South Sudan Medical Journal

Transforming stroke care in Africa: Early initiatives of a UK-based charity

Godwin Ogbole — 2024-09-04

No Abstract

Annual health dialogue report in Kigile Payam, Maiwut County, Upper Nile State, South Sudan

Panom Puok Duoth Kier — 2024-09-04

No Abstract.

Perioperative anaesthetic management of a patient with single ventricle undergoing mastoidectomy

Ehssan Mohamed — 2024-09-04

Patients with single ventricles undergoing non-cardiac surgery have a higher incidence of perioperative complications. Factors associated with the most significant risk are the complexity of cardiac disease and the patient’s physiological status. We here describe the anaesthetic management and pathophysiological considerations of an 18-year-old male with a single ventricle undergoing elective mastoidectomy. Comprehensive and multidisciplinary perioperative care is mandatory for optimal management. The patient had a history of previous cardiac surgeries for his cardiac condition and presented for elective mastoidectomy due to chronic suppurative otitis media. Preoperative assessment revealed a satisfactory general condition with peripheral oxygen saturation (Spo2) of 90-92% on room air. Cardiovascular evaluation showed weak S1 and S2 heart sounds and a faint systolic murmur heard best at the left upper sternal border. Echocardiography indicated a common ventricle with a small left atrium and significant tricuspid regurgitation. Long term medications included carbamazepine, warfarin, and aspirin. Comprehensive perioperative care, including meticulous preoperative assessment, tailored intraoperative management, and appropriate postoperative monitoring is crucial for patients with single ventricles undergoing non-cardiac surgery. Specialized centres equipped to manage high-risk cases are recommended to optimize outcomes and minimize complications.

Radiological accuracy in locating a migrated IUD from the uterine cavity

Peter Joseph Wangwe — 2024-09-04

The Intra Uterine Device (IUD) is a safe and common form of contraception. Locating a lost IUD following silent perforation of the uterus either during or after IUD insertion is challenging. Locating the IUD using radiological investigation is straightforward. However, the use of a series of radiological investigations which brings the same management outcome is controversial in terms of cost. This is a report of a rare case in which several radiological investigations were conducted following IUD migration from the uterine cavity. The patient presented with lower abdominal pain and dyspareunia for oneyear post IUD insertion. Plain pelvic X-ray has less diagnostic accuracy in locating a migrated IUD compared to pelvic ultrasound and pelvic Computer Tomography (CT). Although it is cheap and can be done in low resource areas where there is minimal health investment it should be used as a preliminary investigation in case pelvic ultrasound is not available. This case report shows the important role of different imaging modalities, depending on cost, infrastructure, availability of radiological expertise, and the timely availability of endoscopic services, in diagnosing and managing a displaced IUD compared to open surgery.

Neurocysticercosis epilepsy diagnosed by Magnetic Resonance Imaging

Ronald M. E. Woro — 2024-09-04

Neurocysticercosis is prevalent in most developing countries where pork is consumed. It is estimated that approximately 30% of cases of epilepsy may be due to neurocysticercosis. We present a case of a middle-aged man who presented to a health facility in the city of Juba in South Sudan with tonic-clonic seizures and left-sided weakness. He was originally diagnosed as having epilepsy and Transient Ischaemic Attacks (TIA). Post-seizure confusion and odd behaviour prompted referral to a psychiatrist but was referred to the Juba Medical Complex (JMC) for a medical opinion and further management. The diagnosis of cysticercosis was confirmed on Computerised Axial Tomographic (CAT) scanning and Magnetic Resonance Imaging (MRI). Verbal consent was obtained from the patient to publish his clinical details anonymously.

Phalangeal microgeodic syndrome: A case series in five adults

Lucy Parker — 2024-09-04

Phalangeal Microgeodic Syndrome (PMS) is rare, characterised by cold related discolouration, pain and swelling of the digits. A handful of case reports exist mainly in a paediatric population in Japan. We describe five cases of PMS. The underlying aetiology remains uncertain, however, a possible correlation with infection or autoimmune dysregulation may suggest a common pathway which is yet to be identified. However, many cases seem to resolve spontaneously.

Onchocerciasis-associated epilepsy in Western Equatoria State, South Sudan

Stephen Raimon Jada — 2024-09-04

Onchocerciasis-associated epilepsy (OAE) is a neglected public health problem in remote African regions endemic to onchocerciasis with suboptimal elimination programmes. OAE manifests in previously healthy children aged 3-18 years in the absence of any obvious cause for epilepsy and is marked by a diverse range of seizure types, including head nodding seizures (nodding syndrome). This paper reviews recent studies investigating the association between onchocerciasis and epilepsy in South Sudan. Surveys in Maridi, Mundri West, and Mvolo Counties demonstrated a very high prevalence (3-6%) and incidence of epilepsy, as well as substantial onchocerciasis serological prevalence (12-34%) in young children. However, a longitudinal population-based study conducted in Maridi and Mvolo showed that strengthening onchocerciasis elimination programmes was followed by a significant and consistent reduction in the incidence of epilepsy. Despite this progress, a large epilepsy treatment gap and a high level of misconceptions about epilepsy and epilepsy-related stigma were observed. Treating epilepsy in onchocerciasis-endemic regions is challenging. More advocacy is needed to provide uninterrupted access to free anti-seizure medication and promote community awareness programmes for improving the lives of persons with epilepsy and their families in these impoverished areas.

