas. Wet gangrene when the tissue is infected by saprogenic microorganisms and occurs in naturally moist tissue and organs such as the mouth, bowel, lungs, cervix and vulva. Gas gangrene is a bacterial infection that produces tissue gas in gangrene. This deadly form of gangrene is usually caused by Clostridium perfringens bacteria. In this case, the newborn was full-term normal delivery born with a 2.6kg birth weight. The mother has put socks on both feet of the neonate tied with tight thread to avoid cold exposure. The next day of the discharge on day 3, the parents brought the newborn for icterus and during the examination, the physician noticed the bilateral gangrene present with a line of demarcation at the junction between healthy and gangrenous parts. Parents were counselled for the emergency operation to amputate the feet.

A retrospective cohort study on the cost-effectiveness analysis of kidney transplantation compared to dialysis in Cameroon: evidence for policy

Rene Kanjo Njamnshi — 2024-06-06

Introduction: chronic kidney disease affects one in ten adults in Cameroon. Haemodialysis was the only renal replacement therapy (for adults) in Cameroon and its sub-region until November 10, 2021. Thereafter through May 2022, the Yaoundé General Hospital successfully completed four living-donor kidney transplants. This paper examines policy implications.

Methods: medical records of cohorts of kidney failure patients who started haemodialysis at Yaoundé General Hospital in 2012 (n=106) and 2017 (n=118) were abstracted retrospectively through 2021 and their survival analyzed with Microsoft Excel and Kaplan-Meier curves. Using hospital data, the literature, and price indexes, the annual medical cost per patient of dialysis and living-donor kidney transplantation in 2022 prices was derived.

Results: the 9.5-year survival rate for the 2012 cohort was 11% and the 5-year rate for the 2017 cohort was 18%. Annual haemodialysis cost per patient averaged $17,681 (26.5% from households and 73.5% from government). Initial transplantation costs averaged $10,530 per patient, all borne by the government. Under the brand-drug option, first-year transplantation follow-up costs $19,070 (4% for laboratory and 96% for drugs).

Conclusion: annually, haemodialysis in Cameroon costs per patient 12 times the country's average income ($1,537), driven especially by the costs of equipment purchase, maintenance, and consumables. Cameroon's initial cost of transplantation is lower than in other African countries. Generic drugs could lower annual follow-up costs by 89%. If Cameroon could achieve long-term survival with generic drugs after kidney transplantation, that modality would become a reasonable option for selected kidney failure patients (e.g. younger and without other comorbidities).

Exploring data trends and providers' insights on measles immunization uptake in south-west Nigeria

Marcus Ilesanmi — 2024-06-06

Introduction: measles outbreak remains a recurring episode and continues to be responsible for millions of deaths globally every year. This study examines measles immunization coverage and uncovers barriers and enablers to effective provision and uptake of measles immunization services from the supply end and provider´s perspective in a developing nation´s context.

Methods: the study employed a mixed-method approach to explore trends and patterns of measles immunization uptake in Ekiti State-a state in the southwestern region of Nigeria-utilizing DHIS 2014 - 2019 data of 789,518 under 1-year children and complemented the quantitative study with key informant interviews from appointed Immunization Officers in the state. Using deductive methods, we thematically analyzed the interview data using NVivo version 12 while STATA 16 was used to analyze the quantitative data.

Results: the annualized measles immunization coverage ranged between 49% and 86% from 2014 to 2019, which is below the WHO set threshold for measles infection prevention. Caregiver, geographical, human, and infrastructural factors were elicited as barriers, while potential enablers include increased public engagement and enhanced media involvement.

Conclusion: while programmatic efforts are being improved nationally to drive up the uptake, this study provides baseline information for benchmarking the subsequent level of efforts and recommends improved collaboration across contextually similar states to promote program efficiency. The results can inform policy and program development, execution and direct future research on measles immunization to address uptake challenges at both local and central administration levels, especially in the aspect of surveillance and monitoring.

Evaluation of intestinal parasites as a causative agent of diarrhea in children and some treatments used in Babylon Governorate

Khulood Abdul-Majeed Mohammed Jafeer — 2024-06-06

Letter to the editors

Long travel times from health center to hospital reduce caesarean section access: a study from Kirehe District, Rwanda

Hillary Miller — 2024-06-06

Introduction: timely access to safe cesarean section (c-section) delivery can save the lives of mothers and neonates. This paper explores how distance affects c-section access in rural sub-Saharan Africa, where women in labor present to health centers before being referred to district hospitals for surgical care.

Methods: this study included all adult women delivering via c-section between April 2017 and March 2018 in Kirehe District, Rwanda. We assessed the association between travel times and village-level c-section rates.

Results: the estimated travel time from home-to-health center was 26 minutes (IQR:13, 41) and from health center-to-hospital was 43 minutes (IQR: 2, 59). There was no significant association between travel time from home-to-health center and c-section rates (RR=1.01, p=0.42), but the association was significant for health center-to-hospital travel times (RR=0.96, p=0.01); for every 15-minute increase in travel time, there was a 4% decrease in c-sections for a health center catchment area.

Conclusion: in the context of decentralized health services, minimizing health center to hospital referral barriers is of utmost importance for improving c-section access in rural sub-Saharan Africa.

Left atrial myxoma presenting with acute pulmonary edema and syncope in a middle-aged black African woman: a case report

Kasiemobi Eberechukwu Uchime — 2024-06-06

Cardiac myxoma is a very rare benign cardiac neoplasm. Its annual incidence globally is between 0.5 to 1 case per one million individuals. It has a 0.03% prevalence rate in the general population. It commonly occurs in the left atrium, but can also be located in the other heart chambers. Its clinical presentations are variable, non-specific, and can mimic various cardiovascular and systemic diseases, posing a diagnostic dilemma. Thus, a high index of suspicion with appropriate use of radiologic and laboratory diagnostic tools is essential for its accurate diagnosis and management. The diagnosis and management of a rare case of left atrial myxoma in a middle-aged African woman who presented with heart failure-like symptoms, features of acute pulmonary edema, and syncope is presented in this literature. The diagnosis was suspected following echocardiography. The tumor was surgically excised, and the diagnosis was confirmed histopathologically. The patient´s post-operative condition has been excellent.

Entangled epidemics: tackling vaccine-preventable diseases in the era of frequent epidemics in Africa

Vinie Kouamou — 2024-06-06

Whilst the largely limited health system and funds are already overstretched while responding to multiple epidemics, ongoing vaccine-preventable diseases (VPD) including polio and measles continue to be a public health threat and expose the weaknesses of the public health system in many African countries. The surge in VPD outbreaks during epidemics appears to be a common trend in Africa, often due to reduced vaccination coverage. The World Health Organization reported that, in 2021, nearly 25 million children missed their first measles dose, 5 million more than in 2019. The drop in childhood immunizations was partly attributed to the COVID-19 pandemic which has caused significant interruption in public health services delivery and reduced vaccination coverage. Vaccines help reduce the incidence of VPD. Therefore, effective VPD outbreak response mechanisms and strategies that include ramping up catch-up campaigns for immunization during epidemic troughs including the provision of vaccines outside clinics as well as assessing newer vaccine delivery models during pandemics are essential to minimize the impact of VPD outbreaks during emerging epidemics. Ensuring access to vaccines to address outbreaks and provide supplemental vaccination is essential if we are to be a VPD-free region.

Syndrome de McCune-Albright: à propos d´un cas et revue de la littérature

Hédi Chabouni — 2024-06-06

Le syndrome de McCune-Albright est une maladie héréditaire caractérisée par l'association d'une dystrophie fibreuse de l'os, des taches cutanées café au lait et d'une puberté précoce révélant une hyperactivité endocrinienne. Sur le plan génétique, cette maladie est due à une mutation de la protéine Gs responsable d'une activation de l'adénylate cyclase avec production excessive de l'AMPc. La morphologie particulière des taches café-au-lait doit évoquer précocement le diagnostic. Son traitement dépend de l'endocrinopathie dont souffre le patient et de l'étendue de la dysplasie fibreuse. Les bisphosphonates ont prouvé leur efficacité sur les douleurs osseuses et la limitation de la dysplasie fibreuse. La chirurgie garde sa place dans les formes compliquées. Nous rapportons un cas rare d'un syndrome de McCune-Albright compliqué d'une fracture du fémur chez une fille de 12 ans et nous mettons au point les caractéristiques cliniques et paracliniques de cette entité pathologique.

Completely calcified mastic kidney

Hicham El Bote — 2024-06-06

A 64-year-old man who had a history of pulmonary tuberculosis (TB) with extrapulmonary relapse at the urogenital system that was treated and declared cured 20 years ago, presented a simple left lumbago. Ultrasonography detected a large right kidney that looked destroyed with a strong acoustic shadow, the left kidney was normal, non-contrast computed tomography showed a right kidney with a rounded calcification involving the entire parenchyma which was damaged. Although the QuantiFERON-TB Gold test was positive, the Löwenstein-Jensen culture and a polymerase chain reaction (PCR) test in urine were negative as well as the chest X-ray. Thus, the diagnosis of mastic kidney complicating previous renal tuberculosis was made. The collegial decision with the nephrologists was a therapeutic abstention due to normal renal function and the absence of symptoms. According to the latest World Health Organization (WHO) report, TB is the second most common cause of death from a single infectious agent after coronavirus (COVID-19). The disease usually affects the lungs (pulmonary TB), but can also affect other parts of the body (extrapulmonary TB). Renal TB is the most common form of urogenital TB. It accounts for 20% of extrapulmonary localisations and 4-8% of patients with pulmonary TB develop destructive lesions in the genitourinary tract. The primary infection in the kidney remains confined to the glomeruli, but on reactivation, Mycobacterium tuberculosis spreads to the medulla and interstitium. In the active phase the disease progresses from periodic ruptures, granuloma formation, caseous necrosis and cavitation in the renal parenchyma, while in the cicatricial phase, the host's healing response induces fibrosis, calcium deposition and stricture formation. Mastic or Putty kidney is the radiological appearance of a dystrophic calcification of the unfunctional kidney caused by tuberculosis (auto-nephrectomy).

Distal tibial trabecular morphometry in a Sprague Dawley rat model of fetal alcohol syndrome: a micro focus X-ray computed tomography case-control study

Robert Ndou — 2024-06-06

Introduction: intrauterine alcohol exposure has adverse health effects on the offspring, which may result in fetal Alcohol Spectrum Disorders (FASD). The neurological and craniofacial aspects have been well studied; however, long bones have received limited attention despite the short stature reported in FASD children.

Methods: time-mated (n=13) pregnant Sprague Dawley dams were assigned to either the ethanol (n=5), saline control (n=5) or untreated group (n=3) which received no treatment. The ethanol and saline control dams were treated with 0.015ml/g of 25.2% ethanol or 0.9% saline, respectively. Treatment was for the first 19 days of gestation. Two pups from each dam were used and terminated at 21 days of age. Paired tibiae were harvested. Each bone was scanned using a Nikon XTH 225L 3D-μCT to investigate trabeculae morphometry.

Results: the ethanol group had less bone to total volume (BT/TV), thinnest trabeculae (TbTh) which were less spaced (TbSp) compared to the controls. However, number of trabecular (TbN) remained unaffected in all three groups. Tibial length was similar in all three groups; however, the distal metaphysis volume was smallest in the ethanol group. Logistic regression showed that distal trabecular separation was the main parameter affected the most in gestational alcohol in the tibia. The negative correlation of trabecular thickness and spacing in the ethanol group may be a contributor to bone weakness.

Conclusion: gestational alcohol exposure affects bone internal morphology in addition to the bone size. Overall, this study supports the findings clinical observation of small stature in FAS children.

Reasons for leaving home and pattern of child abuse and substance misuse among street children in Khartoum, Sudan: a cross-sectional survey

Suha Mohammed Elhassan Ali Hassan — 2024-06-06

Street children are particularly susceptible to health-related adversities, including those resulting from substance abuse and child abuse. Information on street children is deficient in Sudan. This study provides basic data on characteristics, factors for leaving home, the pattern of child abuse and substance misuse among street children in Khartoum State, Sudan. This is a descriptive, cross-sectional, and community-based study. Data were collected through direct questioning of a sample of street children using a structured, standardized, and pretested interview-administered questionnaire. Two hundred and seventy-five (275) street children were interviewed. Most street children were males (83%). Of the interviewed children, 36.7% were illiterate, 66.1% had a single parent, and 36% did not recognize a home to return to. The commonest reported reasons for being on the streets were family conflicts and financial/economic difficulties (28.4 % and 27.5%), respectively. 89.1% of the children admitted to being substance abusers, mostly of glue (86.5%) and smoked tobacco (67.3%). Seventy-five-point three percent 75.3% of the children reported being subjected to a form of abuse, with physical and sexual abuse reported by 70.2% and 27%, respectively. Of the 74 children who reported sexual abuse, 49 were males (29% of males), and 25 were females (65% of females). The survey results are thought to guide further research and shape appropriate policymaking and coordinated interventions by concerned stakeholders, whether governmental or non-governmental.

The interest of intranasal clonidine in the prevention of perioperative children´s anxiety: a prospective randomized trial

Mariem Keskes — 2024-06-06

Introduction: perioperative anxiety in children may lead to psychological and physiological side effects. Clonidine is in increasing use in the pediatric population as an anxiolytic, sedative, and analgesic because of its central alpha2-adrenergic agonist effect. Our study aimed to evaluate the effect of clonidine in the prevention of perioperative children´s anxiety.

Methods: we conducted a prospective controlled randomized double-blinded clinical trial including children aged between 2 and 15 years undergoing tonsillectomy surgery. The patients were randomly allocated to receive either an intranasal dose of clonidine (4 μg/kg) (clonidine group) or an equal volume dose of saline solution (control group) 30 minutes before entering the operating room. The level of anxiety assessed using the m-YPAS score was recorded before premedication, at the time of parent-child separation, and at the time of installation in the operating room. Acceptance of premedication, degree of sedation on entering the operating room as well as agitation on awakening, and sedation on arrival post-anesthesia care unit were noted. Adverse effects were recorded during the surgical procedure and in the postoperative recovery room.

Results: the number of patients analyzed was 78 with 39 patients in each group. There were no signification differences in demographic data and premedication acceptance between the two groups. Levels of anxiety before any premedication were similar in the two groups. However, the anxiety level 30 minutes after premedication and in the operating room was significantly lower in the clonidine group (p<0.001). Children who received clonidine showed better sedation on entering the operating room (p=0.002) as well as postoperatively on entering the post-anesthesia unit care (p=0.006). The hemodynamic and respiratory parameters recorded were statistically comparable.

Conclusion: intranasal clonidine is an interesting premedication to prevent perioperative children´s anxiety with few side effects.

La chirurgie laparoscopique de downstaging pour cancer colorectal avec métastases hépatiques synchrones: quel intérêt dans les hépatectomies en deux temps? à propos d’une série de 6 cas

Zaki Boudiaf — 2024-06-06

Les métastases hépatiques bilobaires des cancers colorectaux posent un problème de prise en charge, la chirurgie curative nécessite souvent plusieurs temps. Le but de notre étude était d´évaluer l´approche laparoscopique avec ligature portale dans le premier temps des hépatectomies en deux temps pour les métastases hépatiques synchrones des cancers colorectaux (MHSCCR). Il s´agissait d´une étude rétrospective monocentrique d´août 2016 à janvier 2020 qui avait inclus les patients présentant des MHSCCR nécessitant une chirurgie curative en deux temps à cause d´une insuffisance du volume du futur foie restant (FFR). L´objectif principal était d´évaluer la morbi-mortalité postopératoire du premier temps laparoscopique à 30 jours. Les objectifs secondaires étaient d´évaluer le taux de conversion, l´hypertrophie du FFR après ligature portale laparoscopique, la morbi-mortalité postopératoire du 2^e temps hépatique et enfin d´évaluer le taux d´achèvement de la stratégie thérapeutique. Nous avons inclus six patients (4 hommes et 2 femmes), l´âge moyen était de 64 (44-72) ans, le premier temps opératoire avait consisté en une résection colique laparoscopique associée à une ligature portale droite chez 5 patients et gauche chez un patient. La morbi-mortalité postopératoire était nulle. Le taux de conversion était nul. Après ligature portale, 5 sur les 6 patients avaient hypertrophié le FFR de façon significative, le gain moyen de volume du FFR était de 59,48% (31,02%-68,71%). Deux patients parmi les six avaient présenté une morbidité sévère après le deuxième temps hépatique (Clavien IIIb). La stratégie thérapeutique a été achevée chez tous les malades.

Hematoma of cavum septum pellucidum by ruptured aneurysm

Fresnel Lutèce Ontsi Obame — 2024-06-06

A 57-year-old male patient, with no past medical history, was admitted with sudden-onset headaches, vomiting, and loss of consciousness. A neurological examination revealed disorientation. His pupils were equal and reactive to light. He had purposeful responses of all extremities. The blood pressure was 200/100 mmHg. Complete blood counts and coagulation profiles were normal. Unenhanced cerebral computed tomography showed corpus callosum hematoma, septum pellucidum hematoma, and intraventricular flooding corresponding to Fisher grade 4 subarachnoid hemorrhage. Cerebral angiography showed an anterior communicating artery aneurysm, suggesting the diagnosis of subarachnoid hematoma (SAH) due to a rupture of an anterior communicating artery aneurysm. An external ventricular shunt was placed. Afterward, the patient was treated by endovascular embolization the next day.

Broad ligament ectopic pregnancy at 18 weeks: diagnosis and management in a resource-limited setting (a case report)

Madye Ange Ngo Dingom — 2024-06-06

Broad ligament ectopic pregnancy is a relatively rare condition described in the literature. We did not find enough data concerning this subject in Cameroon. It is therefore important to know about its existence because late management can lead to increased maternal mortality. This paper reports the case of a 22-year-old lady at 18 weeks gestation who had generalized abdominal pain for two months. Prior to her arrival at our service, an abdominal and pelvic ultrasound done revealed a viable singleton 18-weeks intra-abdominal pregnancy with a moderate amount of abdominal fluid collection. The diagnosis of haemorrhagic shock complicating an abdominal pregnancy at 18 weeks of gestation was retained. An emergency laparotomy was done, and a right total salpingectomy and oophorectomy with resection of the right broad ligament were carried out. After surgery, dissection of the mass revealed a non-viable male foetus weighing 218 grams. In conclusion, there´s a very high morbidity and mortality rate associated with broad ligament pregnancies. Due to the fact that there is late access to antenatal care, the prognosis of pathologic pregnancies is endangered.

