Characteristics, physiology and mortality of intubated patients in an emergency care population in sub-Saharan Africa: a prospective cohort study from Kigali, Rwanda

2021 ◽  
Vol 38 (3) ◽  
pp. 178-183
Author(s):  
Gabin Mbanjumucyo ◽  
Adam Aluisio ◽  
Giles N Cattermole
Keyword(s):  
Endotracheal Intubation ◽  
Teaching Hospital ◽  
Univariate Analysis ◽  
Outcome Data ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Rapid Sequence Intubation ◽  
Shock Index ◽  
Success Rates ◽  
Sub Saharan

BackgroundFormalised emergency departments (ED) are in early development in sub-Saharan Africa and there are limited data on emergency airway management in those settings. This study evaluates characteristics and outcomes of ED endotracheal intubation, as well as risk factors for mortality, at a teaching hospital in Rwanda.MethodsThis was a prospective observational study of consecutive patients requiring endotracheal intubation at the University Teaching Hospital of Kigali ED conducted between 1 January and 31 December 2017. A standardised data collection tool was used to record patient demographics, preintubation clinical presentation, indication for intubation, vital signs. medications and equipment used, and periintubation complications. The primary outcome was in-hospital mortality. Univariate associations were determined for risks of mortality.ResultsOf 198 intubations were analysed, 72.7% were male and the median age was 35 years (IQR 23–51). Airway protection was the most common indication for intubation (73.7%). Rapid sequence intubation was performed in 74.2% of cases; sedative-only facilitated intubation in 20.6% and non-drug assisted in 5.2%. The most common agents used were Ketamine for sedation (85.4%) and vecuronium for paralysis (65.7%). All patients were successfully intubated within three attempts, 85.4% on the first attempt. During intubation, 23.1% of patients experienced hypoxia, 6.7% aspiration and 3.6% cardiac arrest. Median ED length of stay was 2 days. Outcome data were available for 164 patients of whom 67.7% died. Bonferroni-corrected univariate analysis demonstrated that mortality was associated with higher postintubation shock index (p=0.0007) and lower postintubation systolic blood pressure (SBP) (p=0.0006).ConclusionThe first-attempt and overall success rates for intubation in this ED in Rwanda were comparable to those in high-income countries (HIC). Mortality postintubation is associated with lower postintubation SBP and higher postintubation shock index. The high complication and mortality rates suggest the need for better resources and training to address differences in compared with HIC.

scholarly journals Myomectomy under Cervico-Isthmic Tourniquet: Experience of the Gynecologic-Obstetric Department at the University Teaching Hospital of Cocody (Abidjan)

2021 ◽  
pp. 1-3
Author(s):  
Adjoby Cassou Roland ◽  
◽  
Akobé Priva ◽  
Keyword(s):  
Blood Loss ◽  
Teaching Hospital ◽  
Foley Catheter ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Control Group ◽  
Sub Saharan ◽  
The University ◽  
Control Study

Objective: To report the experience of Cocody’s University Teaching Hospital in the practice of myomectomies under cervico-isthmic tourniquet and to assess its impact on per and post-operative blood loss. Methodology: It was a case control study covering a 10-year period (that is from January 2009 to December 2018), and a population of 600 patients divided into two groups (A and B). The first (A) includes all patients admitted and operated on uterine myomas after the introduction of a cervico-isthmic tourniquet (CIT) by Foley catheter (case) and the second all patients admitted and operated on without CIT(Control). Results: The average age of patients was 37 years with extremes of 24 and 50 years They were nulligestous in 38.3% of cases and nulliparous in 61.7% of cases. Hemorrhagic complications made up 65% of the surgical indications. The practice of myomectomy under cervico-isthmic tourniquet was associated with a relatively significant reduction in the duration of intervention including 20 minutes of time saved and a considerable reduction in blood loss(p<0,001). Blood loss was estimated at 438.8 ml (+/- 127) in the CIT group, compared to 685.4 ml (+/- 182) in the control group(p<0,001). The postoperative hemoglobin rate in the cervico-isthmic tourniquet patients was 10.1 g/dl compared to 8.7 g/dl in the non-distort patients(p<0,0012). No complications related to the presence of CIT were observed after sufficient follow-up. The length of stay in the hospital was estimated to be 2.8 days compared to 4.4 days in patients who did not use a tourniquet (p=0,15). Conclusion: The use of the cervico-isthmic tourniquet in myomectomy, considerably limiting blood loss and reducing postoperative morbidity, appears to be an alternative to blood transfusion in countries of sub-Saharan Africa, where the dispensing of blood products remains a problem.

