Pan African Medical Journal最新文献

Introduction: Mpox remains a significant public health concern in Africa with a notable increase in cases and outbreaks in several countries. Despite the efforts of surveillance and other specific interventions, Nigeria has been reporting ongoing cases since its re-emergence in 2017. We conducted an epidemiologic description of the 2024 Mpox outbreak in Abia State to understand the drivers and inform its control strategies.

Methods: we investigated the cases and conducted a descriptive study of suspected cases of Mpox line listed in 2024. Data were collected with a standardized case investigation form. An active case search was conducted in affected communities, and a review of hospital records was done. Samples were collected and tested at the National Reference Laboratory for confirmation. The data was downloaded from SORMAS, cleaned, and analysed using SPSS. Frequencies, proportions, and attack rates were generated.

Results: sixty-one suspected Mpox cases were line listed and 10 (16.4%) were laboratory-confirmed, with 6(60%) out of the confirmed cases having varicella zoster virus (VZV) coinfection. Among the confirmed cases, males constituted 60% (6/10), and the median age was 9.5 years (IQR: 3 - 27 years). The predominant age group was 0 - 15 years, 7 (70%). Out of the 12 reporting LGAs, confirmed cases were dominant in 5 LGAs. The commonest symptoms were fever (90%) and itchy vesiculopustular rash (90%). The most common symptom was fever (30%). Among all confirmed cases with rashes (90%), skin lesions were mostly on the face, legs, arms, and genitals. Ukwa East LGA had the highest attack rate (3/100,000 population).

Conclusion: the confirmed cases were mostly children with a high prevalence of VZV coinfection, and males were mostly affected. We recommended targeted public health awareness campaigns to the demographic groups mostly affected and emphasized enhanced surveillance and early diagnosis to minimize complications from Mpox/VZV coinfection.

In 2024, mpox was declared a public health emergency. Several response measures have since been implemented by health authorities in the affected countries to control the outbreak. Our perspective was triggered by an article in the special issue on the surge of mpox in Africa that highlighted rashless or non-exanthematous presentations of mpox in Nigeria. Although these have been previously highlighted, especially during the global outbreak in 2022, the contribution of these factors to the general outbreak dynamics remains poorly understood. We reflect on the possible implications of this outbreak and strategies to address it in the context of a newer clade 1b responsible for the current upsurge, where no prevalence studies of rashless mpox have been done. Using our experiences, we also discuss how diagnostic expectations centred on the presence of rash may hinder timely detection, response, and reporting. Moreover, current outbreak situation reports do not disaggregate cases by symptom profile (for example, rash-presenting versus rashless), a gap that undermines a comprehensive understanding of the actual burden of mpox. Finally, we analyse the potential implications of undetected spread, surveillance, vaccination strategies and risk communication and behavioural change practices, to help break the chains of transmission that might have been missed.

Uterine Müllerian adenosarcoma rarely presents as a cervical "cancer-like" mass; we report the first detailed case in a 79-year-old woman whose 5-cm exophytic lesion mimicked advanced cervical carcinoma on imaging. She presented with 2 weeks of post-menopausal bleeding and a friable polyp protruding through the cervical os; MRI described a bulky cervical tumour extending into the lower uterine segment, while tumour markers remained normal. Initial biopsy was inconclusive; subsequent excision and hysterectomy revealed FIGO stage Ib1 low-grade adenosarcoma originating from the lower uterine segment with superficial cervical involvement. Laparoscopic total hysterectomy with bilateral salpingo-oophorectomy was performed uneventfully, and at 7 months she remains disease-free. The case underlines that adenosarcoma can masquerade as cervical cancer, emphasises the need for generous tissue sampling and WT1/ER-based immunohistochemistry to define tumour origin, and confirms excellent outcomes with complete surgical excision for stage I disease.

Introduction: the government of Nigeria, through concerned agencies/authorities, is ensuring a large-scale and equitable distribution of COVID-19 vaccination across the country. To understand how the eligible population accesses these vaccines, we assessed the perception of availability and accessibility of the COVID-19 vaccines in Nigeria.

