African health sciences最新文献

Introduction: Acute hepatic encephalopathy significantly damages the normal functioning of human nervous system in a very short period of time. AHE gives birth to micro-hemorrhages which increases the morbidity and mortality associated with this disease. Hence, early diagnosis of this disease and its impacts is a key area of interest.

Objective: To investigate value of magnetic resonance susceptibility weighted imaging (SWI) in the diagnosis of intracranial micro-hemorrhage in patients with acute hepatic encephalopathy (AHE).

Methods: 85 AHE patients in our hospital from January 2017 to September 2019 were enrolled and received the CT and MRI examinations. The intracranial micro-hemorrhage and lesions detected by CT and MRI were compared to find out the sensitivity of each modality with special focus on SWI technique.

Results: The detection rate of intracranial micro-hemorrhage in SWI was higher than the detection rate of intracranial micro-hemorrhage observed in T1WI, T2WI and CT (P<0.05). Similarly, the detection rate of lesions in SWI was considerably better than the detection rate of such lesions observed in T1WI, T2WI and CT (P<0.05).

Conclusion: Magnetic resonance SWI has significantly better sensitivity in AHE patients with intracerebral micro-hemorrhage, which has proved to be of high value in clinical diagnosis.

Introduction: Uganda hosts an estimated 1.5 million refugees and 12.5% are urban refugees living in Kampala. Uganda is implementing an integrated healthcare system in which refugees and host populations utilize the same health care services.

Objective: To assess the level of utilization of antenatal care services and associated factors among urban refugee adolescents in Kampala, Uganda.

Methods: We conducted a cross-sectional study among 637 urban refugees who were adolescent mothers aged 10-19 years. Participants were interviewed using ODK software. The data were analyzed using Stata version 17. Uni-variate, bi-variate and multivariate analyses were performed, and the results reported as proportions, p values, odds ratios and confidence intervals.

Results: Most (92.6%) had attended at least one ANC visit, however only a few (11.5%) attended the recommended WHO 8 visits. Less than half (41%) attended the initial ANC visit within the first trimester. The factors associated with ANC utilization included being married and living in an extended family. The factors associated with ANC attendance in the first trimester included being married, education and duration of stay in the area.

Conclusions: Utilization of ANC by urban refugee adolescents in Kampala is sub-optimal. There is a need for targeted interventions to encourage adolescent refugees to utilize antenatal care services optimally.

Background: Sickle Cell Disease (SCD) is a hereditary disorder with significant public health implications such as chronic pain, and premature mortality. The disease is majorly in sub-Saharan Africa including Uganda. Amidst all this, research has reported low levels of awareness especially among young people such as university students who are the next generation of parents hence the need to conduct the research.

Objectives: This study determined the knowledge of Sickle Cell Disease and its associated factors among undergraduate students at Makerere University.

Methods: This was only a quantitative cross-sectional study conducted across 10 Colleges at Makerere University among three hundred eighty-five (385) undergraduate students. The students were randomly selected and data collected using an online structured questionnaire designed using Kobo Collect application. Collected data was analysed using logistic regression in STATA 17 software to assess the association between knowledge and demographic factors.

Results: Most participants were between the ages of 18 and 22 (62.08%). While most students had heard of SCD (94.81%), a significant proportion reported that they did not know where SCD testing is done (55.06%) and had never tested for Sickle Cell Trait (92.73%). The mean knowledge score was 58.40%, with 84.68% having poor knowledge. Factors significantly associated with high SCD knowledge included being of Muslim religion (p=0.027) and knowing someone who had ever had SCD (p=0.030).

Conclusions: This study reveals low knowledge levels of SCD among undergraduate students at Makerere University, with higher knowledge associated with Muslim religion and knowing someone with SCD, highlighting the need for targeted educational interventions.

Background: The Glasgow Coma Scale is a widely used tool in the assessment and tracking of patients with acute head and brain insults. However, its reliability and application in low-resource clinical settings have been least explored.

