scholarly journals Early cranial ultrasound findings among infants with neonatal encephalopathy in Uganda: an observational study

2016 ◽  
Vol 80 (2) ◽  
pp. 190-196 ◽  
Author(s):  
Cally J. Tann ◽  
Margaret Nakakeeto ◽  
Cornelia Hagmann ◽  
Emily L. Webb ◽  
Natasha Nyombi ◽  
...  
Keyword(s):  
Brain Injury ◽  
Case Fatality ◽  
Sub Saharan Africa ◽  
White Matter Injury ◽  
Cranial Ultrasound ◽  
Neonatal Encephalopathy ◽  
Term Infants ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Sub Saharan

Abstract Background: In sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) are unknown. We evaluated cranial ultrasound (cUS) scans from term Ugandan infants with and without NE for evidence of brain injury. Methods: Infants were recruited from a national referral hospital in Kampala. Cases (184) had NE and controls (100) were systematically selected unaffected term infants. All had cUS scans <36 h reported blind to NE status. Results: Scans were performed at median age 11.5 (interquartile range (IQR): 5.2–20.2) and 8.4 (IQR: 3.6–13.5) hours, in cases and controls respectively. None had established antepartum injury. Major evolving injury was reported in 21.2% of the cases vs. 1.0% controls (P < 0.001). White matter injury was not significantly associated with bacteremia in encephalopathic infants (odds ratios (OR): 3.06 (95% confidence interval (CI): 0.98–9.60). Major cUS abnormality significantly increased the risk of neonatal death (case fatality 53.9% with brain injury vs. 25.9% without; OR: 3.34 (95% CI: 1.61–6.95)). Conclusion: In this low-resource setting, there was no evidence of established antepartum insult, but a high proportion of encephalopathic infants had evidence of major recent and evolving brain injury on early cUS imaging, suggesting prolonged or severe acute exposure to hypoxia–ischemia (HI). Early abnormalities were a significant predictor of death.

scholarly journals Humanitarian Surgical Missions in Times of COVID-19: Recommendations to Safely Return to a Sub-Saharan Africa Low-Resource Setting

2021 ◽  
Author(s):  
Víctor Lopez-Lopez ◽  
Ana Morales ◽  
Elisa García-Vazquez ◽  
Miguel González ◽  
Quiteria Hernandez ◽  
...  
Keyword(s):  
Sub Saharan Africa ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Sub Saharan

Factors associated with high-risk HPV positivity in a low-resource setting in sub-Saharan Africa

2014 ◽  
Vol 210 (1) ◽  
pp. 81.e1-81.e7 ◽  
Author(s):  
Sheona M. Mitchell ◽  
Musa Sekikubo ◽  
Christine Biryabarema ◽  
Josaphat J.K. Byamugisha ◽  
Malcolm Steinberg ◽  
...  
Keyword(s):  
High Risk ◽  
Sub Saharan Africa ◽  
Factors Associated ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Sub Saharan ◽  
High Risk Hpv

scholarly journals Calibration of the Epilepsy Questionnaire for Use in a Low-Resource Setting

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Joseph O. Yaria ◽  
Adesola Ogunniyi
Keyword(s):  
Health Sector ◽  
Sub Saharan Africa ◽  
Health Providers ◽  
Good Test ◽  
Retest Reliability ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Sub Saharan ◽  
Test Retest Reliability

Background. Burden of epilepsy in sub-Saharan Africa is huge in the midst of shortage of human resource in its health sector. Using skilled staff to supervise and support lower level healthcare workers providing frontline primary healthcare is a pragmatic coping solution. But, lower level health providers face enormous challenges due to absent clinical algorithms or pragmatic rapid diagnostic tests. Objective. This study aimed to determine if the use of an epilepsy questionnaire in a traditional clinical setting would improve semiological details obtained and diagnostic accuracy. Methods. A prospective study was conducted involving patients diagnosed with epilepsy each with an eye witness who had regularly witnessed the seizures. Routine seizure history from clinical documentation and an interviewer-based questionnaire were compared. The data obtained were assessed for content, accuracy, intermethod and test-retest reliability. Results. Sixty-seven patients with a median age of 24 years were recruited. Routine seizure history had obtained less semiological details with inadequate description of nonmotor manifestations and lateralizing motor details. The questionnaire-obtained history showed higher accuracy for generalized onset seizure (0.83 vs. 0.56) and focal onset seizures (0.79 vs. 0.59). The questionnaire-obtained history also had good test-retest reliability for various semiological domains except automatisms. Conclusions. Routine seizure histories are not standardized. The use of a questionnaire goes a long way in improving semiology description in a low-resource setting and guides the health provider on what details to focus on. The use of epilepsy questionnaires should, therefore, be considered to improve semiology, especially in nonspecialist settings.

scholarly journals Global trends in incidence and mortality of neonatal encephalopathy due to birth asphyxia and trauma

