Pan African Medical Journal最新文献

Ocular tuberculosis in children poses significant visual risks and exhibits distinct characteristics compared to adults, necessitating careful diagnosis and management. This case illustration presents a 10-year-old girl with intermittent redness in her left eye. Despite initial treatment, her condition worsened, leading to blurred vision. She was diagnosed with ocular tuberculosis complicated by phlyctenular conjunctivitis, interstitial keratitis, diffuse anterior scleritis, anterior uveitis, and neuroretinitis. Antituberculosis therapy was initiated alongside corticosteroids and neuroprotective treatment. The patient showed significant improvement within one month and achieved full resolution after two months of treatment. Ocular tuberculosis in children, it often accompanies extrapulmonary tuberculosis and can lead to significant complications. Additionally, children tend to exhibit a heightened inflammatory response to ocular tuberculosis, necessitating more aggressive corticosteroid therapy to manage the condition effectively.

Introduction: Undescended testis (UDT) refers to the actual absence of one or both testicles from their normal position in the scrotum. It can lead to testicular atrophy, malignancy and male infertility. Our study highlights the epidemiological, diagnostic and therapeutic aspects of UDT in 3 referral hospitals in Douala.

Methods: we conducted a descriptive and retrospective study over 10 years (January 1, 2012 to December 31, 2021). We collected data from the medical records of patients aged 1 to 15 years, who underwent surgery for UDT. The sociodemographic, clinical, paraclinical and therapeutic data were collected, recorded and analyzed using CS Pro 7.3 and SPSS 23 software.

Results: we reviewed 741 records, excluding 595 that were not managed during our study period, leaving 105 cases included. UDT accounted for 1.39% (741 out of 53,431 cases) of urological consultations. The average age was 6.65±3.13 years. Scrotal emptiness was the main reason for consultation (81.9%), discovered by a parent at home in 76.7% of cases (n=66). Six point seven percent of the patients (n=7) had a brother with a history of UDT and 2.8% (n=3) a father. The left testis was most commonly affected: 44.8% (n=47). The testis was palpable in the inguinal region in 91.4% of cases (n=96). The diagnosis was mainly clinical, with ultrasound performed in 14 patients (13.4%). Cryptorchidism was the most diagnosed condition: 85.7% (n=90). The average hospital stay was 1.85±0.74 days. Two surgical approaches were used: inguinal in 99 patients (94.3%) and laparoscopic in 6 patients (5.7%).

Conclusion: from our study, we can conclude that UDT is a relatively uncommon condition in urological consultations, emphasizing the importance of proper diagnosis and management. Surgically, two approaches are available: the inguinal approach, which is the most commonly used, and laparoscopy, which is essential when the testicles are intra-abdominal or non-palpable in the inguinal region.

Anaphylactic reactions are rare but potentially life-threatening events that may occur during medical procedures. This present case highlights a distinct occurrence of an anaphylactic reaction in a patient undergoing hemodialysis, specifically induced by the utilization of a fistula needle along with a review of the literature.

Introduction: in 2010, Nigeria adopted the Test-Before-Treat recommendation in her "national guideline for diagnosis and treatment of malaria." Across Nigeria, donor agencies including the Global Fund to Fight AIDS, Tuberculosis and Malaria, support states in malaria control, particularly at the Primary Healthcare level. This study aims to compare compliance to Test-Before-Treat recommendations in managing uncomplicated malaria among health workers in global fund-supported and government-supported Primary Healthcare Centers (PHCs) in Anambra State.

Methods: a cross-sectional comparative study involving 32 PHCs across Anambra State. Using multi-stage sampling, the facilities were selected from four local government areas in two of the three senatorial zones. Data were collected using 1536 proforma for retrospective audit of case records, 82 health worker questionnaires, 32 facility assessment questionnaires, and 32 observational checklists for health facility inventory; and analyzed using IBM SPSS Statistics version 20. The Chi-square test of independence and Fisher's exact test was used to determine the association between categorical variables. Statistical significance (p) was set at 0.05.

