The Central African journal of medicine最新文献

Objectives: To determine prevalence of acute kidney injury and associated factors, among neonates admitted at a referral hospital.

Design: Cross sectional study conducted 1 May to 31 July 2010.

Setting: Harare Central Hospital, Neonatal Unit. Subjects: 270 neonates ≥ 37 weeks gestation admitted within 12 hours of birth. Systematic random sampling was used to select study participants.

Methods: Maternal details were collected through an interviewer administered questionnaire. Neonatal clinical examination was performed. Blood for serum creatinine was collected within 12 hours of life and repeated 24-48 hours of life.

Main outcome measure: Acute Kidney Injury (AKI) defined by decrease of estimated Glomerular Filtration Rate (GFR) by ≥ 25% from baseline value, using RIFLE criteria (an acronym for Risk, Injury, Failure, Loss and End stage).

Results: The prevalence of AKI in term neonates was 33.3% (95% CI 0.27; 0.39). Factors significantly associated with AKI were Hypoxic Ischaemic Encephalopathy (HIE) 1(OR 3.05 95%CI 1.56;5.97), HIE 2 and 3 (OR 9.57 95%CI 3.83;23.92), APGAR score ≤6 (OR 3.82 95%CI 2.16;6.78), respiratory rate >60 (OR1.96 95%CI 1.09;3.55), chest recessions (OR 2.73 95% CI 1.56;4.75), history of neonatal fits (OR 5.78 95%CI 1.56;4.75),hypothermia (OR 3.05 95%CI 1.56;4.75) and maternal age ≥35 years(OR 5.89 95%CI1.11;31.41). Strong determinants of AKI on multivariate logistic regression analysis were HIE 1, hypothermia and chest recessions.

Conclusion: The prevalence of AKI in term neonates admitted at a Harare hospital was high. It is recommended to assess for AKI in neonates with identified risk factors and monitor for chronic kidney disease.

Objective: The purpose of this study was to determine the relationship between perceived self-efficacy and adherence to self-care activities in type 2 diabetic clients. Low adherence to diabetic self-care activities result in increased risks of developing chronic serious and life-threatening complications with increased morbidity and mortality in diabetic patients.

Design: The study was conducted using a descriptive correlational design. The Health Belief Model was utilized as the conceptual framework.

Setting: The study was carried out at Parirenyatwa hospital, a central referral health facility located in Harare, the capital city of Zimbabwe.

Subjects: The study had a sample of 74 subjects selected through systematic probability sampling with clients aged 40-65 years old suffering from type 2 diabetes mellitus and attending an outpatient diabetic clinic at the study site during the period of study. There were no dropouts they had to be at least one year post diagnosis and being able to speak either English or Shona or both.

Interventions: Data was collected through a structured interview. The interviews were conducted between08:00 hrs and 12:00hrs, which are the clinic hours. A questionnaire was used that was divided into three parts namely demographics, adherence and perceived self efficacy.

Main outcome measures: levels of adherence to self care and perceived self efficacy were the main outcome measures levels of adherence to self care and perceived self efficacy were the main outcome measures

Results: 45.9% of the subjects in the study had high adherence level of diabetic self-care activities, and this finding is inconsistent with the desirable adherence level for a chronic condition with potential for serious and life threatening complications. A high perceived self-efficacy level was found in 75.7% of the study subjects. There was a strong positive relationship between perceived self-efficacy and adherence to diabetic self-care activities (r = .964), and regression analysis showed an r squared of .930 which is evident of a strong positive relationship.

Conclusions: There is need for the medical-surgical nurses to develop strategies that would further improve diabetic clients' perceived self-efficacy so as to increase adherence to diabetic self-care activities.

Objective: The study was carried out to compare the effectiveness of the Ponseti manipulation versus the Kite's manipulation in the treatment of idiopathic Congenital Talipes Equino Varus (CTEV) as evaluated by the Pirani score.

Design: An intervention study, prospective non randomized trial.

Setting: Hospital based study at three central hospitals namely Harare Central Hospital (HCH), Parirenyatwa Group of Hospitals (PGH) and Chitungwiza Central Hospitals (CCH) in Zimbabwe. Subjects: 38 feet in 25 patients, 13 bilateral and 12 unilateral CTEV deformities in children less than one year of age and without prior manipulation or surgical treatment were purposively allocated to either Ponseti (20 feet) or Kite's method (18 feet) at three central hospitals. There were no dropouts.

Intervention: Participants in two hospitals were managed using the Ponseti method and one hospital managed participants using the kite's method. Baseline Pirani scores were measured before the first treatment was done. Thereafter they were followed up weekly and analysis was done for three and six week outcomes using the Pirani score. Correction was measured by the difference between the baseline hindfoot, midfoot and total scores and the Pirani scores at three weeks and six weeks. Within group analysis of the data was done using a single student t - test and between groups analysis was done using the independent student t - test.

Results: Both methods were effective in correcting CTEV deformity. Feet managed by the Ponseti method showed faster rates of decrease in Pirani score (improvement) as compared to feet treated by Kite's method. The between group analysis (Kite Ponseti) at three weeks was -1,4056 (p = 0.0000) [CI = -1.900 to -0.9103] showing a significantly difference between the methods at three weeks. The between group analysis (Kite Ponseti) at six weeks was -2.2302 (p = 0.0000) [CI = -2.9789 to -1.4815] showing a significantly difference between the methods at six weeks.

