Pan African Medical Journal最新文献

Pancreas divisum occurs during development when the ventral and dorsal buds of the pancreas do not fuse. It is the most common congenital anomaly of the pancreas. Patients with this condition are usually asymptomatic, but almost 25% of these patients experience recurrent pancreatitis, which may progress to chronic pancreatitis. This is a case of a 16-year-old male with a significant history of recurrent pancreatitis. The patient underwent a computed tomography scan which revealed pancreatitis. Further magnetic resonance cholangiopancreatography supported the diagnosis of pancreatic divisum. This case highlights the importance of considering even rare etiologies such as pancreas divisum in unexplained cases of recurrent pancreatitis. After ruling out the obvious etiologies (gallstones, alcohol intake, metabolic disorders), it is recommended to demand a magnetic resonance cholangiopancreatography (MRCP) to better analyze the anatomy of the biliary and the pancreatic ductal systems. Early confirmation of the underlying etiology and aggravating factors can improve patient outcomes and prevent the recurrence of pancreatitis.

Introduction: given the significant disruption in educational activities during the COVID-19 pandemic and the uncertainties about the post-pandemic future, coupled with increasing demand for the healthcare workforce, e-learning may bridge the gap in training medical students. It was imperative to survey the perception and readiness of the trainers on the use of e-learning for undergraduate medical training in Nigeria.

Methods: this cross-sectional study was conducted among teachers of medical students in Nigeria. Using Google Forms, information on socio-demographic details, perception of online medical education, and individual and institutional preparedness to adopt e-learning were obtained. Data analysis was done using SPSS (version 21.0).

Results: there were 300 respondents from 25 to 72 years (mean of 47.1 ± 7.8 years). Most were willing to give core lectures and seminars by e-learning, but only about half (159; 53.0%) had ever delivered any lecture online. Many were against conducting laboratory demonstrations (51%), clinical demonstrations (51.7%), and bedside teachings (54.7%) by e-learning. Few (22.0%) were familiar with assignment management packages. Lack of internet connectivity (69.7%) and poor power supply (69.0%) were the most common barriers to implementing e-learning. There was a significant difference (p < 0.001 for all) in institutional internet provision and accessibility, staff training, and using e-learning for lectures between private and public institutions.

Conclusion: utilization of e-learning for medical education is low in Nigeria, with private institutions significantly outperforming the public sector. Many trainers prefer that the practical and clinical aspects should not be integrated into e-learning. Government, institutions and trainers need to do more to improve the acceptance and utilization of e-learning.

Anterior segment dysgenesis exerts its influence on a diverse array of ocular structures, encompassing the cornea, iris, ciliary body, anterior chamber and lens. We present a 20-month-old boy with bilateral corneal opacity. The visual acuity (VA) was 6/480 in both eyes. Upon examination, we found bilateral central corneal opacity with keratolenticular adhesions, anterior lens dislocation and opacification, aniridia. The clinical findings indicate diagnosis features of type II Peters anomaly (PA). Lens aspiration combined with adhesiolysis on the left eye (LE) was performed to address cataract-induced visual axis obstruction and prevent corneal decompensation from keratolenticular adhesions. We contemplated on prioritizing surgery for the LE initially due to the less severe corneal opacity compared to the right eye (RE). Further evaluations are required to determine the visual enhancement and the necessity of additional procedures. The management of type II PA proved to be a challenging experience. Cautious manipulation and extensive counseling can prevent further corneal decompensation.

While the prevalence of overweight and obesity is rising in Africa, the practice of bariatric surgery remains limited in our country, Cameroon. Weight loss outcomes following sleeve gastrectomy (SG), the most widely used bariatric surgery technique worldwide, have not yet been studied in our context. The medical records of all patients who underwent SG in our surgery department between January 1, 2016, and September 30, 2020, were reviewed retrospectively. The primary outcome studied was medium-term weight loss, one year after surgery. Weight loss was calculated using the postoperative body mass index (BMI) and the percentage of excess weight loss (%EWL). Reinhold criteria were used to assess the %EWL. We collected data from the medical records of 21 patients, of whom 19 (90.5%) were female. The average age of patients was 40.3±10.8 years, with a mean BMI of 44.9±7.4 kg/m². All patients had at least one obesity-related comorbidity. All procedures were performed laparoscopically, without conversion, with a mean duration of 192.2±52.8 min. One year after surgery, the mean BMI was 32.51±3.7 kg/m² and the mean %EWL was 63.35±6.5%. According to Reinhold's criteria, the %EWL was considered satisfactory. In our context, SG provides satisfactory results for medium-term weight loss.