Purpose: The study aimed at determining the IRR of GCS among health workers and evaluating the effect of a standardized GCS Aid as an educational intervention in improving the accuracy and IRR of the GCS when assessing patients with neurological deficits at a tertiary facility in Uganda.

Methods and materials: The study employed a pre-test, post-test quasi-experimental design. Participants included health workers working within wards with adult patients with acute brain insults. A total of 45 participants completed the study.

Results: Findings indicate that higher training levels increased knowledge of GCS (F = 3.753, p = 0.01). The GCS AID improved the accuracy and IRR of the GCS post-test with eye-opening showing the greatest improvement (α, 0.65-0.88) followed by verbal (0.74 to 0.89), motor (0.83 to 0.93).

Conclusion: The use of the GCS-AID improved the IRR of GCS among health workers in the assessment of patients with acute brain insults.

Background: Sensory integration, particularly visual feedback, is essential for motor control and balance. Stroboscopic glasses, which intermittently restrict visual input, have emerged as a promising tool for rehabilitation and performance enhancement.

Objective: This systematic review and meta-analysis evaluated the impact of balance training with stroboscopic glasses on postural stability and activity levels in patients with chronic ankle instability or multiple sclerosis.

Methods: A systematic search of Science Direct, Web of Science, and PubMed was conducted up to September 2024 using relevant keywords. Randomized controlled trials published in English were included, excluding studies with incomplete data or abstract-only publications. From 5,691 screened records, five studies met the criteria, involving predominantly male patients with chronic ankle instability or multiple sclerosis.

Result: Balance training with stroboscopic glasses significantly improved postural stability (Z = 4.83, p < 0.001), while changes in activity scores were not statistically significant. Most studies demonstrated low risk of bias and strong methodological quality.

Conclusion: Stroboscopic glasses appear effective in enhancing postural stability, though their impact on activity levels remains unclear. Larger, diverse samples and comparative studies with other training methods are needed to validate these findings and explore long-term benefits.

Background: Effective postoperative pain management in orthopaedics is challenging, with conventional tools lacking time-adjusted assessment. The Summed Pain Intensity Difference (SPID) scale, quantifying cumulative pain reduction, requires clinical validation.

Objectives: This study assessed SPID's utility in evaluating postoperative pain management efficacy, correlating it with patient outcomes, analgesic use, and recovery. Primary outcomes included 48-hour SPID scores; secondary outcomes were satisfaction, analgesics, and hospitalization duration.

Methods: A prospective observational study included 148 orthopaedic patients over six months. Sociodemographic, surgical, and analgesic data were collected. Pain intensity (Numerical Rating Scale, NRS) was measured preoperatively and at 0-48 hours postoperatively. SPID (maximum: 144) was calculated as cumulative NRS differences from baseline, adjusted for time. Statistical analyses included descriptive/inferential tests (p<0.05).

Results: Mean SPID was 72 (50% of maximum), indicating moderate pain relief. Spinal/epidural anesthesia (44.4%/31.9%) reduced postoperative NRS (moderate: 6.84±0.36; severe:8.44±0.76) versus general anesthesia. Comorbidities (hypertension/diabetes) correlated with higher baseline pain (NRS:8.44±0.76). NSAIDs/opioids improved SPID by 50%. Hospitalization averaged 6.5 days, shorter with SPID≥50% (p<0.05). Overall satisfaction was 67.5%, correlating with SPID (r=0.45,p<0.01).

Conclusions: SPID demonstrated validity as a time-adjusted tool, aligning with patient satisfaction and recovery metrics. Its integration can standardize pain assessment in orthopaedic care, particularly in resource-limited settings.

Background: Type 2 diabetes mellitus (T2DM) is significantly influenced by the Elabela hormone, Elabela has been discovered to be a new endogenous apelin receptor (APJ) ligand.

Objective: To detect the potential changes of Elabela-21 and Elabela-11 levels in recently developed T2DM.