Conclusion: Ponseti management causes faster improvement in CTEV deformity using the Pirani scores than Kite management at three weeks and six weeks. It would therefore be more efficacious to use the Ponseti method of manipulation in the conservative management of CTEV. Issues of cost effectiveness will need to be researched further.

Objective: To compare the prices charged for clinical laboratory tests in Zimbabwean institutions with those of similar institutions abroad.

Design: An online analytical cross sectional study was conducted.

Setting: An online survey.

Subjects: We did an online survey of clinical laboratories that published prices of the tests offered on their websites. We also extracted price information from documents published by fees regulatory authorities.

Main outcome measures: Laboratory test prices for independent institutions, Laboratory test prices for State institutions.

Results: Overally for all countries, laboratory test prices were lower in state laboratories compared to the independent laboratories. In Zimbabwe, state laboratories generally charged about 50% of the independent laboratory tariff for most tests. However prices from both Zimbabwean institutions were generally much higher than those of the comparison countries (United Kingdom, South Africa, India, United States of America and New Zealand).

Conclusion: Prices of laboratory tests are indeed higher in Zimbabwean institutions compared to other centres abroad. These higher prices could be attributed to challenges in consumable procurement logistics. We also present measures that could be put in place to reduce the costs and therefore prices.

Background: Ectopic intrahepatic gallbladder is a rare phenomenon. Gallbladder duplication is an even rarer phenomenon. Pathological processes are more common in congenital anomalies of the gall bladder than normal gallbladders due to poor drainage.

Case report: We present a case of duplex gallbladder with one component intrahepatic and the other extra-hepatic, the duo draining via a common cystic duct into the common bile duct. Both gallbladder moieties were diseased. The intrahepatic moiety was gangrenous and perforated thus mimicking an intrahepatic abscess by a gas forming organism. The extra-hepatic moiety was chronically inflamed and packed with gallstones of the same physical and biochemical characteristics as the intrahepatic moiety. The definitive diagnosis was only made at emergency laparotomy. Stone gathering and debridement of the ruptured, gangrenous intrahepatic moiety and cholecystectomy for the extra-hepatic moiety was done. On table cholangiography, though desired, was not available. The patient fully recovered after post-operative intensive care.

Conclusion: An extensive internet literature search did not reveal any previously described case. This could be the first such case described in the world literature. Though rare, congenital anomalies of the gallbladder must be known to surgeons as they can present unexpectedly and pose diagnostic and operative surgical challenges with serious clinical implications. The management challenges experienced and literature review is presented.

Objective: To assess the role of Zimbabwean dental practitioners in Provider Initiated HIV Counseling and Testing (PITC).

Design: A cross-sectional analytic study was conducted. A structured interviewer administered questionnaire was used to collect data from participants.

Setting: Harare private and public dental practices.

Subjects: Forty dental practitioners practicing in Harare and two hundred and ninety three patients attending dental practices in Harare were interviewed.

Main outcome measures: Dental practitioners' practices on HIV counseling and testing for dental patients, acceptability of HIV testing in dental settings and missed opportunities for HIV counseling and testing in dental settings were assessed.

Results and conclusion: Half of the dental practitioners (20) interviewed reported offering HIV counseling to dental patients during their clinical duties. The majority 62% only referred their patients for HIV testing when they presented with oral manifestations of HIV infection. Seventy three percent (29) of practitioners interviewed were not aware of the Ministry of Health and Child Welfare guidelines on HIV counseling and testing. Eighty seven percent (255) of dental patients in this study reported not being counseled nor referred for HIV counseling and testing by their dental practitioner during their dental visits. More than a third (36.5%) of the dental patients experienced repeated missed opportunities for accessing HIV counseling and testing in health settings. The minimal that the dentists may need to be involved with in PITC is counseling their patients and improve referral for care. There is need for continued medical education for dentists on issues related to new HIV interventions or protocols such as PITC.

Infants younger than one year of age with Rhabdomyosarcoma appear to have worse prognosis compared to older children due partly to high rates of local failure. We report a 4 months old infant with orbital rhabdomyosarcoma with poor outcome. Reluctance to use aggressive local control measures and suboptimal chemotherapy dosing are significant contributory factors. Call is made for need for more studies to determine appropriate local therapy in infants with rhabdomyosarcoma.

Objective: To determine the proportion of deaths, characteristics of children and risk factors for mortality w ithin 24 hours of admission to a Paediatric hospital in Harare.

Study design: Prospective cohort study.

Settings: Paediatric Unit, Harare Central Hospital.

Subjects: All patients admitted to the medical wards who consented to participate were enrolled. Preadmission factors including duration of illness and health seeking behaviour prior to presentation, delays in A&E department assessed by lag time to assessment, administration of initial medications and admission to the ward were documented. The presenting clinical signs and admission diagnoses were also recorded

Main outcome measure: Death within 24 hours of admission.

Results: Of the 737 paediatric admissions during the study period, 54 children died within 24 hours giving a case fatality rate of 7.3%. These constituted 34.6% of total deaths in the study population (54/155). The median age of the children in this study was 16 months (Q1 = 4, Q3 = 36) and 53.2% were male. Having subcostal recessions on admission was significantly associated with mortality (within 24 hours of admission) with a RR 29.9 (95% CI 1.56.74) while socio-demographic factors, duration of illness, fever, diagnosis on admission and delays in A & E department were not.

Conclusion: The contribution of deaths within 24 hours of admission to the overall mortality in children remains unacceptably high. Sub-costal recessions on admission (a proxy for severe pneumonia) had the highest risk of mortality within 24 hours of admission. There is need for early identification and aggressive management of children with pneumonia.