Pattern and causes of tympanic membraneperforation at a private hospital in Dar es Salaam, Tanzania

Introduction: There is variation in the size, shape and position of tympanic membrane perforations; the degree of conductive hearing loss depends on the size and position of perforation.Objective: To determine the pattern and causes of tympanic membrane perforation at a private health facility in TanzaniaMethod: A hospital-based cross-sectional study in the ENT clinic at Ekenywa Specialised Hospital was conducted from January to May 2019. Ears were examined thoroughly by an Otorhinolaryngologist. Data were analysed using SPSS Version 21Results: Two hundred and fifty patients were examined and 50 (20%) were found to have tympanic membrane perforations. Thirty (60%) were new patients while twenty (40%) were under review. Most 35(70%) were males. Central perforation predominated in 30 (60%), followed by subtotal in 10 (20%), total in 8 (16%) and marginal perforations in 2 (4%). The left ear was more affected in (60%) than the right ear. Bilateral perforations accounted for 5 (10%) of cases. Chronic suppurative otitis media was found in 35 (70%); other causes were acute suppurative otitis media in 13 (26%) and trauma in 2 (4%) patientsConclusions: The clinical picture depicted in this study is similar to that found elsewhere. There is a need for prompt diagnosis of tympanic membrane perforation. Proper education on ear care in patients with perforated tympanic membrane is of paramount importance

Clinical challenges in the co-management of diabetes mellitus and tuberculosis in Southern Africa

Over the past 20 years; tuberculosis incidence in southern Africa has increased at an alarming rate; fuelled primarily by the human immunodeficiency virus epidemic. The emerging prevalence of diabetes mellitus in the region represents a new threat to tuberculosis control. The intersecting double burden is a cause for concern since diabetes mellitus increases the risk of tuberculosis and results in poor treatment outcomes. This review article discusses the evidence of a causal association between these two conditions; and examines the numerous clinical challenges that relate to tuberculosis and diabetes mellitus co-management. Diabetes is associated with a more advanced age and body weight in patients with tuberculosis; although not with a specific clinical presentation of tuberculosis. Rifampicin adversely alters glycaemic control by lowering the concentrations of most oral antidiabetic drugs. Poor glycaemic control; possibly exacerbated by tuberculosis and anti-tuberculous therapy; is an important contributing factor to tuberculosis case fatality and relapse. Clinicians need to be aware of these clinical and pharmacological challenges when co-managing these complex diseases

Facteurs predisposant au traitement chirurgical dans la prise en charge de la pelviperitonite a Yaounde; Cameroun

Contexte et objectifs: Les facteurs d'echec de l'antibiotherapie en cas de pelviperitonite sont peu connus. L'objectif de cette etude etait de determiner les facteurs predisposant du traitement chirurgical dans la prise en charge de la pelviperitonite. Methodologie: Il s'agissait d'une etude cas-temoins avec collecte retrospective des donnees; concernant tous les cas de pelviperitonite traitees a l'Hopital Gyneco-Obstetrique et Pediatrique de Yaounde du 1er janvier 2007 au 31 decembre 2011. Resultats: Quatre-vingt-douze malades ont ete incluses; parmi lesquelles 75 patientes (75/92 ; 81;5) n'avaient recu que le traitement medical (groupe temoin) et dix-sept (17/92 ; 18;5) avaient necessite une prise en charge chirurgicale (groupe cas); soit une incidence de la chirurgie dans le traitement des pelviperitonites de 18;5. Les facteurs predisposant au traitement chirurgical etaient: un age 25 ans [P

Etude de la mortalite maternelle et des facteurs associes a l'hopital Jason Sendwe a Lubumbashi; Congo: de 2000 a 2010