Factors associated with measles outbreak in three health districts of Cameroon in 2019: a cross-sectional study

Esum Mathias Eyong — 2024-06-06

Introduction: measles is an infectious viral disease that affects susceptible individuals of all ages. It is a leading cause of death among young children globally due to suboptimal vaccination coverage. In 2019, measles outbreaks affected several parts of the world, including three health districts (HDs) of Cameroon's South West Region (SWR) experiencing armed conflict. Herein, we assessed the factors associated with the outbreak in the SWR.

Methods: we conducted a comparative study from March to August 2020. Data on study participants were compared between the three HDs that experienced a measles outbreak and three other HDs of the region that reported a case of measles but did not get into an outbreak. Records on vaccination between 2015 and 2019 were reviewed.

Results: information was obtained from 56 participants with known measles status, 32 from outbreak districts, and 24 from non-outbreak districts. The population in the outbreak group was more likely to have traveled from an area in a measles outbreak (OR 2, 95%CI 1.1-11.20). There was a suboptimal availability of measles vaccines in both categories of districts compared to the needs, and there was a downward trend in vaccination coverage in both groups. In addition, vaccines were more exposed to extreme temperatures in HDs with the outbreak (P<0.01) from 2015 to 2019. We found no statistically significant difference between both groups concerning the preexisting comorbidities of participants.

Conclusion: there is an urgent need to improve the cold chain and intensify vaccination activities in these districts.

Pulmonary involvement in primary Sjögren’s syndrome: contribution of the different means in the systematic investigation

Maysam Jridi — 2024-06-06

The prevalence of pulmonary involvement in primary Sjögren´s syndrome (pSS) varies depending on investigation methods. Our study aimed to identify the contribution of the different means of investigation in the systematic screening for pulmonary involvement in pSS. This is a retrospective and descriptive study including medical records of pSS patients, who validated the 2016 American College of Rheumatology/European League Against Rheumatism classification criteria for pSS and who had undergone pulmonary assessment. We enrolled 30 patients: twenty-nine females (97%) and one male (3%). The mean age was 55±17.4. In nine patients (30%), pulmonary disease revealed the diagnosis. Dyspnoea and cough were respectively reported by 43% (N=13) and 30% (N=9) of patients. The six-minute walk test showed desaturation in four cases (14%) and the percent predicted distance was less than 70% in three cases (11%). Pulmonary function tests (PFTs) showed restrictive patterns (N=7, 26%), obstructive patterns (N=2, 7%), combined patterns (N=1, 4%), and isolated small airway disease (N=1, 4%). The prevalence of pulmonary involvement based on high-resolution computed tomography (HRCT) was 31% (N=9/29). The most frequent interstitial lung disease (ILD) was observed in five scans (56%) and usual interstitial pneumonia was the most frequently seen in three cases (60%). Bronchiolitis was observed in four cases (25%) out of 16 abnormal scans. The six-minute walk test results correlated with PFT results (P<0.05). Pulmonary involvement was noted in 50% of cases (N=15). It was clinically silent in one-third of cases (N=5). In conclusion, pulmonary involvement in Sjögren´s syndrome can be asymptomatic in 33% of cases. The six-minute walk test has a strong correlation with the results of PFT, it should be considered as an assessment tool that reflects the functional state of the patient.

A case of unilateral lung collapse

Ashwin Karnan — 2024-06-06

A 10-month-old infant was brought to our emergency department with complaints of acute respiratory distress for the past half an hour with no significant family, birth, or history. On examination, pulse rate (PR) was 130 beats/min, saturation 75% on room air, respiratory rate (RR) of 32 breaths/min, blood pressure of 100/70mmhg, and on auscultation, there were absent breath sounds on the right side. Chest X-ray showed opaque right hemithorax. An emergency bronchoscopy was done, which showed thick mucus plugs in the right segmental bronchi causing lung collapse. Mucus plugs were removed and post-procedure Chest X-ray showed complete resolution of the right lung. The mucus is a mixture of water, proteins, proteoglycans, lipids, and secretions from the goblet cells, which line most of the respiratory tract. This mucus along with the continuous movement of cilia on respiratory epithelium helps to prevent dust particles, pollutants, and infectious agents from entering the system. In conditions where there is delayed mucociliary clearance or mucus hypersecretion, this mucus accumulation may cause cough and narrowing of airways resulting in a decline in lung function. In bronchial asthma, allergic bronchopulmonary aspergillosis, cystic fibrosis, and primary ciliary dyskinesia there may be mucus accumulation which may lead to bacterial colonization. Decongestants, mucolytics, coughing techniques, and chest physiotherapy in the form of chest percussion and postural drainage may aid in reducing secretions.

A rare case of alopecia universalis

Amol Deshpande — 2024-06-06

A 28-year-old patient came to the outpatient department of Mahatma Gandhi Ayurved College Hospital and Research Center, Salod, Wardha with complete loss of hairs from all over the body. First, he had Alopecia areata, but then he developed complete hair loss. He took various medications but of no use. Alopecia universalis is a rare variation of alopecia areata (AA), characterized by widespread hair loss that affects both the scalp and the body. Inhibitors of the tumor necrosis factor (TNF) have mainly failed to treat AA and have been found to either cause or exacerbate AA in some people. Unknown is the precise pathophysiology of AA. It is thought that stress, environmental circumstances, and genetics all play a part. Perifollicular inflammation and, in particular, a peribulbar lymphocytic infiltration surrounding anagen hair follicles can be seen in pathology specimens from patients with active illness. Inflammation, changes in hair cycling, and eventually hair loss are thought to result from CD4+ and CD8+ T lymphocytes infiltrating the hair and becoming reactive to hair bulb autoantigens.

Exogenous Cushing syndrome

Ashwin Karnan — 2024-06-06

A 10-year-old girl presented to our hospital with acute respiratory distress and diminished vision for the past 10 days. She was a recently diagnosed case of diffuse midline glioma who was on palliative care and had been extensively treated with oral corticosteroids by a local physician. On examination, she was afebrile, had a pulse rate of 104 beats per minute, respiratory rate of 28 breaths per minute, and blood pressure of 150/70 mmHg, on auscultation, there were bilateral crepitations, had a round, moon-like face with acne and papular lesions, dorsocervical fat deposition, central obesity with marked striae. All routine investigations were done. She was stabilized and started on intravenous antibiotics. Twenty-four (24) hour urine-free cortisol level was high which was suggestive of Cushing syndrome. An ophthalmology evaluation was done, and she was diagnosed with central serous chorioretinopathy. The steroid was slowly tapered, and the patient was transferred to the oncology department for radiotherapy. Exogenous Cushing syndrome is common in clinical practice. The commonest signs and symptoms include moon facies, supraclavicular fat pads, buffalo hump, ecchymoses, facial plethora, skin thinning, hirsutism, acanthosis nigricans, central obesity, peptic ulcers, high blood pressure, proximal muscle weakness, osteoporosis, glaucoma, cataract and avascular necrosis of the hip. The treatment for exogenous Cushing syndrome is a gradual withdrawal of the drug. A patient with hypothalamic-pituitary-adrenal axis suppression cannot increase steroid production during illness or stress and hence should receive stress-dose steroids to prevent adrenal crisis.

Effect of health education on knowledge of home management of diarrhoea amongst caregivers of under-five children in Yenagoa, Nigeria

Njideka Mesiobi-Anene — 2024-06-06

Introduction: low knowledge level of diarrhoea treatment, and appropriate use of oral rehydration therapy by caregivers, has been attributed to delay in commencing home management of diarrhoea. This delay in commencing home treatment; has led to preventable loss of lives arising from complications of diarrhoea, occasioned by lack of knowledge. Health education has been shown to help reduce delays in the commencement of home management of diarrhoea. The aim of this study was to assess knowledge of home management of diarrhoea among caregivers of under-fives in Yenagoa Bayelsa State and determine if educational intervention impacted knowledge of diarrhoea management among them.

Methods: a quasi-experimental study which involved an intervention (given health education) and a control (not given health education) group. Using a non-probability convenience sampling technique, 220 participants were recruited. Informed consent was obtained from the participants, after which a 25-item knowledge-assessing structured questionnaire was administered to the participants in both groups to assess their background knowledge of diarrhoea and its home management. Thereafter, only the intervention group was trained using a training guide. At the second contact (one month later), the knowledge of participants of both groups was re-assessed with the 25-item knowledge-assessing structured questionnaire. Responses were scored and then converted to percentages, participants with 70% and above, 50 - 69%, and below 50% were considered to have ´good´, ´fair´ and ´poor´ level of knowledge; this was compared pre- and post-intervention.

Results: at first contact, the knowledge of home management of diarrhoea among the participants was poor in both groups (intervention 9.1%, control 8.2%). However, there was a significant improvement in the knowledge of home management of diarrhoea among those in the intervention group compared to the control group (intervention 95.5%, control 7.3%) (p=0.001), at second contact.

Conclusion: the study shows that health education interventions are effective in strengthening diarrhoea literacy among caregivers of children less than five years of age. Public enlightenment through regular health education of caregivers and the use of mass media is recommended.

Bladder hernia: a rare clinical image

Abdessamad El Bahri — 2024-06-06

Bladder hernia is a relatively uncommon medical condition, accounting for 0.5% to 4% of all hernias, primarily affecting men between the ages of 50 and 70. It can lead to a range of symptoms, from mild irritative syndrome to severe obstructive renal failure. A noteworthy clinical indicator is the two-stage micturition process, which involves pressure on the hernia and its disappearance after urination. However, in many cases, this condition remains asymptomatic and is typically diagnosed during surgery. Common complications associated with bladder hernia include urinary tract infections, urinary calculi, and the rare occurrence of intrahernial bladder tumors. Treatment involves surgical intervention to repair the hernia and reposition the bladder. The protruding portion can be removed in cases of significant hernia size, bladder diverticulum, short neck, or bladder necrosis. We present the case of a 61-year-old patient with a history of ischemic stroke due to arterial hypertension. The patient sought medical attention for lower urinary tract symptoms, including dysuria, frequent urination (pollakiuria), and a burning sensation during urination (micturitional burns), which had been ongoing for three years. An abdominal computed tomography scan revealed the presence of a bilateral inguinal hernia containing the bladder on the right side (sagittal section and transverse section). The patient underwent bilateral surgical repair of the hernia and bladder reintegration. The postoperative recovery was uneventful.

Relationship between maternal and infant serum vitamin D levels in Jos, Plateau State, Nigeria: a cross-sectional study

Ishaya Ibrahim Abok — 2024-06-06

Introduction: there is growing interest in the link between maternal and infant vitamin D (VD) levels. Breast milk transmission and the fact that the mother and her child may share risk factors for VD, such as exposure to sunlight, diet, and sociocultural influences may impact VD status, the magnitude of which is largely unknown in our topical low-middle income setting. We assessed the connection between maternal and infant VD status including their correlates.

Methods: this cross-sectional study investigated 95 maternal-infant pairs in Jos. Mothers were interviewed using a questionnaire. Blood sampling and analysis of serum total 25 hydroxy VD were performed using the chemiluminescent immunoassay method. Maternal and infant VD levels were classified as VD deficient (VDD), VD insufficient (VDI), and VD sufficient (VDS). The mean maternal and infant VD were compared, and the Spearman correlation between them was assessed, a stepwise linear regression was also performed with infant vitamin D as a dependent variable. For all statistical analysis, p<0.05 was considered significant.

Results: the median maternal and infant VD was 29.68 ng/ml and 29.41 ng/ml, respectively. The mean infant VD (32.19 ± 10.61 ng/ml) was comparable to maternal VD (31.12 ± 12.94 ng/ml) (p=0.483), with a Spearman correlation coefficient of 0.3 (p=0.037). Maternal vitamin D (beta=0.539, duration of exclusive breastfeeding (beta=-3.490), and infant age (beta=1.655) were found to be significant independent predictors of infant vitamin.

Conclusion: beyond neonatal age, a significant positive relationship between maternal and infants´ VD levels exists and suggests that family-focused vitamin D intervention might be an effective public health approach in the tropical city of Jos.

Désarticulation scapulo-thoracique, une conséquence d'un échec de traitement traditionnel chez une adolescente: à propos d'un cas

Wendlamita Toussaint Tapsoba — 2024-06-06

La désarticulation scapulo-thoracique pour une pathologie traumatique est exceptionnelle. La présentation de ce cas clinique vise à partager notre expérience à propos d'un cas de désarticulation scapulo-thoracique et situer l'intérêt d'une telle indication. Il s'est agi d'une patiente de 12 ans, de latéralité droite, scolarisée, qui a été hospitalisée pour traumatisme fermé du membre thoracique droit compliqué d'une infection après une semaine de traitement traditionnel (massage, bandage avec attelles en roseau). Le diagnostic de fracture du col chirurgical de l'humérus droit compliquée d'une gangrène humide de tout le membre et d'une anémie sévère, a été posé. Une transfusion sanguine, une triple antibiothérapie et une désarticulation scapulo-humérale ont été nécessaires. Une excision progressive de tissus nécrotiques puis une scapulectomie (à J24) pour nécrose scapulaire ont permis d'aseptiser le foyer et de réaliser une greffe cutanée (à J43). La patiente, sortie après 2 mois d'hospitalisation, avec un suivi conjoint en psychologie et en kinésithérapie, a présenté des suites opératoires simples sur un recul de 7 mois. L'échec du traitement traditionnel des fractures de membre peut mettre en jeu le pronostic vital et occasionner de graves séquelles.

Prevalence of gestational diabetes mellitus and associated factors among women receiving antenatal care at a tertiary hospital in South-Western Uganda

Irene Kahimakazi — 2024-06-06

Introduction: gestational diabetes mellitus is one of the major causes of morbidity and mortality among pregnant women worldwide. We aimed to determine the prevalence and factors associated with gestational diabetes mellitus among women attending the antenatal care clinic at a tertiary care hospital in South-Western Uganda.

Methods: this was a hospital-based cross-sectional study conducted among women at ≥24 weeks of amenorrhea attending the antenatal care clinic at Mbarara Regional Referral Hospital between December 2020 and March 2021. We screened all women for gestational diabetes mellitus using the World Health Organization 2013 diagnostic criteria. We obtained socio-demographic, medical, and obstetric data. Multivariable logistic regression was used to determine the factors independently associated with gestational diabetes mellitus.

Results: we enrolled 343 pregnant women with a mean age of 27.3 (SD ±12.3) years. Of the 343 participants, 35 (10.2%) had gestational diabetes mellitus (GDM) (95% C.I: 7.4%-13.9%) and 7 (2%) had diabetes in pregnancy. The factors significantly associated with gestational diabetes mellitus were; previous history of foetal macrosomia in any of the previous pregnancies (aOR: 5.53, 95% C.I: 1.29-23.65) and family history of diabetes mellitus in the first-degree relatives (aOR: 4.45, 95% C.I:1.48-13.34).

Conclusion: one in every ten pregnant women attending the antenatal care clinic at Mbarara Regional Referral Hospital is likely to have gestational diabetes mellitus in pregnancy. There is a need to strengthen routine testing for gestational diabetes mellitus among women attending the antenatal care clinic, especially pregnant women with a prior history of foetal macrosomia and a family history of diabetes mellitus in first-degree relatives.

A propos de 39 cas de diverticules sous-urétraux de la femme: expérience monocentrique sur 30 ans

Salim Lachkar — 2024-06-06

Nous rapportons l´analyse rétrospective de 30 années d´expérience concernant 39 femmes atteintes de diverticule sous-urétral. L´âge moyen est de 37 ans (24-56 ans). La parité moyenne est de 2 (1-7). Soixante-cinq pourcent (65%) soient 25 des accouchements sont dystociques, avec utilisation de forceps dans 43% (17) des cas. Des antécédents infectieux urologiques ou gynécologiques sont présents chez toutes les patientes. Les symptômes révélateurs sont hétérogènes et sont principalement les infections urinaires récidivantes (26 cas), la pollakiurie (23 cas), l´écoulement urétral post-mictionnel (21 cas), la douleur vaginale (17 cas) et une sensation de boule vaginale (15 cas). Le bilan radiologique est variable: urographie intra-veineuse, urétrocystographie rétrograde et mictionnelle, échographie ou IRM. La diverticulectomie par voie transvaginale est le traitement pour toutes les patientes, sans complication per-opératoire rapportée. A 4 ans les résultats sont satisfaisants. Nous déplorons 4 récidives diverticulaires. Ces données fournissent des informations importantes sur les caractéristiques cliniques, les résultats diagnostiques et les résultats à long terme de la diverticulectomie transvaginale, permettant ainsi une meilleure prise en charge de cette affection rare.

Impact of filtering face pieces (FFP3) respiratory protective mask usage on the respiratory functions of informal sector carpenters in Douala: a five-month before-after study

Catherine Bouland — 2024-06-06

Introduction: informal sector carpenters in Douala, Cameroon, face potential risks to their respiratory health due to daily exposure to fine particles and wood dust. The study aims to demonstrate the importance of preventing respiratory problems in this population through regular use of filtering face pieces (FFP3) respiratory masks.

Methods: the before-after study involved 37 carpenters who wore FFP3 masks during their professional activities for five months. Spirometry measurements were taken before and after the intervention to assess changes in respiratory function.

Results: significant improvements were observed in forced vital capacity (FVC) 89.6 % to 95.0 % (p<0.000), forced expiratory volume in one second (FEV1) 88.1 % to 95.0 % (p<0.000), Tiffeneau index 82.4 to 84.9 (p<0.000), and peak expiratory flow (PEF) 6.7 l/s to 7.9 l/s (p<0.000) after mask usage, indicating enhanced lung function.

Conclusion: the regular use of FFP3 masks had a positive impact on the respiratory health of informal sector carpenters in Douala, enhancing lung function and reducing airway obstruction. The study highlights the importance of preventive measures to safeguard the respiratory well-being of workers exposed to occupational hazards. Spell out Greek characters (i.e: alpha, beta).

