C. Verenga, S. Farayi, L. Hlatshwayo, AS Zanga, M. Ndagurwa, M. Nkomo, F. Rupande, ML Khumbula
Background: Aneuploidies pose a diagnostic challenge in low resource settings where diagnostic tests are unavailable or costs are beyond the reach of many. This provides a clinical challenge in case management and counselling for women with foetuses carrying multiple congenital anomalies. A pragmatic approach in the management of foetal medicine cases in these settings becomes imperative. Design: Screening survey and diagnostic test, the well accepted standard for Aneuploidy screen and laboratory tests. In this case we seek to illustrate the use of ultrasound in low resource setting where diagnostic tests are expensive and inaccessible. Setting: This was a hospital-bases case in a low-income setting. Subjects: A 45-year-old woman in her first pregnancy was referred at 20 weeks gestation to the Fetal Medicine Unit (FMU) with an ultrasound scan diagnosis of exomphalos. Intervention: A syndromic pattern approach was used in making a clinical diagnosis of trisomy 18 in a setting with ultrasound equipment and well-trained personnel. The syndromic pattern approach recognises that the common aneuploids such as Trisomy 21, 18 and 13, Monosomy X and Triploidy have a set of foetal malformations that accompany each of the syndromes. Main Outcome Measures: Diagnosis of Aneuploidy Results: A large exomphalos containing bowel and liver was identified. Additional abnormalities were identified which included bilateral mild ventriculomegaly, choroid plexus cysts, left diaphragmatic hernia, atrioventricular septal defect, and kyphoscoliosis of the thoracolumbar vertebrae. Conclusion: The case illustrates the utility of the sonographic syndrome approach in managing pregnancy with multiple foetal defects in low-resource settings. Core Tip: Aneuploidies pose a diagnostic challenge in low resource settings where diagnostic tests are unavailable or costs are beyond the reach of many. We report a case in which a sonographic syndromic pattern approach was used in making a clinical diagnosis of trisomy 18 in a setting with ultrasound equipment and well-trained personnel. This approach helps with case management and patient counselling.
{"title":"Utility of the sonographic syndromic pattern approach in diagnosis of aneuploidy in a low resource setting: case report","authors":"C. Verenga, S. Farayi, L. Hlatshwayo, AS Zanga, M. Ndagurwa, M. Nkomo, F. Rupande, ML Khumbula","doi":"10.4314/cajm.v67i7-12.4","DOIUrl":"https://doi.org/10.4314/cajm.v67i7-12.4","url":null,"abstract":"Background: Aneuploidies pose a diagnostic challenge in low resource settings where diagnostic tests are unavailable or costs are beyond the reach of many. This provides a clinical challenge in case management and counselling for women with foetuses carrying multiple congenital anomalies. A pragmatic approach in the management of foetal medicine cases in these settings becomes imperative. \u0000Design: Screening survey and diagnostic test, the well accepted standard for Aneuploidy screen and laboratory tests. In this case we seek to illustrate the use of ultrasound in low resource setting where diagnostic tests are expensive and inaccessible. \u0000Setting: This was a hospital-bases case in a low-income setting. \u0000Subjects: A 45-year-old woman in her first pregnancy was referred at 20 weeks gestation to the Fetal Medicine Unit (FMU) with an ultrasound scan diagnosis of exomphalos. \u0000Intervention: A syndromic pattern approach was used in making a clinical diagnosis of trisomy 18 in a setting with ultrasound equipment and well-trained personnel. The syndromic pattern approach recognises that the common aneuploids such as Trisomy 21, 18 and 13, Monosomy X and Triploidy have a set of foetal malformations that accompany each of the syndromes. \u0000Main Outcome Measures: Diagnosis of Aneuploidy \u0000Results: A large exomphalos containing bowel and liver was identified. Additional abnormalities were identified which included bilateral mild ventriculomegaly, choroid plexus cysts, left diaphragmatic hernia, atrioventricular septal defect, and kyphoscoliosis of the thoracolumbar vertebrae. \u0000Conclusion: The case illustrates the utility of the sonographic syndrome approach in managing pregnancy with multiple foetal defects in low-resource settings. \u0000Core Tip: Aneuploidies pose a diagnostic challenge in low resource settings where diagnostic tests are unavailable or costs are beyond the reach of many. We report a case in which a sonographic syndromic pattern approach was used in making a clinical diagnosis of trisomy 18 in a setting with ultrasound equipment and well-trained personnel. This approach helps with case management and patient counselling.","PeriodicalId":74979,"journal":{"name":"The Central African journal of medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43916219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Gwanzura, Y. Bikwa, N. C. Changata, C. Chikwenjere, A. Machakaire, M. Madziyire
Broad ligament leiomyomas are rare with an incidence of less than 1%. We present a 36-year-old female patient with anabdominopelvic mass with a clinical suspicion of a right ovarian mass after ultrasound scan and Computed Tomography (CT) scan. Laparotomy revealed a broad ligament mass that had undergone cystic degeneration which was confirmed as leiomyoma at histology. The degenerative changes in the leiomyoma lead to clinical and diagnostic confusion. Thus, although uncommon, broad ligament fibroids should be considered during evaluation of an adnexal mass for optimal patient management. Ahigh index of suspicion for fibroids located in the broad ligament should be kept particularly when the risk of malignancy index is low. Transvaginal ultrasound is comparable to Computed Tomography scan/Magnetic Resonance Imaging in identifying site of origin of adnexal mass and should be used in resource-limited settings.
