scholarly journals Pitfalls and technical errors in the first approach to neonates with anorectal malformations in a non-specialist context: can we do any better? A review from three Eastern African Centres

2021 ◽  
Vol 21 (3) ◽  
pp. 1340-1345
Author(s):  
Alessandro Calisti ◽  
Faisal Abdelgalil Nugud ◽  
Kibreab Belay ◽  
Agnes Mlawa ◽  
Pierluigi Lelli Chiesa
Keyword(s):  
Neonatal Period ◽  
Anorectal Malformations ◽  
Sub Saharan Africa ◽  
Pediatric Surgeon ◽  
Technical Errors ◽  
Distal Loop ◽  
The Mean ◽  
Sub Saharan ◽  
Delayed Referral

Introduction: In sub-Saharan Africa, Anorectal malformations (ARM) are the most frequent cause of neonatal obstruc- tion. Referral to a Pediatric Surgeon is frequently delayed. The first treatment is often delivered at not specialist level and mismanagement may result. Aim: To study ARM patients referred beyond neonatal period and managed at a non-specialist level. Materials and Methods: One hundred and thirty patients were included (M/F ratio 63/67) among 144 admitted to three Eastern African Hospitals with Pediatric Surgical facilities. Demographics, type of anomaly, delay on referral, previous man- agement, most commonly observed errors are reported. Results: The Mean age at referral was 23 months (range five weeks – 23 years). Colostomy was the most frequent surgery (92 cases). Stomas often did not follow the recommended criteria. Ten per cent were not on the sigmoid, and 35% were not divided. "Loop" or "double-barrel" colostomies did not exclude the distal loop. Inverted (10,5%), prolapsed stomas (7,5%), short distal loop (16%) were observed. Twenty-four cases (26%) needed redo. Primary perineal exploration in eight patients resulted in incontinence. Conclusions: Investments on training practitioners, acting at District/Rural level, and closer links with tertiary centres are recommended to avoid ARM mismanagement and delayed referral to a Specialist. Keywords: Ano rectal malformations; neonate; low resources context.

scholarly journals Potential of Spirulina Platensis as a Nutritional Supplement in Malnourished HIV-Infected Adults in Sub-Saharan Africa: A Randomised, Single-Blind Study

2011 ◽  
Vol 4 ◽  
pp. NMI.S5862 ◽  
Author(s):  
M. Azabji-Kenfack ◽  
S. Edie Dikosso ◽  
E.G. Loni ◽  
E.A. Onana ◽  
E. Sobngwi ◽  
...  
Keyword(s):  
Body Composition ◽  
Viral Load ◽  
Serum Albumin ◽  
Spirulina Platensis ◽  
Sub Saharan Africa ◽  
Nutritional Rehabilitation ◽  
Group A ◽  
The Mean ◽  
Sub Saharan ◽  
Group B