Introduction: vitamin A is a nutrient required for normal visual system function, growth, and development. Periodic vitamin A supplementation is a cost-effective strategy for preventing vitamin A deficiency in children. This study aimed to assess the coverage and associated factors of vitamin A supplementation among children aged 6-59 months in Gondar City, Northwest Ethiopia 2022.

Methods: a community-based cross-sectional study with a multistage random sampling technique was done on 587 mothers with 6-59-month-old children from October 20 to November 10, 2022, in Gondar City. The descriptive statistics are summarized by frequency, percent, and summary statistics. Binary logistic regression was performed, and variables with a P-value <0.05 were considered significantly associated.

Results: the vitamin A supplementation coverage was 34.4% (95% CI (30.3% - 38.3%)). Children aged 6-13 months [AOR=9.50, 95% CI; (4.59-9.66)], 14-27 months [95% CI; (3.07-12.03)], mothers who had an education level of certificate or above [AOR=3.79, 95% CI; (1.45-9.90)], mothers who learned in secondary schools [AOR=3.29, 95% CI; (1.28-8.45)], mothers who had four or more antenatal care visits [AOR=4.32 (95% CI: (1.54-11.97) and mothers' good knowledge towards vitamin A [AOR: 2.20 (95% CI: 1.60-4.10)] showed a statistically significant association.

Conclusion: the coverage of vitamin A supplementation exceeded the 70% UNISAFE threshold. A younger child's age, maternal education level, more than 4 antenatal visits, and good knowledge of vitamin A were significant factors. Extended and more integrated immunization programs with robust health education regarding vitamin A supplementation would play a prodigious role in getting higher coverage.

Introduction: despite the considerable progress made to date, access to health care in public health facilities remains a challenging public health problem in Benin. This study aimed to assess trends in access to care over five years and to identify factors associated with low access to care.

Methods: a cross-sectional community-based study was conducted in the Bopa district, a rural area of southern Benin between January and February 2020. Twenty (20) villages were randomly selected using the two-stage probabilistic clustering method. The sample consisted of 620 participants (31 per village) distributed across the seven sub-districts of the Bopa district. Mixed-effect logistic regression models, using a clustered sampling design, were used to identify the factors associated with low access to care at public health centers.

Results: less than half of the recruited sick participants (38.9%) reported having had access to care at public health facilities in the month before the visit. Using public health services proportion in the population progressively increased from 2014 (29.7%) to 2019 (47.1%). Factors associated with no access to care were lack of mutual health insurance (adjusted odds ratio (aOR: 5.3, 95% CI: 2.1-13.5, p=0.001); low household income (aOR: 3.7, 95% CI: 1.7-8.1, p=0.001); and lack of transport (aOR: 3.4, 95% CI:1.8-6.2, p<0.001).

Conclusion: this study highlights the importance of a well-implemented and sustained community-based mutual health insurance system, particularly in rural areas. In addition, improving the living standards of the population would likely increase access to care. Policy makers should take these factors into account.

Patient engagement and shared decision-making (SDM) between patients and clinicians is the foundation of patient-centered care. It aims to reach a treatment option that fits the patient's preference and is guideline-concordant. We sought to evaluate the possible causes and outcomes of patient's non-guideline-concordant care choices. Using a retrospective analysis of the medical records of patients who underwent cryoablation for small renal masses between January 2010 and January 2023. Inclusion criteria were patients with renal tumor(s) who underwent cryoablation which was not recommended by the multidisciplinary team (MDT). We present three patients with unilateral clear cell renal cell carcinoma. Based on imaging and other findings, the oncology MDT recommended partial/radical nephrectomy. Upon consultation, each refused surgery and preferred cryoablation. Respecting their choice, cryoablation was undertaken. The patients had treatment failure and developed recurrences that could have possibly been avoided with guideline-concordant care. Shared decision-making in healthcare involves several aspects: patient/family; uncertainty of available evidence of various treatments; MDT meetings; and treatment team. For patients to select 'wise' treatment preferences i.e. guideline-concordant care, multi-layered complex intellectual and cognitive processes are required, where experience may play a role. Healthcare professionals require guidance and training on appropriate SDM in clinical settings, and awareness of tools to solicit patient choice to guideline-concordant care whilst observing patient autonomy. Patients and treatment teams need the capacity, knowledge, and skills to reach a 'wise' guideline-concordant care treatment preference jointly. Patients' unwise preference could lead to suboptimal outcomes, in the case of our patients, tumor recurrence.

Introduction: arterial hypertension (AH) may persist beyond three months postpartum after preeclampsia, increasing the long-term risk of cardiovascular complications. The purpose of this study is to describe the epidemiological aspects and factors associated with persistent hypertension following preeclampsia.