{"title":"A broad ligament leiomyoma mistaken for a cystic ovarian tumour: A case report","authors":"C. Gwanzura, Y. Bikwa, N. C. Changata, C. Chikwenjere, A. Machakaire, M. Madziyire","doi":"10.4314/CAJM.V65I4-6","DOIUrl":"https://doi.org/10.4314/CAJM.V65I4-6","url":null,"abstract":"Broad ligament leiomyomas are rare with an incidence of less than 1%. We present a 36-year-old female patient with anabdominopelvic mass with a clinical suspicion of a right ovarian mass after ultrasound scan and Computed Tomography (CT) scan. Laparotomy revealed a broad ligament mass that had undergone cystic degeneration which was confirmed as leiomyoma at histology. The degenerative changes in the leiomyoma lead to clinical and diagnostic confusion. Thus, although uncommon, broad ligament fibroids should be considered during evaluation of an adnexal mass for optimal patient management. Ahigh index of suspicion for fibroids located in the broad ligament should be kept particularly when the risk of malignancy index is low. Transvaginal ultrasound is comparable to Computed Tomography scan/Magnetic Resonance Imaging in identifying site of origin of adnexal mass and should be used in resource-limited settings.","PeriodicalId":74979,"journal":{"name":"The Central African journal of medicine","volume":"9 1","pages":"45-48"},"PeriodicalIF":0.0,"publicationDate":"2019-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73222418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The study was carried out to determine the prevalence and antimicrobial susceptibility of Methicillin Resistant Staphylococcus aureus (MRSA) in Harare, Zimbabwe.Design: This was a cross-sectional study on the prevalence of MRSA and antimicrobial susceptibility of the MRSA isolates. S. aureus isolates were collected from clinical laboratories in Harare and were tested for MRSA. The MRSA isolates were tested for their susceptibility to antimicrobial drugs.Setting: This was a laboratory-based study.Subjects: Three hundred and eighty one clinical isolates of Staphylococcus aureus were included in the study.Main Outcome Measures: The prevalence of MRSA was 11.8% and they were all susceptible to vancomycin and teicoplanin. There was a high resistance rate of 73.3% to erythromycin and clindamycin inducible resistance was detected in 46.7% of the MRSA isolates.Results: Methicillin Resistant Staphylococcus aureus was detected in 45 (11.8%) of the 381 S. aureus isolates which were tested. High MRSA prevalence rates of over 10% were observed in isolates from blood cultures and urethral, pus, eye and nasal swabs. All the MRSA isolates were susceptible to vancomycin and teicoplanin and 82.2% were susceptible to mupirocin. About 50% of the isolates were susceptible to doxycycline, gentamicin and rifampicin. Most of the isolates (75.6%) were susceptible to clindamycin but 73.3% were resistant to erythromycin. Clindamycin inducible resistance was detected in 42.2% of the MRSA isolates.Conclusion: There was a low prevalence of MRSA amongst the S. aureus isolates which were all susceptible to vancomycin and teicoplanin but showed a high resistance to some drugs commonly used in Zimbabwe.