Background Malnutrition is a major global public health issue and its impact on communities and individuals is more dramatic in Sub-Saharan Africa, where it is compounded by widespread poverty and generalized high prevalence of human immunodeficiency virus (HIV). Therefore, malnutrition should be addressed through a multisectorial approach, and malnourished individuals should have access to nutritional rehabilitation molecules that are affordable, accessible, rich in nutrient and efficient. We thus assessed the efficacy of two affordable and accessible nutritional supplements, spirulina platensis versus soya beans among malnourished HIV-infected adults. Methods Undernourished patients, naïve of, but eligible to antiretroviral treatment (ART), aged 18 to 35 years were enrolled and randomly assigned to two groups. The first group received spirulina (Group A) as food supplement and the second received soya beans (Group B). Patients were initiated ART simultaneously with supplements. Food supplements were auto-administered daily, the quantity being calculated according to weight to provide 1.5 g/kg body weight of proteins with 25% from supplements (spirulina and soya beans). Patients were monitored at baseline and followed-up during twelve weeks for anthropometric parameters, body composition, haemoglobin and serum albumin, CD4 count and viral load. Results Fifty-two patients were enrolled (Group A: 26 and Group B: 26). The mean age was 26.4 ± 4.9 years (Group A) and 28.7 ± 4.8 (Group B) with no significant difference between groups ( P = 0.10). After 12 weeks, weight and BMI significantly improved in both groups ( P < 0.001 within each group). The mean gain in weight and BMI in Group A and B were 4.8 vs. 6.5 kg, ( P = 0.68) and 1.3 vs. 1.90 Kg/m2, ( P = 0.82) respectively. In terms of body composition, fat free mass (FFM) did not significantly increase within each group (40.5 vs. 42.2 Kg, P = 0.56 for Group A; 39.2 vs. 39.0 Kg, P = 0.22 for Group B). But when compared between the two groups at the end of the trial, FFM was significantly higher in the spirulina group (42.2 vs. 39.0 Kg, P = 0.01). The haemoglobin level rose significantly within groups ( P < 0.001 for each group) with no difference between groups ( P = 0.77). Serum albumin level did not increase significantly within groups ( P < 0.90 vs. P < 0.82) with no difference between groups ( P = 0.39). The increase in CD4 cell count within groups was significant ( P < 0.01 in both groups), with a significantly higher CD4 count in the spirulina group compared to subjects on soya beans at the end of the study ( P = 0.02). Within each group, HIV viral load significantly reduced at the end of the study ( P < 0.001 and P = 0.04 for spirulina and soya beans groups respectively). Between the groups, the viral load was similar at baseline but significantly reduced in the spirulina group at the end of the study ( P = 0.02). Conclusion We therefore conclude in this preliminary study, firstly, that both spirulina and soja improve on nutritional status of malnourished HIV-infected patients but in terms of quality of nutritional improvement, subjects on spirulina were better off than subjects on soya beans. Secondly, nutritional rehabilitation improves on immune status with a consequent drop in viral load but further investigations on the antiviral effects of this alga and its clinical implications are strongly needed.

scholarly journals Squamous Cell Carcinoma in African Children with Xeroderma Pigmentosum: Three Case Reports

2016 ◽  
Vol 8 (3) ◽  
pp. 311-318 ◽  
Author(s):  
Mamadou Kaloga ◽  
Pauline Dioussé ◽  
Boubacar Ahy Diatta ◽  
Mariama Bammo ◽  
Sarah Kourouma ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Xeroderma Pigmentosum ◽  
Case Reports ◽  
Sub Saharan Africa ◽  
Skin Cancers ◽  
Black Skin ◽  
The Mean ◽  
Sub Saharan

Introduction: Xeroderma pigmentosum is a rare autosomal recessive genetic disease. This disease predisposes patients to early-onset skin cancers, particularly squamous cell carcinoma. Here, we report 3 pediatric cases, including 2 deaths. Observation: The subjects included 2 boys and 1 girl with skin type VI. All subjects were from consanguineous marriages, and the average age was 7.6 years. The patients all had ulcerative budding tumor lesions in the cephalic region, and the mean disease duration was 18 months. In all 3 cases, the diagnosis of xeroderma pigmentosum was made before the poikilodermal appearance of sun-exposed areas and photophobia. Neurological-type mental retardation was noted in 1 case. Histology confirmed squamous cell carcinoma in all 3 cases. The evolutions were marked by the death of 2 children (cases 1 and 3). In one case, the outcome was favorable following cancer excision and subsequent chemotherapy with adjuvant radiotherapy. Conclusion: Squamous cell carcinoma is a serious complication related to xeroderma pigmentosum in Sub-Saharan Africa. Prevention is based on the early diagnosis of xeroderma pigmentosum, black skin photoprotection, screening and early treatment of lesions, and genetic counseling.

scholarly journals Farmer Demand and Willingness-To-Pay for Sweetpotato Silage-Based Diet as Pig Feed in Uganda

