scholarly journals Paediatric HIV - Looking beyond CD4 Counts

2013 ◽  
Vol 69 (4) ◽  
Author(s):  
J. Potterton ◽  
N. Hiburn ◽  
A. Stewart ◽  
C. Humphries
Keyword(s):  
Sub Saharan Africa ◽  
Paediatric Hiv ◽  
Life Challenges ◽  
Social Challenge ◽  
Sub Saharan ◽  
The University ◽  
Significant Health

Paediatric HIV remains a significant health and social challenge in sub-Saharan Africa despite many countries gaining improved access to antiretroviral treatment. Paediatric HIV affects multiple body systems and has the potential to cause wide ranging impairments as well as activity and participation limitations. The aim of this paper is to highlight some of the impairments that remain, despite the children having access to better medical care, in order to establish a possible role for physiotherapists. Nine studies conducted through the department of physiotherapy at the University of the Witwatersrand, South Africa are presented. The results of these studies demonstrate the neurodevelopmental, musculoskeletal, respiratory and quality of life challenges which children infected with HIV as well as their caregivers continue to face. The need for long term, multidisciplinary follow up of children infected with HIV is emphasized.

scholarly journals Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework

2017 ◽  
Vol 31 (1) ◽  
pp. 109-138 ◽  
Author(s):  
Mark J. Siedner
Keyword(s):  
Quality Of Life ◽  
Conceptual Framework ◽  
Care Delivery ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Objective: The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. Methods: A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. Results: We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. Conclusions: Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.

scholarly journals Jeune syndrome with renal failure

2017 ◽  
Vol 145 (3-4) ◽  
pp. 147-152
Author(s):  
Amira Peco-Antic ◽  
Mirjana Kostic ◽  
Brankica Spasojevic ◽  
Gordana Milosevski-Lomic ◽  
Dusan Paripovic ◽  
...  
Keyword(s):  
Renal Failure ◽  
Growth Failure ◽  
Term Survival ◽  
Jeune Syndrome ◽  
Long Term Follow Up ◽  
The University ◽  
Age Range

Introduction/Objective. Jeune syndrome (JS) is a rare hereditary ciliopathy characterized by asphyxiating thoracic dystrophy, shortened limbs and brachydactyly. Extraskeletal anomalies such as chronic renal failure (CRF), hepatic fibrosis, and retinitis pigmentosa may be a part of the JATD phenotype. The aim of this study is to present long-term follow-up of JS patients with early progressive kidney disease. Methods. This is a retrospective study of pediatric patients with JS and CRF who were treated at the University Children?s Hospital between January 1980 and December 2014. The patients? data were retrospectively reviewed from the medical records. Results. There were thirteen patients from 11 families, five girls and eight boys mean aged 4.3 years at the time of diagnosis. All of the patients had characteristic skeletal findings, retinal degeneration and an early onset of CRF at age range from 1.5 to 7 years. Five patients had neonatal respiratory distress and congenital liver fibrosis was diagnosed in five patients. One patient died due to complications of CRF, while others survived during follow-up of mean 11 years. IFT140 mutations were found in four genetically tested patients. Conclusion. The average incidence rate of JS with renal phenotype in Serbia was about 0.2 per one million of child population. Long-term survival of JS patients depends on renal replacement therapy, while skeletal dysplasia, growth failure, respiratory and eyes problems have impact on the patients? quality of life.

scholarly journals Outcomes of ventriculoperitoneal shunt insertion in Sub-Saharan Africa

2010 ◽  
Vol 6 (4) ◽  
pp. 329-335 ◽  
Author(s):  
Esther Gathura ◽  
Dan Poenaru ◽  
Richard Bransford ◽  
A. Leland Albright
Keyword(s):  
Sub Saharan Africa ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Good Outcome ◽  
Sub Saharan ◽  
Poor Outcomes