{"title":"Synopses of the dissertations Masters of Medicine in Anaesthesia and Critical Care Medicine degrees of the University of Zimbabwe, College of Health Sciences (1990-2016)","authors":"H. Chinyanga, S. Shumbairerwa, F. Madzimbamuto","doi":"10.4314/CAJM.V65I1-3","DOIUrl":"https://doi.org/10.4314/CAJM.V65I1-3","url":null,"abstract":"Objective: The study was carried out to determine the prevalence and antimicrobial susceptibility of Methicillin Resistant Staphylococcus aureus (MRSA) in Harare, Zimbabwe.Design: This was a cross-sectional study on the prevalence of MRSA and antimicrobial susceptibility of the MRSA isolates. S. aureus isolates were collected from clinical laboratories in Harare and were tested for MRSA. The MRSA isolates were tested for their susceptibility to antimicrobial drugs.Setting: This was a laboratory-based study.Subjects: Three hundred and eighty one clinical isolates of Staphylococcus aureus were included in the study.Main Outcome Measures: The prevalence of MRSA was 11.8% and they were all susceptible to vancomycin and teicoplanin. There was a high resistance rate of 73.3% to erythromycin and clindamycin inducible resistance was detected in 46.7% of the MRSA isolates.Results: Methicillin Resistant Staphylococcus aureus was detected in 45 (11.8%) of the 381 S. aureus isolates which were tested. High MRSA prevalence rates of over 10% were observed in isolates from blood cultures and urethral, pus, eye and nasal swabs. All the MRSA isolates were susceptible to vancomycin and teicoplanin and 82.2% were susceptible to mupirocin. About 50% of the isolates were susceptible to doxycycline, gentamicin and rifampicin. Most of the isolates (75.6%) were susceptible to clindamycin but 73.3% were resistant to erythromycin. Clindamycin inducible resistance was detected in 42.2% of the MRSA isolates.Conclusion: There was a low prevalence of MRSA amongst the S. aureus isolates which were all susceptible to vancomycin and teicoplanin but showed a high resistance to some drugs commonly used in Zimbabwe.","PeriodicalId":74979,"journal":{"name":"The Central African journal of medicine","volume":"159 1","pages":"1-20"},"PeriodicalIF":0.0,"publicationDate":"2019-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84727646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Arinze, O. Okoye, N. Udeh, S. Onwubiko, C. Ezisi, B. Eze, I. Arinze, R. Umeh, E. Onwasigwe
Background : Ulcerative keratitis is a potentially blinding eye disease found in eyes with predisposing risk factors. Objectives : To determine the incidence, distribution, causative organisms and risk factors for ulcerative keratitis in patients presenting at the University of Nigeria Teaching Hospital (UNTH)- a tertiary referral eye care facility, Enugu, Nigeria. Study Design: This was a hospital based cross-sectional study of 61 new patients with ulcerative keratitis who presented at the UNTH from October 2011-September 2012. Participants’ socio-demographics and predisposing risk factors were documented. Corneal scrapings were collected for microbial diagnosis. Results: A total of 11,056 new patients presented during the study period giving an incidence rate of 0.6%. Of the 61 participants, 44(72.1%) were males, 17(27.9%) were females with an age range of 6 – 75 years and a median age of 54 years. Of the 40(65.6%) culture positive corneal scrapings, 21(52.5%) were purely bacterial, 17(42.5%) were purely fungal while 2(5%) were mixed infection, caused by both bacterial (Staphylococcus aureus) and fungal (Aspergillus fumigatus) organisms in both cases. Commonest predisposing risk factor was non- surgical trauma 43(70.5%) followed by use of harmful Traditional Eye Medicine (TEM) 27(44.3%). The seasonal distribution of corneal ulcer was highest in month June 11(18.0%). Complications from the ulcers included central leucoma 19 (31.2%) and panophthalmitis 6 (9.9%). Conclusion : The incidence rate of ulcerative keratitis is 0.6% occurring highest in the month of June with more bacterial than fungal isolates. Many participants were exposed to non- surgical trauma and use of TEM. Eye health education (emphasizing the deleterious effects of TEMs) and protection (especially for artisans) if instituted can reduce the visual morbidity associated with corneal ulcers.