L'hopital SENDWE est le deuxieme hopital de la Republique Democratique du Congo sur le plan capacite et est typique des pays pauvres. Cette etude a pour objectif de determiner le taux de mortalite maternelle ainsi que les facteurs associes a cette mortalite maternelle dans cette formation medicale.Methodes Cette etude; de type descriptif comparatif; s'etale sur 12 ans et couvre la periode qui va de janvier 2000 a decembre 2011. Pour analyser les donnees; nous avons utilise les mesures de tendance centrale et de dispersion; le calcul d'Odds ratio et d'intervalles de confiance. Les donnees ont ete encodees; traitees et analysees a l'aide des logiciels Excel 2007 et Epi info version 3.04.Resultats Le taux de mortalite maternelle fluctue en fonction des gestionnaires de l'hopital et de l'organisation de la maternite; nous avons les extremes de deces maternels de 314 pour 100.000 N.V. en 2002 et 870 pour 100.000 N.V. en 2011. Les etiologies les plus frequentes sont les hemorragies genitales avec 44;2. Les gestantes de 18 ans et moins courent pres de deux fois plus de risque que leurs homologues plus agees (OR=1;81 IC95 :1;38-2;38); celles de plus de 35 ans courent pres de quatre fois plus de risque que les moins de 35 ans (OR=3;93 IC 95 : 3;04-5;08). Les primipares presentent pres de deux fois plus de risque que les autres (OR=1;68 IC 95 : 1;32-2;14) et les grandes multipares ont douze fois plus de risque que les autres (OR=12;12 IC 95 : 9;64-15;24). Les gestantes et l'etat congolais ont une plus grande part de responsabilite dans la survenue des deces maternels.Conclusion Avec la disponibilisation d'un personnel qualifie; des trousses operatoires et des produits pharmaceutiques d'urgence ainsi que de poches de sang; la plupart des deces maternels sont evitables

Outcome of non-operative management of femoral shaft fractures in children

Background: Femoral shaft fractures are common injuries in childhood. There is paucity of information on their presentation and outcome of the available treatment methods in the African population. This study evaluated the outcome of non-operative methods of treatment of femoral shaft fractures in our centre. Patients and Methods: A retrospective review of the database of children aged 14 years and below with femoral shaft fractures treated non-operatively over a 10-year period. Results: A total of 134 patients with 138 fractures met the study criteria. This consisted of 71 boys (mean age = 6.1 years ± SD) and 63 girls (mean age = 6.5 years ± SD). Pedestrian vehicular accident was the most common cause of femoral shaft fractures in the study population. The midshaft was the most common site of fractures. There were associated injuries to other parts of the body (especially head injury) in 34.3% of the patients. The commonest mode of treatment was skin traction only (87.7%). The mean time to fracture union was 4.9 weeks ± SD (range = 3-15 weeks). The mean length of hospitalisation was 6.7 weeks ± SD (range = 5 days-11 weeks). There was a fairly strong positive correlation between the length of hospitalisation and the presence of associated injuries, especially head injury, upper limb fractures and bilaterality of the fractures. The mean total cost of treatment was #7685 (Naira) or $51.2 (range = $14.2-$190). At the last follow up, 97.8% of the fractures united without significant angulation or shortening. Conclusion: The outcome of non-operative treatment of femoral shaft fractures in our setting is comparable to the results of other workers. Methods of treatment that shorten the length of hospitalisation without unduly increasing cost should be encouraged

Factors Affecting Unmet Need for Family Planning in Southern Nations; Nationalities and Peoples Region; Ethiopia