Chronic recurrent multifocal osteomyelitis of clavicle: a rare isolated location (a case report)

Khaled Kamoun — 2024-06-06

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disease. It is a non-microbial inflammatory bone affection that occurs more often in children with insidious onset and non specific presentation making diagnosis challenging. This study reports a case of CRMO with an unusual location. A 9-year-old child had a painful swelling over the medial side of clavicle with fixed mass. Radiographs showed osteolytic lesion on the medial part of clavicle extending to the acromioclavicular joint with soft tissue edema in magnetic resonance imaging (MRI). No inflammatory markers in biological exam. Needle biopsy, initially performed, suspected bone infection but children didn´t recover after 2 weeks of antibiotics. Surgical biopsy, histology sections were compatible with CRMO diagnosis. Children received a non steroid inflammatory drug with positive response, pain relief and decreasing of the clavicle swelling. CRMO should be suspected and biopsy is some time helpful in such unusual location.

A rare neuroendocrine tumor of the lung

Ashwin Karnan — 2024-06-06

A 51-year-old female presented to us with complaints of breathlessness, cough with expectoration, left-sided chest and back pain with general tiredness for the past 1 month. She was a farmer by profession, with no significant past history. All routine investigations were done. Contrast computed tomography thorax showed a large heterogeneously enhancing soft tissue mass occupying the left hemithorax and single precarinal necrotic node. Bronchoscopy followed by CT-guided lung biopsy was done, which showed a neuroendocrine tumour with high mitotic activity and extensive necrosis suggestive of large cell neuroendocrine carcinoma. Immunohistochemical staining for neuroendocrine markers was done, which was positive for chromogranin A and synaptophysin. She was then shifted to the oncology department for surgery followed by chemotherapy. Lung neuroendocrine tumours are rare tumours accounting for about 20% of all lung tumours, 1-2 % of all tumours and 25% of all neuroendocrine tumours. Lung tumours comprise 75-80%, neuroendocrine tumours (NETs), 1-2 % carcinoid tumours (typical and atypical carcinoid), 3% large cell neuroendocrine carcinoma of the lung (LCNEC) and 15-20% small cell lung cancer (SCLC). Immunohistochemical examination is the most important criterion for lung neuroendocrine tumours (LNET). The classical symptoms of carcinoid tumours are cough, dyspnoea, recurrent respiratory tract infection and haemoptysis. For patients with high surgical risk, interventional bronchoscopy and endobronchial resection may be done. For advanced SCLC, chemotherapy with cisplatin and etoposide is the standard treatment.

Unusual presentation of secondary syphilis mimicking erythema multiforme in HIV positive patient: a case report

Amira Suryani Rahmatika — 2024-06-06

Secondary syphilis is known as “The Great Imitator”. It can mimic numerous diseases clinically and histologically, including erythema multiforme (EM). Coinfection with HIV often makes its manifestations more atypical leading to delays in diagnosis and therapy. A 34-year-old male-sex-male patient who had received coronavirus disease 2019 (COVID-19) vaccine 1 week earlier presented with complaints of slightly pruritic scaly erythematous targetoid plaques and erythematous macules on the trunk and extremities for 6 weeks. Histopathology examination showed basal cell vacuolar degeneration of the epidermis and lymphocytic infiltrates along the dermal-epidermal junction and superficial dermis, consistent with EM. Upon further investigation, syphilis and HIV serology were reactive (VDRL 1:128, TPHA 1:40960, CD4+ 461 cells/µl). Lesions improved significantly after a single dose of 2,4-million units of benzathine penicillin intramuscular injection. Secondary syphilis presenting as erythema multiforme (EM)-like eruptions is very rare. Physicians should be aware of this unusual presentation to prevent complications.

COVID-19 pandemic and the global economic situation: a year on

Kwame Adjei-Mantey — 2024-06-06

A year after the World Health Organisation´s declaration of the novel COVID-19 as a pandemic, the global macro-economic landscape has experienced severe shocks. As a result, developed and developing countries have been saddled with intense economic uncertainties. In this study, we discuss the global macro-economic environment during the pandemic declaration period and juxtapose it with the one-year post-pandemic declaration. The evidence shows significant negative impacts on macro-economic variables in the year of the declaration. However, signs of recovery are evident a year on, albeit slowly. To sustain and accelerate the recovery gains, we suggest that strategic macro-management policies are designed and strictly implemented. Anything short of this will see especially fragile countries plunged into an “economic abyss” with severe sociopolitical implications.

Relationship between measures of adiposity and hypertension amongst secondary school adolescents in an urban setting in Cameroon

Loveline Lum Niba — 2024-06-06

Introduction: measures of obesity such as body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) have been shown to be associated with high blood pressure (BP) in children and adolescents. The purpose of this study was to determine the proportion of secondary school adolescents with elevated BP and high BP in relation to some measures of adiposity (BMI, WC, WHtR) and to examine the association between BP and adiposity indices amongst the children.

Methods: the study was an institutional-based cross-sectional study involving 534 adolescents (mean age 15.1 ± 2.3 years) attending 4 secondary schools (2 public and 2 private) in the Bamenda municipality of the North West Region of Cameroon. Anthropometric and BP measurements were carried out following standard procedures. Diagnosis of hypertension in the children was done by obtaining three elevated systolic or diastolic BP readings (BP ≥ 95^th percentile for the child's age, sex and height). Linear regression was used to determine the relationship between BP and some measures of adiposity (BMI, WC, WHtR) amongst the children

Results: the prevalence of elevated BP and hypertension amongst the study participants was 33.3% and 33.3% in the BMI-obese children, 25.9% and 25.2% in the WC overweight/obese children and 29.4% and 41.2% in the “high risk” (WHtR ≥ 0.5) children respectively. Body mass index-obese, WC overweight/obese and “high risk” (WHtR ≥ 0.5) children had a significantly (p <0.05) higher mean SBP and DBP compared to their healthy weight counterparts. Linear regression indicated a significant association (p <0.001) between WC (β=0.75; 95% CI = 0.57, 0.92), BMI (β=0.88; 95% CI = 0.49, 1.25) and WHtR (β= 67.08; 95% CI = 45.64, 88.51) with systolic BP for the unadjusted analysis. After adjusting for age, gender and school type, only WC (β= 0.66; 95% CI = (0.43, 0.89) showed a positive significant (p <0.001) relationship with systolic BP.

Conclusion: this study has demonstrated that WC is positively associated with high BP in children and adolescents. Thus, WC can be used in predicting children and adolescents with a high risk of developing high BP in our setting.

The spiked helmet sign in a patient with erysipelas: an alarming electrocardiogram sign (a case report)

Salihou Fall — 2024-06-06

Early diagnosis of the spiked helmet sign is challenging. This ST-elevation myocardial infarction mimic was first described in 2011 by Littmann and colleagues and was linked to severe non-coronary pathologies, with a high risk of mortality. We present a case of a 60-year-old female patient who developed severe erysipelas with sepsis associated with severe hypokalemia. She had a spiked helmet sign on her routine electrocardiogram at hospital admission. We performed a coronary angiogram that showed no culprit artery. She developed afterward an ischemic stroke. Through intensive management of the patient’s sepsis and electrolyte disturbance, she had a favorable outcome.

Usage and parental knowledge of antibiotics in children undergoing (adeno) tonsillectomy in northern Tanzania

Denis Robert Katundu — 2024-06-06

Introduction: Antimicrobial Resistance (AMR) is a growing concern globally, mostly being contributed by a limited understanding of antibiotic utilization as a result of inappropriate acquisition and prescription. Parental awareness is essential in optimizing their usage and preserving the effectiveness of these crucial medications. The current study investigates the usage and parental knowledge of antibiotics in children undergoing (adeno) tonsillectomy ((A)TE) in Northern Tanzania.

Methods: a cross-sectional survey was conducted among parents/caregivers of children who underwent (A)TE in Northern Tanzania. A modified and well-structured questionnaire, which was adapted from a World Health Organization (WHO) questionnaire and used to assess the parents´ knowledge of antibiotics and antibiotic use.

Results: the study included 157 participants. About 54% of the children under the age of 5 years. As of 88% of children had already received antibiotics prior to surgery, 92% of the used antibiotics were prescribed by a clinician, and 5% of parents to used leftovers antibiotics for their children. While 88% of the parents reported adhering to prescriptions, 8% of reported buying the same antibiotic (as prescribed before) without consulting a clinician again when their children are sick.

Conclusion: the use of antibiotics, including broad-spectrum antibiotics, was found to be high in our study group. Parents demonstrate a relatively good understanding of antibiotic usage. It is plausible to speculate that a higher prevalence of non-insured, unemployed, and less educated parents may lead to an increased incidence of misuse and misinterpretation of antibiotics.

Accreditation of a molecular HIV diagnostic laboratory following the Strengthening Laboratory Management Towards Accreditation (SLMTA)-Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) approach in Kenya: an implementation scie

Joy Mwende Ndunda — 2024-06-06

Introduction: accreditation is the most effective approach to ensure the quality of services. Laboratory performance can be evaluated using the World Health Organization (WHO)-SLIPTA checklist, which checks a laboratory´s compliance with ISO 15189 on a five-star score scale and improved using the SLMTA approach. Compliance is assessed by an external body and can result in accreditation. In this paper, we describe the steps taken by the Kenya Medical Research Institute (KEMRI) HIV Laboratory, Alupe, a resource-limited public entity, towards accreditation, and discuss the lessons learned.

Methods: the laboratory adopted a SLMTA-SLIPTA approach that included targeted mentorship, on-site workshops, and training. Mentorship-based interventions were used to establish a robust quality management system. Targeted mentorship, on-site workshops, and training were conducted between September 2015 and July 2016. Audits used the SLIPTA checklist to detect gaps in 12 quality system essentials. Performance indicators including turnaround time, external quality assurance, sample rejection rates, and corrective actions were tracked. An external assessment by the national accreditation body was conducted between September 2016 and November 2016.

Results: training and mentorship-based interventions were successfully conducted. Quality management systems aligned with ISO 15189 were established. Baseline, midterm, and exit audits yielded scores of 47%, 75%, and 94% respectively. Early infant diagnosis external quality assurance scores were 100% in 2014-2016, while average viral load scores were at 60%, 70% and 90% during the same period. Turnaround time from September 2015 surpassed the 80% target. Accreditation was awarded in March 2017.

Conclusion: the SLMTA-SLIPTA approach is suitable for quality improvement in resource-limited laboratories.

Determinants of quality of life among people with HIV and tuberculosis in an underserved area in Indonesia: a cross-sectional study

Elfride Irawati Sianturi — 2024-06-06

Introduction: human immunodeficiency virus (HIV) and tuberculosis (TB) remain global health problems and impose a substantial reduction in people´s quality of life (QoL). This study aimed to assess and compare the QoL in HIV and TB patients and factors associated with QoL between those groups.

Methods: a cross-sectional study was conducted at a hospital clinic in Jayapura, Indonesia, between December 2022 and March 2023. Those who were aged above 18 years, diagnosed with HIV or TB infection, have been taking HIV or TB medications for at least 3 months, and provided informed consent were eligible to participate. Patients´ QoL was measured using the Bahasa Indonesia version of a validated 26-item World Health Organization Quality of Life - Brief (WHOQOL-BREF) questionnaire.

Results: a total of 365 patients with HIV and 125 with TB were included. The majority of participants were Papuan (75.9%) and aged 20 - 65 years (92.9%). More than half of the participants were female (56.5%), employed (50.8%), married (65.5%), and had family support (64.9%). Education level and social support were predictors of poor physical health in the HIV group, while ethnicity was a predictor in the TB group. Patients´ age was associated with poor psychological health in HIV, whereas sex was the associated factor in TB patients. Ethnicity was the only predictor of poor social relationships in those with TB. Whereas patients´ age was a predictor of poor environmental health in the HIV group, marital status, and education were predictors in the TB group. Finally, only social support was associated with poor general QoL in TB patients.

Conclusion: tuberculosis (TB) patients had poorer QoL than those with HIV. There is a need for more awareness to support those receiving TB treatment. In addition, further research is needed to understand in more detail the determinants of patients with drug-resistant TB, TB with HIV, and drug-resistant TB-HIV, to ensure that interventions are designed to help them.

Hashimoto's thyroiditis presenting with cardiac tamponade: a case report

Muhammadnur Rachim Enoch — 2024-06-06

Cardiac tamponade as the initial manifestation of Hashimoto's thyroiditis is an exceedingly uncommon occurrence. We present the case of a 36-year-old female who was admitted due to acute respiratory distress. A cardiac ultrasound revealed a severe pericardial effusion with tamponade signs. Subsequently, percutaneous pericardiocentesis was performed, resulting in a swift clinical improvement. Laboratory examinations confirmed severe hypothyroidism associated with Hashimoto's disease. Despite undergoing hormone replacement therapy, histological analysis of the pericardium revealed a chronic inflammation process. A follow-up cardiac ultrasound conducted six months later indicated the presence of a well-tolerated chronic pericardial effusion. In conclusion, clinicians should consider hypothyroidism as a potential cause when cardiac tamponade is observed, particularly in the absence of tachycardia. The prognosis is generally favorable with hormone replacement therapy, but regular ultrasound monitoring should be maintained until the patient achieves a euthyroid state.

Hypogonadism in hemodialysis patients: a first snapshot of prevalence and predictive factors in Tunisian patients

Nidhal Ati — 2024-06-06

Introduction: patients with chronic kidney disease commonly exhibit testosterone deficiency. We aimed through the current study to assess the prevalence and the risk factors of hypogonadism in male patients on hemodialysis and to establish their relationship with erectile dysfunction.

Methods: we conducted a cross-sectional study based on data collected from hemodialysis male patients. Sociodemographic and clinical data as well as hormone levels were collected from January 2017 to December 2017. Sex hormones were measured in all subjects. The International Index of Erectile Function was used to evaluate erectile dysfunction. Data were expressed as mean ± standard deviation, and frequencies (number), and proportions (%).

Results: one hundred and ten: 55 male hemodialysis patients were recruited. The level of follicule-stimulating hormone, luteinizing hormone and prolactin were high and the level of testosterone was low in the hemodialysis group. Hypogonadism was significantly linked to advanced age, anemia, and absence of treatment by erythropoietin. The incidence of erectile dysfunction was high and the erectile function score was low. Testosterone significantly dropped in patients with erectile dysfunction.

Conclusion: hypogonadism was so prevalent in the hemodialysis men and it was associated with erectile dysfunction. Future studies are needed to determine the effect of testosterone therapy on erectile dysfunction.

Nigerian men and modern contraceptives: who are the non-users and what are their perceptions about family planning?

Joshua Odunayo Akinyemi — 2024-06-06

Introduction: the decision of men is pertinent to contraceptive uptake in a patriarchal society like Nigeria. Earlier studies on contraception in Nigeria have focused majorly on women. In this paper, we identified factors influencing contraceptive use, and non-users’ perceptions about family planning among Nigerian men.

Methods: using data from the 2018 Nigeria Demographic and Health Survey, this retrospective cross-sectional study focused on men aged 15-59 years. Three outcome variables were analysed: modern contraceptive use categorised as non-users or users; perception about contraception captured using two statements- “contraception is woman’s business”; “women who use contraception may become promiscuous”. Data were analyzed using multivariable logit model with robust standard errors (α= 0.05).

Results: mean age of the men was 37.3 years (SD=10.2). Out of 9622 study participants, 71.0% do not use any modern contraceptive method; 19.9% believed that contraception is woman’s business while 38.1% believed that women who used contraceptives may become promiscuous. Significant predictors of non-use of contraceptives and perceptions about family planning were older age, low education, Islamic religion, exposure to family planning messages, desire for more children and residence in Northern part of Nigeria.

Conclusion: large proportion of contraceptive non-users had negative perceptions. Educational intervention and advocacy among Nigerian men are essential to increase contraceptive uptake.

Impact of respiratory muscle training on clinical and functional parameters in COVID-19 recovered patients

Imen Sahnoun — 2024-06-06

Introduction: early respiratory rehabilitation is required for patients with coronavirus virus disease 2019 (COVID-19) sequelae to reduce the risk of serious disabilities after hospital discharge.

Methods: it was a comparative prospective study including patients with persistent symptoms one month after discharge. The patients were hospitalized at the pneumology department D of Abderahman Mami hospital for COVID-19 pneumonia. The study involved two groups: (G1) included patients who participated in respiratory muscle training program (twice a week during 6 weeks), and a control group (G2). The groups were matched based on age, sex and body mass index (BMI). Persistent symptoms and pulmonary lung function (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), total lung capacity (TLC) and diffusion capacity for carbon monoxide (DLCO), maximal inspiratory pressure (PI max) and maximal expiratory pressure (PE max), 6 Minute Walk distance (6-MWD) at baseline and after 6 weeks were compared between the two groups.

Results: the two groups of patients were comparable in terms of age, sex, BMI, comorbidities, and extent of lung computed tomography (CT) lesions. Compared to G2, a significant improvement of persistent symptoms was noted in G1, including dry cough (p=0.002), dyspnea (p=0.001), chest pain (p=0.002), and fatigue (p=0.001). The mean of percutaneous oxygen saturation (SpO2) increased from 96.68% to 97.93% (p<0.01) in G1. A significant improvement in the percentages of change of FEV1 (p=0.005), FVC (p=0.003), TLC (p<0.001), DLCO (p<0.001), and 6-MWD (p=0.015) was also noted in G1 after this program. Nevertheless, only the percentage of FEV1 (p=0.02) increased in the control group. No impact of respiratory muscle training on PI max and PE max was noted.

Conclusion: the present study demonstrated a significant improvement of persistent symptoms and exercise tolerance after short-term respiratory muscle training in patients suffering from COVID-19 sequelae.