scholarly journals Pitfalls in Diagnosing Heterotopic Pregnancy in Sub-Saharan Africa: A Case Report at the Yaounde University Teaching Hospital (Cameroon)

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Andre Ngandji Dipanda ◽  
Jovanny Tsuala Fouogue ◽  
Valere Koh Mve ◽  
Bruno Kenfack ◽  
Jean Dupont Ngowa Kemfang
Keyword(s):  
Teaching Hospital ◽  
Clinical Signs ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Heterotopic Pregnancy ◽  
Resource Poor ◽  
Wrong Diagnosis ◽  
Gestational Sac ◽  
Sub Saharan ◽  
Ectopic Pregnancies

Heterotopic pregnancy (HP) is a dizygotic twin pregnancy in which one gestational sac is intrauterine and the other is extrauterine. The prevalence of HP is unknown in Cameroon where the diagnosis is difficult and usually fortuitous like in other resource-poor settings. We herein depict pitfalls and delays in the diagnosis and management of a ruptured heterotopic pregnancy at the Yaounde University Teaching Hospital. After a wrong diagnosis and inadequate treatment, our patient presented at our emergency unit with severe pelvic pain and clinical signs of hemoperitoneum with shock. She underwent a total left salpingectomy through laparotomy. She had a complete spontaneous abortion five days after the surgery. Given that sonography is not routinely available in emergency departments in resource-poor settings, it may be relevant for practitioners to always bear HP in mind when facing ruptured ectopic pregnancies.

scholarly journals Prevalence of HIV in surgical patients at the Rivers State University Teaching Hospital

2021 ◽  
Vol 11 (3) ◽  
pp. 115-119
Author(s):  
Eli S ◽  
Aaron FE ◽  
Okagua KE ◽  
Omodu OJ ◽  
Iyama AC
Keyword(s):  
Teaching Hospital ◽  
Cross Sectional Study ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Surgical Patients ◽  
State University ◽  
Cross Sectional ◽  
Highly Active ◽  
Sub Saharan ◽  
Rivers State

Background: With the high prevalence of HIV in Sub-Saharan Africa, screening for this viral infection is a routine in many health institutions prior to surgery, the world has recorded success story in the research of HIV especially with the advent of Highly Active Anti-Retroviral Therapy (HAART) this disease burden has been reduced globally. The prevalence of HI in Nigeria is 1.4%. Aim: To determine the prevalence of HIV in surgical patients at the Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Rivers State, Nigeria. Method: This was a cross sectional study of ANC attendees at the RSUTH, from January 1st to June 31st, 2019. They were surgical patients who were systematically selected, information was obtained from patients case notes with a structured proforma. The information obtained was coded and analyzed using SPSS version 25. Result: A total of 370 patients were attended to pre-operatively. There were 146 (39.5%) males and 224 (60.5%) females. The mean age was 31 years. One hundred and ninety four (52.4%) were obstetrics and gynaecological surgeries while 176 (47.6 %) were non-gynaecological surgeries. The commonest indication for surgery was caesarean representing 126 (34.1%) of the subjects.The prevalence of HIV in surgical patients was 8 (2.1%). Three (1.6%) of the obstetrics and gynaecological patients had HIV compared to 1(0.5%) non-obstetrics and gynaecological patient. Conclusion: The study revealed that prevalence of HIV in surgical patients at the RSUTH was high (2.1%). HIV infection was thrice as common in obstetrics and gynaecological patients compared with other surgical disciplines. There is need to step up surveillance amongst ANC attendees who are reflection of the populace in this region.