BACKGROUND: High fertility and low contraceptive prevalence characterize Southern Nations; Nationalities and Peoples Region. In such populations; unmet needs for contraception have a tendency to be high; mainly due to the effect of socio-economic and demographic variables. However; there has not been any study examining the relationship between these variables and unmet need in the region. This study; therefore; identifies the key socio- demographic determinants of unmet need for family planning in the region. METHODS: The study used data from the 2000 and 2005 Ethiopian Demographic and Health Surveys. A total of 2;133 currently married women age 15-49 from the 2000 survey and 1;988 from the 2005 survey were included in the study. Unmet need for spacing; unmet need for limiting and total unmet need were used as dependent variables. Socio- demographic variables (respondent's age; age at marriage; number of living children; sex composition of living children; child mortality experience; place of residence; respondent's and partner's education; religion and work status) were treated as explanatory variables and their relative importance was examined on each of the dependent variables using multinomial and binary logistic regression models. RESULTS: Unmet need for contraception increased from 35.1in 2000 to 37.4in 2005. Unmet need for spacing remained constant at about 25; while unmet need for limiting increased by 20between 2000 and 2005. Age; age at marriage; number of living children; place of residence; respondent's education; knowledge of family planning; respondent's work status; being visited by a family planning worker and survey year emerged as significant factors affecting unmet need. On the other hand; number of living children; education; age and age at marriage were the only explanatory variables affecting unmet need for limiting. Number of living children; place of residence; age and age at marriage were also identified as factors affecting total unmet need for contraception. CONCLUSION: unmet need for spacing is more prevalent than unmet need for limiting. Women with unmet need for both spacing and limiting are more likely to be living in rural areas; have lower level of education; lower level of knowledge about family planning methods; have no work other than household chores; and have never been visited by a family planning worker. In order to address unmet need for family planning in the region; policy should set mechanisms to enforce the law on minimum age for marriage; improve child survival and increase educational access to females. In addition; the policy should promote awareness creation about family planning in rural areas

Prevalence and Predisposing Factors Regarding Intestinal Parasitic Infections among Rural Primary School Pupils at Minia Governorate; Egypt

About 400 million school-age children are infected with roundworm; whipworm and hookworm worldwide. This study aims to assess prevalence of parasitic infections among rural primary school pupils at Minia Governorate; Egypt; and to identify relevant predisposing factors of the school and pupils to intestinal parasitic infections. A total of 264 pupils out of 1053; aged 6-12 years; were randomly selected for parasitological investigation and the school was inspected on site for sanitary facilities and conditions of hygiene; as well as the conditions of hygiene of the pupils. The pupils were examined for ova; cysts and/or larvae of intestinal parasites using direct wet mount and formal-ether concentration techniques. Inspection of sanitary facilities and the conditions of hygiene of the school; as well pupil's conditions of hygiene; were carried out through observation checklists. Findings revealed the following intestinal parasites: Entamoeba coli (in 19.3of pupils); Ascaris lumbricoides (3.8); Hymenolepiasis nana (12.5); Enterobious vermicularis (5.7) and Giardia lamblia (12.5); with varying percentages between male and female pupils; and a highly statistical association between pupil sex and type of parasites (P0.001). Unapproved sanitary facilities and conditions of hygiene of the school and pupils were observed. Many intestinal parasitic infections among the primary school pupils were found. Unapproved and low inventory school sanitary facilities were observed; in addition to poor conditions of hygiene of pupils which may play a crucial role in these infections. The school facilities and sanitary conditions; especially the quality of water in the toilets; should be improved. Pupils and school personnel have a real need for health education about modes of transmission and preventive methods of intestinal parasitic infections

Factors Associated to Infant Mortality in Sub-Saharan Africa

Half of the 10 million children who die annually in the world are from Sub-Saharan Africa (SSA). The reasons are known; but lack of will and resources avoid the development of sustainable policies. Associated factors to the high infant mortality rate (IMR) in SSA have been investigated in this research. An ecological multi-group study was designed comparing rates within SSA. The dependent variable is the IMR and health services; economic and development indicators are the independent variables. Information and data sources were WHO; World Bank; UNICEF and UNDP (1997-2007). IMR mean value is 92.2 (per 1000 live births) and a relationship with several of the factors could be observed. In the bi-variate analysis direct relationship was observed with maternal mortality rate and an inverse relationship was observed with prenatal care coverage; births assisted by skilled health personnel; gross national income per capita; per capita government expenditure on health; social security expenditure; adult literacy rate; net primary school enrolment rate; population with access to safe drinking water (in urban and rural areas) and with population with access to basic sanitation in rural areas. In the multi-variate analysis IMR had an inverse relationship with children under 5 years with diarrhoea who receive oral re-hydration; with social security expenditure as percentage of general government expenditure on health and with per capita government expenditure on health. The situation in SSA would change if their inhabitants received education and information to demand more equitable polices and better investments from their governments