Magnitude and associated factors of chewing khat during pregnancy in Eastern Ethiopia, 2022: a mixed method cross-sectional study

Amsalu Taye Wondemagegn — 2024-06-06

Introduction: khat (Catha edulis Forsk), is an evergreen flowering tree or shrub widely produced and consumed in East Africa and the Arabian Peninsula. In Ethiopia, it is largely produced, freely marketed and consumed by almost all segments of the population. This is more pronounced in the Eastern part of the country. However, there exists little scientific information on the level and associated factors of khat use among pregnant women in Ethiopia, despite a few available evidences indicated its adverse effect on pregnancy outcomes. Moreover, the perceived reasons for chewing khat during pregnancy were not yet explored qualitatively to triangulate the quantitative findings. Hence, the aim of the present study was to determine the magnitude and associated factors of chewing khat during pregnancy in Eastern Ethiopia, 2022, in a Mixed Method study approach.

Methods: an institution-based cross-sectional study was conducted from August 1^st to 14^th, 2022 using both quantitative and qualitative methods. Two hundred forty-two pregnant mothers on Antenatal care (ANC) were included in the study. Moreover, 18 purposively selected pregnant mothers on ANC were also considered for qualitative data. Analysis of quantitative data was performed on Statistical Package for the Social Sciences (SPSS) version 27 and thematic framework analysis was performed for qualitative data. Univariable and multivariable logistic regression analysis was performed to identify variables which are significantly associated with khat chewing during pregnancy and to estimate the variable's crude and adjusted odds' ratio with corresponding 95% CI. The statistically significant association was declared at p-value of less than 5%.

Results: the overall magnitude of chewing khat during pregnancy in the present study was 27.4% (95% CI: 22.2-33.0). Variables which significantly associated with chewing khat during pregnancy in this study were being >26 years [adjusted odds' ratio (AOR)=2.81 95% CI: 1.19-6.59], being a rural resident (AOR=2.82 95% CI: 1.19-6.69), being illiterate (AOR=4.31 95% CI: 1.02-18.20), participants having chewer husbands (AOR=3.51 95% CI: 1.33-9.24) and respondents having other chewer family members (AOR=3.05 95% CI: 1.19-7.77). In addition, the perceived reasons for chewing khat explored through in-depth interviews were for socialization, to obey tradition, to be happy with friends, husbands and families, to be free from tensioned situations, to be effective in performing daily activities, and due to lack of knowledge of its harm

Conclusion: in the present study, a relatively higher proportion of mothers chewed khat during their current pregnancy. Being older age, living in rural areas, being illiterate, having khat chewer husbands and other family members were statistically significant variables associated with khat chewing during pregnancy. Moreover, pregnant mothers are practicing chewing of khat in the current study area due to deep-rooted sociocultural issues. Hence, creation of awareness on possible harm of chewing khat during pregnancy especially for those found to be at significantly increased risk of consumption in this study is highly recommended during their antenatal care visits. In addition, creation of awareness out of health institutions, at household and community level, is highly recommended, probably using community volunteers (health development armies) in the present study area. At last, we highly also recommend the local government and religious leaders to work on how to stop the chewing practice especially during pregnancy. For example, the local government and religious leaders can work on averting consideration of chewing by the community as culturally accepted practices.

Pharmacological management of hypertension and outcome among patients on hemodialysis at Muhimbili National Hospital, Tanzania: a cross-sectional study

Devis Mhagama — 2024-06-06

Introduction: hypertension is prevalent among patients attending hemodialysis. However, published information on hypertension management among patients on hemodialysis in African countries is scarce. This study assessed antihypertensive medication prescribing patterns and blood pressure control among patients with hypertension on hemodialysis in Tanzania.

Methods: an analytical cross-sectional study was conducted at Muhimbili National Hospital in Dar es Salaam from April to June 2022. The study population consisted of patients with hypertension undergoing hemodialysis. Data on demographic, clinical characteristics and the antihypertensive medications used by the patients was collected using a structured questionnaire. Analysis was performed using Statistical Package for the Social Sciences software version 26. Uncontrolled pre-dialysis blood pressure determinants were assessed using a modified Poisson regression model. A p-value < 0.05 was considered statistically significant.

Results: out of 314 participants, the majority (68.2%, n= 214) were male, and the median age was 52 (interquartile range: 42, 60) years. Only 16.9% (n= 53) of patients had their pre-dialysis blood pressure controlled. The most frequent antihypertensive medications prescribed were calcium channel blockers (73.2%, n= 230). Patients with less than three dialysis sessions were 20% more likely to have uncontrolled blood pressure than those with three sessions in a week (adjusted prevalence ratio = 1.2).

Conclusion: most patients on hemodialysis with hypertension had poor blood pressure control, according to the study. Patients with hypertension should be strongly encouraged to adhere to at least three hemodialysis treatments to achieve optimal blood pressure control.

Prevalence and factors associated with lumbopelvic pain among pregnant women in their third trimester: a cross-sectional study

Samuel Kizito — 2024-06-06

Introduction: pregnancy related lumbopelvic pain, which refers to low back pain and pelvic girdle pain, is a common musculoskeletal disorder affecting quality of life. The purpose of this study was to establish the prevalence and the factors associated with lumbopelvic pain among pregnant women in their third trimester

Methods: four hundred and nineteen pregnant women were included in this institutional-based cross-sectional study. The study was carried out from October 2018 to March 2019 at Kawempe national referral hospital in Uganda. Pregnant women in the third trimester participated in the study. Pregnant women with preexisting backache, a fracture or surgery to the back, hip or pelvic area in the preceding 12 months were excluded. Lumbopelvic pain was defined as low back pain and pelvic girdle pain. Bivariate and multivariable logistic regression were carried out to establish the factors associated with lumbopelvic pain. The presence of lumbopelvic pain was assessed for and diagnosed using the illustrations in the pelvic girdle questionnaire.

Results: the prevalence of pregnancy related lumbopelvic pain was 46% (95% CI:40.8-50.4). Most women who had pregnancy related lumbopelvic pain experienced lumbar pain. The factors independently associated with pregnancy related lumbopelvic pain (PLPP) were being HIV sero positive [adjusted odds ratio (AOR) 2.25, 95% CI: 1.17-4.35] and having no monthly income (AOR 0.53, 95% CI: 0.30-0.94).

Conclusion: in this study, PLPP is common in women attending antenatal clinic in their third trimester. The factors associated with PLPP were being HIV positive and having no income. In future pregnant women who come for antenatal care with pregnancy related lumbopelvic pain should be given appropriate advice and support.

Quality of life of patients one year after breast-conserving surgery versus modified radical mastectomy for early breast cancer: a Kenyan tertiary hospital five-year review

Andrew Senoga — 2024-06-06

Introduction: breast-conserving surgery (BCS) followed by radiotherapy (BCT) and modified radical mastectomy (MRM) are the most common surgical techniques utilized in treatment of early breast cancer (EBC) with similar overall survival and recurrence rates. Western literature suggests that these treatments impact the quality of life (QOL) of patients variably. There are no comparison studies on these treatments as per patient’s QOL in East Africa. The objectives were to compare the QOL of patients with EBC at least one year after BCT or MRM and assess the factors that affect this QOL.

Methods: this was a cross-sectional study conducted at Aga Khan University Hospital-Nairobi (AKUHN). Eligible female patients with EBC who had undergone either BCT or MRM between January 2013 and December 2018 were invited to fill out European Organization for the Treatment and Research of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Data on participant demographics and clinical information was also obtained. Average scores for each aspect of QOL were obtained and overall means for each surgical treatment were compared. Linear regression was done to assess the factors that affected this QOL

Results: forty-two patients had BCS/BCT and 39 had MRM. Patients who had undergone BCS/BCT had a better overall QOL than those who had undergone MRM (p=0.0149). Multivariate analysis revealed that five years from time of surgery, level of education and diabetes mellitus significantly (p<0.05) affected the QOL of these patients.

Conclusion: after one year from surgery for EBC, patients who had undergone BCS/BCT had a better QOL as compared to MRM.

A palpable change in medical education post-COVID-19 pandemic

Haitham Mohamed El Bingawi — 2024-06-06

COVID-19 has brought with it a global crisis, but it also highlighted many important take-home messages to educators that are worth considering and implementing for better future medical education. We highlight 5 of these messages; (1) redefining of what considered being a core in training, (2) better to be prepared for the future challenges of online learning, (3) re-envision faculty development practices, (4) attention shift from stethoscope to microscope, (5) extra-curricular scientific activities should not lag.

Investigation of human tungiasis cases, Sheema District, Uganda, November 2021-February 2022

Sherry Rita Ahirirwe — 2024-06-06

Introduction: no formal surveillance system exists in Uganda for jiggers (tungiasis); however, outbreaks are frequently reported in the media. On 27^th January 2022, a news alert reported a jiggers’ outbreak in Sheema District, Southwestern Uganda. We investigated to establish the magnitude of the problem and identify possible exposures associated with infestation to inform control measures.

Methods: we defined a confirmed case as visible Tunga penetrans in the skin of a resident of any of 6 villages in Bwayegamba Parish, Sheema District, in February 2022. A suspected case was self-reported T. penetrans infestation during the three months preceding the interview. We visited all households in the 3 most affected villages in Bwayegamba Parish to identify cases and conducted interviews to identify possible exposures. We described cases by person, place, and time. We assessed socioeconomic status, household construction, mitigation measures against jiggers, and observed participants and their environments for hygiene. We conducted 2 case-control studies. One compared case-households (with ≥1 case) with control-households (without any cases). The second compared individual cases (suspected and confirmed) to neighbourhood controls.

Results: among 278 households, we identified 60 case-patients, among whom 34 (57%) were male. Kiyungu West was the most affected village (attack rate=31/1,000). Cases had higher odds of being male (ORMH=2.3, 95% CI=1.3-4.0), <20 years of age (ORMH=2.0, 95%CI=1.1-3.6), unmarried (ORMH=2.97, 95% CI=1.7-5.2), unemployed (ORMH=3.28, 95% CI=1.8-5.8), and having poor personal hygiene (ORMH=3.73, 95% CI=2.0-7.4) than controls. In the household case-control study, case-households had higher odds of having dirty or littered compounds (ORMH=2.3, 95% CI=1.2-4.6) and lower odds of practicing mitigation measures against jiggers (ORMH=0.33, 95% CI=0.1-0.8) than control-households.

Conclusion: males, unemployed persons, and those with poor personal or household hygiene had increased odds of tungiasis in this outbreak. Multi-sectoral, tailored interventions that improve standards of living could reduce risk of tungiasis in this area. Adding tungiasis to national surveillance reporting tools could facilitate early identification of future outbreaks.

The impact of HIV infection on surgical gastrointestinal diseases at the Princess Marina Hospital, Gaborone, Botswana: a cross-sectional study

Alemayehu Ginbo Bedada — 2024-06-06

Introduction: various gastrointestinal diseases affect surgical patients. Literature on the burden and outcomes of surgical gastrointestinal diseases in a high HIV infection prevalence is scares. This study aimed to investigate this topic at the Princess Marina Hospital.

Methods: medical records of patients admitted with surgical gastrointestinal diseases to adult surgical wards were reviewed from August 2017 to July 2018. Demographics, date of admission and discharge, HIV status, CD4 count, and outcomes were analyzed.

Results: six-hundred and ninety-eight (698) patients with known HIV infection status and surgical gastrointestinal diseases were admitted. HIV+ patients contributed 274 (39.3%). Among HIV+, females contributed 147 (53.6%). Symptomatic gallbladder stone disease was significantly higher in HIV- patients, p=0.008; while anal cancers, p=0.001, anal warts, p=0.001, and perianal infections and fistulae, p=0.010 were significantly higher in HIV+ patients. Overall, surgical site infections were recorded in 15 (2.1%) and mortalities in 43 (6.2%). The mortality rate was higher in HIV+ than in HIV- patients, p=0.048. The total number of surgical procedures and median hospital stays among HIV- and HIV+ patients were not statistically significant, p=0.868 and p=0.249 respectively. The total number of complications, p=0.338, mortality, p=0.149, and median hospital stay, p=0.181, among HIV+ patients based on CD4 count, < 200 vs. ≥ 200, were not significantly different.

Conclusion: symptomatic gallbladder stone diseases were significantly higher in HIV- patients; while anal cancer, anal warts, and perianal infections and perianal fistulae were significantly higher in HIV+ patients. HIV+ patients had a significantly higher mortality rate than HIV- patients, and this needs further investigation.

Reasons behind permanent tooth extraction at a Dental University Hospital in Morocco: a survey among patients of the International Faculty of Dental Medicine of Rabat

Rime Chraibi — 2024-06-06

Introduction: this cross-sectional study aimed to investigate the factors contributing to tooth extractions and possible correlations between tooth loss and various variables.

Methods: the study took place at the dental university hospital affiliated with the International University of Rabat over a period of two months (December 15^th, 2020, to February 15^th, 2021). The data collected has been recorded from patients who had tooth extraction procedures. The variables analyzed included age, gender, and the reason for extraction. To analyze the significance of the variables Chi-square test was used, and to investigate the variance in the mean number of teeth extracted per patient ANOVA was used.

Results: in 159 patients with different ages, a total of 586 permanent teeth were extracted. Men had an extraction rate of 54.5% while women formed 45.5%. Overall, the most frequent reason for tooth extraction was caries (46.28%), and periodontal diseases (44.90%). Other reasons for extraction included prosthetics (4.31%) and aesthetics (2.7%). However, orthodontics reasons were not observed. The topmost tooth extraction rate per patient was seen in the 41 to 50-year-old age group with a mean of 4.22 teeth. Analysis of the reasons for extraction by gender did not show a statistically significant difference (p>0.29).

Conclusion: caries and periodontal disease were the main causes of tooth extractions. Improving oral prevention health programs can help patients maintain healthier and functional oral health throughout their lives.

Antiretroviral therapy programme outcomes at Senkatana antiretroviral therapy clinic, Lesotho: a four-year retrospective cohort study

Mwamba Kabuya — 2024-06-06

Introduction: sub-Saharan Africa, home to over 10% of the world´s population, is the worst Human Immunodeficiency Virus (HIV)-affected region in the world. HIV/AIDS is a major public health challenge in Lesotho, with an HIV prevalence of 25.6% in 2018. The aim of this study was to evaluate the treatment outcomes of people living with HIV (PLHIV) on antiretroviral therapy (ART) after 48 months of initiation.

Methods: we conducted a register-based retrospective cohort study for all patients registered at the Senkatana ART Clinic from January to December 2014 and followed them for 48 months until 2018. The ART treatment register and treatment cards were the primary source of data. Data were captured and cleaned in Epi info version 7 and exported into Stata version 14 for analysis. Descriptive statistics were used to describe participant characteristics. Due to the lack of incident data, the factors associated with treatment outcomes were determined using Chi-square tests and logistic regression.

Results: in 2014, 604 patients were enrolled on ART, of which the majority were female (59.4%) and married (54.8%). The mean age (standard deviation (SD)) at which ART was started was 36 years (10.5) years. After 48 months of initiation, the cohort consisted of 387 patients of which 365 (94.3%) were retained on treatment. In the multivariable logistic regression model, neither demographic characteristics nor clinical factors were associated with ART treatment outcome (viral load suppression, adherence, or ART retention), however, the univariable analysis showed that higher CD4 count at initiation was associated with viral load suppression.

Conclusion: retention, viral load suppression, and adherence were generally good in this cohort after 48 months of initiation. CD4 at initiation was a significant predictor of viral load suppression at 48 months. The ART programme has managed to maintain high viral load suppression and improve immunity in patients who are immunocompromised. Proper data quality management is required for adequate patient monitoring to enable clinical personnel to record and use individual patient data for guiding the clinical management of such patients. Strengthening patient support and tracing will help to reduce the number of patients lost to follow-up.

Challenges and strategies to implement exclusive breastfeeding in the selected Districts of Limpopo Province, South Africa: professional nurses' perspectives

Azwinndini Gladys Mudau — 2024-06-06

Introduction: despite the efforts of professional nurses, exclusive breastfeeding rate is very low in South Africa. Per statistic South Africa, EBF rate is 32% with Limpopo Province being rated 8% as one of the lowest in South Africa. Implementation of exclusive breastfeeding required professional nurses´ efforts, lactating mothers, families, and community need information and support from the health care system. The purpose of this study aimed at exploring professional nurses´ challenges regarding implementation of exclusive breastfeeding in Limpopo Province.

Methods: qualitative research involving phenomenological design was employed to explore professional nurses´ challenges using one on one, unstructured, in-depth interview with 30 professional nurses; 27 females and three males, working in the six birthing facilities of two selected districts; Vhembe and Waterberg, in Limpopo Province.

Results: the three higher order themes emerged were challenges experienced by nurses during promotion of exclusive breastfeeding; findings revealed challenges as cultural and religious beliefs, lack of family/community and health professional support, teen and HIV positive mothers, nurses found to have challenges to implement exclusive breastfeeding. Healthcare system and services such as shortage of staff and lack of proper training on lactation management and perceived measures to promote exclusive breastfeeding suggested by health professionals, which include ongoing health education, door to door campaigns, implementation of policy by health care professionals would promote exclusive breastfeeding strategies that are in place and encourage families and community to support lactating mothers to improve their confident on breastfeeding.

Conclusion: professional nurses had challenges in promoting exclusive breastfeeding. An intervention is needed to promote exclusive breastfeeding.

Predictors of COVID-19 infection among health care workers in Harare City, Zimbabwe, 2021

Talent Bvochora — 2024-06-06

Introduction: preventing COVID-19 infection among health workers maintains the health system capacity and reduces secondary transmission. Of 506 health workers tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Harare City between December 2020 and February 2021 (second wave), 128 (25%) tested positive, affecting service delivery. We investigated factors associated with COVID-19 infection and described breakthrough infections among health workers.

Methods: we conducted a cross-sectional study in Harare City. Interviews were conducted with 467 health workers to determine behavioral, occupational, and non-occupational factors associated with COVID-19 infection. Fifteen key informants were interviewed to verify responses. Records and line-list were reviewed to verify cases, outcomes, and vaccination status. Observations were done to check adherence to prevention measures. Epi-info generated means, frequencies, proportions and conducted univariate, bivariate and multivariate analysis. Statistical significance was at p-value<0.05.