Methods: we conducted a longitudinal descriptive study, from January 2022 to June 2023. The study included patients who were hospitalized for preeclampsia in the maternity ward of the Chad-China Friendship Hospital and followed in the cardiology outpatient clinic for at least three months. A multivariate analysis using binary logistic regression was performed to identify factors associated with persistent hypertension.

Results: during our study period, 144 patients were hospitalized for preeclampsia, of whom 92 were included in the study. The average age of patients was 26.32 ±7.05 years, with extremes ranging from 16 to 42 years. Multiparity was observed in 41.3% (n=38) of patients and severe preeclampsia occurred in 80.4% (n=74). Additionally, 17.4% (n=16) had twin pregnancies and obesity was found in 19.6% (n=18). Persistent arterial hypertension was present in 24 patients, representing a prevalence of 26.10% (n=24). A personal history of preeclampsia was the only factor significantly associated with persistent arterial hypertension (adjusted OR 5.30, 95% CI 1.31-21.44, p=0.01).

Conclusion: it is necessary to develop a care pathway for patients who have had preeclampsia in order to prevent and manage long-term complications at an early stage.

Introduction: according to the World Health Organization (WHO), Non-Communicable Diseases (NCD) were a major cause of death in 2022 accounting for 4 million (74%) of deaths worldwide. Diabetes mellitus and hypertension are the two illnesses that are not contagious but linked closely. The objective of the research was to establish the prevalence and risk factors of undiagnosed diabetes among patients with hypertension attending St. Orsola Hospital in Tharaka Nithi County, Kenya.

Methods: the study utilized a descriptive cross-sectional design with random sampling. Data were collected from 384 patients with hypertension attending outpatient medical from October to December 2022 using a structured questionnaire. Analysis was conducted using the Statistical Package for the Social Sciences (SPSS). The chi-square test was used at the bivariable level and multiple logistic regression at the multivariable level, with a significance level set at P<0.05.

Results: the findings revealed that the age of the participants ranged between 20-89 years, with majority (62%) being below 60 years, where of these participants (66%) were women. Seventy-five percent (288/384) of participants were found to be with no diabetes, with 21 (5.5%) with undiagnosed diabetes mellitus and 75 (19.5%) being pre-diabetes. Significant associations were found between diabetes status and socio-demographic factors, with higher body mass index (BMI > 24.9) showing a strong correlation with undiagnosed diabetes (AOR 3.794 95% CI: 1.345-4.705). Education level was also significant, with lower education levels (primary or below) associated with a higher risk of undiagnosed diabetes (AOR 1.821 95% CI: 2.134-8.567). Employment status played a critical role, with unemployed individuals more likely to have undiagnosed diabetes (AOR 2.845 95% CI: 1.211-6.683). Additionally, lower frequency of vegetable consumption (less than three times per week) was linked to a higher likelihood of undiagnosed diabetes (AOR 2.937 95% CI: 1.135-7.602). Gender disparities were evident, with 62% of undiagnosed diabetes cases occurring in women. These findings underscore the importance of addressing both socio-economic and behavioral factors in the prevention and management of undiagnosed diabetes among patients with hypertension.

Conclusion: the study highlights a substantial prevalence of undiagnosed diabetes among patients with hypertension. These findings underscore the need for integrated screening programs, targeted health education, and lifestyle modification interventions.

While the significance of strengthening the biomedical workforce in resource-limited settings has been widely acknowledged, there remains a paucity of information specific to the local context. In this regard, we underscore the importance of formulating a biomedical engineering policy based on empirical evidence. To provide such evidence, we conducted an analysis of the government-led biomedical training program in Tanzania, titled 'Capacity Enhancement of Medical Equipment Technical Services (CEOMETS)'. The program demonstrated statistically significant outcomes at the individual level, as evidenced by a T-test comparing pre- and post-self-assessments of self-efficacy indicators from 2018 to 2022 (n=121) (***p < 0.001). However, the program's impact was largely confined to individual-level capacity building, with limited effects at the systemic level. The findings also revealed substantial structural and institutional gaps, as well as a lack of engagement from global stakeholders and key actors in the field of biomedical engineering. From this perspective, therefore, we emphasize the necessity of two key preconditions. First, on a national level, there is an urgent need to develop strategic plans, guidelines, and workforce policies that formally integrate biomedical engineers into efforts to strengthen the health system in Tanzania. The other arm is a way to call for action to the global health players to engage more actively in supporting biomedical engineering development in such contexts. Ultimately, this perspective paper aims to set a milestone in establishing the policy-making process regarding biomedical engineering as a health policy issue in Tanzania.