Results: compliance with Test-Before-Treat recommendations in global fund-supported PHCs was 99% (760/768) versus 84% (645/768) in the government-supported (p=0.00). Comparatively, global fund-supported PHCs had higher availability of free malaria rapid diagnostic test kits (mRDT), job aids, copies of national guidelines in consulting rooms, staff with recent training on mRDT, and staff recently exposed to supervision.

Conclusion: donor fund supports enhanced compliance to Test-Before-Treat recommendations by increasing the availability of free mRDT kits, job aids, National Guidelines, and frequency of staff exposure to supervision and training on mRDT.

Introduction: although blood-sparing properties of tranexamic acid (TA) and desmopressin (Desmo) have been well described following various surgical procedures, few studies have compared the effect of Desmo to that of TA in total knee arthroplasty (TKA). The purpose of our study was to compare the effectiveness of TA and Desmo in reducing perioperative bleeding during TKA.

Methods: we conducted a prospective double-blind study including patients undergoing TKA under spinal anesthesia, randomized into 2 groups: the Desmo group (patients received 0.3 μg/kg of Desmo in 100 ml of saline over 30 minutes before incision, followed by a saline infusion of 30 ml/kg over 12 hours) and the TA group (patients received 20 mg/kg of TA in 100 ml of saline over 30 minutes before incision, followed by 10 mg/kg of TA in 30 ml/kg of saline over 12 hours). The endpoints were perioperative bleeding, transfusion requirement and postoperative complications.

Results: the study included 55 patients divided into 2 groups: TA group (28 patients) and Desmo group (27 patients). Blood accumulation in the jar during the procedure was significantly higher in the TA group (339±40 ml) than in the Desmo group (295±77 ml) (p=0.038). During the first 12 postoperative hours, additional blood accumulation in the redon was significantly higher in the Desmo group (h6: 288±55ml, H12: 383±63ml) compared to the TA group (h6: 188±42ml, h12: 287±60ml) with at H6: p= 0.001 and at H 12: p= 0.009. After 12 hours postoperatively, blood volume in the redon became similar in the 2 groups. From the time of discharge from the post-interventional monitoring room (PICU) to 2 days postoperatively, hemoglobin and hematocrit levels were similar in the 2 groups. Platelet count (PLT) was significantly higher in the Desmo group than in the TA group upon leaving the PICU (Pq desmo: 193929±25000 vs Pq AT: 157370±24300; p< 0.001) and on postoperative day 1 (Pq desmo: 178929±26200 vs Pq AT: 168929±25100; p= 0.048). By postoperative day 2, platelet counts became similar in the 2 groups. During the postoperative period, only one patient in the Desmo group required an allogeneic blood transfusion. No postoperative thromboembolic events were noted in our patients.

Conclusion: both TA and desmopressin are comparably effective in reducing perioperative blood loss during TKA under spinal anesthesia.

Introduction: seasonal malaria chemoprevention (SMC) is an effective strategy to prevent malaria. In 2022, Niger's national malaria control program expanded SMC to include children aged 6 to 9 years, increasing the regimen to five cycles. The objective of this study was to determine factors influencing adherence to the second and third doses of SMC within the context of its extension to Guidimouni, Zinder.

Methods: focus groups were held with nannies; community relays and in-depth interviews were conducted with caregivers and administrative and customary authorities. Interviews were recorded and transcribed, those in local languages were translated into French and the transcriptions analyzed using N'Vivo software.

Results: in total, nine focus groups and six individual interviews were conducted. SMC and its extension were widely accepted as a key preventive measure. Adherence to SMC among parents of children aged 3-5 and 6-9 years appeared to be generally good, indicating compliance with the second and third doses. The main factors influencing adherence included poor application of administration guidelines, the use of SMC drugs to treat other illnesses, withholding a significant portion of the medication, which can impact the threshold dose required for prevention, and the perception of SMC as a curative rather than preventive treatment for malaria. The prevalence of malaria among children under 5 years and those over 10 years was 32.03% and 35.68% respectively in 2019; 46.76% and 37.11% in 2020, 53.07% and 49.09% in 2021, 51.93% and 45.92% in 2022. Malaria cases within these age groups in the village of Guidimouni continued to rise, with a high prevalence in the community despite seasonal malaria chemoprevention efforts.