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Lau
Keyword(s):  
Birth Asphyxia ◽  
Case Fatality ◽  
Premature Death ◽  
Sub Saharan Africa ◽  
Neonatal Encephalopathy ◽  
Global Trends ◽  
The Past ◽  
Incidence And Mortality ◽  
Sub Saharan ◽  
Over Time

Abstract Background Neonatal encephalopathy due to birth asphyxia and trauma is a leading cause of premature death and long-term disability as estimated by the Global Burden of Disease (GBD) 2017 study. To evaluate comparative improvements in prevention and survival, this analysis evaluated GBD 2017 mortality to incidence (MI) ratios as a proxy for case fatality over time, location, and socio-demographic status. Methods We derived estimates of cause-specific mortality and incidence at birth from GBD 2017, calculating MI ratios of neonatal encephalopathy in children &lt;1 year. We analyzed temporal, geographic, and socio-demographic trends in incidence, mortality, and MI ratio. Results Neonatal encephalopathy incidence shows little change over time, with global incidence in children under one essentially the same in 2017 (1,996 cases per 100,000 (1,334-2,912)) and 1990 (1,996 cases per 100,000 (1,331-2,926)). Regions show the same trend, though a large difference exists between the highest and lowest regional incidence, with incidence in Central Sub-Saharan Africa over 20 times higher than in Australasia. Over the same period, MI ratios for neonatal encephalopathy have decreased across all regions. Model input data represented 52 countries for prevalence and 145 countries for mortality, with notable data sparsity in Africa and Eastern Europe. Conclusions Case fatality of neonatal encephalopathy, as approximated by MI ratio, has declined worldwide over the past three decades, but incidence has shown little change. This suggests treatment of neonatal encephalopathy has improved, but more research is needed on risk factors in order to increase prevention. Continued work is also needed to reduce disparities in incidence and mortality between countries with different levels of SDI. Improving data coverage in lower SDI regions will be critical to accurately monitor progress toward reducing inequity. Key messages Neonatal encephalopathy is a leading cause of premature death and disability. Incidence of neonatal encephalopathy has changed little since 1990, indicating more work is needed on prevention. Case fatality of neonatal encephalopathy can be approximated by the mortality to incidence ratio, and has declined worldwide over the past three decades, suggesting improvements in treatment.

scholarly journals A Tanzanian Boy with Molecularly Confirmed X-Linked Adrenoleukodystrophy

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
M. C. J. Dekker ◽  
A. M. Sadiq ◽  
R. Mc Larty ◽  
R. M. Mbwasi ◽  
M. A. A. P. Willemsen ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Clinical History ◽  
Sub Saharan Africa ◽  
Adrenal Failure ◽  
Low Resource ◽  
Radiological Features ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Sub Saharan ◽  
Resource Environment

Adrenoleukodystrophy (ALD) is an X-linked peroxisomal disorder with classical features, which can be also recognised in a low resource setting. It had been described in various populations across the globe, but very few cases have been reported from Africa. In a boy with features of a progressive central nervous system condition and adrenal failure, ABCD1 gene screening was performed based on a clinical history and basic radiological features which were compatible with ALD. A common ABCD1 mutation was identified in this patient, which is the first report of genetically confirmed ALD in Sub-Saharan Africa. ALD is likely under recognised in those areas where there is no neurologist. This genetic confirmation widens geographical distribution of ABCD1-associated disease, and illustrates recognisability of this disorder, even when encountered in a low-resource environment.

scholarly journals Reversible deafness and blindness in a patient with cryptococcal meningitis in Tanzania

2015 ◽  
Vol 7 (4) ◽  
Author(s):  
Matt Douglas-Vail ◽  
Taylor Bechamp ◽  
Simran Gohal ◽  
Robert Soegtrop ◽  
Sarah Vitali ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Hearing Loss ◽  
Cryptococcal Meningitis ◽  
Sub Saharan Africa ◽  
Cerebrospinal Fluid Drainage ◽  
Raised Intracranial Pressure ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Sub Saharan

Cryptococcal meningitis is a common and devastating complication of advanced HIV, and is most prevalent in low resource settings in sub Saharan Africa. Raised intracranial pressure is one of the hallmarks of the disease, which can lead to visual and hearing loss and ultimately death. We present the case of a patient with visual and hearing impairment secondary to Cryptococcal meningitis successfully managed by serial cerebrospinal fluid drainage. This case highlights some of the challenges of managing this severe opportunistic infection in a low resource setting.

scholarly journals A Case of William’s Syndrome in a Ugandan Child: A Feasible Diagnosis Even in a Low-Resource Setting

Children ◽  
2021 ◽  
Vol 8 (12) ◽  
pp. 1192
Author(s):  
Massimo Mapelli ◽  
Paola Zagni ◽  
Valeria Calbi ◽  
Aliku Twalib ◽  
Roberto Ferrara ◽  
...  
Keyword(s):  
Intellectual Disability ◽  
Pulmonary Stenosis ◽  
Sub Saharan Africa ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Sub Saharan ◽  
Valvular Pulmonary Stenosis ◽  
And Function ◽  
Behavior Profile ◽  
And Behavior

