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 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 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 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 Vascularized fibula flap in the management of segmental bone loss following osteomyelitis in children at a Ugandan hospital

2021 ◽  
Vol 6 (6) ◽  
pp. 179-187
Author(s):  
Antonio Loro ◽  
Andrew Hodges ◽  
George William Galiwango ◽  
Francesca Loro
Keyword(s):  
Soft Tissue ◽  
Bone Defects ◽  
Sub Saharan Africa ◽  
Soft Tissue Envelope ◽  
Low Resource ◽  
Fibula Flap ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Vascularized Fibula ◽  
Segmental Bone

Abstract. Background: Hematogenous osteomyelitis is commonly observed in the pediatric population across sub-Saharan Africa. This retrospective case series was designed to evaluate the complications and outcomes of treatment using a vascularized fibula flap (VFF) to fill segmental bone defects secondary to osteomyelitis in children in a low-resource setting in CoRSU Rehabilitation Hospital, Uganda. Methods: Clinical notes and radiographs of children with a diagnosis of osteomyelitis that subsequently underwent a VFF procedure between October 2013 and December 2017 were reviewed. All patients were clinically and radiographically evaluated in 2019. Results: Forty-four children, with an average bone defect of 10.5 cm, were included. Eighty-four percent of children had successful VFF limb reconstruction. Integration of the graft was radiologically sound in 20.8 weeks on average. The postoperative phase was uneventful in 29 % of patients. Complications were observed in the remaining patients, including flap failure (6), donor leg neurapraxia (3), cutaneous paddle necrosis (11), graft fracture (2), skin graft loss (6), fixator failure (1) and non-union (2). Functional outcomes were rated as excellent in 13 patients, good in 14, fair in 9 and poor in 8. There was no recurrence of the bone infection in any of the enrolled children. Conclusion: Despite being a complex and demanding procedure, VFF is a good option for reconstructing post-osteomyelitis bone defects, particularly when associated with loss of soft tissue envelope. Considering the more than satisfactory functional and clinical outcomes, this procedure should be kept in mind for these complex pediatric cases of bone and soft tissue loss, even in a low-resource setting.

scholarly journals COVID-19 Response in Sub-Saharan Low-Resource Setting: Healthcare Soldiers Need Bullets

2020 ◽  
Vol 103 (2) ◽  
pp. 549-550 ◽  
Author(s):  
Denis Mukwege ◽  
Guy-Bernard Cadière ◽  
Olivier Vandenberg
Keyword(s):  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Sub Saharan

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 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 Validation of the Communication Profile-Adapted in Ethiopian children with neurodevelopmental disorders

2021 ◽  
Vol 8 ◽  
Author(s):  
Caterina Ceccarelli ◽  
Ioannis Bakolis ◽  
Bethlehem Tekola ◽  
Mersha Kinfe ◽  
Anton Borissov ◽  
...  
Keyword(s):  
Internal Consistency ◽  
Neurodevelopmental Disorders ◽  
Convergent Validity ◽  
Clinical Severity ◽  
Sub Saharan Africa ◽  
Retest Reliability ◽  
Validity Assessment ◽  
Sub Saharan ◽  
And Function ◽  
Test Retest Reliability

Abstract Background Neurodevelopmental disorders (NDDs) are conditions affecting a child's cognitive, behavioural, and emotional development. Appropriate and validated outcome measures for use in children with NDDs in sub-Saharan Africa are scarce. The aim of this study was to validate the Communication Profile Adapted (CP-A), a measure developed in East Africa to assess caregivers' perception of communication among children with NDDs. Methods We adapted the CP-A for use in Ethiopia, focusing on the communicative mode (CP-A-mode) and function (CP-A-function) scales. The CP-A was administered to a representative sample of caregivers of children with NDDs and clinical controls. We performed an exploratory factor analysis and determined the internal consistency, test-retest reliability, within-scale, known-group, and convergent validity of the identified factors. Results Our analysis included N = 300 participants (N = 139 cases, N = 139 clinical controls, N = 22 who did not meet criteria for either cases or controls). Within the CP-A-mode, we identified two factors (i.e. verbal and physical communication); the CP-A-function scale was unidimensional. Combining both scales into one summary variable (the CP-A-total) resulted in a scale with excellent internal consistency and test-retest reliability (Cronbach's alpha = 0.97; Kappa = 0.60–0.95, p < 0.001; ICC = 0.97, p < 0.001). Testing known-group validity, the CP-A-total scores were significantly higher for controls than cases (Δ mean = 33.93, p < 0.001). Convergent validity assessment indicated that scores were negatively and moderately correlated with clinical severity (ρ = −0.25, p = 0.04). Conclusion The CP-A is a valid tool for the assessment of communication among children with NDDs in Ethiopia. It holds promise as a brief, quantitative, and culturally appropriate outcome measure for use in sub-Saharan Africa.

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