Challenges to paediatric tuberculosis care as perceived by health workers in Kano, North-western Nigeria

uberculosis (TB) remains the world's deadliest infectious disease that affects a third of the world's population and newly infected an estimated 10 million people in 2018. The number of TB infected Nigerians ranks sixth in the world and first in Africa. Kano State has the highest Nigerian TB prevalence. I aimed to identify Paediatric TB care challenges as perceived by Kano Medical and DOT health care providers. The study design was prospective, descriptive and cross sectional involving structured questionnaire interviews of 43 healthcare providers, during TB supervision visits of 10 Health facilities in Kano. Generated data was entered, validated and analysed using the STATA 13 statistical software package. The sample size was convenient, since it is the number of all the health providers working in the facilities assigned to the author for supervision under a supervision contract with KNCV in 2017. Of the 43 respondents, there were 26 males, with a M: F ratio of 1.5: 1. Those health workers aged from 30 and 40 years constituted 58% of respondents. The staff cadre of respondents comprised of Community Health Extension Workers [CHEW] (40%), doctors (30%) and nurses (3%). Up to 51% of respondents had over 10 years health worker experience and greater than 36 months Child TB DOT care provision. The most commonly identified challenges to paediatric TB care included poor health knowledge (97.7%), poor health seeking behaviour (95.4%), poverty (95.4%), the inability of children to cough up sputum 95.4%, late presentation (90.7%), contact tracing logistics (90.7 %), patient and community factors of stigma and discrimination (86%) and poor health worker paediatric TB knowledge (70%). Perceived health worker challenges to effective Paediatric TB care were the adult orientation of the TB programme and its contact tracing logistic challenges, inadequate health worker Paediatric TB knowledge, children's inability to cough up sputum, poverty, poor patient TB health knowledge, community stigma and discrimination, poor health seeking behaviour and late presentation.

Médulloblastome versus épendymome : qu'apporte l'IRM multimodale

Objectifs : décrire et comparer les aspects IRM de l'épendymome et du médulloblastome de la fosse postérieure. Matériels et méthodes : étude rétrospective incluant 29 cas de médulloblastome et 11 cas d'épendymome de la fosse postérieure. Les examens étaient réalisés en pondération T1 sans puis après injection de gadolinium, T2, T2*, Flair, diffusion, séquences de perfusion et de spectroscopie. Résultats : sur le plan morphologique, nous n'avions pas relevé de différence significative en ce qui concerne la taille tumorale, leur signal et leur rehaussement. Par contre les épendymomes étaient de topographie intra ventriculaire dans 90,9% contre 62,1% pour les médulloblastomes avec une extension dans le trou occipital respective de 81,8% et 10,3%. Les médulloblastomes présentaient une restriction de la diffusion dans 86,2% contre 27,3%. Une néoangiogenèse était notée dans 79,3% des médulloblastomes contre 45,5% pour les épendymomes. Sur le plan spectral, une chute du NAA et de la créatine associée à une augmentation du pic de Choline était retrouvée chez tous nos patients avec accumulation de myo-inositol dans 72,8% des épendymomes et présence de taurine dans 34,5% des médulloblastomes. Conclusion : l'IRM morphologique associée aux techniques avancées permet une meilleure approche diagnostique du type et du grading des tumeurs de la fosse postérieure

Morphological Pattern and Frequency of Intacranial Tumours in Adults and Children in Tanzania

Objective: The objective of the present study was to study the histopathological pattern of intracranial tumours and to provide a comprehensive data about their frequency in adults and children less than 16 years and to correlate the site with histological diagnosis.Design: A descriptive studyPlace and duration of study: The study was carried out at the departments of Histopathology and Morbid Anatomy; Muhimbili National Hospital and Neurosurgery; Muhimbili Orthopaedic Institute in Tanzania; over a period of seven years (1998- October 2004).Patients and Methods: The histopathological data of 104 brain tumours of all adults and children less than 16 years histopathologically evaluated was performed on H et E stained sections of paraffin embedded tissue. Special stains were performed whenever indicated.Results: The ages ranged from 2 to 90 years with an overall mean of 34.4 years while that of children below 16 years was 9.5 years and in adults was 41.9 years. The male to female ratio was 1.2:1. Meningiomas comprised the largest category (51.9) and Glial tumours ranked the second (21.4) of primary brain tumours and among all gliomas astrocytomas were the commonest comprising of 16.4 of all intracranial neoplasms. Out of 104 brain tumours; 83(79.8) were supratentorial and 21(20.2) were infratentorial in location while in adults 72(84.7) were in supratentorial region and 13(15.3) were in infratentorial region. In children below 16 years; 11(57.9) and 8(42.1) were in supratentorial and infratentorial in location respectively. The most common tumour overall in both supratentorial and infratentiorial regions were meningiomas (53) and all were in WHO grade I. When age was taken in consideration; meningiomas remained the commonest supratentorial tumours in adult (56.9) while in children below 16 years; cranioparyngioma was the commonest supratentorial neoplasm (45.4). In children less than 16 years medulloblastoma and pilocytic astrocytoma were the commonest neoplasms in the infratentorial region (37.5 of each).Conclusion: Meningioma was the commonest intracranial tumour overall in both supratentorial and infratentorial locations. However medulloblastoma and pilocytic astrocytoma were the most common tumours in the infratentorial region in children below 16 years of age