A rare and challenging case of teratoma associated Anti-NMDA receptor encephalitis

Kevan English — 2024-09-04

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease that is often underdiagnosed due to the variability and complexity of its clinical presentation and is frequently misdiagnosed as viral encephalitis. It is sometimes characterized as a form of limbic encephalitis, which predominantly affects children and younger adults, with a female-to-male ratio of 4:1. The neurological disease is commonly associated with an underlying tumour. Its pathophysiology is attributed to the formation and binding of IgG1 and G3 antibodies to the NR1 subunit of the NMDA receptor in the central nervous system. We present the case of a 23-year-old woman with a one-year history of episodic mood lability and psychosis who sought medical attention at the emergency department due to the sudden onset of agitation, hallucinations, and altered mental status. Brain magnetic resonance imaging revealed findings suggesting possible encephalitis. A cerebrospinal fluid analysis was positive for NMDAR antibodies, and a transvaginal ultrasound later revealed a right ovarian mass, from which a biopsy confirmed a mature cystic teratoma. Despite surgical resection of the tumour and medical treatment, the patient experienced persistent cognitive impairment and gait dysfunction following three months of hospitalization in the neuroscience intensive care unit. In light of the complexity and aggressiveness of the clinical symptoms of NMDAR encephalitis, the disease has a relatively good prognosis, especially following surgical resection of the associated malignancy and medical treatment in most patients. On the other hand, a delay in diagnosis and treatment may result in long-term functional deficits and poorer clinical outcomes.

The model street method: considering its suitability beyond poverty and sustainability into post-conflict settings

Shelley Grierson — 2024-09-04

Introduction: The model street method was developed in 2015 to provide a framework for delivering high-impact, low-cost, scalable community health interventions for communities affected by poverty in Africa. Since then, the method has been adapted to other contexts, including sustainable redevelopment of urban areas in Europe and North America. Therefore, the suitability of the model as a template from which other contexts could benefit should be considered. Post-conflict settings have several features in common with poverty settings, where this model has been well demonstrated as effective.

Method: The method involves physically transforming a community through improved neighbourhood infrastructure and design. The aim is to improve the physical and psychological wellbeing of the residents. In its flagship project, residents of the deprived neighbourhood Dandora (Kenya) achieved a significantly improved quality of life. The project was delivered over six stages across 18 months. These stages included field research, collaboration laboratories, community workshops, building parties, implementation, and launch.

Results: Key success measures included improvements in perceived safety and security of residents, and better livelihood opportunities, relationships with authorities, play opportunities for children, and drainage and environmental quality. The results achieved recognition in several international awards. The method has since been applied to other neighbourhoods in comparable settings, such as Cape Town, Accra, and Kampala. It has also been adapted successfully to settings other than poverty alleviation, including its use in Europe and North America.

Conclusion: As a community health intervention method, it is low-cost, and its focus on collaboration maximises suitability across a variety of contexts. However, there are unique features specific to post-conflict settings, so it is recommended that the model street methods’ suitability for application in postconflict settings be further considered and investigated.

Coping with healthcare ethical issues in Cameroon

Kevin TJ. Dzi — 2024-09-04

Introduction: Most healthcare professionals (HCPs) face numerous ethical challenges while performing their tasks, regardless of clinical ethics support structures (CESS) in many health facilities. There has been little research on CESS in Africa. This study sought to determine how often Cameroonian HCPs in the Southwest Region (SWR) faced ethical issues, how many health institutions have CESS and whether those with no CESS are willing to have one created.

Method: From December 2022 to June 2023, a cross-sectional study of 469 nurses and physicians working in the SWR was conducted. Descriptive statistics and the chi-squared test were used. The threshold for statistical significance was p < 0.05.

Results: Of the 466 respondents who answered the question about encountering ethical issues, 177 said they encountered them once a month, whereas 217 reported encountering them weekly. Of the 464 responses to the questions about the CESS, 172 (37.1%) agreed that there was one in their health facility. Where there was no CESS, 255 out of 292 respondents (87.3%) expressed their willingness for one to be established.

Conclusions: SWR nurses and physicians regularly face ethical issues, and they are willing that CESS be established in their hospitals to assist them in resolving complex ethical problems. The Ministry of Public Health is requested to support such initiatives.

Mpox is a public health emergency of international concern

Edward Eremugo Kenyi — 2024-09-04

No Abstract