2020 ◽  
Vol 12 (16) ◽  
pp. 6452
Author(s):  
Marsy Asindu ◽  
Emily Ouma ◽  
Gabriel Elepu ◽  
Diego Naziri
Keyword(s):  
Willingness To Pay ◽  
Smallholder Farmers ◽  
Secondary Data ◽  
Market Potential ◽  
Sub Saharan Africa ◽  
Structured Interviews ◽  
Livestock Feed ◽  
The Mean ◽  
Pig Feed ◽  
Sub Saharan

Smallholder livestock farmers across Sub-Saharan Africa are racing against time to find cheaper, nutritious, and sustainable feed alternatives to the more pronounced and expensive commercial concentrates amidst the increasing global demand for livestock products. Lately, many prominent feed conservation technologies have been developed, with a notable example being the sweetpotato silage technology that turns wasted sweetpotato components into a palatable and nutritious livestock feed. However, despite the potential benefits associated with these technologies, the level of demand and acceptance among smallholder farmers remains largely unknown. Thus, this paper assesses the farmer demand and willingness-to-pay (WTP) for sweetpotato silage-based diet as pig feed by smallholder farmers in Uganda. The information for the study was collected through secondary data review and semi-structured interviews to assess farmer WTP. The 256 semi-structured interviews were randomly drawn from 16 purposive clusters formed at a radius of 3 km around 16 farmers piloting sweetpotato silage-based diets for pig feed. The results show that pig farming is mainly the responsibility of women, with farmers’ mean willingness-to-pay price amounting to 0.20 USD per kilogram of sweetpotato silage-based diet. At the mean price, the annual demand for silage was estimated at 17,679 tons, with a market potential of approximately 3.59 million USD. The study concludes that, at the mean willingness-to-pay price, there is a substantial market potential that can be exploited by small and medium-sized enterprises (SMEs) venturing in the livestock feed industry.

scholarly journals Poor availability of essential medicines for women and children threatens progress towards Sustainable Development Goal 3 in Africa

2019 ◽  
Vol 4 (Suppl 9) ◽  
pp. e001306 ◽  
Author(s):  
Benson Droti ◽  
Kathryn Patricia O’Neill ◽  
Matthews Mathai ◽  
Delanyo Yao Tsidi Dovlo ◽  
Jane Robertson
Keyword(s):  
Sustainable Development ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
Essential Medicines ◽  
Effective Interventions ◽  
Rural And Urban ◽  
Women And Children ◽  
The Mean ◽  
Sub Saharan ◽  
Children’S Medicines

BackgroundMost maternal and child deaths are preventable or treatable with proven, cost-effective interventions for infectious diseases and maternal and neonatal complications. In 2015 sub-Saharan Africa accounted for up to 66% of global maternal deaths and half of the under-five deaths. Access to essential medicines and commodities and trained healthcare workers to provide life-saving maternal, newborn and post-natal care are central to further reductions in maternal and child mortality.MethodsAvailable data for 24 priority medicines for women and children were extracted from WHO service availability and readiness assessments conducted between 2012 and 2015 for eight countries in sub-Saharan Africa. The mean availability of medicines in facilities stating they provide services for women or children and differences by facility type, ownership and location are reported.ResultsThe mean availability of 12 priority essential medicines for women ranged from 22% to 40% (median 33%; IQR 12%) and 12 priority medicines for children ranged from 28% to 57% (median 50%; IQR 14%). Few facilities (<1%) had all nominated medicines available. There was higher availability of priority medicines for women in hospitals than in primary care facilities: range 32%–80% (median 61%) versus 20%–39% (median 23%) and for children’s medicines 31%–71% (median 58%) versus 27%–57% (median 48%). Availability was higher in public than private facilities: for women’s medicines, range 21%–41% (median 34%) versus 4%–36% (median 27%) and for children’s medicines 28%–58% (median 51%) versus 5%–58% (median 46%). Patterns were mixed for rural and urban location for the priority medicines for women, but similar for children’s medicines.ConclusionsThe survey results show unacceptably low availability of priority medicines for women and children in the eight countries. Governments should ensure the availability of medicines for mothers and children if they are to achieve the health sustainable development goals.