Materials and methods: A recent cross-sectional study with 180 participants was conducted. The participants were divided into three groups based on WHO classifications: T2DM patients, prediabetic cases, and healthy controls. Five milliliters of blood samples were collected in the morning during 9-12 hours of fasting. Tests were carried out for each patient and control involving glucose and lipid profile using the enzymatic methods by a biochemical auto-analyzer, glycated hemoglobin using the ion exchange high-performance liquid chromatography (HPLC), Elabela-21, and Elabela-11 using an ELISA technique.

Results: Serum Elabela-21 level in T2DM patients was (803.2067 ± 11.47459 pg/mL), and in prediabetic cases, it was (641.2417 ± 3.216256 pg/mL), which was higher than the value of the healthy controls (542.6983 ± 3.59739 pg/mL), and the differences were statistically significant (P < 0.001). Also, serum Elabela-11 level was significantly higher in people with T2DM and prediabetic cases (502.6683 ± 11.51197 and 339.25 ± 3.452898 pg/mL, P < 0.001), respectively, compared to the healthy controls (140.83 ± 3.603656 pg/mL). These differences were statistically significant (P < 0.001).

Conclusion: Elabela-21 and Elabela-11 levels in the blood gradually increased from prediabetes to recently developed T2DM. They were positively correlated with body mass index, glycemic, and lipid profile and negatively associated with HDL.

Background: The overuse of CT examinations (CTEs), especially in low-resource settings (LRS), is a growing public health issue. Up to 50% of these CTEs are considered inappropriate, with children and young adults being particularly affected. While clinical imaging guidelines (CIGs) have been developed to address this issue, their effectiveness in LRS remains unclear.

Objective: This study aimed to assess the impact of continuous professional development (CPD) and the introduction of CIGs on CT appropriateness in Ugandan hospitals.

Methods: A before-and-after study was conducted in six public and private hospitals over 12 months.

Results: Post-intervention, CTEs performed increased by 33%, with significant rises in public hospitals (30%) and private-for-profit hospitals (41%). Head CTs rose by 19%, and contrasted studies substantially increased by 252%. Conversely, trauma-related CTEs decreased by 8%. However, the overall proportion of inappropriate CTEs increased by 15%, with inappropriate contrasted examinations rising by 28% and non-trauma cases by 13%. Inappropriate non-contrasted CTEs and trauma-related CTEs reduced by 28% and 31%, respectively.

Conclusion: The study highlights the challenges of consistently implementing CIGs in LRS, despite some improvements. It calls for more tailored interventions and further research to explore factors influencing guideline adoption to optimize CT utilization and improve patient outcomes.

Background: Systemic inflammatory response (SIR) occurs in normal pregnancy and is exacerbated in pre-eclampsia (PE). Most markers of SIR are expensive to measure, require trained personnel, and thus are limited for routine application in resource-limited settings. Thus, we aim to determine the clinical utility of hematologic markers of systemic inflammatory response in Preeclampsia in a resource limited setting.

Methods: A cross-sectional comparative study was conducted in Enugu from April to October 2021. Forty-five women with pre-eclampsia (PE) and 45 matched normotensive (NT) pregnant women were recruited. Hematological markers of systemic inflammatory response (red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), monocyte lymphocyte ratio (MLR), and platelet indices) were measured using the automated Mythic 22 Orphee hematology analyzer. Statistical analysis was by student T-test, receiver operating characteristics (ROC) curve, and Pearson correlation test. A P value of < 0.05 was considered significant.

Results: The age difference between the groups was not significant (P = 0.76). Pregnant women with preeclampsia had significantly higher RDWS (P=0.02) and NLR (P <0.001) but a significantly lower PLR (P =0.04). The NLR had the largest area under the ROC curve (AUC 0.82, 95% CI (0.74-0.906, P <0.001), cut-off >2.56, sensitivity 71.1%; specificity 22.2%) followed by MLR (AUC 0.68, 95% CI (0.58-0.80, P =0.002) cut-off >0.18, sensitivity 64.4%; specificity: 28.9 %;).

Conclusion: The NLR and MLR were good and affordable biomarkers of Systemic Inflammatory response (SIR) in Preeclampsia, thus possible alternative in resource-limited settings.