Stillbirths at the Jos University Teaching Hospital: Incidence; Risk; and Etiological Factors

Introduction: Death of a fetus in-utero or intrapartum is both devastating to the couple and of concern to the clinician. Identifying the etiological and risk factors of stillbirths will help in the prevention or reduction of its occurrence. Materials and Methods: This was a prospective observational study of all stillbirths over a 16-month period (from January 2006 to April 2007) at the maternity Unit of Jos University Teaching Hospital. Information on maternal socio-demographic details; history of antenatal complications of the index pregnancy; and maternal medical history were obtained by personal interview of all mothers who had a stillbirth. For each stillbirth; information was obtained on the type of stillbirth; estimated gestational age at delivery; sex of baby; and the mode of delivery. These characteristics were subjected to analysis. Etiological causes were assessed using the clinico-pathological approach advocated by Baird-Pattinson. Results: There were a total of 3;904 deliveries with 158 stillbirths during the study period; giving a stillbirth rate of 40.5 per 1;000 total births. There were 84 (53.2) macerated and 74 (46.8) fresh stillbirths. Of the 3;904 total deliveries; there were 2;022 (51.8) males and 1;882 (48.2) females. There were 84 male and 74 female stillbirths; giving stillbirth rates of 41.5 per 1;000 and 39.3 per 1;000 total deliveries for male and female deliveries; respectively; which was not statistically significant (X2 = 4.6865; P 0.3564). The major causes were abruptio placentae (17.7); hypertensive disorders of pregnancy (12.7) and maternal HIV infection 10.7of stillbirths. Other causes were cord accidents (7.0); placenta praevia (3.8); and anemia in pregnancy (3.8). Forty-six (29.1) of the stillbirths were unexplained. The main risk factors identified were lack of antenatal care; poor antenatal clinic attendance; home delivery; and late presentation of complicated labor to the facility. Conclusion: The stillbirth rate in our centre is high; major causes being abruptio placenta and maternal medical conditions. Maternal HIV infection has emerged as a major contributor to stillbirths in this study

Deferral patterns of voluntary blood donors at the National Blood Transfusion Service, North East zonal centre, Maiduguri

Appropriate donor selection in an important step in ensuring safe supply of blood and blood products. In this study deferral patterns of voluntary non-renumerated blood donors were determined at the North-Eastern Zonal Centre of the National Blood Transfusion service. The study was conducted between April 2007 and April 2009; and it involved the administration of a structured questionnaire. A total of 4032 voluntary blood donors were recruited; seven hundred and thirteen (17.7) were temporarily deferred. The commonest reasons for deferral were low haemoglobin; self-deferral; high blood pressure; low weight and high risk behaviour. Other reasons are use of certain medications; low blood pressure and failed venopuncture. Gender analysis showed that more females were deferred for low haemoglobin and more males were self-deferred. Following donor recall; 146 of the 173 donors temporarily deferred came back to donate. These consisted of 113 deferral due to low haemoglobin; 30 self-deferred and 3 induced in risky behaviour. Effective education or counseling; the old tradition of giving haematinics and good dietary advice to those with low haemaglobin values; improved the safety and availability of blood and blood products. Donors who are self-deferred and those involved in high risk bahviour should never be persuaded to donate blood. There is also the need for a review of operational guidelines with regards the uniform acceptable cut-off point of 12.5g/dl haemoglobin value for males and females

Testing the effectiveness of existing psycho-educational material (The Alliance Programme) for patients suffering from schizophrenia in the South African context

The objective of this study was to test the effectiveness of the existing psycho-educational material (The Alliance Programme) for patients suffering from schizophrenia in the South African context. Method: A qualitative research approach was used. Fifteen Setswana speaking participants, with a diagnosis of schizophrenia were exposed to the programme. Semi-structured and screening interviews were used to collect demographic and clinical data. The participants were divided into two groups and were exposed to either the Alliance Programme or on adapted version of the programme. Participatory communication instruments including focus groups; were used to assess comprehension and knowledge retention of the material over time. Results: Participants who were exposed to the original Alliance Programme experienced the contents of the programme to be technical, difficult to read or recall. They were unable to relate their previous symptoms to the psycho-education given. Participants who were exposed to the adapted version faired much better; gained more insight and were able to relate better to their illnesses. Participants preferred booklets with examples and illustrations; video clips and films over formal lectures. Conclusion: Psycho-education material given to people suffering from schizophrenia and their caregivers has to be adapted to their context to be effective