{"title":"Ulcerative Keratitis: incidence, seasonal distribution and determinants in a tertiary eyecare facility south east Nigeria","authors":"O. Arinze, O. Okoye, N. Udeh, S. Onwubiko, C. Ezisi, B. Eze, I. Arinze, R. Umeh, E. Onwasigwe","doi":"10.4314/cajm.v63i7-9","DOIUrl":"https://doi.org/10.4314/cajm.v63i7-9","url":null,"abstract":"Background : Ulcerative keratitis is a potentially blinding eye disease found in eyes with predisposing risk factors. Objectives : To determine the incidence, distribution, causative organisms and risk factors for ulcerative keratitis in patients presenting at the University of Nigeria Teaching Hospital (UNTH)- a tertiary referral eye care facility, Enugu, Nigeria. Study Design: This was a hospital based cross-sectional study of 61 new patients with ulcerative keratitis who presented at the UNTH from October 2011-September 2012. Participants’ socio-demographics and predisposing risk factors were documented. Corneal scrapings were collected for microbial diagnosis. Results: A total of 11,056 new patients presented during the study period giving an incidence rate of 0.6%. Of the 61 participants, 44(72.1%) were males, 17(27.9%) were females with an age range of 6 – 75 years and a median age of 54 years. Of the 40(65.6%) culture positive corneal scrapings, 21(52.5%) were purely bacterial, 17(42.5%) were purely fungal while 2(5%) were mixed infection, caused by both bacterial (Staphylococcus aureus) and fungal (Aspergillus fumigatus) organisms in both cases. Commonest predisposing risk factor was non- surgical trauma 43(70.5%) followed by use of harmful Traditional Eye Medicine (TEM) 27(44.3%). The seasonal distribution of corneal ulcer was highest in month June 11(18.0%). Complications from the ulcers included central leucoma 19 (31.2%) and panophthalmitis 6 (9.9%). Conclusion : The incidence rate of ulcerative keratitis is 0.6% occurring highest in the month of June with more bacterial than fungal isolates. Many participants were exposed to non- surgical trauma and use of TEM. Eye health education (emphasizing the deleterious effects of TEMs) and protection (especially for artisans) if instituted can reduce the visual morbidity associated with corneal ulcers.","PeriodicalId":74979,"journal":{"name":"The Central African journal of medicine","volume":"15 1","pages":"87-94"},"PeriodicalIF":0.0,"publicationDate":"2018-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87476224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Tuberculosis (TB) is the main cause of mortality in people infected with the Human Immunodeficiency Virus (HIV), accounting for more than a quarter of deaths. Although the World Health Organization (WHO) recommends isoniazid preventive therapy to mitigate the TB epidemic, its uptake has been slow.Objectives: To determine initiation and completion rates of Isoniazid Preventive Therapy (IPT) in HIV infected paediatric outpatients. The secondary objective was to determine the reasons for non-initiation and non-completion of IPT.Setting: Harare Central Hospital Paediatric HIV Clinic.Materials and Methods: A retrospective review of medical records for paediatric HIV infected outpatients was conducted from 1 January 2014 through 31 December 2016. Two focus group discussions with parents/guardians and healthcare practitioners at the hospital were conducted to understand the reasons for non-initiation and non-completion of IPT.Results: Out of total of 351 patients included in the study, 259 (73.8%) were initiated on IPT. There was a delay in the initiation of IPT in the majority (n= 231, 89.2%) of patients with an average delay in initiation of 10.2 months (SD=6.1). A total of 245 patients (94.6%) completed the 6 months of IPT. The main reasons for non-initiation or non-completion of IPT were drug stock outs and poor documentation of patient consultation visits. No patient developed active TB disease during the course of IPT. The focus group discussions revealed concerns about pill burden, adverse effects, development of resistance to anti-TB drugs, and lack of knowledge on IPT as factors related to non-initiation and non-completion of IPT.Conclusion: The IPT initiation rate was sub-optimal while the IPT completion rate was relatively high. Uninterrupted supply of isoniazid and pyridoxine in all public healthcare facilities is critical for the successful implementation of the IPT program and for the reduction of TB burden.
{"title":"Use of isoniazid preventative therapy in HIV infected paediatric patients at Harare Central Hospital","authors":"M. F. Zirma, N. Chifamba, H. Mujuru, S. Khoza","doi":"10.4314/CAJM.V64I7-9","DOIUrl":"https://doi.org/10.4314/CAJM.V64I7-9","url":null,"abstract":"Background: Tuberculosis (TB) is the main cause of mortality in people infected with the Human Immunodeficiency Virus (HIV), accounting for more than a quarter of deaths. Although the World Health Organization (WHO) recommends isoniazid preventive therapy to mitigate the TB epidemic, its uptake has been slow.Objectives: To determine initiation and completion rates of Isoniazid Preventive Therapy (IPT) in HIV infected paediatric outpatients. The secondary objective was to determine the reasons for non-initiation and non-completion of IPT.Setting: Harare Central Hospital Paediatric HIV Clinic.Materials and Methods: A retrospective review of medical records for paediatric HIV infected outpatients was conducted from 1 January 2014 through 31 December 2016. Two focus group discussions with parents/guardians and healthcare practitioners at the hospital were conducted to understand the reasons for non-initiation and non-completion of IPT.Results: Out of total of 351 patients included in the study, 259 (73.8%) were initiated on IPT. There was a delay in the initiation of IPT in the majority (n= 231, 89.2%) of patients with an average delay in initiation of 10.2 months (SD=6.1). A total of 245 patients (94.6%) completed the 6 months of IPT. The main reasons for non-initiation or non-completion of IPT were drug stock outs and poor documentation of patient consultation visits. No patient developed active TB disease during the course of IPT. The focus group discussions revealed concerns about pill burden, adverse effects, development of resistance to anti-TB drugs, and lack of knowledge on IPT as factors related to non-initiation and non-completion of IPT.Conclusion: The IPT initiation rate was sub-optimal while the IPT completion rate was relatively high. Uninterrupted supply of isoniazid and pyridoxine in all public healthcare facilities is critical for the successful implementation of the IPT program and for the reduction of TB burden.","PeriodicalId":74979,"journal":{"name":"The Central African journal of medicine","volume":"2105 1","pages":"58-63"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86553243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Mangombe, K. Zimudzi, S. Bopoto, R. Masanganise, R. Makunike-Mutasa
Seborrheic Keratosis (SK) is a benign neoplasm of the epithelium that occurs commonly on the eyelid skin. It is rarely found on the conjunctiva. We report a case of a 71 year old HIV positive man who presented with a pigmented conjunctival growth in his right eye. A working diagnosis of a pigmented Ocular Surface Squamous Neoplasia (OSSN) with malignant melanoma as a differential was made and an excisional biopsy done. The histology showed acanthotic epithelium with areas of pseudo-horn cysts, keratin pearls and squamous eddies. A histological diagnosis of seborrheic keratosis of the conjunctiva was made. Conjunctival Seborrheic Keratosis is extremely rare and the pigmentation makes it easily confused clinically with malignant melanoma or pigmented OSSN in the setting of HIV.