Results: we interviewed 467 health workers, 166 (35.5%) had a history of COVID-19 infection. Females were the majority 357 (76.4%), mostly nurses 200 (42.8%). Those not trained on infection control measures in the past six months (aOR=2.13; 95%CI 1.06-4.27; p=0.03), not observing social distance at mealtimes (aOR=6.33; 95%CI 3.36-11.89; p<0.01), having a household COVID-19 case (aOR=9.03; 95%CI 3.93-20.76; p<0.01) and not properly wearing facemasks (aOR=16.68; 95%CI 9.39-29.61; p<0.01) were significantly associated COVID-19 infection. Of 378 health workers fully vaccinated, 39 (10.3%) had breakthrough infections. Most with breakthrough infections, 33 (84.6%) had asymptomatic or mild disease. One death was recorded, a female, not vaccinated, with uncontrolled diabetes.

Conclusion: predictors of COVID-19 infection among health workers were, no training on infection and prevention and control (IPC) measures, lack of social distancing at mealtimes, improper use of facemasks, and having a COVID-19 case at household level. We conducted refresher training to strengthen infection control measures.

Knowledge, attitude, and practice towards hepatitis B virus among healthcare workers: a cross-sectional, hospital-based study in Montserrado County, Liberia

Bluefin Masell Freeman — 2024-06-06

Prevention is critical in safeguarding against the spread of hepatitis B virus (HBV) infection. The knowledge, attitudes, and practices of healthcare workers (HCWs) regarding the disease play an important role in its prevention or spread, yet in this regard, data in Liberia remains scarce. Hence, determining the Knowledge, Attitude, and Practices (KAP) level of HCWs toward HBV infection becomes necessary. A descriptive cross-sectional hospital-based study was conducted among 251 HCWs at two major health facilities in Monrovia. KAP regarding HBV was assessed using a standardized structured questionnaire. Results were analyzed using descriptive statistics for demographic characteristics, percentages for categorical variables, and mean ± standard deviation for continuous variables. Kruskal Wallis test, p < 0.05, was used to derive statistical inferences. Complete data from 248 respondents showed a mean age of 36.3 ± 8.9 years with most respondents were within 30-39 age range (45.82%). While poor knowledge was observed in responses to all categories of questions, correct response rates to questions range from 41.93 - 99.19% for transmission of HBV, to 98.79 - 100% for preventive measures of HBV. About 77.8% and 90.32% of study respondents strongly agreed that hepatitis B is a major public health threat and that following infection control guidelines will protect them from being infected with HBV at work respectively. More than half of the participants (60.08%) had a history of needle-stick injury (NSI), and washing the injury site with water and soap, sterilizing the wound, and checking whether the patient has a blood-borne disease was done by 48.79%, 53.62% and 27.01% of the respondents respectively. Findings from this study show that there is an inadequate level of KAP regarding HBV infection among the HCWs. It therefore is expedient to conduct regular awareness campaigns for HCWs on preventive measures against HBV infection in hospitals, in addition to workshops and in-service trainings on infection prevention and control (IPC) best practices.

Spinal muscular atrophy in Ghanaian children confirmed by molecular genetic testing: a case series

Charles Kumi Hammond — 2024-06-06

Spinal muscular atrophy (SMA) is an autosomal recessive inherited motor neuron disease characterized by progressive muscle weakness due to degeneration and loss of the anterior horn cells in the spinal cord and the brain stem nuclei from foetal life through infancy and childhood. SMA is prevalent in Ghanaian children, though not widely reported. Cases are likely missed or misdiagnosed due to lack of expertise and investigations. Newborn screening is not currently available in Ghana. The management remains supportive as newly approved genetic modifications therapies are currently not available. We present a retrospective folder review of children attending a tertiary pediatric neurology clinic who were diagnosed with SMA and confirmed by molecular genetic testing. Between January 2018 and August 2021, five (5) children from three families had molecular genetic tests confirming their diagnosis of SMA. Three (3) children had SMA I phenotype while 2 had SMA III phenotype. Two (2) of the 3 children with SMA I died from respiratory complications. The last surviving child with SMA I was diagnosed through newborn screening program overseas and received gene modification therapy. Careful history and physical examination remain the best approach to diagnosis as confirmatory genetic testing and supplemental investigations are not readily available. The current management of the children with SMA in Ghana include respiratory care, physiotherapy, and genetic counselling. Genetic modification therapies are currently not available.

Prévalence des hépatites virales B et C chez les hommes ayant des rapports sexuels avec d´autres hommes mobilisés pour une étude de démonstration de la prophylaxie préexposition au VIH à Cotonou, au Bénin

Luc Béhanzin — 2024-06-06

Introduction: les hommes ayant des rapports sexuels avec d´autres hommes (HSH) sont touchés de façon disproportionnée par le virus de l´hépatite B (VHB) et le virus de l´hépatite C (VHC) dans le monde. Au Bénin où il n´y a pas de données sur les HSH, cette étude visait à estimer les prévalences du VHB et du VHC et les facteurs associés au VHB chez des HSH séronégatifs au virus de l´immunodéficience humaine (VIH).

Méthodes: dans cette étude transversale à visée analytique, un échantillonnage aléatoire à deux degrés a permis de recruter 204 HSH. Un test immunochromatographique rapide (One Step Multi-infectious Disease Test) et des tests immuno-enzymatiques (Monolisa) ont été utilisés pour détecter antigènes/anticorps du VHB et du VHC. La régression log-binomiale a été utilisée pour l´identification des facteurs associés au VHB.

Résultats: les prévalences de l´AgHBs, d´antécédent d´hépatite B et de l´hépatite C étaient, respectivement, de 8,8%, 37,7% et 0,9%. L´AgHBs et l´antécédent d´hépatite B étaient plus fréquents chez les HSH de 30 ans et plus comparativement aux plus jeunes: 16,7% contre 6,4% (p<0,0001) et 66,7% contre 28,8% (p<0,0001), respectivement. Les rapports sexuels sous l´effet de la drogue ou de l´alcool et le fait de vivre en couple étaient aussi associés à l´hépatite B.

Conclusion: la prévalence de l´hépatite C était faible, mais l´hépatite B était fréquente, surtout chez les HSH plus âgés. Le dépistage et la vaccination contre l´hépatite B devraient être renforcés au sein de cette population.

AWaRe classification of antibiotics prescribed within 2018-2021 for hospitalised medical and surgical patients in Uyo, Nigeria

Agantem Ekuma — 2024-06-06

Introduction: point prevalence surveys have been used as a standardized tool to monitor antibiotic consumption to inform antimicrobial stewardship interventions in many countries. The 2021 WHO model list of Essential Medicines has classified antibiotics into three groups: access, watch and reserve. The aim of this paper is to describe the antibiotics used within a space of three years between 2018 and 2021 at the University of Uyo Teaching Hospital based on WHO AWaRe classification.

Methods: three point-prevalence surveys were conducted in the wards in our 500-bed tertiary hospital in 2018, 2019 and 2021. Each ward was surveyed on a particular day within a four-week period. The wards were grouped into medical and surgical for comparison. Antibiotics were classified as access, watch, and reserve. Validated data were analyzed with IBM SPSS Statistics for Windows, Version 20.0 (Armonk, NY:IBM Corp.).

Results: a total of 526 patients were surveyed out of which 344 were on antimicrobial therapy with a total of 687 antibiotic prescriptions. The overall prevalence of patients who received at least one antimicrobial was 65.4% (62.4 -72.8%). The Access group of antibiotics made up 48.2% of prescriptions while the watch group made up 50.5% of prescriptions. More watch Antibiotics were prescribed by surgical wards (49.7%) than by medical wards (43.7%).

Conclusion: the use of Access group antibiotics in our hospital falls below the WHO target level in both medical and surgical wards. There is a need for strengthening antibiotic stewardship activities to reduce the use of watch group antibiotics and limit antimicrobial resistance.

Lessons learned from early implementation of the Growing Expertise in E-health Knowledge and Skills (GEEKS) program in Nigeria, 2019 - 2021

Audrey Rachlin — 2024-06-06

Introduction: the Growing Expertise in E-health Knowledge and Skills (GEEKS) program is an applied apprenticeship program that aims to improve informatics capacity at various levels of the national health system and create a sustainable informatics workforce. Nigeria adapted the GEEKS model in 2019 as a mechanism to strengthen data quality and use of routine immunization (RI) and vaccine-preventable disease (VPD) surveillance data among Expanded Programme on Immunization (EPI) staff. Since the start of the GEEKS-EPI program, there has not been a formal assessment conducted to measure the extent to which GEEKS-EPI has been able to build local informatics workforce capacity and strengthen RI and VPD surveillance (VPDS) data quality and use in Nigeria.

Methods: we conducted a qualitative assessment to inform the extent to which GEEKS-EPI has been able to build informatics skillsets to enhance local workforce capacity, foster collaboration across government agencies, and create a sustainable informatics workforce in Nigeria. In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs) were held with GEEKS-EPI supervisors, mentors, and mentees from previous GEEKS-EPI cohorts.

Results: while there were challenges reported during early implementation of the GEEKS-EPI program in Nigeria, particularly early on in the COVID-19 pandemic, participants and supervisors reported that the fellowship provided a framework for building a sustainable RI and VPDS informatics workforce through regular mentorship, peer-to-peer exchanges and Subject Matter Expert (SME)-led trainings.

Conclusion: lessons learned from early implementation of GEEKS-EPI in Nigeria will help to inform its implementation in other countries, where strengthened national RI and VPDS informatics capacity is the primary objective.

Hepatitis B and C virus prevalence among patients and healthcare workers´ prevention practices towards the viruses in a secondary healthcare facility in Northern Nigeria

Amaike Chikwendu — 2024-06-06

Introduction: hepatitis B Virus (HBV) and hepatitis c virus (HCV) affect millions of people globally. Healthcare workers (HCWs) are at increased risk of infection due to occupation exposures where the viruses are spread mainly through needle stick injuries and exposure to infected blood and body fluid. The objective of this study was to assess the prevalence of viral hepatitis among patients and the practices of HCWs.

Methods: this study involved a 5-years retrospective review of laboratory results of patients for HBV and HCV in addition to a questionnaire-based assessment of the preventive practices of 103 HCWs on HBV and HCV. Data was analyzed using SPSS.

Results: the prevalence of HBV among the patients was 12.6% and 15.2% for HCV while the prevalence among the HCWs was 6.6% for HBV and 6.5% for HCV. About 60% of the HCWs had good overall preventive practices for viral hepatitis. Among the HCWs, 29.28% dropped needles in sharp containers after use, 53.5% recapped needles, 21.4% reused needles, 36.9% did not practice regular hand washing, and 53.4% completed the doses for HBV vaccine.

Conclusion: there is high prevalence of HBV and HCV among the patients and the HCWs. This increases the occupational risk of infection with the viruses among HCWs. We recommend that more enlightenments and trainings be done for the HCWs to enable them take appropriate measures to protect themselves. Also, HCWs should provide HBV and HCV screening to patients accessing care and those found positive should be linked to care and treatment.

Before diagnosing SARS-CoV-2-related juvenile ischemic stroke, a causal link needs to be established

Josef Finsterer — 2024-06-06

To the editors of the Pan African Medical Journal

A rare presentation of childhood interstitial lung disease attributed to KDM3B gene mutation: a case report

Zaineb Benslimane — 2024-06-06

Childhood Interstitial Lung Disease (chILD) encompasses various respiratory conditions affecting children's lung airspaces and tissues, with diverse causes. One rare cause involves structural vascular changes. We describe a case of a 10-year-old boy diagnosed with chILD who exhibited specific dysmorphic features, developmental delay, and intellectual disability. He was diagnosed with severe pulmonary arterial hypertension (PAH) due to venous thromboembolic disease, an unusual underlying condition for chILD. A Whole Exome Sequence showed mutations in KDM3B and SIN3A genes, respectively responsible for Diets-Jongmans syndrome (DIJOS) and Witteveen-Kolk syndrome (WITKOS). Both syndromes can explain our patient´s phenotype and KDM3B mutation has been previously described to be associated with PAH. Our case suggests a potential association between KDM3B mutation and PAH leading to chILD. It also enriches the knowledge of genotypic diversity in KDM3B and SIN3A genes as well as the spectrum of clinical associations with DIJOS and WITKOS syndromes.

Uptake of health insurance in Malawi in 2019-2020: evidence from the multiple indicator cluster survey

Wingston Felix Ng´ambi — 2024-06-06

Introduction: although countries in sub-Sahara Africa (SSA) show progress in implementing various forms of health insurance, there is a dearth of information regarding health insurance in settings like Malawi. Therefore, we conducted this study to determine the uptake of health insurance and describe some of the factors associated with the prevailing uptake of health insurance in Malawi using the 2019-2020 Multiple Indicator Cluster Survey (MICS).

Methods: this was a secondary analysis of the 2019-2020 MICS data. Data were analysed using frequencies and weighted percentages in Stata v.17. Furthermore, since the number of persons with health insurance is very small, we were unable to perform multivariate analysis.

Results: a total of 205 (1%) of the 31259 had health insurance in Malawi in 2019-2020. Of the 205 individuals who owned health insurance, 118 (47%) had health insurance through their employers while 39 (16%) had health insurance through mutual health organizations or community-based. Men had a higher uptake of health insurance than women. The residents from urban areas were more likely to have health insurance than those in rural areas. Persons with media exposure were more likely to own health insurance as compared to their counterparts. There was an increasing trend in the uptake of health insurance by wealth of the individual with the poorest being less likely to have health insurance compared to the richest. The persons with no education were least likely to have health insurance while those with tertiary education were most likely to have health insurance.

Conclusion: the uptake of health insurance in Malawi was extremely low. In order to increase the uptake of health insurance, there is a need to increase insurance coverage amongst those in formal employment, and consider minimizing the geographic, economic, and demographic barriers in accessing the health insurance.

Custom-made ocular prosthesis: solitary method to improve facial aesthetics (a case report)

Neha Hajira — 2024-06-06

Loss of facial structures has a physical, social and psychological impact on affected individuals. Ocular trauma caused by assaults, falls, road traffic accidents, and household or work-related accidents may necessitate eye enucleation. Enucleation is also performed to treat severe infections of the eye, intraocular tumours and painful blind eyes. This procedure can result in post-enucleation socket syndrome with facial disfigurement and severely compromising facial aesthetics. Our patient complained of facial disfigurement because of a defect associated with the right eye. History and clinical features were suggestive of post-enucleation socket syndrome. The defect was rehabilitated with an ocular prosthesis. The rehabilitation procedure provided satisfactory results and a happy patient with good aesthetics. Maxillofacial prosthesis can restore and rehabilitate lost facial structures with artificial substitutes and helps in regaining patient´s natural appearance, the health of adjoining structures and subsequently, provide physical, social and psychological well-being.

Relationship between interviewer-assisted international prostate symptom score and other objective measures of bladder outlet obstruction in Southeast Nigeria: a cross-sectional study

Solomon Kenechukwu Anyimba — 2024-06-06

Introduction: there are concerns that interviewer-assisted administration of the International Prostate Symptom Score (IPSS) may introduce bias to the extent that values obtained may not correlate with the more objective measures of bladder outlet obstruction (BOO) in benign prostate enlargement (BPE). This study aims to determine the relationship between interviewer-assisted IPSS and the more objective peak urine flow rate (Qmax) and postvoid residual urine volume (PVR) in men with lower urinary tract symptoms (LUTS) due to BPE in a low-resource setting.

Methods: a cross-sectional study from July 2020 to June 2021. Using systematic random sampling, men ≥ 40 years old with LUTS attributable to uncomplicated BPE were recruited. Participants completed the English-language IPSS questionnaire with the needed assistance from the interviewer. Thereafter, the Qmax was assessed using uroflowmetry while PV and PVR were assessed using ultrasonography. Age, serum total prostate-specific antigen (tPSA), body mass index (BMI), and the highest level of formal education attained were determined. Multivariate logistic regression analysis was used to examine the relationship between these variables and IPSS.

Results: in all, 170 men of mean age 63.7±9.9 years participated. The mean PV, PVR, and Qmax were 70.84±39.50 cm³, 77.66±69.30 cm³, and 20.25±9.70 ml/s, respectively. Of these 170 participants, 134 (78.8%) attained formal education beyond the primary level. Increasing points of interviewer-assisted IPSS have a strong relationship with worsening self-perceived quality of life due to LUTS (r: 0.76; p= 0.001), but a rather weak relationship with decreasing Qmax (r: -0.40; p= 0.009) and increasing PVR (r: 0.49; p= 0.005). Higher formal education was associated with lower IPSS at presentation and was statistically significant (p = 0.004). There were no predictable relationships between IPSS and age, tPSA, PV, and BMI (p > 0.05).

Conclusion: interviewer-assisted IPSS can be relied upon, but with some caution, in low-resource, low-formal education settings to give clinical information consistent with the objective measures of BOO.

Medical students in Sudan: an urgent need for support

Haitham Mohamed El Bingawi — 2024-06-06

Medical students are smart enough to be dismissed for academic reasons. Unfortunately, without support, they do. In Sudan, the statistics are deficient on how medical schools provide support to their students, and as the country marches towards an exciting new future of development, it is important to ensure launching in the right direction. Based on the literature search and the author's experience as a medical student, clinician, and medical educator, the difficulties facing medical students in Sudan were explored; and the required roadmap for support is suggested. Under-resourced facilities, staff migration, lack of robust student support service, and limited access to authentic databases are major problems facing medical students in Sudan. The support roadmap should come at three complementary levels: governmental, institutional, and community. National interventions need to be established to impose standards that universities must observe to ensure that students receive minimal support. The suggestions discussed in this article provide a roadmap for any medical school in Sudan whether it is facing these challenges or simply wants to improve its students' educational environment.

Utilization of pregnant women waiting area and associated factors among mothers at Damboya District, Kembata Tembaro Zone, Southern Ethiopia

Yonas Petros — 2024-06-06

Introduction: pregnant women waiting areas are residential facilities where women who live remotely can wait before giving birth at a hospital or health center. About 80% of people in developing countries live in rural areas, where poor access to maternity services accounts for many maternal and perinatal deaths. Although, pregnant women waiting areas are recommended to reduce maternal and infant deaths data on the utilization of pregnant women waiting areas limited in Ethiopia and the study area. Thus, this study assessed the utilization of pregnant mothers waiting area and associated factors among pregnant mothers at Damboya district Kembata Tembaro Zone south, Ethiopia in 2020.