Conclusion: it is crucial to strengthen awareness and education efforts for parents regarding the correct administration of SMC.

Introduction: Intra-Procedural Pain (IPP) is common among women undergoing Manual Vacuum Aspiration (MVA) for incomplete abortion. Globally, the proportion varies between 60% to 90% while in sub-Saharan Africa including Uganda, the proportion varies between 80% to 98%. Intra-procedural pain management during MVA includes a para-cervical block (using 1% lidocaine) or an opioid (using 100 mg of intravenous pethidine). The study aimed to determine the proportion and factors associated with IPP among women undergoing MVA for incomplete abortion at Mbarara Regional Referral Hospital (MRRH).

Methods: we conducted a cross-sectional study among 207 women who underwent MVA for incomplete abortion between December 2020 and May 2021. An interviewer-administered structured questionnaire was used, and pain assessment was done using the Visual Analogue Scale (VAS) considering an IPP as a pain score of 6 or more. The participant characteristics were summarized. The proportion of women with IPP was calculated. We performed multivariable logistic regression to determine the factors associated with IPP.

Results: we consecutively enrolled 207 women with a mean age of 25.8 ± 5.8 years. The proportion of women with IPP undergoing MVA at MRRH was 82.6%, 95% C.I 76.8 - 87.2. The factors significantly associated with IPP were age and cervical dilatation. The odds of IPP increased with decreasing age of the women; compared to older women aged >30 years, teenagers aged <20 years; aOR: 8, 95% CI 1.85-34.61; p=0.005, while women aged 20-24 years; aOR: 3.45, 95% CI 1.47-8.20; p=0.004 and those aged 25-30 years; aOR: 2.84, 95% CI 1.20-6.74; p=0.018. Women with cervical dilatation of 1-2 cm had the odds of IPP increased; aOR: 2.27, 95% CI 1.11-4.62; p=0.024 compared to a cervical dilation of 3-4 cm.

Conclusion: majority of women undergoing MVA at MRRH experienced IPP. Younger women and those with cervical dilatation 1-2 cm are more likely to experience IPP. We recommend optimised and personalised pain management strategies for women undergoing MVA.

Despite a high disease burden, sub-Saharan Africa's mortality rates from diseases are currently lower than those in other regions, largely due to the continent's younger population. However, the region is more susceptible to health risks, resulting in frequent health emergencies. Even recently, monkeypox, which originated in an African country, has been declared a global health emergency. Sub-Saharan Africa´s predominantly youthful demographic presents a valuable opportunity to use this advantage to accelerate progress toward sustainable industrialization. By analyzing pre- and post-pandemic trends in major sectoral indicators, population dynamics, and technology exports, this discussion explores the potential for sub-Saharan Africa to enhance its long-term industrial growth.

The Nigerian Institute of Medical Research (NIMR) was established by the National Science Technology (NST) Act of 1977 to conduct research on diseases of public health importance, train health professionals, and disseminate research findings. Since its inception, NIMR has successfully performed these mandates. However, the NST Act recommends that NIMR can conduct research, but it did not mandate the agency to fund research. This constraint has limited NIMR's ability to play a proactive active role in competitive funding and conduct of research in response to Nigeria's changing disease profile and other emerging health challenges that have occurred in the country in the last two decades. It is necessary to reposition NIMR to become a Medical Research Council with improved funding to make it fit for purpose like the medical research councils in the Gambia, South Africa, United Kingdom, and United States of America. To achieve this goal, NIMR collaborated with relevant stakeholders including legislators from the Nigerian Senate and the House of Representatives to successfully create and pass a bill to reposition NIMR into the Nigerian Medical Research Council (NMRC). The factors that contributed to the success of this initiative are the recognition by NIMR staff that it is easier to upgrade NIMR to be a medical research council than to establish a completely new agency, the mobilization of representatives of interest groups including staff from national governmental and international non-governmental organizations, health professional associations, academia, and the media. This article describes the process and outcomes of the interventions that led to the creation of NMRC. Countries planning to establish a similar council will benefit from the initiatives in Nigeria by applying the strategies adopted to implement this initiative in their countries.