Hospital-acquired gastroenteritis at a referral hospital in Gaborone, Botswana

2017 ◽  
Vol 13 (2) ◽  
Author(s):  
Henry Welch ◽  
David M. Goldfarb ◽  
Banno Moorad ◽  
Margaret Mokomane ◽  
Marek Smieja ◽  
...  
Keyword(s):  
Adverse Outcomes ◽  
Sub Saharan Africa ◽  
Severe Malnutrition ◽  
Oral Rehydration ◽  
History Of ◽  
Rehydration Solution ◽  
The Mean ◽  
Sub Saharan ◽  
Hospital Acquired ◽  
Monthly Incidence

Background: Hospital-acquired infections, including hospital-acquired gastroenteritis (HAGE), are well documented in Western countries but little is known about these infections in sub-Saharan Africa. Aim: To determine the incidence of and explore modifiable risk factors for HAGE. Methods: A prospective cohort study of children 72 hours after admission or upon admission after recent discharge for a non-GE illness. Children were followed until discharge to ascertain therapies used and adverse outcomes. Enteric pathogens were identified by multiplex PCR. Findings: Virtually all of the 32 children with HAGE were < 2 years (n=30, 94%) and most were male (n=19, 59%). Few had HIV infection (n=6, 19%), severe malnutrition (n=8, 25%), or a history of vitamin A use in the past 6 months (n=2, 6%). The mean monthly incidence of HAGE was 2.3 per 1000 patient days, and associated with the monthly number of community-acquired gastroenteritis (CAGE) admissions (IRR 1.02, 95% CI 1.00, 1.04, p=0.025). A stool pathogen was detected in 15/27 (56%) children, including norovirus (n=7, 26%) and rotavirus (n=5, 18%). Most children received oral rehydration solution (n=26, 81%), or IV fluids (n=9, 28%). Antibiotics were administered to 5 (16%) children. Two (6%) children with HAGE were admitted to the ICU and 4 (12%) died. Conclusions: We found HAGE was relatively common and associated with severe outcomes. The monthly incidence of HAGE was associated with CAGE admissions. Common pathogens included norovirus and rotavirus.

Providing Safe Surgery for Neonates in Sub-Saharan Africa

2003 ◽  
Vol 33 (3) ◽  
pp. 145-147 ◽  
Author(s):  
Emmanuel A Ameh ◽  
Nkeiruka Ameh
Keyword(s):  
Neonatal Intensive Care ◽  
Surgical Care ◽  
Developed Countries ◽  
Sub Saharan Africa ◽  
Neonatal Surgery ◽  
Emergency Situations ◽  
Neonatal Transport ◽  
Sub Saharan ◽  
Delayed Referral ◽  
And Training

Advances in neonatal intensive care, total parenteral nutrition and improvements in technology have led to a greatly improved outcome of neonatal surgery in developed countries. In many parts of sub-Saharan Africa, however, neonatal surgery continues to pose wide-ranging challenges. Delivery outside hospital, delayed referral, poor transportation, and lack of appropriate personnel and facilities continue to contribute to increased morbidity and mortality in neonates, particularly under emergency situations. Antenatal supervision and hospital delivery needs to be encouraged in our communities. Adequate attention needs to be paid to providing appropriate facilities for neonatal transport and support and training of appropriate staff for neonatal surgery. Neonates with surgical problems should be adequately resuscitated before referral where necessary but surgery should not be unduly delayed. Major neonatal surgery should as much as possible be performed by those trained to operate on neonates. Appropriate research and international collaboration is necessary to improve neonatal surgical care in the environment.

