The Clinical Picture of Keratoconjuctivitis in Uganda

"A total of 287 patients suffering from vernal-keratoconjunctivities were followed up for periods ranging from nine months to five years. Patients were aged between six months to 43 years; and were recruited from Lower Mulago Clinic; and one private clinic in Kampala city. the common clinical presentation of vernalkeratoconjuctivitis (VKC) in Uganda has been documented in this study; and its significantly different from that seen in temperate climates which is what is written in eye textbooks that are used even in Uganda. The most important differences between temperate and Uganda VKC is first the much younger age of Ugandan patients; and secondly the almost total lack of ""cobblestone"" formation in the palpebral subtyped of VKC. Instead; there is almost total concealment of the palpebral conjunctival vessels. This sign is not even mentioned among patients seen in the temperate climates."

HIV UVEITIS: Two case reports

I present two patients with severe bilateral panuveitis; which did not respond to standard treatment for uveitis. Both patients were suffering from clinical AIDS; and none of them was receiving antiretrovirals for HIV: none could afford them; but were both receiving ordinary antibiotics for opportunistic infection. Both received corticosteriod eye drops for at least a week before being referred to me. I put each of them on intensive anti-uveitis topical therapy; but after ten days; there was no significant improvement. I then added oral vitamin A to their treatment. Within three days; both patients showed significant improvement

Angiod streaks in Uganda

A study on the ophthalmoscopic appearance of angiod streaks and their suspected association with local and systemic diseases among Ugandan Africans is presented. In all 40 eyes of 20 patients were studied and the results indicate an interesting association with certain diseases

The Impact of vitamin A deficiency on childhood morbidity and mortality

Vitamin A deficiency is one of the greatest public health problems in tropical and subtropical regions. In Uganda; the intake of vitanin A is based on vegetables. Indeed adequate vitamin A helps the body to maintain resistance to several diseases. So to reduce morbidity and mortality of children vitamin A supplements should be given to them

Adverse effects of quinine

Plasmodium falciparum malarial parasites are increasingly becoming resistant to most available therapeutic drugs; except quinine. Unfortunately this drug may produce some very adverse and permanent side effects. Very often there is individual hypersensitivity to quinine and sudden blindness in both eyes may occur. Children should be given syrup quinine instead of tablets or injections

Occupational Exposure to HIV Infection and its Ethics and Legal Issues

A. Exposure: Nosocomial HIV transmission is a particular worry for many doctors; medical students and nurses who work in low income countries such as Uganda. Firstly; the prevalence of HIV infection among the patients we care for in poor countries is high. Secondary; many health workers; such as medical students; interns and new nurses are often relatively experienced - their technical skills may not be well practiced and hence they are likely to be exposed to blood and other body fluids. Thirdly; many developing countries with a high prevalence of HIV lack the resources to implement universal precautions adequately. Finally; poor or inadequate equipment and facilities are more often encountered in developing countries; especially in Africa south of Sahara and can increase the risks of exposure to HIV infection. These occupational risks are clearly additional to the risks from unprotected sex; for which separate preventive measures apply. although the risk of infection per exposure may be low; the comulative risk with repeat incidents icnreases and sero-conversion does occur (1). Devastating personal and professional consequences may then ensue. Example of the Problem: A few years ago a team of doctors reviewed nosocomial HIV exposure at a rural district hospital in Southern Africa. In this hospital 25of patients attending for antenatal care were positive for HIV. Most medical staff are relatively hunior doctors; including those from Europe who spend a year or more doing general medical duties; including surgical and obstetrics; that regularly expose them to blood and other body fluids. In a recent period of 10 months; five out of eight doctors experienced a needlestick injury while treating a patient infected with HIV. This is eqivalent to 0.75 exposures per doctor per year. All incidents were considered severe as each broke the doctor's skin; involved a bloody needle and drew the health worker's own blood. Three doctors were exposed while using faulty or incorrect eqquipment for an operation or resuscitation. Extent of the Problem: This frequency of exposure is by no means unusual. In parts of West Africa; a group of indigenous doctors reported an annual average of four needlestick injuries. A group of Dutch doctors working in Africa reported an annual average of five needlestick injuries (2). In one Zambian district hospital it was estimated that each general surgeon experience three parenteral exposures each year; and that the risk of acquiring HIV infection through work was 1.5over five years(3). These are minimum estimates of risk because needlestick injuries and other exposures to body fluids are under reported and their frequency is higher among less experienced practitioners. How many African Health professionals work in settings where the prevalence of HIV is high; or for how long; is unknown. However; by way of example; Uganda has in active medical services tens of thousands of nurses and midwives; a thousand doctors; eight thousand clinical officers and tens of thousands of other health professionals. They are all working in settings where the prevalence of HIV is high. The estimated annual neddlestick injury to each surgeon is ten; and the risk of acquiring HIV infection through work may be as high as 5-10over five years. B. Ethical Issues: Under current guidelines health workers who think that they may be HIV positive are advised to informe their employers. If there is considered to be no risk to patients the person concerned can continue working. However; most workers who are HIV positive in developing countries do not inform their employers for fear of losing their jobs without compensation even if they contracted HIV in the line of their duty. Doctors however; especially surgeons; ar eunder ethical obligation to protect their patients. doctors must put the safety of their patients foremost. When confronted with the information which suggests a doctor has been at risk of HIV infection; he/she must inform someone of authority; such as Medical Council; Senior Colleague or employer. Failure to disclose the information is a betrayal of patients trust; and undermines the trust placed by the public in the Medical profession. In 1994; a British doctor; an ENT Surgeon at Gartnavel General Hospital in Glasgow; by the name George Browning; discovered that he was HIV positive patient. he made a public announcement soon afterwards. The GMC deliberated over his case; and decided to allow him return to the operating theatre. However; GMC stated that patients to be operated on by Professor Browning will be asked to sign a consent form stating that they know that he is HIV positive; and anyone can ask for another surgeon if he or she wishes. C. Legal Issues: (i) Taking Responsibility: Are governments and other organisations that recruit and employ health workers under legal obligations to provide cover for occupational hazards such as needlestick injuries? What formal and legal responsibilities do medical schools have for clinical students? How may a student prove that he did not acquire the infection through sexual intercourse? In britain; for example; anyone exposed to HIV in a work setting would expect to have immediate access to prophylaxis. (ii) Cost of protection: If post-exposure prophylaxis is to be provided; who pays for the drugs? A dose of 1000mgm Zidovudine per day for four weeks; a regimen shown to be effective; costs $500. Now both Britain and the US recommend four weeks of triple therapy (Zedovuline 200mgm tds; lamivudine 140mgm BD; and indinavir 800mgm tds); at a cost of $680

The Kamuli district Vitamin A fortification rapid assessment tool Survey for Sugar: an application of the fortification rapid assessment guidelines and Tool (FRAT) in Uganda

In this study; which describes the first documented used of the fortification Rapid Assessment guidelines and Tool (FRAT) in Uganda; a population based; cross-sectional survey to assess the suitability of sugar as a vehicle for vitamin A fortification for Kamuli District