Telemedicine and biomedical care in Africa: Prospects and challenges.

The use of information and communication technology for health care delivery, particularly in poor settings where access to medical services is inadequate, holds promise in expanding health care access. In rural or impoverished environment, where disease is prevalent, doctors are scarce, and health care infrastructure is inadequate, telemedicine holds a good prospect in improving the health conditions of the people. However, telemedical practice in Africa cannot be without challenges because some aspects are often difficult to implement in underdeveloped settings where ignorance and poverty are rife. Apart from nonavailability of facilities and poor communication, most Africans have different understanding of ailments, which often affect the health system. Considering the increasing disease burden in Africa and the need for tremendous progress in achieving the health component of the millennium development goals, telemedicine should be of concern to health policy makers. This paper critically examines the prospects and challenges of telemedical practice in Africa through a systematic review of 31 relevant publications which, in addition to the authors' knowledge and experience in biomedical care in Africa, supported the information as presented.

Tuberculosis treatment outcome and its determinants in a tertiary care setting in south-eastern Nigeria.

AIMS AND OBJECTIVES: To evaluate tuberculosis treatment outcomes in a Nigerian tertiary-care setting and to identify factors associated with unsuccessful treatment outcome. PATIENTS AND METHODS: Retrospective audit of tuberculosis patients registered for treatment from January 2006 to December 2010 at Federal Medical Centre Abakaliki, Nigeria. Six treatment outcome criteria were assessed based on guidelines set by the World Health Organisation (WHO). Analysis was conducted using SPSS. Multivariable logistic regression analysis were used to identify independent predictors for unsuccessful treatment outcome and statistical significance was taken as P <0.05. RESULTS: A total of 671 patients (55% male, 45% female) with a mean age of 36.4 years were registered for treatment; 147 (22%) were smear-positive, 270 (40%) smear-negative and 254 (38%) had extra-pulmonary tuberculosis. Also, 189 (28.2%) of them were HIV positive and; 341 (51%) lived in a rural area. Overall, 387 patients (57.7%) had a successful treatment outcome and 284 (42.3%) had an unsuccessful treatment outcome. Of the patients with unsuccessful treatment outcome, 192 (67.6%) had defaulted, 55 (19.4%) had died, 3 (1%) had treatment failure and 34 (12%) were transferred-out. Nil significant change in trend of treatment success over the study period [P = 0.75 for trend]. In multivariable analysis, unsuccessful treatment was associated with older age (aOR = 2.3), rural residence (aOR = 2.1), smear negative PTB (aOR=1.6), being on retreatment (aOR 3.8), and HIV seropositivity (aOR=1.7). CONCLUSION: Treatment success rate was poor; targeted measures should be considered to improve treatment success among identified high-risk groups.

Sexual practices of HIV-positive individuals: The need for continued intervention in developing countries.

SUMMARY: This questionnaire survey explored the sexual practices and problems of 184 HIV-positive individuals in two tertiary health institutions in south-east Nigeria over a 6 month period. It showed that many (56.5%) HIV-positive individuals continue to be sexually active and almost half (47.6%) of them do not know the sero-status of their partners. About 60% (n = 62) of sexually active respondents use condoms with 27.9% using them consistently, 31.7% inconsistently, while 40.4% engage in unprotected intercourse. Condom use was more among the male than the female respondents (p < 0.05) and the married or divorced couples than the unmarried (p > 0.05). Diagnosis of HIV resulted in increased abstinence (37.3%) due to loss of interest in sex and/or loss of partner. Almost half (49%) of the respondents had sexually related problems in the form of lack of sexual desire (82.4%), erectile dysfunction (25.5%) and ejaculatory problems (5.9%). These problems are more in the first 6 months of HIV diagnosis and are probably psychological. There is a need for continued discussion on safe sexual practices with HIV-positive individuals during the course of routine clinical consultation.

The Impact of Intervention on Sexual Practices of HIV Positive Individuals in Southeast Nigeria.

Objective. To describe the impact of repeating behavioral educational intervention on sexual practices of HIV positive individuals. Method. A prospective cohort study of HIV positive individual was conducted in southeast Nigeria from June 2007 to May 2008. Information on sexual practices was collected at initial visit; education was given and its impact was evaluated afterwards. Results. Knowledge about risk of unprotected intercourse increased by 41%, condom use by 27% (P < .001) and consistent condom use by 55% (P < .001). The significant predictors of consistent condom use include male gender, multiple sexual partner, as well as good knowledge of HIV transmission, higher educational status and being married. Non use of condom at postintervention survey were characterized by female gender (n = 4), monogamous relationship (n = 10), little or no education (n = 10), and unmarried (n = 7) respondents. Conclusion. Repeated behavioral education intervention improves consistent condom use among HIV positive individuals and will help curb the spread of HIV/AIDS.

Proptotic panophthalmitis and bilateral supraclavicular lymph node metastases from prostatic carcinoma. A case report and literature review

"The authors describe a 68-year old Nigerian male farmer who had right-sided panophthalmitis in association with proptotic orbital metastasis and bilateral suprachlavicular lymphadenopathy from disseminated prostatic carcinoma. This combination; in one patient; of such unusual features of disseminated prostatic carcinoma as orbital metastasis with panophthalmitis and bilateral ""sign of Troisier""; albeit in the absence of urinary symptoms; to our knowledge; has not been reported previously. The patient showed initial response to diethylstilbestrol administration and had the panophthalmitic right eye eviscerated after antibiotic therapy."