Cultural and socio-economic conditions as factors contributing to chronic stress in sub-Saharan African communities

2014 ◽  
Vol 92 (9) ◽  
pp. 725-732 ◽  
Author(s):  
Phaedra Henley ◽  
Megan Lowthers ◽  
Gideon Koren ◽  
Pamela Tsimbiri Fedha ◽  
Evan Russell ◽  
...  
Keyword(s):  
Chronic Stress ◽  
Reference Group ◽  
Sub Saharan Africa ◽  
Economic Conditions ◽  
Enzyme Linked Immunosorbent Assay ◽  
Hair Cortisol ◽  
Hair Samples ◽  
The Mean ◽  
Sub Saharan ◽  
Slum Settlements

Stress is known to contribute to overall health status. Many individuals in sub-Saharan Africa are believed to be stressed about their employment, income, and health. This study aimed to investigate hair cortisol as a biomarker of chronic stress in settlement communities in Kenya. Hair samples were collected from 108 volunteers from settlement communities in Kenya. An enzyme-linked immunosorbent assay technique was used to measure hair cortisol concentrations. In parallel, a health survey was completed. The mean ± SD for the cortisol concentration in the hair of volunteers from the settlement communities in Naivasha was 639 ± 300 ng/g, which was higher than found for a Caucasian reference group (299 ± 110 ng/g; one-way ANOVA, P = 0.0003). There were no differences in hair cortisol concentrations between members of slum settlements adjacent to large floriculture farms in Naivasha (Karagita, Kamere/Kwa Muhia/DCK, and Kasarani) compared with those well-removed from all floriculture in Mogotio (Mogotio and Westlands/Katorongot). However, hair cortisol concentrations were significantly higher in females, divorced volunteers, those who made below minimum wage, and those who reported feeling unsafe collecting water or using sanitation facilities within these 2 settlement groups. We found no evidence for increased chronic stress (measured by hair cortisol content) between members of slum settlements adjacent to versus distant to large floriculture farms. Cultural and socio-economic conditions that prevail in much of sub-Saharan Africa were found to be factors contributing to chronic stress.

scholarly journals 258Change in population mean BMI accounts for the majority of change in underweight and obesity

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Maria Laura Caminia Iurilli
Keyword(s):  
Social Inequalities ◽  
Sub Saharan Africa ◽  
Healthy Foods ◽  
Effective Response ◽  
Men And Women ◽  
East And Southeast Asia ◽  
The Mean ◽  
Sub Saharan ◽  
Objectively Measured ◽  
Poor Nutrition

Abstract Background Prevalence of underweight has decreased and that of obesity increased in most countries. A shift of the whole BMI distribution in the population would simultaneously change the mean BMI and the prevalence of underweight and obesity, whereas a change only at the tails would have limited impact on the mean. Methods Generalised linear regression of prevalence of underweight and obesity with mean BMI using worldwide data from 2,765 surveys with objectively measured height and weight on 143.5 million men and women aged 20 to 79 years from 1985 to 2016. Results Trends in the prevalence of underweight and obesity are largely driven by shifts in the distribution of mean BMI, with smaller contributions from changes in the shape of the distribution. There was a smaller than expected change in the decline of underweight in east and southeast Asia and sub-Saharan Africa and in the rise of obesity in Oceania. Conclusions The worldwide rise in obesity and decline in underweight are largely population phenomena. There is also evidence of excess obesity and persistent underweight beyond the distributional shift in some regions, which may be related to growing social inequalities that restrict access to healthy foods for those at highest risk of poor nutrition. Key messages Rise in obesity and decline of underweight are largely driven by increase in mean BMI. Effective response must include restrictions on unhealthy foods while making healthy options more accessible.

scholarly journals Acute complications of preeclampsia: prognosis and management at Pikine National Hospital in Dakar (Senegal)

2017 ◽  
Vol 7 (1) ◽  
pp. 33
Author(s):  
Diallo M. ◽  
Diouf A. A. ◽  
Niassy A. C. ◽  
Gombet C. E. G. ◽  
D. Lydie ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
Normal Range ◽  
National Hospital ◽  
Maternal Survival ◽  
Acute Complications ◽  
Retroplacental Hematoma ◽  
The Mean ◽  
Sub Saharan ◽  
Epidemiological Profile ◽  
Hepatic Cytolysis

