The East African health research journal最新文献

Background: Guinea worm disease carries health risks with potential effects on social and economic wellbeing of an individual and community. Emergence, the fact of manually removing the worm, is slow, painful, and disabling and therefore, it has a serious adverse socioeconomic outcome on the health, agricultural productivity, and school attendance of affected population. This study was conducted to identify case of Guinea worm among children attending Al Sabah Children Hospital, South Sudan.

Methodology: The study extracted register data which covered the period from January to December 2022. Using a systematic random sampling, 422 children were selected from the hospital's Statistics Department of Al Sabah Hospital. Descriptive data analysis was performed using SPSS Statistics software.

Results: Of the children who received hospital services, the vast majority (76.3%) were children <5 years old, and more than half were females. None of the sampled children had Guinea worm infection.

Conclusion: In 2022, none of the attendees of the Al Sabah Children Hospital was diagnosed with Guinea worm infection. But this does not mean that the country is free of the disease as the study design did not allow to establish true prevalence.

Background: About one-fifth of women undergo repeated caesarean section (RCS) deliveries worldwide. However, an increase in the number of RCS may lead to maternal and foetal morbidity and mortality. This study aimed to determine the rates of RCS deliveries and associated maternal and foetal complications at a tertiary hospital in northern Tanzania.

Methods: This was a hospital-based cross-sectional study conducted at Kilimanjaro Christian Medical Centre (KCMC), Northern Tanzania. A total of 253 women who underwent caesarean section (CS) deliveries during the study period were included. Information from patient files was reviewed to abstract specific variables of interest, including maternal demographic and obstetric characteristics, maternal complications such as adhesions, postpartum haemorrhage, infections, anaesthetic complications, hysterectomy, and maternal deaths. Foetal complications related to RCS were also extracted, including the Apgar score, admission to the neonatal unit, neonatal infections, respiratory problems, and perinatal death.

Result: A total of 253 women were enrolled in this study. Of these, 133 (52.5%) had RCS delivery. The mean (± standard deviation) age of women at enrolment was 29.9 (±6.5) years. The overall complications rate was 56.5% (32.9% among women having first CS and 67.1% RCS, P<.001). For women who underwent RCS, 37.2% had anaesthesia-related complications, including hypotension, nausea, bradycardia, difficult intubation, aspiration, and respiration. Other complications were sepsis (15%), postpartum haemorrhage (PPH) (11.9%), and wound dehiscence (5.5%). Only sepsis was independently associated with repeated CS delivery (adjusted odds ratio (aOR=11.3, 95% confidence interval [CI], 3.3 to 8.9; P<.001).

Conclusion: The reported RCS in this study was high, associated with high CS complications. Necessary measures should be taken by healthcare providers to avoid unnecessary primary CS delivery, and counselling for trial of labour with close monitoring of labour for successful vaginal birth after caesarean section should be emphasised to avoid RCS and its complications.

Background: People living with HIV (PLWH) face numerous psychosocial challenges within the context of healthcare systems and the community where they live. This study aimed to describe psychosocial challenges and individual coping strategies among adults attending Care and Treatment Clinics (CTCs) in Ubungo Municipality, Tanzania.

Materials and methods: A qualitative descriptive study was conducted at CTCs in Ubungo Municipality, an urban setting in Dar es Salaam. Data were collected through audio-recorded in-depth interviews with 10 purposively selected participants. Audio files were transcribed verbatim and analyzed using a thematic analysis approach.

Results: Difficulty in accepting HIV-positive test results, feeling desperate, fears of HIV disclosure, HIV-related stigma, and financial instability related to HIV infection were the main psychosocial challenges described by the participants. However, their main coping strategies included seeking social support, positive experiences from regular CTC attendance, adaptive coping, disregarding people's comments, and seeking HIV-related information.

Conclusion: PLWH encounter various psychosocial challenges. Feeling desperate, fear of HIV disclosure, and HIV-related stigma are the main causes of psychosocial distress among people diagnosed with HIV. Changing the individual perspectives on these challenges through effective coping strategies can improve the quality of life for PLWH. The Ministry of Health, through the National AIDS Control Program, can design interventions focused on addressing these challenges. Future research should be undertaken to quantify the magnitude of these challenges and the coping strategies in similar settings.