Urinary Retention in Women: Causes and Management

Urinary retention in women is uncommon and there are numerous etiological factors. Most reported studies are from Europe and North America; with few studies from developing countries. The aim of this study was to review the etiology of urinary retention in women referred to our institution; a public sector hospital serving a largely indigent population. Patients and Methods We reviewed the clinical records of all patients admitted with urinary retention to the Urology wards in our hospital during the period September 1998 to June 2007. In total there were 589 patients with urinary retention; 558 (94.7) men and 31 (5.3) women. Results The average age of the 31 women was 51.9 years (range 20 to 88 years). The underlying pathology was cervical carcinoma (4 patients); urethral carcinoma (4); transitional cell carcinoma of the bladder (3); eosinophilic cystitis (3); hematuria due to miscellaneous causes (3); antiincontinence surgery (2); cerebral palsy (2); multiple sclerosis (1 patient); diabetes mellitus (1); hypotonic detrusor (1); bladder stone (1); vaginal leiomyoma (1); cyclophosphamide cystitis (1); constipation (1); postpartum (1); blocked indwelling catheter and idiopathic (1). Renal dysfunction was present in 17 (55) of the patients. Conclusion The most common causes of urinary retention in women in this study were malignancy in 11 patients (36) and neuropathic bladder dysfunction in 5 (16). Eosinophilic cystitis; normally a rare condition; was diagnosed in 3 women (10). The high incidence of malignancy in this study differs from other reported series; in which neuropathic bladder dysfunction was the most common cause of urinary retention in women

Abortion and unwanted pregnancy in Adigrat Zonal Hospital, Tigray, North Ethiopia

Unwanted pregnancy is associated with increased risk of maternal mortality and morbidity. This study was done to determine the causes of unwanted pregnancy and its impact on maternal health. A cross sectional study (February 1, 2002-January 31, 2004) was conducted on 907 patients with diagnosis of abortion and admitted to the gynecological ward of Adigrat zonal hospital, Tigray Region, Ethiopia. This accounts to 12.6% of all hospital and 60.6% of gynecolo-gical admissions. The majority of these women (69.8%) had unwanted pregnancy. Modern contraception methods were not in use in 76.2% of unwanted and 57.7% of wanted pregnancies (P = 0.008). Interference was reported in 81.4% of unwanted pregnancy. High incidence of complication was reported in patients with unwanted pregnancy. In this study it is found that unwanted pregnancy is associated with increased risk of maternal morbidity and mortality. The development and prompt implementation of a strategy that enables women to safely manage unwanted pregnancy is recommended (Afr. J. Reprod. Health 2010; 14[3]: 183-188)

Factors that influence male involvement in sexual and reproductive health in Western Kenya: a qualitative study

This study explored factors that influence male involvement in reproductive health in western Kenya. Qualitative study design was used. From December 2008 to February 2009, data were collected via in-depth interviews and focus group discussions (FGDs) at three provinces of western Kenya. Twelve in-depth interviews and eight FGDs were conducted. Five participants in in-depth interviews were female, seven were male. Four of the FGDs had all-male participants, four all-female. The factors that influence male involvement in reproductive health emerged in two themes, namely gender norms and the traditional approaches used to implement reproductive health and family planning programs. Any strategy taken to involve men in reproductive health must therefore consider addressing these two factors. A review of the traditional approaches of implementing reproductive health is necessary to make them more male-friendly (Afr J Reprod Health 2010; 14[4]: 33-43)

