Ocular manifestations in paediatric HIV/AIDS patients in Mulago Hospital, Uganda.

BACKGROUND: In Uganda the prevalence of HIV averages 12% as was reported to the STD/AIDS control surveillance unit. In Uganda there are approximately 30,000 HIV infected infants per year. The burden of HIV disease is high in Uganda and patients present with ocular complications. However, there is paucity of information and knowledge concerning ocular manifestations in the paediatric HIV/AIDS population and how they may differ from those of adults. OBJECTIVES: To describe the ocular manifestations of HIV/AIDS infection in an African paediatric population. Generally the study will record the external ocular manifestations seen but specifically to document the intra-ocular lesions, in particular the retinal changes associated with paediatric HIV/AIDS. DESIGN: A cross-sectional hospital based study. SETTING: The study was conducted at the Paediatric Infectious Disease Clinic at Upper Mulago Hospital, in Kampala, Uganda. PATIENTS: Patients are those with positive HIV sero status, with or without symptoms and signs of AIDS. Parents/caretakers of the children were interviewed to obtain the socio-demographic data of the patients and a general physical as well as an ophthalmic examination were conducted to document any ocular problems. RESULTS: A total of 158 HIV -infected children were examined. The overall rate of ophthalmic involvement was 35%. The most common finding was a non-purulent conjuctivitis, observed in 12% of the patients, followed by perivasculitis of the peripheral retinal vessels, in 12% of patients and molluscum contagiosum.

A survey of the prevalence of refractive errors among children in lower primary schools in Kampala district.

BACKGROUND: Refractive errors are a known cause of visual impairment and may cause blindness worldwide. In children, refractive errors may prevent those afflicted from progressing with their studies. In Uganda, like in many developing countries, there is no established vision-screening programme for children on commencement of school, such that those with early onset of such errors will have many years of poor vision. Over all, there is limited information on refractive errors among children in Africa. OBJECTIVE: To determine the prevalence of refractive errors among school children attending lower primary in Kampala district; the frequency of the various types of refractive errors, and their relationship to sexuality and ethnicity. DESIGN: A cross-sectional descriptive study. SETTING: Kampala district, Uganda PATIENTS: A total of 623 children aged between 6 and 9 years had a visual acuity testing done at school using the same protocol; of these 301 (48.3%) were boys and 322 (51.7%) girls. RESULTS: Seventy-three children had a significant refractive error of +/-0.50 or worse in one or both eyes, giving a prevalence of 11.6% and the commonest single refractive error was astigmatism, which accounted for 52% of all errors. This was followed by hypermetropia, and myopia was the least common. CONCLUSION: Significant refractive errors occur among primary school children aged 6 to 9 years at a prevalence of approximately 12%. Therefore, there is a need to have regular and simple vision testing in primary school children at least at the commencement of school so as to defect those who may suffer from these disabilities.

Sugar as a potential vehicle for vitamin A fortification: experience from Kamuli district in Uganda.

BACKGROUND: Despite measures put in place by the Uganda Government ten years ago to combat Vitamin A deficiency, the number of children suffering from this deficiency remains high. OBJECTIVE: To determine whether sugar may be used as a vehicle for vitamin A fortification. DESIGN: Cross-sectional descriptive study. SETTING: Kamuli district in Uganda. PATIENTS: One thousand one hundred and four children, and one thousand one hundred and two mothers or care-takers participated in the study. Sugar consumption patterns for the two age groups were determined. The methods of sugar storage in households were also determined. The children were aged 12 to 36 months, and mothers/caretakers 16 to 45 years. RESULTS: The overall proportion of households where sugar was consumed in the last seven days was 89.2% for children, and 88.3% for mothers/caretakers. Sugar was stored in covered tins in 67% of the households, and in covered baskets in 28% of households. CONCLUSION: Sugar is a potential vehicle for fortification with vitamin A for Kamuli district. Storage of sugar in covered tins and baskets means that the stability of the vitamin A in the fortified sugar might not be affected by exposure to light.

A Survey of the prevalence of refractive errors among children in lower primary schools in Kampala district

Refractive errors are a known cause of visual impairment and may cause blindness worldwide. In children; refractive errors may prevent those afflicted from progressing with their studies. In Uganda; like in many developing countries; there is no established vision-screening programme for children on commencement of school; such that those with early onset of such errors will have many years of poor vision. Over all; there is limited information on refractive errors among children in Africa. Objective: To determine the prevalence of refractive errors among school children attending lower primary in Kampala district; the frequency ofthe various types of refractive errors; and their relationship to sexuality and ethnicity. Design: A cross-sectional descriptive study. Setting: Kampala District; Uganda. Patients: A total of 623 children aged between 6 and 9 years had a visual acuity testing done at school using the same protocol; of these 301 (48.3) were boys and 322 (51.7) girls. Results: Seventy-three children had a significant refractive error of +-0.50 or worse in one or both eyes; giving a prevalence of 11.6and the commonest single refractive error was astigmatism which accounted for 52of all errors. This was followed by hypermetropia; and myopia was the least common. Conclusion: Significant refractive errors occur among primary school children aged 6 to 9 years at a prevalence of approaximately 12. Therefore; there is need to have regular and simple vision testing in primary school children at least at the commencement of school so as to defect those who may suffer from these disabilities

Sexual Misconduct in the Practice of Medicine

There is a long-standing consensus within the medical profession that sexual contact or sexual relations between doctors and patients are unethical. Current ethical thought uniformly condemns sexual relations between patients and doctors. The ban on doctor-patient sexual contact is based on the recognition that such contact jeopardises patients' medical care. A number of studies in the Western World have tried to establish the incidence of doctor-patient sexual contact. Much of the research done on the prevalence of doctor-patient sexual contact is based on studies that survey doctors about their own behaviour. The general stigma attached to sexual contact with patients and the professional repercurssions that many researchers to beleive that the occurrence of patient-doctor sexual contact is under-reported. One the local scene no study has ever been conducted on the subject; however; an ecdotal tales reveal that the problem exists. Available studies from eleswhere show that between 5and 10of doctors engage in sexual contact with patients

Partnership Replaces Paternalism in Medical Practice

"The belief and practice that doctors know best what is good and suited for their patients is deeply rooted among practicing doctors in Uganda. It is benign; and may be well intentioned; but it has had the effect of creating and maintaining an unhealthy dependency which is now out of step with currents elsewhere or even with out currents in Uganda. Assumptions that doctor; nurse or midwife knows best; making all decisions on behalf of patients without involving them; and feeling threatened or offended when patients ask questions or make suggestions - these signs of patermilism should have no place in modern health care. In this article I consider the scope for creating meaningful partnership between doctors and patients. ""Paternalism"" has no further part to play in health care delivery now; and most countries have embraced or are embracing ""partnership""; which is known to greatly increase patients satisfaction and compliance; and also increases the rate of recovery from their illnesses."