{"title":"Seborrheic keratosis of the conjunctiva: a case report","authors":"S. Mangombe, K. Zimudzi, S. Bopoto, R. Masanganise, R. Makunike-Mutasa","doi":"10.4314/CAJM.V63I1-3","DOIUrl":"https://doi.org/10.4314/CAJM.V63I1-3","url":null,"abstract":"Seborrheic Keratosis (SK) is a benign neoplasm of the epithelium that occurs commonly on the eyelid skin. It is rarely found on the conjunctiva. We report a case of a 71 year old HIV positive man who presented with a pigmented conjunctival growth in his right eye. A working diagnosis of a pigmented Ocular Surface Squamous Neoplasia (OSSN) with malignant melanoma as a differential was made and an excisional biopsy done. The histology showed acanthotic epithelium with areas of pseudo-horn cysts, keratin pearls and squamous eddies. A histological diagnosis of seborrheic keratosis of the conjunctiva was made. Conjunctival Seborrheic Keratosis is extremely rare and the pigmentation makes it easily confused clinically with malignant melanoma or pigmented OSSN in the setting of HIV.","PeriodicalId":74979,"journal":{"name":"The Central African journal of medicine","volume":"113 1","pages":"30-32"},"PeriodicalIF":0.0,"publicationDate":"2017-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79394806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Gudza-Mugabe, R. T. Mavenyengwa, Mapingure Mp, S. Mtapuri-Zinyowera, A. Tarupiwa, V. Robertson
Objective: To determine the current susceptibility patterns of bacterial pathogens isolated from cases of meningitis in children.Design: A cross-sectional study of children less than 59 months admitted at a central hospital to determine the susceptibility patterns of bacteria causing meningitis to antibiotics in routine use in Zimbabwe. The disk diffusion and E-testing were done according to Clinical Laboratory Standard Institute (CLSI) methodology determined the Minimum Inhibitory Concentrations (MIC) for penicillin and ceftriaxone.Setting: Harare Central Paediatric Hospital, a major referral centre in Zimbabwe.Participants: Children less than 59 months admitted with suspected meningitis whose Cerebrospinal Fluid (CSF) was collected by convenience sampling targeting four types of bacteria namely Neisseria meningitidis, Streptococcus pneumonia, Streptococcus agalactiae and Haemophilus influenzae type.Results: A total of 15 S. pneumoniae isolates and one H. influenzae isolate were available for antibiotic sensitivity testing. Of these, 13 (86.7%) S. pneumoniae isolates were sensitive to benzyl-penicillin and clindamycin with only 2 (13%) being resistant while all the isolates were sensitive to ceftriaxone and vancomycin. Fourteen (93.3%) were sensitive to chloramphenicol with one isolate (6.6%) resistant. There was total resistance to cotrimoxazole (100%) while 6 (40%) isolates were resistant to tetracycline.Conclusion: Sensitivity to penicillin was high and the high sensitivity of bacteria to ceftriaxone suggested that it can be recommended for treatment of bacterial meningitis in Zimbabwe. No major changes have taken place in sensitivity of the studied bacterial organisms to the selected antibiotics compared to earlier studies.