Object Ventriculoperitoneal (VP) shunts in Sub-Saharan Africa are traditionally associated with high complication rates and poor outcomes. The aim of this study was to review one large institutional experience with VP shunts, to evaluate the feasibility of shunt insertion procedures with acceptable long-term outcomes in Africa, and to identify factors correlated with good and/or poor outcomes. Methods A retrospective study was conducted by reviewing the charts of all children who underwent primary (93%) or subsequent VP shunt insertions at the Kijabe Hospital between November 2004 and March 2007. Epidemiological data, clinical investigations, etiology of the hydrocephalus, details of the VP shunt insertion, outcome at follow-up, and morbidity and mortality data were collected. Outcomes were graded as good, fair, or poor, according to visual, motor, and seizure criteria. Results The authors analyzed 593 VP shunt insertions in 574 patients. The sex distribution was 53% male and 47% female. The mean age at shunt insertion was 8.5 months (range 0–309 months). The commonest etiologies for hydrocephalus were spina bifida (43.4%) and postinfectious (27.7%). Follow-up was available in 76% of children, with a mean follow-up period of 8.9 months (range 2–30.5 months). The median patient age was 3.3 months. The overall shunt function rate at 2 years was 65%, and the complication rate per procedure was 20%, with infection encountered in 9.1% and shunt malfunction in 11%. Complications were significantly related to hydrocephalus etiology and to sex (p = 0.03 and p = 0.01, respectively). Overall outcomes were good in 40.2% and poor in 59.8%. Overall mortality in the group was 7.1%. Younger patients who survived had an overall good outcome (p = 0.0001). Only 10% of patients with a head circumference greater than 60 cm had a good outcome. Conclusions Despite limited resources, VP shunt procedures can be carried out in Sub-Saharan Africa with acceptable complication rates and fair long-term outcomes.

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.

Reconsidering African Elections

2019 ◽  
Author(s):  
Carolien van Ham ◽  
Staffan Lindberg
Keyword(s):  
Cold War ◽  
Significant Contribution ◽  
Civil Liberties ◽  
Sub Saharan Africa ◽  
Considerable Progress ◽  
Coup D'etat ◽  
Sub Saharan ◽  
The Cold War

The quality of elections in Africa demonstrates considerable progress from the early attempts in the 1950s and 1960s to the increasingly democratic era following the end of the Cold War. In terms of scope, 46 of 49 countries in sub-Saharan Africa now select the most powerful public offices (i.e., the executive and/or legislature) via elections, and reserved power domains have become relatively uncommon. In terms of choice, single-party elections, once so common across Africa, have now all but vanished from the continent. However, the integrity of elections still varies widely, ranging from elections with serious irregularities to elections that are fully free and fair. Even so, considerable progress is apparent over the last three decades. A full 47% of countries in sub-Saharan Africa now hold elections that are free and fair or only involve minor irregularities. Equally important, electoral interruptions in the form of coup d’état, civil war, or annulment of elections have become very rare. Africa is also a continent where the contemporary trend of elections generating broader democratization is particularly palpable. By providing opportunities for citizens to remove incumbents from office and generating expansion of civil liberties after elections are over, stimulating citizens and other actors to increase pressure for more democratic freedoms, elections seem on average to have been conducive to democratic developments in Africa. Elections also increasingly lead to turnovers, especially elections of high electoral integrity, where on average 34% are associated with alternations in power. Taking a long-term view on developments from 1960 until 2017, African elections have seen an impressive increase in quality over time, and provide a much more significant contribution to democratization in sub-Saharan Africa than is often acknowledged in the literature.

scholarly journals Quality of Breast Cancer Treatment at a Rural Cancer Center in Rwanda

2018 ◽  
pp. 1-11 ◽  
Author(s):  
Daniel S. O’Neil ◽  
Nancy L. Keating ◽  
Jean Marie V. Dusengimana ◽  
Vedaste Hategekimana ◽  
Aline Umwizera ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Early Stage ◽  
Locally Advanced ◽  
Sub Saharan Africa ◽  
Cancer Center ◽  
Incidence And Mortality ◽  
Sub Saharan