scholarly journals The Africa weather enterprise : filling a large gap

2021 ◽  
Author(s):  
Tom Copping
Keyword(s):  
Private Sector ◽  
Sub Saharan Africa ◽  
Success Rates ◽  
End User ◽  
Public And Private ◽  
Single Person ◽  
Sub Saharan ◽  
National Economies ◽  
Private Actors ◽  
Warning Services

&lt;p&gt;The study focuses on the role of the private sector in the development and delivery of hydromet and early warning services (EWS) in sub-Saharan Africa, within the current landscape of the Africa Regional Weather Enterprise (ARWE).&lt;/p&gt;&lt;p&gt;The study was sponsored by the World Bank and conducted through interviews with 28 National Hydro&amp;#173;Meteorological Services (NMHS) and 87 participating companies who either work in or have interest in the region&amp;#8217;s hydromet market, varying in size from single-person entities to large multinationals. Less than 4% of companies have their headquarters (and solely operate) in Africa. 157 projects were identified from the 65 most active donors financing hydromet projects in sub-Saharan Africa, and classified by sector and complexity, from niche to &amp;#8220;full-chain&amp;#8221; solutions.&lt;/p&gt;&lt;p&gt;The study analyses which and how private sector actors operate within the framework of national, regional and international hydromet projects, in which countries, which products and services they provide and in which end-user categories, from research and development, to innovation and capacity building initiatives.&lt;/p&gt;&lt;p&gt;The study further analyses the success rates of international companies winning tenders in sub-Saharan Africa , and the patterns leading to success.&lt;/p&gt;&lt;p&gt;The report concludes by drawing on lessons from the positive dynamics and gaps in partnerships and engagements between public and private actors. The results of the study create the need for sixteen recommendations to further improve the ARWE, with a key emphasis on PPE, to successfully complete African hydromet programs, and in turn satisfy end-user needs, to protect lives, property, and to support their national economies for the prosperity of all.&lt;/p&gt;

scholarly journals Pharmacotherapy of infertility in Ghana: retrospective study at the cape coast teaching hospital

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Stephen Mensah Arhin ◽  
Kwesi Boadu Mensah ◽  
Evans Agbeno ◽  
Vitus Sambo Badii ◽  
Charles Ansah
Keyword(s):  
Treatment Regimen ◽  
Teaching Hospital ◽  
Employment Status ◽  
Day Treatment ◽  
Clomiphene Citrate ◽  
Sub Saharan Africa ◽  
Success Rates ◽  
Cape Coast ◽  
Idiopathic Infertility ◽  
Conception Rates

Abstract Background Infertility is a major challenge for couples globally. Due to low income levels and the high cost of other assisted reproductive techniques, pharmacotherapy remain the major first line treatment option for infertility in Sub-Saharan Africa. Objective The aim of this study was to assess the prevalence of infertility as well as the effectiveness and success achieved following infertility pharmacotherapy at the Cape Coast Teaching Hospital in Ghana. Methods This study was a retrospective observational study of 825 couples attending infertility clinic at the hospital. Results Prevalence of infertility at the study center was estimated to be 12.3%. Treatment mainly involved the use of clomiphene citrate, antioxidants, herbo-mineral drugs (Ayurveda), multivitamin and antibiotics. Pharmacotherapy resulted in successful conception in one out of every five couples (19.4%; n = 160). Secondary infertility, although more prevalent in the study population (44.8%; n = 370), had lower conception rates during pharmacotherapy than primary infertility (15% vs 26.2%). Age, kind of infertility, employment status but not educational level were significantly associated with pharmacotherapy success. In ovulation induction, clomiphene citrate plus folic acid and vitamin E adjuncts improved ovulation rates during cycle treatments compared to clomiphene citrate alone. Pharmacotherapy of idiopathic infertility (39%, n = 323) was a major challenge with very limited success rates. Interestingly, it was noted that treating couples or female partners only for idiopathic infertility resulted in higher success rates than treating the male partner only. Again, 90-day treatment regimen doubled conception rates when compared with corresponding 30-day treatment regimen. However, zinc sulfate even in short term treatment regimens (30 days) enhanced conception rates in idiopathic infertility. Conclusions Prevalence of infertility was estimated to be about 12.3%. One out of every five infertile couples achieved success with pharmacotherapy. Factors such as age, type of infertility, employment status, but not education were significantly associated with treatment success.