{"title":"Antibiotic resistance in bacterial pathogens causing meningitis in children at Harare Central Hospital, Zimbabwe","authors":"M. Gudza-Mugabe, R. T. Mavenyengwa, Mapingure Mp, S. Mtapuri-Zinyowera, A. Tarupiwa, V. Robertson","doi":"10.4314/CAJM.V63I4-6","DOIUrl":"https://doi.org/10.4314/CAJM.V63I4-6","url":null,"abstract":"Objective: To determine the current susceptibility patterns of bacterial pathogens isolated from cases of meningitis in children.Design: A cross-sectional study of children less than 59 months admitted at a central hospital to determine the susceptibility patterns of bacteria causing meningitis to antibiotics in routine use in Zimbabwe. The disk diffusion and E-testing were done according to Clinical Laboratory Standard Institute (CLSI) methodology determined the Minimum Inhibitory Concentrations (MIC) for penicillin and ceftriaxone.Setting: Harare Central Paediatric Hospital, a major referral centre in Zimbabwe.Participants: Children less than 59 months admitted with suspected meningitis whose Cerebrospinal Fluid (CSF) was collected by convenience sampling targeting four types of bacteria namely Neisseria meningitidis, Streptococcus pneumonia, Streptococcus agalactiae and Haemophilus influenzae type.Results: A total of 15 S. pneumoniae isolates and one H. influenzae isolate were available for antibiotic sensitivity testing. Of these, 13 (86.7%) S. pneumoniae isolates were sensitive to benzyl-penicillin and clindamycin with only 2 (13%) being resistant while all the isolates were sensitive to ceftriaxone and vancomycin. Fourteen (93.3%) were sensitive to chloramphenicol with one isolate (6.6%) resistant. There was total resistance to cotrimoxazole (100%) while 6 (40%) isolates were resistant to tetracycline.Conclusion: Sensitivity to penicillin was high and the high sensitivity of bacteria to ceftriaxone suggested that it can be recommended for treatment of bacterial meningitis in Zimbabwe. No major changes have taken place in sensitivity of the studied bacterial organisms to the selected antibiotics compared to earlier studies.","PeriodicalId":74979,"journal":{"name":"The Central African journal of medicine","volume":"85 1","pages":"36-41"},"PeriodicalIF":0.0,"publicationDate":"2017-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79359295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives : To determine the prevalence of Asymptomatic Bacteriuria (AsB) and the drug sensitivities of the common causative organisms in antenatal women at Harare and Mbuya Nehanda Maternity Hospitals. Design : This was a descriptive cross sectional study. Setting : Harare and Mbuya Nehanda Maternity Hospital antenatal clinics. Subjects : One hundred and forty one (n=141) consenting women coming for routine antenatal care were recruited between the 15th of November and the 15th of December 2015. Intervention : The women were given health education sessions on AsB and urinary tract infection during pregnancy. A structured questionnaire was utilized to elicit demographic data, antenatal history, sexual hygiene and other risk factors for AsB. Mid stream urine was collected from each participant and dispatched to the laboratory for microscopy, culture and sensitivity. Patients whose culture results were positive were contacted by the researcher for appropriate treatment according to their drug sensitivities. Main Outcome Measures : The prevalence of AsB, the causative bacteria and their drug sensitivities. Results : Among the 141 antenatal women who participated in the study, 23% had positive urine cultures. The predominant bacteria was E. coli accounting for 18 (13%) participants followed by Streptococci in 7 (5%) and Staphylococcus in 5 (4%). Amoxycillin/Clavulinic acid, Nitrofurantoin and Ciprofloxacin were the effective antibiotics against the bacteria. Conclusion : The prevalence of AsB in this population of antenatal women was 23% and the common causative organisms were E. coli, Streptococci, Staphylococci and Klebsiella . The organisms were mostly sensitive to Amoxycillin/Clavulinic acid, Nitrofurantoin and Ciprofloxacin.
