The Central African journal of medicine最新文献

Introduction: Prematurity is a major determinant of neonatal morbidity and mortality in Zimbabwe. Although 8-10% of deliveries are premature , prematurity contributes 33% of neonatal deaths. Identifying local risk factors for prematurity could help incoming up with local intervention and prevention strategies.

Design: 1:1 unmatched case control study.

Setting: Harare and Parirenyatwa central hospitals maternity units.

Subjects: All mothers who delivered in the units June to July 2011. Acase was a mother who had delivered a premature baby and control was a mother who delivered a term baby.

Results: We interviewed 188 cases and 188 controls. Independent risk factors for premature delivery were -A previous premature delivery [AOR 3.15 95% CI 1.17 8.49, 4.61] being admitted with a medical complication in pregnancy[AOR 2.15 95% CI 1.18-3.92]. Birth interval > 24 months [AOR 0.26 95% CI 0.12 0.59] being well nourished evidenced by BMI ≥20kg/m [ AOR 0.926 95% CI 0.88 0.97] and MUAC ≥23cm [AOR 0.95 95% CI 0.91 0.95] reduced the risk of premature delivery. HIV test was done on 87% of participants, 12% were positive (66% controls, 33% cases) (p≤0.001).

Conclusion: Birth interval < 24 months, previous premature delivery, only one ANC attendance, maternal under nutrition and being hospitalized with complications in pregnancy were associated with premature delivery. There was no association with HIV infection. Efforts should be made to give food supplements to pregnant undernourished women.

Objective: To assess the knowledge, attitudes and practices of Harare oral health professionals regarding Hepatitis B Virus (HBV) in the workplace.

Design: A cross sectional study was conducted using a structured 36 item interviewer administered questionnaire to collect data from consenting participants.

Setting: The study was conducted at private and public dental practices in Harare.

Participants: Oral health professionals comprising dentists, dental therapists and technicians were purposively sampled and interviewed.

Results: Eighty nine study participants were interviewed. Seventy four (83%) and 69 participants (77.5%) knew about the potential transmission through contact with blood and saliva respectively. Forty seven (52.8%) participants knew that HBV infection is incurable. Thirty five participants (39.3%) were unaware of the ability of HBV to remain infective in dried blood. Although 22 participants (25%) stated that there was potential for transmission of HBV to patients at their workplace, 81participants (92%) felt they were at risk of contracting HBV infection at work. Sixty one participants (69%) reported being vaccinated, but on verifying the vaccine doses the participants received, 35 (39.3%) received three doses, 15(17%) two doses and 11 (12.4%) one dose. Forty six per cent of the fully vaccinated participants (16 of 35) had a post-HBV vaccination test. Seventy nine (87%) and 83(93.3%) professionals stated consistent use of face masks and gloves during procedures respectively.

Conclusion: Although the oral health professionals in Harare appreciated the risk of HBV transmission in dental settings, they had incomplete knowledge of HBV infection and there was poor uptake of HBV vaccination among these professionals.

Background: Non-adherence reduces the effectiveness of antiretroviral therapy. Knowledge of factors associated with non-adherence would assist clinicians and program planners to design and implement interventions to improve adherence and therefore treatment outcomes.

Objective: To determine the prevalence and factors associated with non-adherence to Highly Active Antiretroviral Therapy (HAART) in children less than 10 years of age.

Methods: A cross-sectional study of 216 caregivers and children less than 10 years of age who had received HAART for at least 60 days prior to this study. Non-adherence was defined as taking less than 95% of prescribed doses. Caregiver self-reports of missed doses in the 30 days preceding a clinic visit, and clinic based pill counts were used to determine non-adherence.

Results: Of the 228 children selected, 216 (94.7%) study participants were assessed using the self-report method. Pill count assessment was done on only 96 (44%) participants who produced unused pills on their review dates. Caregiver self-reports (n=216) estimated the prevalence of non-adherence to be 7.4% (95%: CI 3.90 10.90) whereas clinic-based pill counts (n=96) yielded a higher estimate of 18.8% (95% CI 10.94 26.56). In a regression analysis based on pill count, two or fewer siblings (OR=6.26, 95% CI 1.64-23.95) or adults (OR=3.73, 95% CI: 1.01-13.78) in the household were independently associated with non-adherence to HAART. Of the 16 participants who were non adherent by pill count the reasons for missing doses were, attending gatherings (funeral, church), caregiver forgetting to give dose, medication running out, not understanding dosing instructions, concurrently taking other medicines such as anti tuberculosis drugs and cotrimoxazole, child visiting relatives during school vacation, and inconsistent supply of drugs in the hospital.

Conclusion: The prevalence of non adherence using pill count method was high at this clinic. Caregiver reports of missed doses underestimated the prevalence of non-adherence to HAART. Having fewer siblings or adults in the household to assist with dosing are strongly associated with non-adherence to HAART in this population of children.

Sub-Saharan Africa contributes at least 70% of the global cryptococcal meningoencephalitis cases each year and the majority of cases are caused by the Cryptococcus neoformans species. We present a case of meningoencephalitis due to Cryptococcus gattii in an 18 year old apparently immunocompetent male patient from Zimbabwe.