Background: Williams–Beuren syndrome (WS) is a rare, complex, congenital developmental disorder including cardiovascular manifestations, intellectual disability and a peculiar cognitive and behavior profile. Supravalvular aortic stenosis (SVAS) is the most frequent cardiovascular abnormality in WS children. Data on WS patients in sub-Saharan Africa are scarce. A genetic study is usually required for a definite diagnosis, but genetic testing is often unavailable in developing countries and the combination of a typical clinical phenotype and echocardiographic profile helps to confirm the diagnosis. Case Report: We report the case of a 5-year-old Ugandan child admitted to a large no profit hospital after he was initially managed as a case of infective endocarditis. A physical examination revealed the typical features of WS. A cardiac echo showed severe SVAS (peak gradient 80 mmHg) with a normal anatomy and function of the aortic valve and mild valvular pulmonary stenosis. The child also had a moderate intellectual disability and a characteristic facies consistent with WS. Conclusion: We present the first reported case of WS in Uganda. Cardiac echo and a characteristic clinical picture could be enough to exclude more common causes of heart failure (i.e., rheumatic heart disease) and to make the diagnosis even when specific genetic tests are not available.

scholarly journals A comparison of the efficacy of microscopy versus rapid diagnostic testing in sub-Saharan Africa

2014 ◽  
Vol 83 (2) ◽  
pp. 10-12
Author(s):  
Lauren Prufer
Keyword(s):  
Diagnostic Testing ◽  
Sub Saharan Africa ◽  
Rapid Diagnostic Testing ◽  
Low Resource ◽  
Resource Setting ◽  
Appropriate Treatment ◽  
Low Resource Setting ◽  
Sub Saharan ◽  
Treatment And Diagnosis

Despite advances in treatment and diagnosis, malaria continues to cause a significant number of deaths, particularly in African children.1 Optimized diagnostic and follow-up testing is required for appropriate treatment and eventual eradication of malarial disease in sub-Saharan Africa. Microscopy is compared to rapid diagnostic testing (RDT) for use in a low-resource setting.

scholarly journals Estimated incidence and case fatality rate of traumatic brain injury among children (0–18 years) in Sub-Saharan Africa. A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261831
Author(s):  
Martin Ackah ◽  
Mohammed Gazali Salifu ◽  
Cynthia Osei Yeboah
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Publication Bias ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Sub Saharan Africa ◽  
Reliable Estimate ◽  
Fatality Rate ◽  
Sub Saharan ◽  
Trim And Fill

Introduction Studies from Sub-Saharan Africa (SSA) countries have reported on the incidence and case fatality rate of children with Traumatic Brain Injury (TBI). However, there is lack of a general epidemiologic description of the phenomenon in this sub-region underpinning the need for an accurate and reliable estimate of incidence and outcome of children (0–18 years) with TBI. This study therefore, extensively reviewed data to reliably estimate incidence, case fatality rate of children with TBI and its mechanism of injury in SSA. Methods Electronic databases were systematically searched in English via Medline (PubMed), Google Scholar, and Africa Journal Online (AJOL). Two independent authors performed an initial screening of studies based on the details found in their titles and abstracts. Studies were assessed for quality/risk of bias using the modified Newcastle-Ottawa Scale (NOS). The pooled case fatality rate and incidence were estimated using DerSimonian and Laird random-effects model (REM). A sub-group and sensitivity analyses were performed. Publication bias was checked by the funnel plot and Egger’s test. Furthermore, trim and fill analysis was used to adjust for publication bias using Duval and Tweedie’s method. Results Thirteen (13) hospital-based articles involving a total of 40685 participants met the inclusion criteria. The pooled case fatality rate for all the included studies in SSA was 8.0%; [95% CI: 3.0%-13.0%], and the approximate case fatality rate was adjusted to 8.2%, [95% CI:3.4%-13.0%], after the trim-and-fill analysis was used to correct for publication bias. A sub-group analysis of sub-region revealed that case fatality rate was 8% [95% CI: 2.0%-13.0%] in East Africa, 1.0% [95% CI: 0.1% -3.0%] in Southern Africa and 18.0% [95% CI: 6.0%-29.0%] in west Africa. The pooled incidence proportion of TBI was 18% [95% CI: 2.0%-33.0%]. The current review showed that Road Traffic Accident (RTA) was the predominant cause of children’s TBI in SSA. It ranged from 19.1% in South Africa to 79.1% in Togo. Conclusion TBI affects 18% of children aged 0 to 18 years, with almost one-tenth dying in SSA. The most common causes of TBI among this population in SSA were RTA and falls. TBI incidence and case fatality rate of people aged 0–18 years could be significantly reduced if novel policies focusing on reducing RTA and falls are introduced and implemented in SSA.

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