{"title":"The prevalence, bacteriology and drug sensitivity of asymptomatic bacteriuria in antenatal women at Harare and Mbuya Nehanda maternity hospitals, in Zimbabwe","authors":"N. Zakazaka, M. Madziyire, T. Magwali","doi":"10.4314/CAJM.V63I10-12","DOIUrl":"https://doi.org/10.4314/CAJM.V63I10-12","url":null,"abstract":"Objectives : To determine the prevalence of Asymptomatic Bacteriuria (AsB) and the drug sensitivities of the common causative organisms in antenatal women at Harare and Mbuya Nehanda Maternity Hospitals. Design : This was a descriptive cross sectional study. Setting : Harare and Mbuya Nehanda Maternity Hospital antenatal clinics. Subjects : One hundred and forty one (n=141) consenting women coming for routine antenatal care were recruited between the 15th of November and the 15th of December 2015. Intervention : The women were given health education sessions on AsB and urinary tract infection during pregnancy. A structured questionnaire was utilized to elicit demographic data, antenatal history, sexual hygiene and other risk factors for AsB. Mid stream urine was collected from each participant and dispatched to the laboratory for microscopy, culture and sensitivity. Patients whose culture results were positive were contacted by the researcher for appropriate treatment according to their drug sensitivities. Main Outcome Measures : The prevalence of AsB, the causative bacteria and their drug sensitivities. Results : Among the 141 antenatal women who participated in the study, 23% had positive urine cultures. The predominant bacteria was E. coli accounting for 18 (13%) participants followed by Streptococci in 7 (5%) and Staphylococcus in 5 (4%). Amoxycillin/Clavulinic acid, Nitrofurantoin and Ciprofloxacin were the effective antibiotics against the bacteria. Conclusion : The prevalence of AsB in this population of antenatal women was 23% and the common causative organisms were E. coli, Streptococci, Staphylococci and Klebsiella . The organisms were mostly sensitive to Amoxycillin/Clavulinic acid, Nitrofurantoin and Ciprofloxacin.","PeriodicalId":74979,"journal":{"name":"The Central African journal of medicine","volume":"10 1","pages":"100-104"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75236060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Voluntary Medical Male Circumcision (VMMC) was embarked on in Zimbabwe as a public health intervention measure after it was realised that it significantly reduces the rate of Human Immunodeficiency Virus (HIV) transmission from an infected female to an uninfected male during heterosexual intercourse. Objectives: The main aim of the study was to determine the complication rate and type of complications occurring during and after Male Circumcision (MC) at Spilhaus Clinic, Harare. Design: Retrospective cross sectional study. Setting: Spilhaus Family Planning Clinic, Harare Central Hospital, Zimbabwe. Results: Five hundred and eight records of VMMC were retrieved and analysed. The median age of the MC clients was 28 years (Q 1 = 24 years, Q 3 = 33 years). The complication rate of male circumcision during surgery and up to 48 hours post- surgery was 1.8%. After one month post surgery the complication rate was 1.4%. Nearly 90% of patients had VMMC for the purposes of HIV prevention. About 66% of the patients had been referred to the VMMC centre from Voluntary Counselling and Testing (VCT) centres. Ninety percent of clients seeking male circumcision were sexually active. Close to 11% of VMMC clients had had a Sexually Transmitted Infection (STI) in the three months preceding VMMC. Almost 70% of the VMMC clients had not used a condom during their last sexual encounter. Slightly above 1% of the patients were HIV positive. The median operating time for each circumcision was 23 minutes (Q 1 = 18 minutes, Q 3 = 29 minutes). Excessive bleeding was the most common intra- operative complication (1.2%). Wound infection was the most frequent cause of morbidity (12.6%) from 48 hours post MC to one month post- op. An ASA score of 2 (p< 0.01) was associated with a greater number of complications. Conclusion: The complication rate of MC in the peri- operative period was relatively high. Wound (12.6%) infection was the most common cause of morbidity. This rate could be significantly reduced by improving the aseptic technique and possibly training of doctors. However, on final review the complication rate was only 1.4%. Effort needs to be concentrated on circumcising populations which have a high incidence of HIV infection. Most clients were circumcised in a bid to prevent HIV infection. The HIV contracting risk profile of VMMC- seeking clients is relatively low.