Background: Dolutegravir-based antiretroviral therapy is a clinically proven treatment option for persons living with the human immunodeficiency virus. However, there is emerging clinical evidence that its use may result in hyperglycaemia, but there is limited data in Africa.

Objectives: To determine the prevalence of dolutegravir-associated hyperglycaemia and its covariates among Persons Living with HIV on treatment in a tertiary teaching and referral hospital in Kenya.

Methods: A cross-sectional study was undertaken among adult patients who had been using dolutegravir-based regimens for at least 3 months at the comprehensive care centre in Kenyatta National Hospital. An interviewer-administered questionnaire was used to collect sociodemographic characteristics while clinical data (viral load, CD4 count) were abstracted from patients' charts. Blood samples were taken to determine random blood sugar and glycated haemoglobin levels. Data were analysed using STATA^® statistical software. Associations between hyperglycaemia and patients' sociodemographic and/or clinical data were determined as appropriate whereas the independent correlates of hyperglycaemia were determined through multivariable logistic regression at P≤.05.

Results: We recruited 358 participants all on dolutegravir based therapy and predominantly female (62.0%). Median age was 444 (IQR 38 to 50) years. Prevalence of hyperglycaemia was 55.9%. Age above 40 years (aOR1.7; 95% CI, 1.1 to 2.7; P=.026), being overweight (aOR 1.7; 95% CI, 1.1 to 2.8; P=.026) and obesity (aOR 3.1; 95% CI, 1.7 to 5.5; P<.001) were associated with experiencing hyperglycaemia.

Conclusion: Dolutegravir-based regimens are associated with hyperglycaemia among patients with advanced age and elevated body mass indices.

Background: Hepatitis B virus infection is a common cause of viral hepatitis and affects 257 million people worldwide. Hepatitis B virus disease is a potentially life-threatening liver infection and a major global health problem that puts people at high risk of death from cirrhosis and hepatocarcinoma. The present study sought to investigate the proportion of hepatitis B virus (HBV) and associated factors for its transmission among people aged at least 15 years in three selected cities of Burundi attending the HBV screening campaign.

Methods: We conducted a cross-sectional design by selecting conveniently 629 consenting participants aged at least 15 years during the screening campaign in three selected cities of Burundi namely Gitega, Rumonge and Cankuzo in June 2022. During the campaign, a structured questionnaire was administered by trained healthcare workers to collect socio-demographic and behavioural characteristics, as well as the history of exposure to HBV. HBV screening tests were performed with Cypress Diagnostics HBsAg Cards (Hulshout, Belgium). Univariate and multivariable logistic regression analyses were used to assess factors associated with HBV infection in the screened participants.

Results: The study included 629 participants, 8.43% of whom tested positive for hepatitis B viral infection, with a mean age of 37.84 (SD=13.9) years. The participants were predominantly found in the over 50 years age group (31.1%) and the 18-30 years age group at 26.69%, the married (70.6%), the female (57.71%), and the farmers (60.25%), Rumonge city dwellers (33.39%), and those with a primary school level (36.25%). In this study, the associated factors with viral hepatitis B infection were residence in Cankuzo (OR=2, CI= 1-4, p=.04), and history of sharing sharp materials (OR=1.8, CI=1-3.3, P=.03).

Conclusion: HBV infection was significantly associated with residence in Cankuzo and sharing sharp materials. HBV infection is endemic in these three provincial cities namely Cankuzo, Gitega and Rumonge. Given the various ways for HBV infection to occur within a general population, control of hepatitis B and its associated factors is one of the highest priorities in order to mitigate its transmission and monitor continuous exposure among Burundian population. There needs to be more help in the form of screening, immunizations for adults and other preventative measures, as well as treatment for the patients.

Background: Bone loss resulting from open long bone fractures is a significant concern in low-income countries. This study aims to assess the prevalence, pattern, and treatment of traumatic bone loss in northeastern Tanzania.