Factors associated with induced abortion among women in Hohoe, Ghana

In Hohoe, Ghana, induced abortion is the second highest cause of hospital admissions. We aimed to describe factors influencing induced abortion among 408 randomly selected women aged 15-49 years. 21% of the women had had an abortion; of those, 36% said they did not want to disrupt their education or employment; 66% of the abortions were performed by doctors. Bivariate logistic regression showed that compared with women with secondary education, women with basic education (OR = 0.31, 95% CI: 0.18- 0.54) and uneducated women (OR = 0.24, 95% CI: 0.07-0.70) were significantly less likely to have had an abortion. Women who were married (OR = 1.83, 95% CI: 1.10-3.04), peri-urban residents (OR = 1.88, 95% CI: 0.95-3.94), and women with formal employment (OR = 2.22, 95% CI: 0.86-5.45) were more likely to have had an abortion. Stakeholders should improve access to effective contraception to lower the chance of needing an abortion and target education programmes at those with unmet need for contraception (Afr J Reprod Health 2010; 14[4]: 115-121)

Factors Affecting Fertility Decisions of Married Men and Women Living with HIV in South Wollo Zone; Northeast Ethiopia

Background: In a setting with high HIV prevalence and high fertility rates; addressing fertility issues of People Living with HIV/AIDS (PLWHA) is crucial. However; understanding of the factors associated with fertility decisions of PLWHA in Ethiopia is remarkably low. Objective: The study was conducted to assess factors associated with fertility decisions of PLWHA in South Wollo Zone; Northeast Ethiopia. Methods: The study was conducted from February 1 to March 30; 2008 using cross-sectional design. Quantitative data were collected from a sample of 458 men and 458 women using structured questionnaire. Qualitative data were also collected from six health care providers. Logistic regression was used to analyze the quantitative data. Results: The study showed that 18.3of currently married PLWHA have decided to have a child. The factors found to be independently associated with current decision to have a child were higher family income [OR (95CI) = 2.29 (1.23; 4.26)]; partner's decision to have a child [OR (95CI) = 36.4 (17.0; 77.5)]; having knowledge on PMTCT [OR (95CI) = 2.26 (1.44; 3.54)] and having partner with negative HIV test result [OR (95CI) = 0.408 (0.219; 0.759)]. During in-depth interview the health care providers indicated the fertility related counseling service to be low. Conclusion: In spite of the fact that significant proportion of married PLWHA had decided to have a child; the fertility related counseling service is low. Improving fertility related counseling services to enable clients make informed fertility decision is mandatory. The factors identified to be associated with fertility decision could be of major importance and as such should be investigated further. [Ethiop. J. Health Dev.2010;24(3):214-220]

Factors Affecting Mothers' Choice Ofbreastfeeding Vs. Formula Feeding in the Lower Umfolozi District War Memorial Hospital; Kwazulu-Natal

The aim of this study was to determine which factors influence choice of breast- versus the formulafeeding of infants. This may help to understand where the focus should lie in the promotion of breastfeeding. A structured questionnaire was completed by a 100 women and focus-group discussions were held with 22 women who delivered babies at the Lower Umfolozi District War Memorial Hospital (LUDWM) in Kwazulu-Natal. Most of the mothers (72) chose breastfeeding and 58intended to breastfeed for only 6 months. One-third (33) were influenced by health care professionals and 44of the mothers made their own decisions in their feeding method. Only one participant stated that she chose formula-feeding due to her HIV-positive status; but in the focusgroup discussions; the fear of transmission of HIV through breast-milk was stated as an important reason why mothers chose replacement-feeding. Significantly more HIV-infected than uninfected mothers chose replacement-feeding as the feeding method and mothers who chose breastfeeding were significantly older than mothers who selected replacement-feeding. They made their infantfeeding decision earlier than those who chose replacement-feeding. Findings showed that the majority of women in this study did not have access to running water and flush toilets in their houses. In these areas where replacement-feeding will not be acceptable; feasible; affordable; sustainable and safe; due to lack of sanitation and poor socio-economic status; health professionals should promote exclusive breastfeeding for 6 months; even though there is a high prevalence of HIV infection