scholarly journals Protocol for systematic review and meta-analysis of treatment success rate among adult patients with tuberculosis in sub-Saharan Africa

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024559 ◽  
Author(s):  
Jonathan Izudi ◽  
Daniel Semakula ◽  
Richard Sennono ◽  
Imelda K Tamwesigire ◽  
Francis Bajunirwe
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Treatment Success ◽  
Adult Patients ◽  
Sub Saharan Africa ◽  
Forest Plot ◽  
Kappa Statistics ◽  
Success Rates ◽  
Ethical Approval ◽  
Sub Saharan

IntroductionTuberculosis (TB) is a leading cause of mortality globally. Despite being curable, treatment success rates (TSRs) among adult patients with bacteriologically confirmed pulmonary TB (BC-PTB) in sub-Saharan Africa (SSA) differ considerably. This protocol documents and presents an explicit plan of a systematic review and meta-analysis to summarise TSR among adult patients with BC-PTB in SSA.Methods and analysisTwo reviewers will search and extract data from MEDLINE, EMBASE, Ovid, Cumulative Index to Nursing and Allied Health Literature and Web of Science electronic databases. Observational and interventional studies published between 1 July 2008 and 30 June 2018, involving adult patients with BC-PTB will be eligible. Data abstraction disagreements will be resolved by consensus with a third reviewer, while percentage agreement computed with kappa statistics. TSR will be computed with Metaprop, a Stata command for pooling proportions using DerSimonian and Laird random effects model and presented in a forest plot with corresponding 95% CIs. Heterogeneity between included studies will be assessed with Cochran’s Q test and quantified with I-squared values. Publication bias will be evaluated with funnel plots and tested with Egger’s weighted regression. Time trends in TSR will be calculated with cumulative meta-analysis.Ethics and disseminationNo ethical approval will be needed because data from previous published studies in which informed consent was obtained by primary investigators will be retrieved and analysed. We will prepare a manuscript for publication in a peer-reviewed journal and present the results at conferences.PROSPERO registration numberCRD42018099151.

scholarly journals Neurosurgical Emergencies at a Tertiary Referral Center in a Sub-Saharan African Country

2020 ◽  
Vol 11 (03) ◽  
pp. 407-410
Author(s):  
Thierry Alihonou ◽  
Kisito Quenum ◽  
Adébola Padonou ◽  
François Amossou ◽  
Francis Dossou
Keyword(s):  
Teaching Hospital ◽  
Low Income ◽  
Postoperative Mortality ◽  
Outcome Data ◽  
Diagnostic Tools ◽  
Spine Injury ◽  
Tertiary Referral Center ◽  
Male Predominance ◽  
Low Income Country ◽  
Sub Saharan

Abstract Background The practice of neurosurgery in a teaching hospital requires modern diagnostic tools and a rigorous organization of care. Objectives To present and discuss the management of neurosurgical emergencies in a teaching hospital in poor and low-income country. Patients and Methods This is a retrospective and descriptive study from April 2015 to March 2017 and includes traumatic and nontraumatic neurosurgical emergencies. Epidemiological, diagnostic, operative, and outcome data were evaluated. Results During the study period, 397 cases of neurosurgery were admitted. One hundred seventy-five of them were emergencies (43%), including 168 (96%) of traumatic origin. The average age was 32.5 years (1–80 years) with a male predominance: 149 men for 26 women, the sex ratio was 6.68. The cause of the neurotraumatological emergency was mostly road accidents with 143 cases (85.1%). The trauma was brain injury in 155 patients (92.3%) and spine injury in 13 patients (7.7%). In 64.3% of cases, diagnostic imaging was done beyond 48 hours. Surgery time was more than 48 hours when it was performed (21 cases). Outcome was good for 19 patients. Overall and postoperative mortality were, respectively, 34.5% (58 cases) and 9.5% (2 cases). Conclusion Neurosurgical emergencies care at the Departmental Teaching Hospital of Ouémé–Plateau has become a common activity with encouraging operating results despite difficult practice conditions.

