Tropical Doctor

The HIV/AIDS pandemic is creating a strain on health care services in the developing world, with knock-on consequences for HIV negative patients. We looked for possible changes over time in the patterns of illness and outcomes of admission to an adult medical unit in Zimbabwe.

We performed a prospective descriptive study of discharge diagnoses and causes of in-hospital ;mortality for all medical patients under the care of one consultant at Mpilo Central Hospital, Bulawayo, Zimbabwe. Two similar 7-month periods were compared in 1992 and 2000. Data recorded included: initials, sex, alive or dead status, diagnosis and HIV/AIDS status.

Similar numbers of patients were admitted in 1992 and 2000 (1305 and 1369), but in-hospital mortality increased from 13.3% to 28.6% (P<0.001), especially in male patients (13.1% to 33.9% P<0.001). Mortality rates increased for both infectious and non-communicable diseases such as cardiac failure, stroke and diabetes. The 10 most common diagnoses were similar, apart from Pneumocystis carinii pneumonia (PCP) cases, which increased from 18 to 90. The proportion of patients clinically or serologically positive for HIV/AIDS rose from 13.9% to 51.1% (P<0.001), but the number of cases of the HIV wasting syndrome (SLIM)/chronic gastroenteritis did not change significantly. In 1992 there happened to be a large number of cases of malaria transmission.

Mortality related to both communicable and non-communicable diseases increased, confirming that HIV negative patients are also being affected by the strain on health services. Although based on clinical and radiological diagnosis, PCP pneumonia appears to be increasingly common in this area.

We determined the actual written policies/guidelines and practices of fee exemptions aimed at the primary health-care level for tropical diseases treatment within the Bamako initiative system and the community's and decision makers' preferences for exemption in Nigeria. Health policy documents from the federal and state ministries of health were reviewed to determine the guidelines for exemptions, services, goods and category of people to receive exemptions. The records of the local government areas, health centres and community health committees were also reviewed to check who had received exemptions and modalities for doing so. In addition, household surveys using questionnaires was conducted.

There is no clear-cut national policy regarding exemption. In areas where exemption exists, these are largely unofficial, as no official documents exist to support exemption. A total of 1594 individuals were surveyed. Community members prefer pregnant women, children and patients with TB, malaria, onchocerciasis and leprosy to be exempted from payment of fees: decision makers prefer the poor, children and patients with malaria, TB and leprosy to be exempted from payment for drugs, registration, consultation and preventive services such as immunization and antenatal services. One area of divergence between the preferences of the community and decision makers is the issue of exempting people with malaria and HIV/AIDS.

Child sexual abuse (CSA) is a major contributing factor to the burden of disease among children and adolescents. The aim of this study is to determine the prevalence of CSA and its outcomes among female high school students in Ethiopia. A cross-sectional study was conducted among Jirren high school female students in April 2005. A total of 323 female students from grade 9 were selected by systematic random sampling and they completed a self-administered questionnaire on experiences of sexual abuse. Data were cleaned and analysed by SPSS/PC statistical package. The results revealed that the prevalence of CSA was 68.7%. Among the different forms of sexual abuses, verbal harassment was the most common (51.4%) followed by sexual intercourse, 18.0% and unwelcome kissing, 17.1%. The commonly indicated abusers in this study were unknown persons (36%) followed by school-mates (31.5%). Among victims of sexual abuse, 7.2% had an unwanted pregnancy and 5.9% had sexually transmitted diseases. The rate of other psychological effects of CSA, such as suicide ideation, suicide attempt, and sexual dysfunction, was high. The overwhelming majority (86.4%) considered sexual abuse to be a major social problem. The study revealed that the prevalence of CSA is high. Reproductive health education should be provided to students. Parents, police, and the public in general should be made aware of the problem before it endangers the lives of children and adolescents.

The objective of this study was to describe how people explain mental disorders and its treatment in Pemba Island, Zanzibar. Eight hundred and twenty-one participants (users, carers, health professionals, traditional healers, community members and leaders) were interviewed as part of a cross-sectional survey. Most people viewed mental disorder as arising within their internal or supernatural world. Although they thought that they could be helped both by primary health care and alternative healing, the majority described going to the traditional healers when things went wrong. This provides evidence that there is considerable reliance on traditional care for the treatment of mental disorders. It is therefore important for the health services to be in dialogue with the traditional healers.

