Perspectives on suicide in Africa.

Suicide is a serious worldwide health problem, particularly among youths. It is defined as the intentional act of killing oneself. Analytically, the suicidal act entails: the wish to kill, the wish to be killed and the wish to die. People who die by suicide know what they are doing and are aware of the consequences of their actions. A completed suicidal act is a complex phenomenon associated with psychological, biological and social factors. It follows severe exhaustion under a continuing assault of stressors when the suicidal individual is no longer able to cope with and to restore homeostasis. In order to categorise a case as a suicide, legal authorities demand unequivocal evidence of intent.

Profile of suicide in Dar es Salaam.

OBJECTIVE: To investigate individual socio-demographic characteristics of suicides, the reasons, methods and means employed to commit suicide. DESIGN: A descriptive prospective study of suicides. A structured questionnaire was employed to enquire the details of the itemised objectives. SETTING: Muhimbili National Hospital--in urban Dar es Salaam. SUBJECTS: Fifty three males and 47 females consecutive suicides aged 15 to 59 years RESULTS: The mean age for suicides was found to be 28.2 years. Males were more than females and were ten years older. Sixty two percent of the subjects were single, 30% married. Seventy two percent had primary school education, 19% secondary education. Main reasons for committing suicide were established in 61 cases of which 57.3% (35/61) were due to severe marital and family conflicts, overwhelming disappointments in love affairs and unwanted pregnancies. Eleven subjects with chronic somatic illnesses killed themselves due to unbearable physical pain and overwhelming economic deprivations motivated ten subjects to take their lives. Sixty nine subjects poisoned themselves predominantly using anti-malarials and pesticides while 27 hanged themselves. A third of the suicides consumed alcohol frequently and a quarter of the suicides were HIV positive, a rate twice the national prevalence for sexually active adults. CONCLUSION: Comparatively, women became vulnerable to suicide at a younger age. Dysfunctional social networks played a predominant role among suicides. Family and marital conflicts need closer social attention and timely counseling. Patients with chronic medical conditions and frequent alcohol use need effective exploration concerning suicidal ideation to avert self-annihilation. A policy to control prescriptions of toxic drugs including pesticides is overdue.

Causes of death among mental patients at Muhimbili Medical Centre, Dar es Salaam.

The clinical notes of the 146 patients who died during a five year period in the psychiatric ward at the Muhimbili Hospital were studied and analysed to identify gender, age, duration of hospital stay, psychiatric diagnosis and primary cause of mortality. There were 99 (67.8%) males and 47 (32.2%) females. The mean age, which could be established in only 105 (71.9%) instances, was 31.1 years. The average hospital stay was 21.6 days. The main psychiatric morbidity consisted of functional psychoses (52.7%), organic psychoses (37.6%), epilepsy (6.2%) and puerperal psychosis (2.1%). Mortality was primarily attributed to infectious diseases in at least half of the cases. Pyrexia of unknown origin was associated with death in 11.0% of cases and the cause of death could not be established in 17.1%. Clinical notes need to be improved and greater efforts made to diagnose and treat concomitant physical illnesses effectively.

Myelography with Omnipaque (Iohexol) using basic radiographic facilities: the main adverse effects.

OBJECTIVE: Documentation of main adverse effects, their magnitudes and relationship to contrast concentrations in patients subjected to myelography under basic radiographic facilities. Use of the acquired data for better patient management in the future. DESIGN: In a prospective double blind study consecutive admitted neurological patients of age range seven to 77 years were subjected to myelography with different concentrations of Omnipaque (300* cervical, 240* thoracic and 180* lumbar) under limited radiographic facilities by radiologists (cases). Thirty admitted patients of about the same age range with justified medical problems were subjected to diagnostic lumbar puncture by different physicians (controls). The main adverse effects were assessed in both groups (subjects) by a neuro-physician unaware of subject status. Patients primarily admitted to the hospital with headache, dizziness, nausea, vomiting and convulsions and subjected to lumbar puncture were excluded from the study. SETTING: Cases and controls were derived from patients referred from variable regional hospitals scattered throughout the country. SUBJECTS: 110 consecutive neurological cases referred to the Radiology Department for myelography between December 1989 and January 1991. Thirty consecutive qualifying diagnostic lumbar puncture patients managed at the same period. MAIN OUTCOME MEASURES: Development of symptoms including headache, dizziness, nausea, vomiting and convulsions and evaluation of their magnitude subjectively quantitated from mild (+) and moderate (+2) (tolerable) to severe (+3), (intolerable) among the cases and controls. RESULTS: Overall, symptoms in all magnitudes (mild to severe) occurred in 63.6pc of cases compared to 36.7pc of controls (p < 0.05). Concentrations of 300 and 180 were more associated with the effects (p = 0.017 and 0.016 respectively) while the 240 concentration was relatively safe causing no more adverse effects than a diagnostic lumbar puncture (p = 0.137). In severe magnitudes (intolerable) the same effects occurred in 20.9pc of cases compared to 6.7pc of controls (p < 0.05); differences in contrast concentrations did not significantly feature (p = 0.59: Omnipaque 300; p = 0.063: Omnipaque 240 and p = 0.061; Omnipaque 180). CONCLUSION: Even with limited radiographic facilities, myelography with Omnipaque 240 is relatively safe; being associated with no more adverse effects than a medical diagnostic lumbar puncture; thus the contrast concentration of choice for myelography under sub-optical radiographic set up. With the 180 and 300 concentrations, the procedure is associated with tolerable adverse effects not significantly differing from those arising from the same procedure performed under ideal radiodiagnostic establishments.