Methods: community-based cross-sectional study was conducted from March 16 to April 15/ 2020 at Damboya district Kembata Tembaro Zone Southern Ethiopia. Data were collected using a structured interviewer-administered questionnaire. Data were coded, edited, and cleaned then double entered into epi data version 3.1 and exported to SPSS version 20 for analysis. Descriptive, bivariate, and multivariable logistic regression analyses were done. Finally, variables with p-value < 0.05 by multivariate logistic regression analysis were reported as independently associated factors for utilization status of pregnant mothers waiting area.

Results: this study shows pregnant women waiting area utilization was 28.1% at 95%CI (24-32). A distance greater than 30 minutes [AOR: 2.29, 95%CI (1.38-3.62)], wealth fourth quintile [AOR: 3.66, 95%CI (1.73-7.73)], awareness for PWWAs [AOR: 2.30, 95%cCI (1.12,4.74)], Good attitude [AOR: 3.0, 95%CI (1.8-5.0)], Favorable subjective norm [AOR: 2.40, 95%CI (1.50-4.0)] and low perceived barrier [AOR: 2.10, 95%CI (1.30-3.3)] were factors associated with utilization of Pregnant women waiting areas.

Conclusion: utilization of pregnant women waiting areas in the study area was low. A distance greater than 30 minutes, wealthy family, good awareness of pregnant women waiting areas, favorable subjective norm, good attitude, and low perceived barriers were predictors of utilization. To increase their utilization, we need to focus on; improving the economic status of mothers, awareness creation, and work on attitude, subjective norm, and the barriers to utilize pregnant women waiting areas.

Determinants of a high prevalence of cesarean section among women in eastern Uganda

Alimah Komuhangi — 2024-06-06

Introduction: increasing proportion of Uganda women deliver by cesarean section (C-section) but limited studies have examined the determinants of C-section. We investigated the prevalence and determinants of C-section among women aged 15-49 years in eastern Uganda.

Methods: we retrieved data for women who attended postnatal care across four large healthcare facilities in Kamuli district. C-section (surgical operation to deliver a baby through the abdomen, whether planned or not) was the outcome. Binary logistic regression was done to determine factors independently associated with C-section, reported as adjusted odds ratio (aOR) and 95% confidence interval (Cl).

Results: of 727 participants, 126 (17.3%) had delivered by C-section, with the associated factors as self (aOR=1.92, 95% CI 1.04-3.52) and unemployment (aOR=1.81; 95% CI 1.01-3.21), birth order namely second (aOR=3.13, 95% CI 1.77- 5.65), third (aOR=3.60, 95% CI 1.97-6.78), fourth (aOR=2.88, 95% CI 1.46-5.93) and fifth or beyond birth (aOR=2.16, 95% CI, 1.17-4.09), and a rural health facility (aOR=2.04, 95% CI 1.31-3.22).

Conclusion: the C-section prevalence is slightly higher than recommended by the World Health Organization. There is a need to promote contraceptive use to limit fertility, increase access to contraceptives among rural women, raise awareness among women about the importance of early and regular antenatal visits through education campaigns, equip healthcare facilities with well-trained staff and infrastructure to ensure quality antenatal care to prevent complications that could lead to C-sections, and conduct ongoing research to identify barriers and challenges faced by women in seeking quality healthcare and knowledge about obstetric risk factors.

Prevalence of anxiety and depression in patients with acute coronary syndrome: systematic review and meta-analysis

Percy Junior Castro Mejía — 2024-06-06

Depression and anxiety are common in patients experiencing acute coronary syndrome (ACS), occurring at significantly elevated rates. Together, these depressive symptoms and anxiety have a substantial negative impact on individuals with ACS. Therefore, the aim of the present study was to determine the prevalence of anxiety and depression among patients with ACS. A systematic review and meta-analysis of cross-sectional studies were carried out. A comprehensive search of five databases (PubMed, Scopus, Embase, Web of Science, and ScienceDirect) was performed until August 2, 2023. The quality of the included studies was assessed using the Joanna Briggs Institute statistical meta-analysis review instrument. The collected data were entered into a Microsoft Excel spreadsheet and analyzed with the R program version 4.2.3. A total of 3103 articles were evaluated, and, after the evaluation process, eight studies were included, for a total sample of 1642 participants. The pooled prevalence of mild depression was 14% (95% CI: 06%-23%; I² = 95%), moderate was 12% (95% CI: 06%-19%; I² = 92%), and high/severe was 15% (95% CI: 05%-30%; I² = 97%). The joint prevalence of mild anxiety was 38% (95% CI: 12%-68%; I² = 98%), moderate anxiety was 17% (95% CI: 08%-29%; I²= 89%), and high/severe anxiety was 10% (95% CI: 01%-25%; I² =95%). Therefore, it is concluded that there is a significant prevalence of anxiety and depressive symptoms in patients with ACS. However, more research focused on this area is required to obtain more robust and substantial evidence.

Same-day ART initiation, loss to follow-up and viral load suppression among people living with HIV in low- and middle-income countries: systematic review and meta-analysis

Hafidha Mhando Bakari — 2024-06-06

Introduction: in 2015, the World Health Organization recommended early antiretroviral therapy (ART) initiation after HIV diagnosis. Mixed results on the effect of ART initiation (SDI) over non-ART initiation (NSDI) on loss to follow-up (LTFU) and viral load suppression (VLS) necessitate further evaluation.

Methods: this was a systematic review and meta-analysis of people living with HIV in low- and middle-income countries (LMICs). Multiple databases were searched from January 2016 to December 2022. VLS was defined as HIV RNA <1,000 or <400 cells/ml, depending on the study. Forest plots were used to present the pooled prevalence and 95% confidence intervals (CIs). Heterogeneity was tested by an I² statistic and a p-value of <0.05 indicated its presence. Analyses were performed in STATA.

Results: sixteen studies (5 clinical trials, 10 cohorts, and 1 cross-sectional) were included in the final analysis. Nine studies with 157,633 people living with HIV were analyzed for LTFU and the pooled prevalence of LTFU was 22.0% (95%CI; 18.5-25.7). The pooled prevalence of VLS was 72.7% (95%CI; 65.4-79.5%). The I² statistic had a Q value of 200.62 (p<0.001) and 44.63 (p<0.001) for pooled prevalence of LTFU and VLS, respectively. Overall, compared to those who received NSDI, SDI had a significantly increased risk of LTFU (risk difference (RD)=0.04; 95%CI: 0.01-0.07). Although observational studies showed an increased risk of LTFU among SDI compared to NSDI (RD=0.05, 95%CI: 0.02-0.08), clinical trials did not. There was no statistically significant difference in VLS comparing those who received SDI vs NSDI (RD= 0.02, 95%CI: -0.03 - 0.07).

Conclusion: nearly two in ten people living with HIV in LMICs who initiated ART were LTFU. SDI was associated with increased risk of LTFU. Efforts to prevent LTFU among those who receive SDI are critical to maximize its potential benefits.

Pericapsular nerve group block versus fascia iliaca block for perioperative analgesia in hip fracture surgery: a prospective randomized trial

Mariem Keskes — 2024-06-06

The aim of our study was to evaluate the efficacy of the pericapsular nerve group block (PENG) versus the supra-inguinal fascia iliaca compartment block (SI-FICB) to improve analgesia during positioning for spinal anesthesia (SA) for hip fracture surgery. We conducted a prospective randomized clinical trial involving patients who will undergo hip fracture surgery under SA and randomized into two groups: the PENG group: patients who received PENG block with 10 ml of 0.25% bupivacaine and 10 ml of 2% lidocaine and the SI-FICB group: patients who received SI-FICB block with the same solution. Our primary outcome was the Visual Analogue Scale (VAS) score at positioning for SA. Secondary outcomes were VAS after the block, the ease of spinal positioning (EOSP), the time to perform the block, the postoperative morphine consumption, and the VAS score at the 3^rd, 6^th, 12^th, and 24^th postoperative hours. Eighty-nine patients were enrolled and randomized into two groups: 44 in the PENG group and 45 in the SI-FICB group. The time of block performance was comparable in both groups (p = 0.195). There was a significant decrease in pain scores in the 2 groups, 20 min after the blocks at rest and while positioning for SA. PENG block provided better analgesia than SI-FICB block at positioning (P=0.046) with no significant difference in the ease of positioning (p=0.328). The morphine consumption was comparable in the 2 groups (p = 0.842). There was no significant difference in VAS scores at the 3^rd, 6^th, 12^th, and 24^th postoperative hours with p respectively 0.061, 0.767, 0.198, and 0.130. Both PENG and SI-FICB blocks provided adequate perioperative analgesia with the superiority of the PENG block in the sitting position for SA.

Syndrome de Williams-Beuren: étude rétrospective d´une série de 11 cas du Centre Hospitalier Universitaire Mohammed VI de Marrakech

Fatima Zahrae Bouzid — 2024-06-06

Le syndrome de Williams-Beuren est une maladie génétique rare (1/20 000). Il s'agit d'une microdélétion en 7q11.23 sporadique dans la majorité des cas regroupant 28 gènes dont celui de l'élastine (ELN). Facilement identifiable dans l'enfance, cette anomalie du développement associe une dysmorphie faciale évocatrice, une malformation cardiaque, un retard psychomoteur, un profil comportemental et cognitif spécifique. Nous rapportons dans ce travail une étude rétrospective de 11 cas du syndrome de Williams-Beuren colligée au Service de Génétique du CHU Mohammed VI de Marrakech, l'âge moyen des patients est de 6,05 ans (SD= 6,56; interquartile range= 5), avec une prédominance du sexe féminin 64% (7/11). Le retard mental était quasi constant chez tous nos patients, le diagnostic est confirmé chez 100% (11) des patients par la technique d'hybridation in situ en fluorescence (FISH).

Dose-dependent, non-pigmenting fixed drug eruption with eczematous lesions induced by bosutinib: case report

Joohyung Youh — 2024-06-06

Bosutinib, widely used as a primary treatment for chronic myeloid leukemia (CML), is known to frequently cause cutaneous drug eruptions. Fixed Drug Eruption (FDE) is common, typically presenting as recurrent lesions that heal with residual hyperpigmentation. Diagnosing FDE, especially Non-Pigmenting Fixed Drug Eruption (NPFDE), is often challenging. A correlation exists between the dosage of certain medications, such as levetiracetam, and the emergence of drug eruptions. This report details a unique case of dose-dependent NPFDE caused by bosutinib. In managing cutaneous drug eruptions, particularly when the causative drug is crucial for treatment, a strategy of tapering the dosage should be considered.

Cholera resurgence potentially induced by the consequences of climate in the El Niño phenomenon: an urgent call for strengthened cholera elimination in Africa

Nadège Taty Makuntima — 2024-06-06

A resurgence in cholera cases has been observed throughout Africa during the first half of 2023. Among the many factors that drive cholera transmission, the ongoing climate phenomenon El Niño is likely to continue until March to May 2024. To prevent further cholera spread, it is critical to strengthen cholera control efforts in Africa.

Seroprevalence and risk factors for rubella infection in pregnant women attending a tertiary hospital in Kano - Nigeria

Safiya Usman Zahradeen — 2024-06-06

Introduction: rubella is a leading cause of vaccine preventable birth defects especially in developing countries. Acquisition of infection with the rubella virus in early pregnancy exposes the fetus to a very high chance of developing congenital rubella syndrome. The neonate is born with multiple abnormalities with the triad of congenital cataract, deafness and cardiovascular abnormalities like ventricular septal defect or patent ductus arteriosus. Limited data exist on the seroprevalence of rubella antibodies in pregnant women in Nigeria. The aim of this study was to determine the seroprevalence of rubella antibodies in pregnant women attending antenatal clinic in Aminu Kano Teaching Hospital, Kano state.

Methods: the study was a cross-sectional study involving one hundred and sixty-three pregnant women attending antenatal clinic of Aminu Kano teaching hospital in Kano, Nigeria. Interviewer administered questionnaire was used to collect sociodemographic data and risk factors. Blood samples were taken from consenting pregnant women during antenatal care and samples were subjected to antibody testing (IgG and IgM). Descriptive analysis was done for sociodemographic data and seroprevalence of rubella. Chi-square tests were used to determine associations.

Results: one hundred and sixty-three pregnant women were recruited for the study. The participants´ age ranged from 18 to 41 years with mean age of 27.60±5.7 years. The overall rubella seroprevalence was found to be 68.7%. The seroprevalence of specific anti-Rubella virus IgM and IgG was found to be 58.4% and 37.3% respectively while prevalence of having both anti-Rubella virus IgG and IgM in the women was found to be 26.4%. Non-formal education and immunodeficiency was found to be associated with rubella infection (P-value of 0.018 and 0.001 respectively).

Conclusion: the study found a high prevalence of anti-Rubella virus immunoglobulins in asymptomatic pregnant women attending antenatal care in our facility with immunodeficiency and non-formal education found to be significant risk factors.

Mapping water sources and access to drinking water in the Lake Chad region of Cameroon: a cross-sectional study

Collins Buh Nkum — 2024-06-06

Introduction: people's access to quality water resources significantly improves their health. In Cameroon, access to drinking water is still limited and unequally distributed over the national territory with alarming figures in the northern part of the country. This study aimed to assess the distribution of water points and characterise water storage and treatment practices in households of the Lake Chad region of Cameroon.

Methods: we conducted a cross-sectional descriptive study in Goulfey, Mada, and Makary health districts of the Far North region of Cameroon from December 2013 to February 2014. Data were collected in face-to-face interviews with a structured questionnaire to assess household water behaviour and an observational grid for the characterisation of water points.

Results: we identified a total of 303 water points, out of which 288 were assessed. Of these, 29.5% (85/288) were non-functional with functional failure observed as the main reason (47.6%). Of the 531 households reached, 527 (99.2%) were interviewed. Most households (70.2%) used boreholes as their main water source and only 3% of households used lakes as drinking water. The majority of households (90.4%) used clay pots for water storage within their homes. Buckets with covers are used in 21 (4.0%) while only 1 (0.2%) household used buckets without covers. Only 138 (26.2%) households treat their water and the main treatment method used is chlorination (89.1%).

Conclusion: this study provides further evidence that access to safe water remains a real problem in the Lake Chad Basin. Therefore, interventions are needed to address the problem, but further studies are needed to strengthen its implementation.

Characterizing the progress in traumatic brain injuries research in North Africa: a systematic review

Younes Iderdar — 2024-06-06

Traumatic brain injury (TBI) represents a major health concern worldwide. Currently, systematic TBI studies in North Africa are lacking. Nevertheless, they are highly needed to ameliorate TBI outcomes and increase survival rates among TBI patients. Through this systematic review, we aimed to characterize the progress in TBI research in North Africa and analyse the literature on TBI in the region in the last two decades. A review of North African articles was performed over 22 years (2000-2021) and the required data were collected using keywords: “traumatic brain injury”, “traumatic brain damage”, “traumatic head injury”, and “traumatic head damage”. Abstracts were screened, and selected eligible studies were reviewed independently by two reviewers. The review included 22 studies within the 59,204, 63,083, and 45,918 records that were identified between 2000 and 2021 through Scopus, Web of Science, and PubMed, respectively. The proportion of the total global TBI records that relate to North Africa was less than 1%. Overall, the indices show low progress in the number of new records occurring every year in North Africa and all the records in North Africa were produced after the year 2004. The results show that North Africa has witnessed a low production in TBI research, and the progress is far from being equal to other regions. Production of scientific publications, providing the required information and raising awareness about complications resulting from TBI on individuals and society in general, should be considered.

Asymptomatic fetal bone retention detected 12 years after termination of pregnancy: case report

İbrahim Kale — 2024-06-06

Intrauterine retention of fetal bone fragments is a rare complication that can be seen after pregnancy termination, especially in advanced gestational weeks. Here, we present a case of intrauterine fetal bone retention detected during routine gynecological examination in an asymptomatic woman whose pregnancy was terminated 12 years ago. Under local anesthesia and ultrasound guidance, the fetal bone was removed with a grasper. This case report highlights the importance of post-curettage ultrasound examination to ensure that no fetal tissue is left behind after termination of pregnancy.

Prevalence and impact of infections in acute on chronic liver failure in Rishikesh, India: a prospective cohort study

Beeram Krishna Prasanna Kumar — 2024-06-06

Introduction: infection in Acute on chronic liver failure (ACLF) is associated with poor outcomes. There is limited prospective data on microbiological and resistance profile of infections in ACLF and their impact on in-hospital mortality.

Methods: the study was conducted in the Gastroenterology department of a tertiary care hospital. The study population consisted of patients hospitalized with ACLF. 123 ACLF patients were included into the study and followed till hospital discharge. Data was collected prospectively in prespecified case-record forms. The aim was to prospectively study the prevalence of bacterial infection in ACLF, compare outcomes between patients with and without infection, microbiological profile and its impact on in-hospital mortality in ACLF. Predictors of presence of infection and mortality were estimated using univariable and multivariable regression.

Results: of the 123 patients included [Mean ± SD age 45.5 ± 11.8 years, Males 89%(n=110); Mean ± SD MELD: 32±8], infection was noted in 62% (n=77) patients on admission, but microbiological confirmation was present in only 35 of these who yielded 41 isolates. Spontaneous bacterial peritonitis (SBP) was the most common cause of infection, although most isolates were obtained from blood cultures. 58.5% (n=24) isolates were resistant to multiple drugs. In-hospital mortality was noted in 53% (n=65). Factors associated with in-hospital mortality on multivariable analysis were serum creatinine (aOR: 2.89, 95% CI 1.79-4.65; p < 0.01), international normalized ratio (aOR: 3.169, 95% CI 1.66-6.04; p < 0.001), Infection at admission (aOR: 3.81, 95% CI 1.39-10.44, p 0.009).

Conclusion: ACLF is associated with high prevalence of infection by drug-resistant organisms. Infection at admission is an independent predictor of in-hospital mortality.