The objective of the study was to develop the co-agglutination (Co-A) test, a rapid slide agglutination test for the diagnosis of cysticercosis. The present study included 21 cases of cysticercosis, which comprised seven cases of clinico-radiologically definite cases of neurocysticercosis (NCC) proven with either computed tomography (CT) scan or magnetic resonance imaging (MRI), eight cases of clinically strong NCC, six cases of extraneural cysticercosis in muscle and eye; 40 non-cysticercal parasitic infection controls; and 20 healthy controls. Hyperimmune cysticercus antiserum was raised in rabbits and was used to coat Staphylococcus aureus (Cowan strain-I) bearing protein A (SAPA) cells, and the Co-A was standardized to detect cysticercal antigen in the serum. Serum samples from 12 out of 21 (57%) cases of cysticercosis were positive for cysticercal antigen by the Co-A test. Of the 12 positive samples, eight were from cases of neurocysticercosis and four from cases of extra-neural cysticercosis. Serum samples from seven out of 40 non-cysticercal parasitic infection controls and serum samples from one out of 20 (5%) healthy controls showed a false-positive reaction for the antigen by the Co-A test. There was a statistically significant difference between the antigen detection rates among cysticercosis patients on one hand, and the patients with other parasitic diseases (P=0.0014), and healthy controls (P=0.0003) on the other. The Co-A test appears to be a moderately sensitive and specific test for the diagnosis of cysticercosis.

Local anaesthesia has been identified as the most favourable anaesthesia for elective inguinal hernia repair with respect to complication rate, cost-effectiveness, and overall patient satisfaction.

Operation theatre notes in all seven hospitals in the Northern Region in Ghana over the period of 1 year were reviewed. Only 22.4% out of 1038 repairs were performed under local anaesthesia while predominantly spinal and general anaesthesia were used (48.0 and 29.6%, respectively). African surgeons chose local anaesthesia far less frequently than visiting overseas surgeons (15.6 versus 27.7%, respectively).

All surgeons in resource-poor countries should be encouraged to use local anaesthesia more frequently for elective inguinal hernia repair. Valuable resources in sub-Saharan African hospitals could be saved, especially if used in combination with outpatient surgery.

The technique should be taught in teaching institutions. A simple step-by-step technique is described.

Increasingly, international health links are evolving between UK health-care institutions and those in developing countries, the core aims of which are to seek the transfer of ideas, knowledge, skills and training. This study aimed to evaluate established health links, what constitutes them and how they are supported. Benefits and challenges associated with the links, as perceived both by link coordinators in the UK and their overseas partners, were explored. Fourteen links between health-care organizations in the UK and those in developing countries were identified and interviews were successfully conducted with 22 link coordinators: 13 in the UK and nine in developing countries.

The interviews indicated that health links offer mutual benefits to both partners in terms of shared skills and the promotion of global awareness. Links can act as important catalysts; stimulating increases in institutional capacity for research and training.

They provide opportunities for personal and professional development of staff and promote the development of friendships and supportive networks between diverse communities. Many of the health links showed signs of evolving from uniprofessional links between individual institutions into broader, multidisciplinary community partnerships.

The main challenges facing health links arise from cultural differences, funding problems, communication difficulties and bureaucracy. There was broad agreement that greater recognition of the value and importance of health links by the NHS and closer collaboration between government departments to provide support and resources could promote wider and more effective link partnerships.

Fishing line is an inexpensive and atraumatic suture material. Its properties and uses are summarized here. Comparison is made between different diameters and types of fishing line and commercially available sutures and needles to enable appropriate line selection for its use as suture material.

Squamous cell carcinoma (SCC) is the second most common form of skin cancer and frequently arises in the sun-exposed skin of middle-aged and elderly individuals. We retrospectively reviewed 443 patients managed for SCC (cutaneous and non-cutaneous) in our hospital from January 1979 to December 2002. The age distribution showed peak incidence between fourth and sixth decades of life. The duration of symptoms ranged from 6 months to 552 months (standard deviation [SD] = 54.29), while the head and neck region was the most common site of cutaneous SCC.

SCC is not rare in our environment. Patients with skin lesions are advised to present early to their physician for early diagnosis and appropriate treatment.

Malawi is a poor country with few doctors. It has 21 district hospitals, all of which have operating theatres but none of which has a surgeon. Most district hospitals are manned by a single doctor and two or more paramedic clinical officers. In 2003, a total of 28,594 operations were performed in district hospitals. In all, 12,506 (44%) of these were obstetric or gynaecological procedures, but only 821 (3%) were general surgical cases. It appears that district clinicians are happy to attempt emergency obstetric and gynaecological cases but tend to refer emergency general surgical cases.

This study set out to determine the prevalence of Enterobius vermicularis in surgically removed appendices and to assess the possible relation of the parasite to acute appendicitis. All 624 surgically removed appendices received in the Department of Pathology, BPKIHS, Dharan, Nepal during 2&frac12; years (August 1999&ndash;January 2002) were examined. E. vermicularis was identified in nine (1.62%) appendices from the patients with a clinical diagnosis of appendicitis. The parasite was most frequently seen in histologically normal appendices (6/71) and was rarely associated with histological change of acute appendicitis (3/539). No cases of E. vermicularis infestation occurred in appendices showing chronic inflammation or removed during the course of other surgical procedures. E. vermicularis was found more frequently in uninflamed and histologically normal appendices (8.45%) than those which were inflamed with histopathologic changes of acute appendicitis (0.56%). It may be a cause of symptoms resembling acute appendicitis although the mechanism for this does not involve mucosal invasion by the parasite.

