Tropical Doctor

In a 2-year retrospective analysis of 147 maternal deaths in South African urban and rural hospitals, the maternal mortality rate (MMR) was estimated to be 144 per 100 000 live births. MMR was significantly higher (P = 0.025) in urban hospitals (160 per 100 000) and the main causes of death were hypertensive disease in pregnancy (33%), of which eclampsia contributed to 70% of deaths, and haemorrhage (18%). Only 49.7% of women who died, attended an antenatal clinic. The MMR in South Africa is lower than sub-Saharan countries but unacceptably high for a country with a mix of private and public medicine. Disparities have been noted in maternal mortality rates within the country due to different study designs and poor documentation. Structural changes in the health care system would only be possible if a common information database system were established and confidential enquiries held into maternal deaths.

In order to assess the effect of the HIV epidemic on lymph node biopsies in Central Africa, HIV-1 serology was tested on a cohort of patients undergoing node biopsy in Lusaka in 1990 and the histology of all lymph nodes biopsied in Lusaka in 1981 and 1990 was reviewed. One hundred and eighteen lymph nodes were biopsied in 1981 and 351 in 1990. Cases of tuberculous lymphadenitis increased from 52 (31 children and 21 adults) in 1981 to 186 (22 children, 160 adults, four patients unknown age) in 1990. Sixty-eight of 77 adults (88%) with tuberculous lymphadenitis in 1990 tested HIV-positive. Cases of histology suspicious of primary HIV lymphadenopathy and nodal Kaposi's disease also increased. Cases of malignant lymphadenopathy and overall number of surgical biopsies remained equivalent for 1981 and 1990. The study concludes that the HIV epidemic has led to a large increase in diagnostic lymph node biopsies in Lusaka, mostly through an increase in HIV-related adult tuberculous lymphadenitis.

A prospective study of buffy coat microscopy of 108 infants with respiratory distress during the first 48 h of life was undertaken. Thirty-two infants (29.6%) had positive blood cultures. The buffy coat was stained with methylene blue and with Gram's stain. Using methylene blue staining 94% shared organisms in the buffy coat. Whereas using Gram's stain only 50% were positive — all of which were also positive with methylene blue.

Twenty-four infants with negative blood cultures had radiological signs of pneumonia. Of these 83% showed organisms in the buffy coat with both methylene blue and Gram staining. We conclude that buffy coat microscopy provides a simple and reliable guide in the early diagnosis of neonatal septicaemia or lung infection in infants with respiratory distress.

This article describes specialized software to manage pharmaceutical logistics and medicine inventories in hospitals and central/regional stores. It has been written especially for application in the developing world to support the administration of such departments. Features include ordering, inventory control, supplying, reporting and accounting.

The pattern of rheumatic heart disease in 84 adolescent and adult patients seen over a 9 year period (1982–1990) at the University of Maiduguri Teaching Hospital (UMTH) is presented. Over 70% were in the second and third decades of life. Pure mitral incompetence and mixed mitral valve disease were the commonest valvular lesions. This pattern appears similar to those in other developing countries. Congestive cardiac failure was the commonest complication. Declining economic fortunes of the developing countries, over crowding, malnutrition and inadequate medical facilities may further perpetuate the condition. Early recognition and the management of rheumatic carditis and early valvular lesions will reduce the morbidity and mortality.

Twenty Shigella strains were isolated from bloody stools, of which 10 had been collected from children. Eighty per cent of the Shigella isolates were serogrouped as S. flexneri. All 20 Shigella strains were susceptible to gentamicin, nalidixic acid and ciprofloxacin. More than 80% were resistant to ampicillin, cotrimoxazole and tetracycline and 65% were resistant to chloramphenicol. Ten of 20 Shigella isolates showed a quadruple resistance to all four antibiotics. The usefulness of nalidixic acid for the treatment of multiresistant Shigella infections is discussed.

Our objectives were: (1) to discover requirements for treatment of patients with AIDS (PWAs) for healthcare workers in eight English-speaking African countries; (2) to establish policies for supply of drugs, and develop a method for determining the contents of parcels (PWA-BOXes) for the relief of PWAs. Fifty-seven questionnaires were sent to non-government medical units treating PWAs, supplied by the charity Inter Care. Of these 37 units replied, two had no known PWAs, three were swamped by refugees; therefore, the total number analysed was 32. Only 24 units had access to HIV testing and the mean number of PWAs per unit was 58. The reported complications of AIDS were: diarrhoea 28 units; tuberculosis 27 units; pneumonia 28 units; sexually transmitted diseases 26; candidiasis 28 units; and herpes zoster 20. Lists of drug requirements were received.

We present a protocol for calculation of contents of PWA-BOXes in the hope that this will provide guidelines for other workers in this field.