Purpose As breast cancer incidence and mortality rise in sub-Saharan Africa, it is critical to identify strategies for delivery of high-quality breast cancer care in settings with limited resources and few oncology specialists. We investigated the quality of treatments received by a cohort of patients with breast cancer at Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer center. Patients and Methods We reviewed medical records of all female patients diagnosed with invasive breast cancer at BCCOE between July 2012 and December 2013. We evaluated the provision of chemotherapy, endocrine therapy, surgery, and chemotherapy dose densities. We also applied modified international quality metrics and estimated overall survival using interval-censored analysis. Results Among 150 patients, 28 presented with early-stage, 64 with locally advanced, and 53 with metastatic disease. Among potentially curable patients (ie, those with early-stage or locally advanced disease), 74% received at least four cycles of chemotherapy and 63% received surgery. Among hormone receptor–positive patients, 83% received endocrine therapy within 1 year of diagnosis. Fifty-seven percent of potentially curable patients completed surgery and chemotherapy and initiated endocrine therapy if indicated within 1 year of biopsy. Radiotherapy was not available. At the end of follow-up, 62% of potentially curable patients were alive, 24% were dead, and 14% were lost to follow-up. Conclusion Appropriate delivery of chemotherapy and endocrine therapy for breast cancer is possible in rural sub-Saharan African even without oncologists based on site. Performing timely surgery and ensuring treatment completion were key challenges after the opening of BCCOE. Further investigation should examine persistent quality gaps and the relationship between treatment quality and survival.

scholarly journals Indigenising positive psychology in the ‘Handbook of Quality of Life in African Societies’

2021 ◽  
pp. 122-125
Author(s):  
Jan Alewyn Nel
Keyword(s):  
Quality Of Life ◽  
Social Impact ◽  
Positive Culture ◽  
Sub Saharan Africa ◽  
Indigenous Research ◽  
University Of Pretoria ◽  
Sub Saharan ◽  
The University

This book review highlights the main themes of the Handbook of Quality of Life in African Societies (as edited by Prof Irma Eloff from the University of Pretoria), focusing on meaning and language, culture (and positive culture), and social responsibility. The interrelatedness of all five parts of the book (from a macro, meso and micro perspective) are discussed with specific mention of Ubuntu and its relevance in investigating the phenomenon of quality-of-life. The review emphasises the need for exploratory and indigenous research in communities where social association is of immense importance and to contextualise quality-of-life from this perspective. This book is recommended for scholars who wishes to utilise indigenous methodologies and to deeper understand the diverse influences and social impact on the quality-of-life of individuals south of the Sub-Saharan Africa.

Quality of Care for Adult Inpatients with Malaria in a Tertiary Hospital in Uganda

2020 ◽  
Author(s):  
Ronald Kiguba ◽  
Charles Karamagi ◽  
Sheila M. Bird
Keyword(s):  
Quality Of Care ◽  
Severe Disease ◽  
Malaria Diagnosis ◽  
Tertiary Hospital ◽  
Sub Saharan Africa ◽  
Timely Initiation ◽  
Sub Saharan ◽  
Malaria Microscopy