We retrospectively studied 27 histologically diagnosed cases of schistosomiasis of the appendix at the University of Maiduguri Teaching Hospital between January 1994 and December 2003. Of 1183 cases of appendices histologically examined, schistosomiasis was seen in 27 (2.3%).

The study evaluated the effect of implementing the directly observed treatment (DOT) programme for the treatment of TB in a teaching hospital setting in Nigeria. A significant increase in treatment completion rate and reduction in mortality was observed. The expansion of the DOT programme is desirable to stem the increasing TB epidemic in the country.

Despite the fact that discharging ears (DE) are one of the most common presentations to ear, nose and throat (ENT) clinics in the tropics, few reports have documented the aetiologic agents involved. The pathogenesis is therefore not fully understood and treatment remains controversial. We present in this report the microbiological characteristics of DE over a 3-year-period at the ENT clinic of Ladoke Akintola University Teaching Hospital, Osogbo, Southwest Nigeria.

A community-based, cross-sectional study was conducted to determine the prevalence of anaemia among unmarried, adolescent south Indian girls in an urban slum setting. A total of 100 apparently healthy girls between the ages of 11 and 18 years were recruited. Their socioeconomic, dietary and anthropometric information was collected, and blood haemoglobin (Hb) was estimated. The prevalence of anaemia (Hb<12 g%) was 29%. Most had mild anaemia; severe anaemia was not seen. Two-thirds of those with anaemia had low serum ferritin (<12 μg/L). Significant associations were observed between anaemia and low socioeconomic status, religion and reporting infrequent/non-consumption of meat (heme iron). Only meat consumption was related to haemoglobin by multiple regression analysis. Anaemia is a common problem among adolescent girls in this setting, though severe anaemia is rare. There is a need to improve their haemoglobin status through dietary modification along with preventive supplementation and nutrition education.

A 10-year retrospective descriptive study was conducted looking at the outcome of all neonates weighing less than 1500 g admitted to the University Hospital of the West Indies. Analysis of predictors of mortality using regression models revealed birth weight to be the only independent predictor of mortality. Further improvement in survival of these infants will be dependent on the availability of ventilatory and nutritional support.

There are few data describing patients' attitudes towards the integration of antiretroviral therapy for HIV-infected patients into existing TB services. We investigated this issue among patients receiving TB treatment at a primary care facility in Cape Town, South Africa. Of 85 patients interviewed, the vast majority (92%, n = 78) stated they would be willing to attend an integrated TB/HIV service; perceived stigmatization of TB and HIV was a significant predictor of negative attitudes towards a combined TB/HIV programme (adjusted odds ratio, 19.90, P = 0.02). While integrated TB/HIV services appear generally acceptable in this setting, continuing efforts to combat stigmatization are necessary to ensure maximum uptake.

This was a prospective study to determine the success rate of myringoplasty in a low-resource setting. Myringoplasty was performed on 85 patients and follow-up done for 6 months in order to determine the incidence of closure of the repaired tympanic membrane. The eardrum closure rate at 3 months was 88% and at 6 months 84%. There was a 62% positive change of more than 10 dB in the pure tone averages of air conduction at frequencies 500, 1000 and 2000 Hz and a 24% improvement of less than 10 dB. This compares favourably with results from other studies.

Anaphylaxis following intraperitoneal rupture of a cysticercosal cyst mimicking pelvic peritonitis secondary to appendicular perforation is reported. Human cysticercosis occurs following ingestion of Taenia solium eggs, usually from faecally contaminated food. A case of pelvic cysicercosis presenting with signs and symptoms of anaphylaxis and peritonitis is reported, with plausible explanations for this unusual presentation.

In Ile-Ife, Nigeria, traumatic brain injuries are largely due to traffic accidents caused mainly by the bad maintenance of the roads and unsafe driving. Young men in the productive stage of their lives are those most affected. The resultant disabilities include quadriplegia (in more than half the patients) and paraplegia. The cost of treating and providing adequate facilities for these patients imposes a heavy economic burden upon developing countries.

The present study aimed to reveal the association between family incomes and status of malaria in 50 randomly selected families. Results show that there is an association between income poverty and malaria experiences (P < 0.05) and that 80% of the low-income families experienced malaria while only 20% of high-income families had experienced malaria (P < 0.05).

We detected a prevalence (11%) of hepatitis B virus (HBV) infection among male adult villagers (n = 149) in far western Nepal where migration to India is common. Although only one migrant-returnee was infected with both HBV and HIV, co-infection may occur more frequently in future as the HIV prevalence is high (8%).

Of all cancer patients, 28% had gastrointestinal parasites of medical importance.