{"title":"A review of the cases done in the first six months of the male circumcision programme in Harare: An HIV intervention measure","authors":"B. Rigava, S. Ray, L. Mukavhi","doi":"10.4314/CAJM.V62I5-8","DOIUrl":"https://doi.org/10.4314/CAJM.V62I5-8","url":null,"abstract":"Background: Voluntary Medical Male Circumcision (VMMC) was embarked on in Zimbabwe as a public health intervention measure after it was realised that it significantly reduces the rate of Human Immunodeficiency Virus (HIV) transmission from an infected female to an uninfected male during heterosexual intercourse. Objectives: The main aim of the study was to determine the complication rate and type of complications occurring during and after Male Circumcision (MC) at Spilhaus Clinic, Harare. Design: Retrospective cross sectional study. Setting: Spilhaus Family Planning Clinic, Harare Central Hospital, Zimbabwe. Results: Five hundred and eight records of VMMC were retrieved and analysed. The median age of the MC clients was 28 years (Q 1 = 24 years, Q 3 = 33 years). The complication rate of male circumcision during surgery and up to 48 hours post- surgery was 1.8%. After one month post surgery the complication rate was 1.4%. Nearly 90% of patients had VMMC for the purposes of HIV prevention. About 66% of the patients had been referred to the VMMC centre from Voluntary Counselling and Testing (VCT) centres. Ninety percent of clients seeking male circumcision were sexually active. Close to 11% of VMMC clients had had a Sexually Transmitted Infection (STI) in the three months preceding VMMC. Almost 70% of the VMMC clients had not used a condom during their last sexual encounter. Slightly above 1% of the patients were HIV positive. The median operating time for each circumcision was 23 minutes (Q 1 = 18 minutes, Q 3 = 29 minutes). Excessive bleeding was the most common intra- operative complication (1.2%). Wound infection was the most frequent cause of morbidity (12.6%) from 48 hours post MC to one month post- op. An ASA score of 2 (p< 0.01) was associated with a greater number of complications. Conclusion: The complication rate of MC in the peri- operative period was relatively high. Wound (12.6%) infection was the most common cause of morbidity. This rate could be significantly reduced by improving the aseptic technique and possibly training of doctors. However, on final review the complication rate was only 1.4%. Effort needs to be concentrated on circumcising populations which have a high incidence of HIV infection. Most clients were circumcised in a bid to prevent HIV infection. The HIV contracting risk profile of VMMC- seeking clients is relatively low.","PeriodicalId":74979,"journal":{"name":"The Central African journal of medicine","volume":"52 1","pages":"29-36"},"PeriodicalIF":0.0,"publicationDate":"2016-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73855886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jo Fernandes, T. Kambarami, T. Dhlandhlara, C. Kaguda, C. Guramatunhu, L. Mudzingwa, S. Ray
Introduction: Continuous one-to-one support for women in childbirth has been demonstrated through a meta-analysis and several studies to improve maternal and infant outcomes and yet is not implemented in most public sector health facilities. The purpose of this qualitative study was to explore the opinions of women, community members and health professionals in an urban Zimbabwe setting, towards the notion of lay birth companions present during labour and delivery. Methods: Brief interviews were conducted with key informants and service-users selected using convenience sampling at an urban polyclinic. The opinions of obstetricians were obtained through consultations held at a central government hospital. Responses were recorded, analysed and grouped under themes that focused on the desirability of the intervention, opinions on who would be suitable candidates for such roles as well as the opinions of the relevant health professionals. Results: Overall 73.3% of all respondents supported the idea of birth companions and 43.6% of respondents opted for the husband as the best person to assume the role. About 80% of health professionals support the concept but cited logistical and cultural issues as barriers. Those against the idea felt it was unnecessary, the support from nurses was sufficient, and the presence of husbands in the delivery room would be culturally inappropriate. Conclusion: The involvement of birth companions supporting women during childbirth could be promoted as a low cost preventive intervention to improve maternal and perinatal outcomes, though cultural and structural barriers still remain to be overcome. Women relatives or trained lay supporters may be more acceptable as birth companions than male partners for privacy reasons.
{"title":"A survey of pregnant and postnatal women, clinic attendees and maternity staff regarding the presence of birth companions during labour and delivery","authors":"Jo Fernandes, T. Kambarami, T. Dhlandhlara, C. Kaguda, C. Guramatunhu, L. Mudzingwa, S. Ray","doi":"10.4314/cajm.v62i1-4","DOIUrl":"https://doi.org/10.4314/cajm.v62i1-4","url":null,"abstract":"Introduction: Continuous one-to-one support for women in childbirth has been demonstrated through a meta-analysis and several studies to improve maternal and infant outcomes and yet is not implemented in most public sector health facilities. The purpose of this qualitative study was to explore the opinions of women, community members and health professionals in an urban Zimbabwe setting, towards the notion of lay birth companions present during labour and delivery. Methods: Brief interviews were conducted with key informants and service-users selected using convenience sampling at an urban polyclinic. The opinions of obstetricians were obtained through consultations held at a central government hospital. Responses were recorded, analysed and grouped under themes that focused on the desirability of the intervention, opinions on who would be suitable candidates for such roles as well as the opinions of the relevant health professionals. Results: Overall 73.3% of all respondents supported the idea of birth companions and 43.6% of respondents opted for the husband as the best person to assume the role. About 80% of health professionals support the concept but cited logistical and cultural issues as barriers. Those against the idea felt it was unnecessary, the support from nurses was sufficient, and the presence of husbands in the delivery room would be culturally inappropriate. Conclusion: The involvement of birth companions supporting women during childbirth could be promoted as a low cost preventive intervention to improve maternal and perinatal outcomes, though cultural and structural barriers still remain to be overcome. Women relatives or trained lay supporters may be more acceptable as birth companions than male partners for privacy reasons.","PeriodicalId":74979,"journal":{"name":"The Central African journal of medicine","volume":"15 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2016-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88546452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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