Objective: To develop and validate a simple procedure for the qualitative determination of chloroquine in urine with potential for use in developing countries lacking sophisticated analytical equipment and expensive reagents.

Design: This was a laboratory based study making use of which combines a colorimetric test, Dill-Glazko's test, and UV/Visible absorbance spectrometry to confirm the presence of chloroquine. The spectrophotometric method was cross validated with the standard Baselt's method for quantification of chloroquine in biological fluids.

Setting: Pharmacology laboratory at the Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe.

Main outcome measures: Recovery of the methods was assessed by comparing the peak absorbances and the resolution of the peaks at 329nm and 343nm. Sensitivity and specificity was determined by analysing in a blinded manner. The limits of detection of both the Dill-Glazko's test and the confirmatory test was determined.

Results: In the prevalidation procedures increasing the volume of the ethylacetate and the volume of the lower aqueous layer extracted was found to increase the recovery of the confirmatory test. There was a significant difference between both the peak absorbances and the peak resolution for the two methods (p<0.0001). The confirmatory test had a sensitivity of 90% and a specificity of 100%, whereas the Baselt's method had a sensitivity of 83.3% and a specificity of 96.7%. The limit of detection of the Dill-Glazko's test was 15mg/Land that of the confirmatory test was 5mg/L.

Conclusions: The confirmatory test had better recovery and was more sensitivity compared with the Baselt's method. The limit of detection of the combination method (Dill-Glazko's plus confirmatory test) was 15mg/L. The combination test showed appreciable sensitivity to be suitable for application to clinicaltoxicology.

Background: There is little data on prevalence of critical illness in Sub Saharan Africa, especially in rural areas, but it is needed to develop critical care services in district hospitals.

Methods: We sought to determine the prevalence of patients 'at risk of' critical illness using an Early Warning Score (EWS) in a district hospital in Botswana. During two-month period patients daily vital signs were recorded and EWSs calculated on adult medical or surgical wards to identify patients who scored ≥3.

Results: EWS on 826 patients were obtained. There were 180 patients with ≥3 [8 refused to give consent and were excluded] with mortality 63(37%) and 646 patients scored below 3, mortality of 3 (0.6%). Patients with scores ≥3 were medical (63%), surgical (27%) and orthopaedic (9%). Of patients that were transferred to a referral centre [6 (3%)], none were admitted to ICU. Patients who died lived for 6.5 (SD 7.0) days after first score of ≥3. HIV prevalence among patients that died was 37%. Other co-morbidities were rare, except hypertension (21%). Cause of death was not clear in 60% of patients. When cause of death could be inferred from clinical records, it was illness related in 75% of cases.

Conclusions: Using the EWS we have identified the burden of critical illness in a rural district hospital in Botswana and the 'critical care gap' where patients do not get the intensive care they need.

Tetralogy of Fallot (TOF) is the commonest congenital heart abnormality beyond the age of one year. Cases of Tetralogy of Fallot can present during pregnancy following successful surgical repair in childhood or occasionally as uncorrected TOF presenting for the first time during pregnancy, indeed the most frequently encountered congenital cyanotic heart lesion during pregnancy is cyanotic TOF. Most adult congenital heart disease in Africa is uncorrected due to widespread unavailability of cardiothoracic surgical services on the continent. Pregnancy is associated with significant haemodynamic alterations affecting both the systemic and pulmonary circulatory beds. These are more likely to have deleterious effects in pregnant women with underlying heart disease or with risk factors for pulmonary hypertension.We describe here the case of a 22 year old pregnant woman with acyanotic tetralogy of Fallot and HIV infection who had an uncomplicated parturition. We discuss possible reasons why this potentially fatal combination was well tolerated by the patient.

Objective: To determine blood glucose levels by conducting an oral glucose tolerance test in low and normal birth weight young black adults.

Design: Acase control study was done. Seventy students in the College of Health Sciences who had neonatal clinic cards as proof of birth weight were recruited into the study. Blood glucose levels were measured before, during and after the oral glucose tolerance test.

Setting: Department of Physiology, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe.

Main outcome measures and results: A total of 70 young adult participants, 47(67%) females and 23(33%)males with mean age 20.28±0.19 years were recruited. 30 had Low Birth Weight (LBW, 21 females and 9 males) and 40 had Normal Birth Weight (NBW,26 females and 14 males).LBW individuals had significantly elevated (p<0.05) mean blood glucose levels at 30minutes(9.41±0.91 for LBW and 7.24±0.28 for NBW, p=0.029) and 60 minutes (9.22±0.75 for LBW and 7.57±0.36 for NBW, p=0.035) after the oral glucose tolerance test. Oral glucose tolerance testing detected 1case of type II diabetes (LBW individual), 13cases of impaired glucose tolerance (9 LBW and 4 NBW individuals)and 1 case of impaired fasting glucose (LBW individual).LBW was associated with an odds ratio of 3.1 for impaired glucose tolerance and it was statistically significant, p<0.05 (p=0.027).

Conclusion: Low birth weight was associated with glucose intolerance and significantly higher mean blood glucose levels at 30 and 60 minutes after glucose loading in young adults.