Abstract Background: Prompt detection and appropriate treatment of malaria prevents severe disease and death. The quality of care for adult malaria inpatients is not well documented in sub-Saharan Africa, particularly in Uganda. We sought to describe the patterns of malaria diagnosis and treatment among adult inpatients admitted to the medical and gynaecological wards of Uganda’s 1790-bed Mulago National Referral Hospital from December 2013 to April 2014.Methods: A prospective cohort of 762 consented inpatients aged >18 years was assembled. Proportions of inpatients who received preadmission and in-hospital antimalarials, missed Day 1 dosing of hospital-initiated antimalarials and/or had malaria microscopy done were determined. Multivariable logistic regression was used to identify risk-factors for missed Day 1 dosing of antimalarials.Results: One in five (19%, 146/762) inpatients had an admitting or discharge malaria diagnosis or both; with median age of 29 years (IQR, 22 to 42 years). Microscopy was requested in 77% (108/141) of inpatients with an admitting malaria diagnosis; results were available for 46% (50/108), of whom 42% (21/50) tested positive for malaria parasitaemia. Only 13% (11/83) of inpatients who received in-hospital injectable artesunate (AS) or quinine (Q) received follow-up oral artemether-lumefantrine (AL); only 2 of 18 severe malaria cases received follow-up oral AL. Injectable AS only (47%, 47/100) was the most frequent hospital-initiated antimalarial followed by injectable Q only (23%, 23/100). A quarter (25%, 25/100; 95% CI: 17% to 35%) of inpatients missed Day 1 dosing of hospital-initiated antimalarials. Each additional admitting diagnosis was more than two-fold likely to increase the odds of missed Day 1 dosing of in-hospital antimalarials (aOR = 2.6, 95% CI: 1.52-4.56; P-value = 0.001).Conclusions: Half the malaria microscopy results were not available; yet, the rate of testing was high. The majority of inpatients initiated on injectable AS or Q did not receive the recommended follow-up treatment of oral AL. One in four inpatients delayed to initiate hospital antimalarials by at least one calendar day. The hospital should encourage prompt availability of malaria test-results to promote the timely initiation and completion of antimalarial treatment, thereby improving the quality of care for hospitalized malaria patients in Uganda.

scholarly journals Antiretroviral treatment Long-Term (ALT) cohort: a prospective cohort of 10 years of ART-experienced patients in Uganda

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e015490 ◽  
Author(s):  
Barbara Castelnuovo ◽  
Frank Mubiru ◽  
Agnes N Kiragga ◽  
Rachel Musomba ◽  
Olive Mbabazi ◽  
...  
Keyword(s):  
Antiretroviral Treatment ◽  
Sub Saharan Africa ◽  
Mineral Density ◽  
Hiv Rna ◽  
Observational Cohort ◽  
Sub Saharan ◽  
Set Up ◽  
Future Plans

PurposeLittle information is available on patients on antiretroviral treatment (ART) after a long-term period from sub-Saharan Africa, with the longest follow-up and related outcomes being after 10 years on ART. At the Infectious Diseases Institute (IDI) (Kampala, Uganda), we set up a cohort of patients already on ART for 10 years at the time of enrolment, who will be followed up for additional 10 years.ParticipantsA prospective observational cohort of 1000 adult patients previously on ART for 10 years was enrolled between May 2014 and September 2015. Patients were eligible for enrolment if they were in their consecutive 10th year of ART regardless of the combination of drugs for both first- and second-line ART. Data were collected at enrolment and all annual study visits. Follow-up visits are scheduled once a year for 10 years. Biological samples (packed cells, plasma and serum) are stored at enrolment and follow-up visits.Findings to dateOut of 1000 patients enrolled, 345 (34.5%) originate from a pre-existing research cohort at IDI, while 655 (65.5%) were enrolled from the routine clinic. Overall, 81% of the patients were on first line at the time of the enrolment in the ART long-term cohort, with the more frequent regimen being zidovudine plus lamivudine plus nevirapine (44% of the cohort), followed by zidovudine plus lamivudine plus efavirenz (22%) and tenofovir plus lamivudine or emtricitabine plus efavirenz (10%). At cohort enrolment, viral suppression was defined as HIV-RNA <400 copies/mL was 95.8%.Future plansThrough collaboration with other institutions, we are planning several substudies, including the evaluation of the risk for cardiovascular diseases, the assessment of bone mineral density, screening for liver cirrhosis using fibroscan technology and investigation of drug–drug interactions between ART and common drugs used for non-communicable diseases.

Sign in / Sign up

Export Citation Format

Share Document