ABSTRACTBackground: The objective of this study was to evaluate the prevalence of acute complications of preeclampsia in order to describe the epidemiological profile of the disease, to assess its prognosis and management.Methods: This was a retrospective study of patients admitted to the Pikine National Hospital from 1 January 2010 to 31 December 2013 (48 months) with severe complicated pre-eclampsia. Included in this study were patients admitted or diagnosed with severe complicated pre-eclampsia and having given birth in the structure or not.Results: The incidence of severe preeclampsia in childbirth varied from 9.7% to 11.5% during the four years of our study. Patients were largely paucigest (55.7% of cases) and paucipares (58.5% of cases). The mean age was 28.14 years with extremes of 14 and 47 years. More than half of the patients (57.7%) were between 21 and 34 years of age. They were mostly married (90.7%). Three-quarters of the patients (76.8%) had proteinuria with ≥ 3 cross-bands. Thrombocytopenia was found in 9.7% of patients, hepatic cytolysis in 12.1%, and elevation of serum creatinine in 13.8%. The level of transaminases was found to be greater than 2 in the normal range in 12.1%. Complicated forms were the most represented in our study. These were acute complications, with 715 cases, or 57.3% of the patients. They were either isolated (52.8%) or associated (4.5%). These included eclampsia (24.9%), followed by retroplacental hematoma (24.6%), fetal death in utero (23.7%), HELLP syndrome (3.4%). , Acute edema of the lungs (1.5%), and acute renal failure (1.4%). The lethality was 2.4%. The causes of maternal death were dominated by eclampsia (14 cases), DIC (3 cases) and OAP (2 cases). We counted 77.7% of live births and a stillbirth of 254.5 ‰.Conclusions: Pre-eclampsia is a serious complication of pregnancy. Its frequency is still high in sub-Saharan Africa. In the presence of signs of severity, maternal (vital and functional) and neonatal prognosis are inevitably involved. If management is based on fetal extraction, resuscitation measures are a guarantee of maternal survival.

scholarly journals Neuromeningeal cryptococcosis in sub-Saharan Africa: Killer disease with sparse data

2015 ◽  
Vol 6 (02) ◽  
pp. 221-224 ◽  
Author(s):  
Komi Assogba ◽  
Mofou Belo ◽  
Majeste Ihou Wateba ◽  
Dieu Donné Gnonlonfoun ◽  
Paul M. Ossou-Inguiet ◽  
...  
Keyword(s):  
Diagnostic Delay ◽  
Clinical Signs ◽  
Latex Agglutination ◽  
Sub Saharan Africa ◽  
Impaired Consciousness ◽  
India Ink ◽  
International Data ◽  
The Mean ◽  
Sub Saharan ◽  
Heavy Mortality

ABSTRACT Introduction: The extent of neuromeningeal cryptococcosis (NMC) has increased since the advent of HIV/AIDS. It has non-specific clinical signs but marked by high mortality. Objective: To analyze the characteristics of the NMC in sub-Saharan Africa. Materials and Methods: We have conducted a literature reviewed on the NMC in sub-Saharan Africa from the publications available on the basis of national and international data with keywords such as “Cryptococcus, Epidemiology, Symptoms, Outcomes and Mortality” and their equivalent in French in July 2011. All publications from 1990 to 2010 with 202 references were analyzed. The following results are the means of different studied variables. Results: We selected in final 43 publications dealing with the NMC which 24 involved 17 countries in Africa. The average age was 36 years old. The average prevalence was 3.41% and the average incidence was 10.48% (range 6.90% to 12%). The most common signs were fever (75%), headaches (62.50%) and impaired consciousness. Meningeal signs were present in 49% of cases. The mean CD4 count was 44.8cells/mm3. The India ink and latex agglutination tests were the most sensitive. The average time before the consultation and the hospital stay was almost identical to 27.71 days. The average death rate was 45.90%. Fluconazole has been the most commonly used molecule. Conclusion: The epidemiological indicators of NMC varied more depending on the region of sub-Saharan Africa. Early and effective taking care of patients to reduce diagnostic delay and heavy mortality remains the challenges.

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