Strategies for promoting male partner involvement in maternal, newborn and child health care in Kiambu County

Joseph Mukobe Okwako — 2024-06-06

Introduction: the 1994 International Conference on Population and Development (ICPD) recommended that men should share responsibility and be actively involved in sexual and reproductive health. The level of male partner involvement in Kenya remains low despite growing evidence showing its benefits in maternal and newborn health. This study sought to explore strategies for encouraging male partners to accompany their spouses to Maternal and Child Health (MCH) department.

Methods: a qualitative exploratory study was used to gather the views of nurse-midwives and invited men on mechanisms to encourage men to accompany their spouses to MCH clinic. Three and two focused group discussions (FGDs) composed of six to eight participants from nurse-midwives and men were conducted respectively. The FGDs were audio recorded and lasted 60-90 minutes. Content analysis was used to generate themes using MAXQDA 2022 software.

Results: seven categories emerged as strategies that can encourage male partner participation in the Maternal Neonatal and Child Health (MNCH) services: creating community awareness and sensitization, engaging men in the MCH department, reducing waiting time, provision of health services that address male health needs, inviting male partners to the MCH clinic, encouraging MCH staff to be receptive to couples and re-scheduling of MCH working days as well as extension of hours.

Conclusion: evidence-based strategies that adopts multi-level interventions with greater focus on community sensitization and re-organization of the MCH services are important in encouraging men accompany their spouses to clinic and actively participate in the MNCH.

Congenital arteriovenous malformation (ISSVA classification for vascular anomalies)

Subrat Narendra Samal — 2024-06-06

Presenting a Magnetic Resonance Imaging (MRI) finding of a 7 years, 5-month old male who was brought to our rural hospital by his father with chief complaints of swelling over his right hand since birth. His father narrated that the swelling is increasing significantly and the child has tenderness over swelling. The child underwent an angioembolism 1 month ago and has been brought for re-embolism. Now sclerotherapy has been planned for the patient. The physiotherapist received a call for a decreased range of motion at the elbow joint. Another haemangioma is also found in the forearm. MRI findings (sagittal T1W, T2W, STIR/PD) noted an altered signal intensity oval lesion of size 5.4 x 5.6 x 6.2 cm appearing in the anterior intermuscular compartment and deep subcutaneous plane of the right arm displacing underlying muscles. Multiple prominent vascular channels are noted in the subcutaneous plane of the right arm. A similar signal with intensity was also noted in the intermuscular compartment of the proximal, a third of the right forearm. The prevalence of Arteriovenous Malformations (AVM) is 1 per 100,000 populations per year. The patient is undergoing medications and physiotherapy rehabilitation exercises. The physiotherapy protocol started early and is continuing. Early medication and rehabilitation is the way to recover the range of motion in such patients.

Predictors of tuberculosis treatment outcomes in Antananarivo: a retrospective cohort study

Sedera Radoniaina Rakotondrasoa — 2024-06-06

Introduction: Tuberculosis (TB) is a global public health issue, affecting Africa and Madagascar. Adverse outcomes following ineffective treatment are common. Previous studies conducted in similar settings have not adequately accounted for confounding factors. The objective of this study is to identify predictive factors that are associated with tuberculosis treatment outcomes in Madagascar.

Methods: a retrospective cohort study was conducted using registries of 628 outpatients with tuberculosis at the Analakely Hospital (CHUSSPA) in 2019. Univariate and multivariate logistic regression analyses were performed.

Results: the study included 628 patients with a mean age of 37.19 ± 15.86 years and a sex ratio of 1.57. These patients were followed up for a total of 2886 person-months. Out of the 628, 517 achieved treatment success, while 31 patients died and 31 discontinued their treatment. The rates of treatment success, death, failure, and default were 82.3%, 4.9%, 0.2%, and 8.3% respectively. Female gender was found to be a predictor of treatment success area of responsibility adjusted odds ratio(AOR 1.67 [1.07-2.66]; p=0.026). Smear-negative pulmonary tuberculosis (SNPTB) was associated with a lower likelihood of treatment success (AOR 0.38 [0.23-0.65]; p<0.001) and was a common factor for default (AOR 3.17 [1.60-6.21]; p=0.001) and death (AOR=8.03 [3.01-23.72; p<0.001]). Extra-pulmonary TB was identified as a predictor of death (AOR 5.15 [1.99-14.95]; p=0.001).

Conclusion: the tuberculosis treatment indicators in this center have not yet met national and global targets. It is necessary to focus on early diagnosis, improving education, and implementing rigorous follow-up procedures for patients at high risk of adverse outcomes (SNPTB and extra-pulmonary tuberculosis(EPTB)

Hysterosalpingographic, ultrasonographic and clinical profile of infertile women in Butembo, Eastern Democratic Republic of Congo

Dieumerci Kaseso — 2024-06-06

Introduction: infertility is a reproductive health issue in modern society. In developing countries, ultrasonography and hysterosalpingography (HSG) are first-line exams investigating infertility in women. It is a highly reported issue in Africa and is linked to abnormalities diagnosed by medical imagery investigations. Our research aimed to evaluate ultrasonography and HSG usage in female infertility investigation in eastern DR Congo, and to point out the most frequent lesions in infertile women in this area.

Methods: it was a cross-sectional research. It included 1024 patients in four equipped hospitals with HSG and ultrasonography, who consulted from January 1^st, 2019 up to December 31^st, 2021. Data were collected from consultation dossiers and imagery protocols.

Results: of 1024 patients, the mean age was 30.85±5.05 years, 41.79 % (n=428) had primary infertility and 57.71% (n=591) had secondary infertility with parity ranges 1.28±1.25, abortion 1.17±1.33. HSG usage rate was 26.85% (n=275) whereas ultrasonography was 66.01%(n=749). The prevalent diagnosed lesions were uterine myomas 10.51 % (n=71), polycystic ovary syndrome (PCOS) 8.28%(n=56), endometrial dysplasia 7.99% (n=54), ovarian cysts 5.03% (n=34) at ultrasonography and tubal obstructions 53.45 %(n=147), hydrosalpinx 4.73% (n=13), cervical impotence 3.27% (n=9), uterine synechias 2.55%(n=7), müllerian abnomalies 2.55%(n=7), uterine retroversion 2.18% (n=6) at HSG. History of upper genital infection was a risk factor aOR= 3.71, 95%CI 1,55-8,88; p <0.001 for tubal obstruction to HSG.

Conclusion: the high prevalence of tubal and uterine abnormalities in infertile women of eastern DR Congo, ultrasonography, and HSG should be more performed exams in clinical practice in low-income countries.

Foot-at-risk among adult outpatients with diabetes mellitus in Bowen University Teaching Hospital, Ogbomoso, Nigeria

Adeola Ebenezer Idowu — 2024-06-06

Introduction: the rising prevalence of diabetes mellitus (DM) around the world has dramatically increased the number of people bearing the complications of this potentially incapacitating disease. One of these complications is foot ulcers that may result in amputation. This study sets out to determine the profiles of the “foot-at-risk” for ulceration and the associated socio-medical factors in DM patients.

Methods: this study was conducted at Bowen University Teaching Hospital, Ogbomoso, Southwest, Nigeria. This was a descriptive cross-sectional study comprising 299 outpatient adults aged 18 years and above with diabetes mellitus of at least 6 months in duration. Comprehensive Foot Examination and Risk Assessment tool was used to identify the foot-at-risk categories of the participants. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 20.

Results: the prevalence of foot-at-risk among the participants was 64.9% (194). Among the 194 participants with foot-at-risk, 35.1% (105) belonged to the foot-at-risk categories 0, 37.8% (113) in category 1, 16.1% (48) in category 2, and 11.0% (33) in category 3. Other factors that had a statistically significant association with foot-at-risk included; age, religion, level of education, duration of diabetes, history of smoking, and glycemic control.

Conclusion: foot-at-risk was found to have an alarming prevalence among the participants. In addition, the level of glycemic control in this group was unacceptably poor. Clinicians need to intensify preventive measures like foot screening and health education to prevent foot ulcerations, which may result in limb amputation in DM patients.

Raptured gas forming pyogenic liver abscess with a biliary fistula in Botswana: a case report

Andrew Ojuka — 2024-06-06

We report a case of gas-forming pyogenic liver abscess (GFPLA) with a ruptured abscess and biliary fistula presenting with peritonitis. The patient had poorly controlled diabetes mellitus and was extremely ill at presentation. The diagnosis was delayed until the abscess ruptured, owing to nonspecific abdominal symptoms at the initial presentation and delayed follow-up radiological investigations. The patient had a high-output biliary fistula post-operatively, which was managed with endoscopic retrograde cholangiopancreatography (ERCP) and stenting with fistula drainage reduction within four weeks. This case highlights the need for follow-up radiological investigations and prompt intervention in patients with diabetes mellitus presenting with fever and vague abdominal pain.

Antibiogram and molecular characterization of extended-spectrum β-lactamase-producing pathogens implicated in chronic suppurative otitis media

Francis Amadi Ibiam — 2024-06-06

Introduction: beta-lactamase-producing bacteria, especially extended-spectrum beta-lactamase (ESBL) producers have strong clinical relevance and have been implicated in chronic suppurative otitis media (CSOM) treatment failures. This study aimed to determine the frequency, antibiogram, and molecular characteristics of ESBL-producing gram-negative bacterial (GNB) pathogens isolated from patients with CSOM.

Methods: three hundred (300) ear swab samples collected from patients with active CSOM were analysed using standard microbiological techniques. Antibiogram of pathogens was determined by Kirby-Bauer disk diffusion technique. Phenotypic detection and molecular characterization of ESBL-producing GNB pathogens were performed by double disk synergy test (DDST) and polymerase chain reaction (PCR).

Results: Escherichia coli and P. aeruginosa were more prevalent among CSOM patients with a duration of discharge >2 weeks. The frequency of ESBL producers among the GNB pathogens was 18.3%. Isolates were generally multidrug-resistant but very susceptible (100% - 70.4%) to ciprofloxacin, imipenem, and amikacin. Multiple antibiotic resistance values of the isolates ranged from 0.7-0.8. Polymerase chain reaction showed that blaSHV (47.6%) was the most predominant ESBL genotype. This was followed by blaTEM (25.2%) and blaCTX-M (10.7%) as the least predominant ESBL gene. Concomitant expression of ESBL gene was observed in 13.6% of the isolates.

Conclusion: this study reported the occurrence and spread of β-lactamase-producing bacteria in patients with CSOM infections. It is therefore very crucial to screen for antibiotic-resistant pathogens at early stages of CSOM infections, for proper antimicrobial therapy and to curb the increasing spread of antimicrobial resistance.

Syndrome de cri du chat révélé par une dysmorphie cranio-faciale et faible succion chez un nouveau-né: à propos d´un cas

Ahmed Hared Bouh — 2024-06-06

Le syndrome du cri du chat est une maladie génétique rare, due à une délétion du bras court du chromosome 5 (5p-) avec une incidence comprise entre 1/15000 et 1/50000 nouveau-nés vivants. Il s'agit d'un nouveau-né de sexe masculin âgé d'un jour, issu d'un mariage non consanguin et de mère primigeste, la grossesse s'est déroulée sans complications et menée à terme. L´accouchement était effectué par césarienne en urgence devant une suspicion d´une chorio-amniotite avec bonne adaptation à la vie extra-utérine et un poids de naissance à 2295g. L'examen clinique a révélé une dysmorphie crânio-faciale avec hypertélorisme et microcéphalie, une hypotonie, une mauvaise succion et un pied bot plus marqué à droite, le reste de l'examen étant sans particularité. Pendant l'hospitalisation, un cri aigu monochromatique imitant le miaulement d'un chat a été observé. Le diagnostic clinique a été confirmé par la fluorescence in situ hybridization, qui a montré une délétion du bras court du chromosome 5 (5p15.2). Le bilan malformatif de base n'a révélé aucune autre anomalie. L'association d'un cri aigu monochromatique et d'une dysmorphie crânio-faciale chez un nouveau-né doit faire évoquer la nécessité d'une étude cytogénétique, en particulier d'une hybridation in situ en fluorescence.

Perceptions and attitudes of midwives on respectful maternity care during childbirth: a qualitative study in three district hospitals of Kigali City of Rwanda

Valentine Uwamahoro — 2024-06-06

Introduction: Respectful Maternity Care (RMC) is “a universal human right for every childbearing woman”. In Rwanda, few studies conducted on RMC assessed how women perceive care provided during childbirth, yet little is known about providers' perspectives. We investigated the perceptions and attitudes of midwives towards the provision of RMC to complement women's viewpoints.

Methods: this qualitative study used individual in-depth interviews in Kinyarwanda language. A purposive sampling method was used to reach out to twenty-eight midwives from three district hospitals in Kigali City. Transcribed interviews were translated into English and thematic content analysis was performed using Atlas Ti, version 7. The University of Rwanda College of Medicine and Health Sciences Institutional Review Board (Ref: 363/CHMS/IRB/2019) ethically approved this study before data collection.

Results: the majority of participants revealed that they have knowledge on RMC and perceive that they provide maternal health care based on women´s rights. Positive attitudes towards providing RMC were reported by midwives, however, a considerable number of participants reported the existence of abusive practices. The majority of midwives reported facing many challenges affecting their ability to provide respectful maternal care.

Conclusion: midwives understand the seven rights of women and have a positive attitude towards providing RMC. However, abusive practices still exist while providing RMC with considerable challenges, including overload and lack of labour monitoring materials. The adjustment of the ratio of midwives to clients and the availability of essential materials in labour monitoring is recommended to improve the quality of healthcare received by women during childbirth.

A rare presentation of esthesioneuroblastoma: a case report and review of the literature

Ahmed Ben Sghier — 2024-06-06

Esthesioneuroblastoma is a rare malignant tumor developing from the olfactory neuroepithelium. It represents less than 5% of all cancers of the nasal cavity. We are going to report the observation of a patient followed at the regional oncology center of Oujda in Morocco who presented a locally advanced esthesioneuroblastoma. Treatment consisted of surgical resection followed by adjuvant radiotherapy on the tumor bed. Currently, the patient is in good control of his disease.

An in-vivo experimental evaluation of the efficacy of fish-derived antimicrobial peptides against multidrug-resistant Pseudomonas aeruginosa

Agharid Ali Al-Rasheed — 2024-06-06

Introduction: due to the fact that antimicrobial peptides antimicrobial peptides (AMPs) from climbing perch have not been fully explored for their antimicrobial potency, this investigation was undertaken to explore that possibility.

Methods: antimicrobial peptides (AMPs) from the mucous secretion of climbing perch were obtained and an in-vivo analysis was conducted using mice.

Results: the results showed inhibitory effects on multidrug-resistant multidrug-resistant Pseudomonas aeruginosa with reduced mortality from 100% among the non-treated group to 25%. Similarly, the level of serum transaminase enzymes (AST and ALT), creatinine levels, and pro-inflammatory cytokines (TNF-α and IL-6) were all found to be higher in the non-treatment group compared to the AMP-treatment group. Also, extensive tissue damage in the lung, liver, and spleen of the non-treated control group mice was observed based on the histopathological lesions recorded. As expected, AMPs from climbing perch significantly alleviated multidrug-resistant P. aeruginosa infection in-vivo and produced enhanced therapeutic efficacy superior to the ciprofloxacin treatment.

Conclusion: this study provides insight into the potential antimicrobial activity of fish innate immune system-derived peptides that could serve as a candidate for the substitute of antibiotics.

Association of triglyceride-glucose index with vascular risk factors and clinical outcomes among COVID-19 patients: a retrospective cross-sectional study in Mengo Hospital, Kampala, Uganda

William Lumu — 2024-06-06

Introduction: triglyceride-glucose (TyG) index is a reliable surrogate marker of insulin resistance. We assessed the association between triglyceride-glucose (TyG) index and vascular risk factors and clinical outcomes of critically ill adult COVID-19 patients.

Methods: data from the charts of all patients with a confirmed diagnosis of COVID-19 who were hospitalized at Mengo Hospital Uganda from December 2020 to August 2021 was used for this study. Data on demographics, past medical history, clinical presentation, laboratory findings and clinical outcomes within the first 10 days of admission was extracted. TyG index was calculated as Inverse (triglyceride (mg/dl) x fasting glucose level (mg/dl)/2 and defined vascular risk factors using standard methods. Bivariate and multivariate logistic regression was conducted to establish a significant association. Statistical significance was set at p< 0.05.

Results: out of 314 patients, 176 (56%) were females. The mean age ± SD was 58.2 years ± 16.82. The median TyG index was 9.76 (9.29-10.33). A high TyG index was found among 85.4% (n= 268, 95% CI: 0.809-0.889) of patients. Elevated total cholesterol was in 55.4% (n=174), triglycerides 70.7% (n=222), LDL 64.7% (n=203), blood glucose 80.6% (n=253), systolic blood pressure 43% (n=135) and 24.8% (n=78) diastolic blood pressure. The majority 49.7% ( n=156) were discharged, 22.0% (n=69) needed admission to the intensive care unit (ICU), 15.3% (n=48) died in the unit and 13.0% (n=41) had a composite outcome. The TyG index was significantly associated with glycated hemoglobin (AOR=1.029, 95%CI 0.561-1.496, p<0.001), low-density lipoprotein cholesterol (AOR=0.121,95%CI 0.023-0.219, p=0.016), high-density cholesterol (AOR=1.956, 95%CI 1.299-2.945, p=0.001), total cholesterol (AOR=2.177, 95%CI 1.5222-3.144, p<0.001, hospital death (AOR=0.778, 95%CI 0.623-0.972, p=0.028) and composite outcome (AOR=1.823, 95% CI 1.221-2.559, p=0.023). There was no association between hypertension and TyG index.

Conclusion: a high TyG index was associated with vascular risk factors and clinical outcomes.

Surrogate markers of adiposity and elevated blood pressure in African children

Aude Laetitia Ndoadoumgue — 2024-06-06

Editorial.