Methods: A hospital-based cross-sectional analytical study was conducted at the Orthopedics and Trauma Department of Kilimanjaro Christian Medical Centre (KCMC) from August 2020 to February 2023. The sample size comprised 365 participants with 394 open injuries. Data collection involved a structured electronic questionnaire, and statistical analysis was performed using SPSS version 25.

Results: The study found that 14.7% of the patients treated at KCMC had traumatic bone loss following open long bone fractures. The majority of these patients were young males from rural areas involved in road traffic crashes. Comminuted fractures, especially in the tibia and fibula, were the most common fracture patterns associated with bone loss. Surgical debridement and external fixators were the primary treatment approach for patients with bone loss.

Conclusion: Traumatic bone loss following open long bone fractures is a significant issue in northeastern Tanzania. This study highlights the association between injury pattern, as per Gustilo classification, and the severity of the injury, consequently influencing the treatment plan and the potential for limb salvage. The factors significantly associated with bone loss were the Gustillo IIIB/IIIC classification of open fractures, fractures in the tibia and fibula, fibula fractures, and residence in an urban area.

Background: Delayed Developmental Milestones is a physical disability affecting the child development, occurs when the child fails to attain normal milestones compared to other children. Globally, 180-200 million infants have signs of developmental delay, and 86% are from developing countries. In Dar es Salaam, proportion of children with cognitive delay is 12.3%.

Objectives: This study explored the experiences and challenges of mothers in caring for infants with delayed developmental milestones.

Methods: In-depth interviews with ten mothers explored their experiences and identified challenges they encountered while caring for infants with delayed developmental milestones. NVIVO plus software was used for content analysis.

Results: Results showed that parents raising infants with delayed developmental milestones had negative experiences on the cause and types of delayed milestones. They lost hope. They were facing different challenges like lack of specialists, conflict in marriage and stigma.

Conclusion: Mothers of infants with delayed developmental milestones had negative experiences about this problem and they face many challenges in caring the infants.

Background: Decision-making is the cognitive process that results in the selection of a course of action from several possible alternative options. The complexity of nurses' decisions requires a broad knowledge base and access to reliable sources of information; as well as a supportive working environment therefore requiring that decision making be evidence based with robust knowledge translation platforms to disseminate the evidence. This review aimed to assess interventions for enhancing the use of evidence-based decision making for quality care among nurses.

Methods: This study followed the Preferred Reporting Items for Systematic Review and Meta-Analysis review (PRISMA 2020) checklist. This study protocol was registered with PROSPERO number CRD42021262318.

Results: The search revealed a total of 143 papers divided as follows: PubMed- 65 papers, CINAHL 25 papers and Cochrane 53 papers. In addition, references of included studies were scanned manually for potential papers and another 46 papers extracted. A total of 133 papers were chosen for detailed extraction following removal of 10 duplicate studies.

Conclusion: Results of this review revealed that the interventions that have been used to enhance the use of evidence for decision making are majorly educational. A few interventions have taken the form of modelling, guidelines and programming. Online solutions have also been seen to enhance the use of evidence for clinical practice of nurses.

Ruptured parasitic dermoid cyst is one of the rare conditions that results from auto-amputation and re-implantation following torsion from the ovary and omentum, among other sites. Due to trauma to the abdomen, it may rupture, resulting in spillage of its contents and causing chemical peritonitis. The diagnosis is based on clinical presentation complimented by abdominal ultrasound in low resource settings. A case of a 44-year-old (Iraqw by tribe) who presented with clinical features of acute generalized abdominal pain and distension for two days following blunt abdominal trauma. The abdominal ultrasound revealed a mass of mixed echogenicity with intraperitoneal free fluid. She underwent laparotomy, revealing ruptured parasitic dermoid cyst adhered to the anterior abdominal wall and urinary bladder, then excised. The high degree of suspicion of ruptured parasitic dermoid cyst is justified in adult patient with chemical peritonitis manifestation. The laparotomy is surgical management of choice in low-resource settings followed by prolonged follow-up.