Nature of referrals to the psychiatric unit at Muhimbili Medical Centre, Dar es Salaam.

During a 24-month period, 205 consecutive new referrals to Muhimbili psychiatric unit were studied. Their socio-demographic characteristics, sources of referral, types of treatment received before referral and the nature of their clinical problems were identified. Their neuropsychiatric disorders were classified according to ICD-10. The ratio of males to females was found to be 1.6:1. The average age was 29.3 years. 23.4% of adult patients were unemployed, two fifths of all patients were single and 70% of all subjects had less than eight years of formal education. Whereas 42.9% of all referrals were from other departments of Muhimbili hospital, the remaining were largely from parastatal dispensaries, district and regional hospitals within Dar es Salaam city. At least a fifth of all patients had consulted traditional healers prior to referral and antimalarials had been given inappropriately to 34 patients with mental problems. Mental disorders consisted of functional psychosis, 36.6% of which three quarters were schizophrenia, neurosis (19.5%), seizures (16.6%), substance abuse (8.8%), organic mental disorders (5.3%), headache (4.9%), sexual dysfunction (2.9%). The rest had conduct disorders and pseudocyesis. Seventeen percent of all cases had concomitant physical disorders. Most patients had delayed to seek medical help.

Electroencephalographic findings in epileptic patients in Tanzania.

Electroencephalogram (EEG) of 524 Tanzanian epileptic patients seen between 1985 and 1988 were reviewed after a description and classification of seizures. Over two thirds were young patients between the age of five and thirty. The majority (86%) had abnormal records. Of these, 89% of abnormal records had focal abnormality and 11% had centrencephalic abnormality. Grand mal seizures did not imply centrencephalic abnormality, only 13% had such abnormality. Absence seizures are rare and over one third of these had temporal focal abnormality. Partial seizures were associated highly with focal abnormality. However, complex partial seizures did not imply temporal focal abnormality. Implications of EEG findings to correlation with epileptic seizures is discussed.

The elderly patients as seen at Muhimbili Medical Centre, Tanzania.

Ageing is fast developing in Tanzania like in most developing countries against a background of many unsolved infrastructural problems. Persons aged 60 years and over constituted only about one percent of the total population in 1961 to 4% of 23.2 million people in 1988. Ageing is a process associated with chronic and disabling diseases. A two year hospital based study at the teaching hospital revealed five major diseases, similar to those in the western world, except for infectious diseases which accounted for a sixth of the total diagnoses. Socio-medical interview of 100 elderly patients uncovered that widowhood among females was ten times more than among males. A large proportion of elderly patients especially women had less than 4 years of education. Most elderly patients lived in extended family structures. Over 40% females and 32% males suffered from a multiplicity of chronic diseases. Physical disabilities increased rapidly with advancing age in both sexes. Capacity for self-care was worse in females than in males. The nature of diseases and disabilities in the elderly in Tanzania are difficult to ignore, particularly in the light of expected rapid progression of an ageing population. The need for systematic planning to meet the needs of the elderly is highlighted in the discussion.

Cannabis and its health-damaging effects

Cannabis is derived from the plant Cannabis sativa. Bhang or marijuana might be the cheapest and most readily available form of cannabis abused mainly by adolescents and young adults in Tanzania; but concrete data is lacking. Some of the drug abusers are mentally unstable individuals who lack self criticism and adequate self restraint. When bhang is smoked; cannabinoids are readily absorbed from the lung and bound by the grey matter of the brain. Cannabinoids are psychoactive ingredients which cause complex behavioural changes with stimulant and depressed properties. This article therefore; aims at raising more awareness concerning the health-damaging consequences of bhang abuse

Phantom pregnancy at Muhimbili.

This is a case report on phantom pregnancy at Muhimbili. Relevant factors pertaining to personality of the patient, the experienced psycho-social stresses, the medical history and possible causes of symptom formation culminating in pseudocyesis are looked into and discussed.

Psychiatric patients presenting with HIV-infection in Dar es Salaam Tanzania

Human immunodeficiency virus (HIV) infection is a serious threat of depopulation in several developing African countries. This study analyses 20 HIV infected patients who were admitted at Muhimbili psychiatric unit from 1st January 1988 till 30th June 1989. Psychiatric symptoms with their respective diagnoses included various physical manifestations of HIV infections are tabulated. Relevant neurological changes are discussed in light of other views