The development of a digital NGO mapping platform in Tanzania, as a tool to strengthen civil society engagement, in pursuit of universal health coverage

Violet Wairimu Mathenge — 2024-06-06

The role of civil society in economic development, improving livelihoods and in providing pathways towards achieving health for all has become increasingly evident. By mapping these organizations, the scope and scale as well as existing capacities, gaps, and opportunities are brought to light. This paper describes the implementation of a digital mapping platform for NGOs; an interactive site which collects, analyses, and visualizes data from a variety of sources about NGOs in Tanzania, through a series of interactive maps, graphs, and charts. We describe the approach and the technology used to develop the platform and its potential contribution towards improving health outcomes. A situation analysis and needs assessment exercise was conducted in February 2023. The developed system requirement specification document served as the guiding document in the design and development of new modules. Participatory techniques and agile iterative methodologies comprising regular stakeholder engagement were employed. A distributed revision control system was used to keep track of system revisions. The modules were deployed to the production server at the National Internet Data Center (NIDC) server room, followed by a system commissioning activity in October 2023. The NGO Information System, NGO Digital Mapping tool, NGO Analytic tool, NGO Search tool and NGO Opportunities module were designed, developed, and commissioned to support NGO operations in Tanzania. The platform was launched during the annual NGO Forum in Dodoma, Tanzania, on October 5, 2023. The modules are publicly accessible and are housed within the NGO Information System (NIS) platform. Investment in whole-of-society engagement to build health systems resilience for universal health coverage is crucial. Leveraging the unique positioning of NGOs draws us a step closer to the ambitious goal of achieving health for all. Through this one-stop web application system, information on the near real-time status, existing gaps, and opportunities for collaboration to serve communities is readily available for all stakeholders. Wide dissemination and enhancement of utilization of the platform across all sectors is now needed, for data to truly inform action.

Acromegaly among a Moroccan population

Ahmed Anass Guerboub — 2024-06-06

Acromegaly is defined as an acquired dysmorphytic syndrome due to excessive secretion of growth hormone (GH) and consequently of insulin-like growth factor-1 (IGF-1). This is a retrospective study of patients who were hospitalized in the Endocrinology Department of the Mohammed V Military Academic Hospital in Rabat over a period of 14 years (2008 to 2022), reporting on their clinical, paraclinical and evolutionary profiles and comparing the results with the data in the literature. Nineteen patients were included in our study. The mean age was 42.7 ± 11.6 years, with a male predominance. The clinical manifestations were dominated by a dysmorphic syndrome present in 97.4% of cases, followed by complications related to acromegaly in 88.9% of cases. The diagnosis was made when GH and IGF-1 values were elevated in 88.9% and 93.8% of cases, respectively; with a mean GH value of 25.1 μg/L. Magnetic resonance imaging (MRI) was used to diagnose the location of pituitary adenoma in all cases, 78.9% of which were macroadenomas and 21.1% microadenomas. The majority of patients (78.9%) had recourse to transsphenoidal surgery. Medical treatment was carried out in 89.5% of cases. Postoperative radiotherapy was performed in 33% of cases. Disease control was achieved in 30.1% of cases. This study shows the complex management of acromegaly. Disease control is a necessary condition in order to avoid complications, but is often difficult to obtain.

Factors related to serum levels of intercellular adhesion molecule-1 in probable COVID-19 patients in surgical treatment: an observational study

Mendy Hatibie Oley — 2024-06-06

Introduction: COVID-19 causes a systemic inflammatory response, involving dysregulation and misexpression of many inflammatory cytokines. The recruitment and activation of inflammatory cells depend on the expression of many classes of inflammatory mediators, with increased expression of endothelial cell adhesion molecules being related to COVID-19 disease severity. With the World Health Organization having recently updated case definitions to suspect, probable, and confirmed, this study aimed to measure the mean value of intercellular adhesion molecule 1 (ICAM-1) and its relation to suspected COVID-19.

Methods: all suspected patients (n=20) were hospitalized and treated following the Indonesian National Guidelines for COVID-19 management. ICAM-1 levels were measured on days 1 and 7, demographic data were recorded, and routine blood count values were measured and additionally considered.

Results: the results showed that the levels of ICAM-1 in the 1^st-day group (mean 271.3 ng/ml) were higher than those in the 7^th-day group (mean 253.9 ng/ml). This difference was statistically significant (p = 0.00, p ≤ 0.05). All of the patients with suspected COVID-19 were included in this study and tested for COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) testing. A total of 10 patients were confirmed positive with a COVID-19 infection, with elevated ICAM-1 levels compared to the confirmed negative patients (with a mean 1^st day 296.8 versus a mean 7th day 279.0 ng/ml). ICAM-1 levels of all patients decreased by the seventh day.

Conclusion: the mean value of ICAM-1 levels for patients with confirmed positive COVID-19 cases was higher than those with suspected COVID-19 cases.

Toxicological evaluation of aqueous leaf extract of Terminalia catappa linn (combretaceae) in pregnant rats

Murtala Abdullahi — 2024-06-06

Introduction: Terminalia catappa (T. catappa) leaves are used in the treatment of hypertension, diabetes, cough, jaundice, indigestion etc, while the bark is used to treat diarrhea, dysentery, abscesses etc. Due to the acceptance and increased use of medicinal plants in pregnancy, there is a need to evaluate their toxicological profiles in pregnancy for safe use. This study aims to evaluate the toxicological effects of aqueous leaf extract of T. catappa in pregnant rats.

Methods: acute toxicity study was carried out using Organization of Economic Corporation Development (OECD) 423 guidelines. Seventy-five rats (50 females and 25 males) were used at the age of 2 weeks just after weaning. The male rats were separated from the female rats in different cages and allowed to mature for 10 weeks. Then the rats were allowed to mate. After mating, 20 female rats with viable spermatozoa counts were selected and divided into 4 groups of 5 rats each (n=5). The control group received distilled water while the treatment groups II, III, and IV were administered with aqueous leaf extract of T. catappa orally at graded doses of 100, 200, and 400 mg/kg respectively for 21 consecutive days. The daily food and water intake, and weight were recorded. On the 22^th day, the rats were anesthetized by chloroform inhalation, and blood samples were collected for haematological and biochemical analysis. The maternal livers, kidneys, and hearts were collected and weighed, and histological studies were carried out. The fetuses were removed and examined. An isolated tissue experiment was carried out on the myometrium of the pregnant rat uterus. The isometric reading of the uterine contractions was recorded.

Results: the oral LD₅₀ was found to be ≤2000-5000 mg/kg. There was a significant (p<0.05) increase in the mean food intake at the 100, 200, and 400 mg/kg doses of the extract used on the 14^th and 21^st days when compared to the 7^th day. The renal function test showed a significant (p<0.05) increase for chloride. The liver function test revealed that the extract at 100 mg/kg dose, significantly (p<0.05) increased only Alkaline Phosphatase (ALP) liver enzyme, while at 200 mg/kg dose, only AST liver enzyme was significantly (p<0.05) increased, while at 400 mg/kg dose, ALT, AST, ALP, and albumin increased significantly (p<0.05) when compared to the control group. There was a significant (p<0.05) decrease in the relative organ weight of the liver at 400 mg/kg dose of the extract. The liver histology showed moderate hepatic vacuolation and necrosis, while the histology of the kidney showed slight tubular necrosis.

Conclusion: this study has shown that the aqueous leaf extract of T. catappa is relatively not safe in the pregnant rats. Although it is non-toxic to the fetus, it exhibited tocolytic effect by inhibiting uterine contractions, thus it should be used with caution during pregnancy, especially in the third trimester or during labor.

Apport de la simulation dans l´apprentissage de la cardiologie interventionnelle chez les débutants: étude tunisienne transversale

Rania Hammami — 2024-06-06

Introduction: l´apprentissage de la cardiologie interventionnelle basée sur la simulation (ABS) est un outil éducatif en plein essor dans le monde entier. Nous avons mené alors cette étude afin d´évaluer l´impact de l´ABS sur l´évolution des compétences des apprenants débutants dans le domaine, à travers un cycle de formation de faible durée.

Méthodes: nous avons mené une étude évaluative quasi-expérimentale de type avant-après dans le centre de simulation de la Faculté de Médecine de Sfax. Nous avons impliqué des résidents en cardiologie au début de leur formation en cardiologie interventionnelle. Tous les participants ont bénéficié d´un cycle de formation ayant duré 4 heures sur un simulateur à haute-fidélité de type Cathi^®, après avoir donné leurs consentements. Le critère de jugement primaire a été définie par l´amélioration significative des scores de performance et de compétence avant et après le cycle. Le critère de jugement secondaire a été défini par la réduction de temps d´irradiation et le temps de la procédure.

Résultats: treize apprenants ont participé dans notre étude. Le score de performance s´est amélioré d´une médiane de 216,12% (ISQ= 285%). Cette amélioration était significativement plus nette chez les apprenants qui n´ont jamais eu accès à la salle de cathétérisme. Le score de performance a évolué d´une médiane de 31 (ISQ=40,5) à une médiane de 120 (ISQ=19,7), (p=0,001). Le score de compétence lié à la coronarographie s´est amélioré significativement, d´une médiane de 16 (ISQ=18) vers une médiane de 70 (ISQ=6), (p=0,001). Le score de compétence lié à l´angioplastie a évolué significativement d´une médiane de 10 (ISQ=17) vers une médiane de 50 (ISQ=13,7), p=0,001. Les durées de la coronarographie et de l´angioplastie ont été nettement réduites ayant évolué respectivement de 12 min (ISQ=2) à 7 min (ISQ=1) après le cycle de simulation (p=0,001), et d´une médiane de 19 min à une médiane de 17 min après la simulation, p= 0,002.

Conclusion: malgré la durée courte de la formation par simulation, notre étude Pilote a démontré une amélioration significative des compétences et performances des apprenants ainsi qu' un gain de temps de la réalisation des procédures et d´irradiation ce qui pourrait augmenter éventuellement le nombre de procédures réalisées quotidiennement dans notre cathlab et limiter l´irradiation du personnel et des patients tout en assurant une formation adéquate aux apprenants.

Five successive waves of SARS-CoV-2 infection in the Central African Republic: a prospective observational study from 2020-2022

Clotaire Donatien Rafaï — 2024-06-06

Introduction: the National Laboratory of Clinical Biology and Public Health (NLBPH) in Bangui in the Central African Republic (CAR) carries out the vast majority of molecular screening tests for SARS-CoV-2 infection nationwide. TThis study aimed to show the contribution of molecular diagnosis and genomic surveillance in monitoring the evolution of longitudinal variations of the SARS-CoV-2 infection epidemic in CAR between 2020 and the end of 2022.

Methods: this is an observational study on the variations in the prevalence of detection of SARS-CoV-2 by RT-PCR at the NLCBPH from nasopharyngeal samples taken prospectively over a period of 3 years since the beginning of the Covid-19 epidemic. A subgroup of SARS-CoV-2 positive samples was selected for molecular sequencing performed by Illumina® and MinIon® at the National Institute for Biomedical Research in Kinshasa, Democratic Republic of the Congo.

Results: from March 2020 to December 31, 2022, 88,442 RT-PCR tests were carried out (4/5 of the country) and detected 9,156 cases of SARS-CoV-2 infection in 5 successive waves. The average age of the patients was 39.8 years (extremes ranging from to 92 years). Age(P=0.001), sex(P=0.001) and symptom presentation(P=0.001) were significantly associated with RT-PCR test positivity. Among the different variants identified during successive waves, the Omicron variant predominated during the last two waves.

Conclusion: this prospective study over a period of 3 years, marked by 5 successive waves, made it possible to report that age, sex and the presence of clinical symptoms are associated with RT-PCR positivity. Among the different variants identified during successive waves, the Omicron variant predominated during the last two waves.

Prevalence and factors associated with condom use among women aged 15-49 years in Rwanda using a survey logistic regression model: evidence from the 2019/20 Rwanda Demographic and Health Survey

Mkhombiseni Zamani Sithole — 2024-06-06

Introduction: although Rwanda's HIV prevalence has declined, many people are still acquiring or living with it. Among other methods of HIV prevention, condoms are a safe and reliable method in addition to preventing pregnancy and other sexually transmitted infections, especially when used properly. This study aimed to determine the prevalence and determinants of condom use during last sexual intercourse among reproductive-aged women in Rwanda.

Methods: using data from the cross-sectional, nationally representative Rwanda Demographic and Health Survey (RDHS) conducted in 2019/2020, we carried out secondary data analysis. A multivariable logistic regression model was applied to determine the factors associated with condom use. All analyses from the model were adjusted for unequal sampling probabilities using survey weights.

Results: results showed a 10.8% prevalence of condom use. The odds of condom use during last sex were significantly lower for women who lived with a man (adjusted odds ratio [aOR]= 0.10, CI=0.08:0.13) and those from the Southern region (aOR=0.69, CI= 0.52 to 0.92) but were significantly higher for those with primary education (aOR=1.38, CI= 1.00:1.88). Also, the rich were more significantly associated with condom use compared to the poor (aOR=1.53, 95% CI= 1.20:1.93). Those who had three or more sexual partners had higher odds of condom use than those with one partner (aOR=3.12, CI= 2.50:3.89).

Conclusion: based on the results, health promotion interventions aimed at raising awareness on HIV prevention should, therefore, target the groups that were found to have a high risk of not using condoms.

An assessment of the experiences, and perceptions of the collateral effects of the COVID-19 lockdown measures in Southeast Nigeria: implications for policy and action

Chigozie Jesse Uneke — 2024-06-06

Introduction: there is limited evidence from developing countries including Nigeria on the collateral effects of the COVID-19 lockdown on the socioeconomic lives of citizens. The aim of this study was to explore citizens´ experiences and perceptions of the impact of COVID-19 lockdown measures on daily living in Southeast Nigeria

Methods: this was a cross-sectional descriptive study conducted among policymakers, researchers, non-governmental organizations (NGO) officials, and health practitioners in Southeast Nigeria. Data were collected using short message sending (SMS), emails, and key informant interviews.

Results: although the COVID-19 lockdown measures had both positive and negative effects, it was largely negative. Some of the effects on family and social life were more quality time with family and improved family ties, increased social vices, reduced social and religious interaction, and disrupted academic calendars and educational pursuits. On economic life, the lockdown provided an additional source of income for those involved in the sales of facemasks and related commodities, while for others it reduced income and increased expenditures. Regarding work/career, the lockdown promoted the use of new technologies and skill acquisition, while remote work relieved work-related stress. The health effects were mostly negative including loneliness, depression, and anxiety, however, it improved health consciousness and personal hygiene. Other systemic effects stated were reduced air pollution and poor patronage at health facilities.

Conclusion: without intending to, the COVID-19 lockdown in Nigeria had mixed effects on family and socioeconomic life, negatively impacting mental health but improving work-related life among others. These findings are a call to policy action to mitigate the negative effects whilst sustaining the positive gains from the lockdown.

A cross-sectional study of clinical features of bacterial meningitis among neonates presumed to have sepsis in a tertiary hospital, Dar es Salaam, Tanzania

Taher Pishori — 2024-06-06

Identifying meningitis among neonates is usually challenging given the non-specific presentation and overlap with neonatal sepsis. This study was aimed at determining the pertinent clinical features that would suggest bacterial meningitis among infants with signs of possible serious bacterial infection and their outcomes. This hospital-based cross-sectional study was conducted among neonates presenting with clinical features of sepsis admitted at Muhimbili National Hospital (MNH) between May and December 2015. Detailed clinical features, blood cultures, and cerebrospinal fluid were obtained. The specimens were tested at the Central Pathology Laboratory at MNH. Short-term clinical outcome was also determined for recruited participants. One hundred and twenty-six neonates met the inclusion criteria and were recruited, males were 67 (53.2%) and the mean age of participants was 10.4 ± 7.9 days. Features of meningitis were noted among 19% (24/126) and very low birth weight neonates were observed to have a statistically higher prevalence of meningitis (p=0.038). Bacterial isolates from cerebrospinal fluid (CSF) culture were Klebsiella spp and E. coli, while predominant isolates from blood culture were Klebsiella spp (35%) and E. coli (20.6%). There was high resistance to ampicillin (91.2%), cloxacillin (94.1%), gentamycin (50%), and ceftriaxone (50%). A high mortality of 24.9% was noted. Neonatal meningitis is common among neonates with sepsis, and bacterial isolates were resistant to routinely used antibiotics. High mortality attributed to meningitis was noted at Muhimbili National Hospital.

Profil épidémiologique de la coqueluche du nourrisson à Casablanca de 2012 à 2019

Bouchra Slaoui — 2024-06-06

La coqueluche est un véritable problème de santé publique en raison de sa morbidité importante chez le jeune nourrisson et sa résurgence malgré une couverture vaccinale élevée. Le but de cette étude est d´analyser le profil épidémiologique de la coqueluche des nourrissons hospitalisés de 2012 à 2019. C´est une étude rétrospective, descriptive menée sur une période de 7 ans et 8 mois, de janvier 2012 à juillet 2019. Elle a concerné 500 nourrissons admis pour une suspicion clinique de coqueluche. L´âge moyen était de 72 jours avec des extrêmes de 28 jours et 18 mois. Soixante-quinze pour cent (75%) des nourrissons avaient moins de 3 mois. Le pic d´incidence a été noté en 2012 et 2016 avec une prédominance estivale (32%). Quatre cent soixante (460) nourrissons (92%) étaient non ou incomplètement vaccinés dont 42,2% étaient trop jeunes pour l´être. Un contaminateur probable dans l´entourage a été retrouvé dans 43,6% des cas. La toux quinteuse cyanosante était le principal motif d´hospitalisation (77,6%). La radiographie pulmonaire avait objectivé un syndrome bronchique (25,4%) et des foyers alvéolaires dans (22,7%) des cas. L´hémogramme réalisé chez 410 nourrissons avait retrouvé une hyperlymphocytose dans 67,5 % des cas. La réaction en chaine par polymérase (PCR) sur prélèvement nasopharyngé réalisée chez 206 nourrissons, était positive pour Bordetella pertussis dans 64% des cas. Cent dix-huit (118) PCR effectuées chez les mères étaient positives dans 47,7% des cas. Tous les nourrissons ont été mis sous Clarithromycine. La coqueluche est une cause importante de morbidité chez le nourrisson à Casablanca. La prévention repose sur la vaccination de tout l´entourage familial des jeunes nourrissons. Cependant la vaccination des femmes enceintes semble plus efficace.