scholarly journals Arterial stiffness is associated with oxidative stress and endothelial activation among persons with treated HIV in Zambia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Theresa Chikopela ◽  
Fastone Goma ◽  
Longa Kaluba ◽  
Wilbroad Mutale ◽  
Chris Guure ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Arterial Stiffness ◽  
Endothelial Activation ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Stiffness Index ◽  
Intercellular Adhesion Molecule ◽  
Vascular Compliance ◽  
Sub Saharan ◽  
Hiv Negative

Background: Cardiovascular disease (CVD) prevalence is rising among persons with HIV (PLWH) in sub-Saharan Africa. Oxidative stress and endothelial activation, resulting in reduced vascular compliance, are contributors to CVD risk. However, there is a paucity of vascular health data in this population.Objectives: To assess the relationships of oxidative stress and endothelial activation with vascular stiffness among PLWH.Method: Fifty-four PLWH on antiretroviral therapy 5 years and 57 HIV-negative controls, all aged 18–45 years, were enrolled from the University Teaching Hospital, Lusaka, Zambia. Oxidative stress was measured by nitrotyrosine, a peroxynitrite biomarker, and endothelial activation by soluble intercellular adhesion molecule-1 (sICAM-1) plasma levels. Vascular compliance was measured using carotid-radial pulse wave velocity (crPWV) and arterial stiffness index (crASI).Results: PLWH had higher sICAM-1 levels (median 345 ng/mL) compared to controls (275 ng/mL, p 0.01), as well as higher nitrotyrosine levels (297 versus 182 nM; p = 0.02). Median crPWV was similar between the groups, but PLWH had higher crASI (2.4 versus 2.2 cm/ms; p 0.05). After adjusting for age, fat mass, and blood pressure, the estimated effect of a one unit increase in nitrotyrosine on crPWV were twofold higher in the PLWH, but neither reached significance. In a model pooling all participants, there were significant differences in the relationship of nitrotyrosine with crPWV and crASI by HIV status.Conclusion: PLWH in sub-Saharan Africa had significantly greater oxidative stress and endothelial activation compared to HIV-negative individuals. These factors may contribute to increased arterial stiffness and higher CVD prevalence in this population.

scholarly journals The Success Rate of Endotracheal Intubation in the Emergency Department of Tertiary Care Hospital in Ethiopia, One-Year Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ayalew Zewdie ◽  
Dejene Tagesse ◽  
Selam Alemayehu ◽  
Tesfaye Getachew ◽  
Menbeu Sultan
Keyword(s):  
Emergency Department ◽  
Success Rate ◽  
Endotracheal Intubation ◽  
Addis Ababa ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Rapid Sequence Intubation ◽  
Care Hospital ◽  
Success Rates ◽  
First Pass

Background. Emergency medical care starts with airway assessment and intervention management. Endotracheal intubation is the definitive airway management in the emergency department (ED) for patients requiring a definitive airway. Successful first pass is recommended as the main objective of emergency intubation. There exists no published research regarding the success rates or complications that occur within Ethiopian hospitals emergency department intubation practice. Objective. This study aimed to assess the success rate of emergency intubations in a tertiary hospital, Addis Ababa, Ethiopia. Methodology. This was a single institute retrospective documentation review on intubated patients from November 2017 to November 2018 in the emergency department of Addis Ababa Burn Emergency and Trauma Hospital. All intubations during the study period were included. Data were collected by trained data collectors from an intubation documentation sheet. Result. Of 15,933 patients seen in the department, 256 (1.6%) patients were intubated. Of these, 194 (74.9%) were male, 123 (47.5%) sustained trauma, 65 (25.1%) were medical cases, and 13(5%) had poisoning. The primary indications for intubation were for airway protection (160 (61.8%)), followed by respiratory failure (72(27.8%)). One hundred and twenty-nine (49.8%) had sedative-only intubation, 110 (42.5%) had rapid sequence intubation, and 16 (6.2%) had intubation without medication. The first-pass success rate in this sample was 70.3% (180/256), second-pass 21.4% (55/256), and third-pass 7.4% (19/256), while the overall success rate was 99.2% (254/256). Hypoxia was the most common complication. Conclusion. The intubation first-pass success rate was lower than existing studies, but the overall intubation success rate was satisfactory.

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