Methods: the study was part of a larger cross-sectional survey conducted in Nigeria between July and August 2021 to understand broader behavioral, social, and access-related drivers of COVID-19 vaccines among healthcare workers (HCW) and non-healthcare workers (NHCWs) using a data tool adapted from the World Health Organization (WHO) guidance on behavioral and social drivers of vaccination. Data was collected from 1548 respondents across 8 Nigerian states using a multistage sampling approach and analyzed descriptively and inferentially, using SPSS Version 20 to understand the perceptions of vaccine availability and accessibility.

Results: individual perceptions on the availability of vaccines were significant across two categories (that is, for NHCWs and HCWs) across rural and urban areas (X²=14.121, p<0.001) and between NHCWs and HCWs (X²=23.508, p<0.001). Non-health care workers were significantly more likely to perceive difficulties in accessing COVID-19 vaccines compared to health care workers (X²=29.8, p<0.001), and rural residents reported more challenges than their urban counterparts (X²=23.0, p<0.001).

Conclusion: the study found that respondents' perceptions of vaccine availability and accessibility were mostly influenced by location and recommended more vaccination points across rural and urban communities to improve the COVID-19 vaccination experience.

Introduction: septic wounds due to multidrug-resistant bacteria (MDR) are costly and result in adverse patient outcomes. Despite the fact that various antiseptics are routinely used for wound dressing, their effectiveness on bacterial load reduction remains to be evaluated to ascertain the usefulness of this step prior to antimicrobial therapies.

Methods: a cross-sectional analytical study was conducted among 203 patients with septic wounds at Bugando Medical Centre (BMC). Wound swab samples before and after dressing were collected, and cultured to quantify the total bacteria, extended-spectrum beta-lactamase-producing (ESBL) Gram-negative bacteria, and Methicillin-resistant Staphylococcus aureus (MRSA) load reduction.

Results: half of the wounds were due to road traffic accidents. A total of 146 (71.9%) patients had positive aerobic culture before wound dressing, which decreased to 39.4% (80/203) after dressing (p-value < 0.001). The median (IQR) of total bacterial load before and after dressing was 205.5 (112-330) and 128 (34.5-235) CFU/mL, respectively (p-value<0.001). The proportions of ESBL-producing Gram-negative bacteria and MRSA were 34.0% and 39.9%, respectively, before dressing (and significantly reduced to 20.2% and 11.3%, respectively, after dressing). Povidone-iodine was independently associated with decreased odds of culture positivity after wound dressing [OR: 95% CI = 0.09 (0.01-0.63), p-value =0.016].

Conclusion: bacterial culture positivity was halved after septic wound dressing. Povidone-iodine significantly reduced both the total bacteria and MDR bacterial load in these wounds. Routine monitoring of antiseptics´ effectiveness is reiterated as a pivotal pre-requisite step prior to antibiotic therapies in septic wound management.

Recurrent pregnancy loss (RPL), defined as the loss of two or more clinically recognized pregnancies before 20 weeks of gestation, poses a significant global medical challenge. Affecting up to 5% of couples trying to conceive, its multifactorial causes include genetic, anatomical, immunological, hormonal, and environmental factors. However, 65% of cases remain idiopathic, exacerbating the complexity of diagnosis and treatment. Low- and middle-income countries (LMICs) face additional challenges due to limited diagnostic capacities, socioeconomic disparities, and the burden of infectious diseases. Advancements in diagnostic and treatment technologies offer promise but are often inaccessible in resource-limited settings. This scoping review involved systematic searches in PubMed, Cochrane Library, and other sources for studies published since 2014. Eligible studies focused on the aetiology, diagnosis, and treatment of RPL. A total of 61 studies were included, primarily from high-income countries, with gaps noted in data from LMICs. Findings highlight RPL's multifaceted aetiology, including chromosomal abnormalities, uterine anomalies, thrombophilias, infections, and lifestyle factors. Advanced diagnostic methods such as next-generation sequencing enable personalized management but remain inaccessible in most LMICs. Management strategies range from immunotherapy and anticoagulants to surgical interventions and lifestyle modifications. Despite promising advancements, gaps in evidence and resource disparities persist, particularly in LMICs, where cultural stigmas and limited healthcare access further complicate care delivery. Addressing RPL requires a multidisciplinary approach encompassing diagnostics, treatment, and psychological support. Tailored strategies are essential for LMICs where inadequate healthcare infrastructure and socioeconomic barriers hinder progress. Prioritizing research, equitable access, and collaborative global efforts are vital to improving outcomes for affected couples worldwide.

