Tropical Doctor

During a 1–7 year follow-up of 1250 African diabetic patients at Muhimbili Medical Centre, Dar es Salaam, 68 (5.4%) were known to have developed pulmonary tuberculosis and two (0.2%) spinal tuberculosis. In 18 (25.7%) of the 70 patients tuberculosis was diagnosed prior to the diagnosis of diabetes, and in 32 (45.7%) after the diagnosis of diabetes. In 20 (28.6%) patients tuberculosis and diabetes were diagnosed at approximately the same time with most presenting with symptoms of diabetes. The prevalence of tuberculosis was greater in the young, in those with a low body mass index (BMI), in patients with insulin-dependent diabetes mellitus compared to those with non-insulin-dependent diabetes mellitus (9.0% vs 2.7%) and in those whose diabetes was poorly controlled. Seventeen (24.3%) of the 70 patients are known to have died. Pulmonary tuberculosis may progress rapidly and a high index of suspicion is required. It remains a significant cause of morbidity and mortality among diabetic patients in developing countries.

Suggested aetiological factors were evaluated in 244 consecutive children presenting with lower respiratory disease at Marondera Hospital, Zimbabwe. Data obtained from these children were compared with information obtained from 500 children seen at the local well baby clinic. There were no differences in the prevalence of malnutrition, breast feeding, overcrowding, poor housing conditions and poverty in these two groups of children. A significant association was identified between lower respiratory disease and exposure to atmospheric woodsmoke pollution in young children. Air sampling within the kitchens of 40 children revealed levels of atmospheric pollution far in excess of the WHO recommended exposure limit¹. Elevated carboxyhaemoglobin concentrations confirmed childhood smoke inhalation. We suggest that in many Third World communities a chemical pneumonitis resulting from the inhalation of noxious constituents of woodsmoke predisposes to lower respiratory disease in children.

In a study of 52 cases of neonatal tetanus admitted to Wesley Guild Hospital, Ilesha, it was found that 17 (33%) of the babies were delivered to mothers who had received adequate tetanus toxoid immunization during pregnancy. The 17 babies were compared with the remaining 35 babies whose mothers had not received tetanus prophylaxis. The case fatality rates in these two groups were 12.5% and 60% respectively (P < 0.01).

This report shows that neonatal tetanus can occur in babies of mothers who were immunized with tetanus toxoid during pregnancy. Maternal immunity may, however, improve the prognosis in such infants.

We studied the reliability of some simple clinical signs in the diagnosis of paediatric lower respiratory infection (LRI). Seventy infants and 148 children attending the outpatient department for cough of less than 15 days duration were studied. These children were examined by a paediatrician, and a proforma of simple clinical signs of LRI was filled in. A chest X-ray was taken on the same day and interpreted by a radiologist who did not know the clinical features of the patient. Clinical signs were then compared with X-ray changes, the latter being taken to indicate the presence of LRI. Respiratory rates of greater than 40/min in infants and greater than 30/min in older children were found to be the best indicators of LRI as revealed by a receiver-operating-characteristic curve. Chest indrawing and nasal flaring were found to be associated with moderate and severe disease.

The rate of postoperative wound infection was found to be low at 1.12% overall in a prospective study. This was achieved by careful preoperative preparation, judicious use of cheap prophylactic antibiotics which are included in the WHO model list of essential drugs, and meticulous operative technique.