Idiopathic granulomatous mastitis (IGM) is a rare benign breast pathology simulating breast carcinomas. The objective of our study was to describe the epidemiological, clinical, therapeutic, and evolutionary profile of IGM. This was a descriptive retrospective study of patients followed for IGM at Cheikh Zaid Hospital from 2019 to 2025. A total of 10 patients were included, corresponding to 83.33% of the 12 patients followed for granulomatous mastitis (GM). The mean age of our population was 35.1 years ± 4.65. The history was represented by pregnancy and breastfeeding in 100% with a mean parity of 2.10 ± 0.568. IGM was revealed by mastodynia in 4 cases (40%). Clinical examination found a breast nodule and unilateral involvement in 100% of patients. Breast ultrasound and mammography were performed in 100% of cases, as was biopsy in favor of MG. Corticosteroids were used in the 10 patients as first-line treatment with a mean dose of 58mg/day ± 14.8 with a minimum dose of 20mg/day of prednisone and a maximum dose of 80mg/day with plete healing in 80% of patients but a relapse rate of 20% with a delay of 2 months and 7 months after stopping corticosteroid therapy; 20% under azathioprine and 40% were drained. It is essential to emphasise the importance of recognising IMG in clinical practice, whose first-line treatment is based on corticosteroid therapy, while recurrent forms may require immunosuppressants.

Bladder paraganglioma is a rare neuroendocrine tumor, accounting for less than 0.05% of all bladder tumours. Its clinical presentation is often variable, making diagnosis challenging, particularly in non-functional forms. We report the case of a patient with a bladder paraganglioma revealed by recurrent haematuria, in the absence of clinical signs of catecholamine secretion. Transurethral resection enabled complete treatment, although the procedure was complicated by stimulation of the obturator nerve, without a notable incident. Postoperative investigations, including follow-up cystoscopy and urinary metanephrine levels, were unremarkable. This case illustrates the diagnostic challenges associated with non-secretory forms. The diagnosis was confirmed by histological and immunohistochemical analysis, which ruled out urothelial carcinoma. Treatment is based on complete resection, and prolonged surveillance is warranted due to the rare but real risk of recurrence or malignant transformation. Although rare, bladder paraganglioma should be considered in the presence of any atypical bladder mass. Appropriate management and close follow-up are essential to ensure an excellent prognosis.

Introduction: glycated hemoglobin (HbA1c) serves as a key indicator of average blood glucose levels over the preceding 2-3 months, reflecting cumulative glucose exposure based on erythrocyte lifespan. Research has documented racial and ethnic disparities in the relationship between HbA1c levels and blood glucose. In this case, the non-Hispanic Black individuals consistently exhibit higher HbA1c levels than their non-Hispanic White and Hispanic counterparts. The primary objective of this study was to establish a country-specific reference interval for hemoglobin A1C in non-diabetic, non-pregnant women and to investigate the correlation between HbA1c levels and demographic and clinical characteristics.

Methods: an institution-based cross-sectional study was conducted on 129 non-pregnant, non-diabetic women aged ≥ 18 years in Addis Ababa, Ethiopia (December 4, 2024, to February 28, 2025); data were analyzed using IBM SPSS Statistics. Normality of continuous variables was assessed with Shapiro-Wilk and Kolmogorov-Smirnov tests. The reference interval for HbA1c was calculated parametrically (mean ± 2SD) if normally distributed or non-parametrically (2.5^th- 97.5^th percentiles) if not, other non-normal variables were summarized as median (range). Correlation between HbA1c and demographic or clinical characteristics was assessed using Pearson´s correlation coefficient. Outliers were identified and excluded using Tukey´s method.

Results: the HbA1c values, measured in mmol/mol, were normally distributed with a mean (±SD) of 38(±3.1), yielding a 95% reference interval of 32 - 44 mmol/mol. The corresponding DCCT percentage values ranged from 5.1% to 6.2%, with a mean (±SD) of 5.6% (±0.28). A statistically significant but weak positive correlation was observed between age and HbA1c levels (r =0.284, p = 0.007).

Conclusion: this study found that the lower limit of the normal HbA1c reference interval in Ethiopian women was higher than reported in some previous studies. Age showed a modest influence on HbA1c levels, highlighting the importance of establishing population-specific reference intervals for accurate clinical interpretations.