Tropical Doctor recent issues

Addressing the attitudes of service providers: increasing access to professional midwifery care in Nepal

Clapham, S, Pokharel, D, Bird, C, Basnett, I — 2008-09-26

Increasing access to professional care during labour and delivery is the central strategy in Nepal's commitment to reducing its maternal mortality ratio. This paper outlines a number of complementary interventions used by the Nepal Safer Motherhood Project to address the negative attitudes prevalent among service providers, which is a contributing factor to the under-utilization of the health-care services. The perspectives of the community and the service providers are presented, with a discussion of the importance of effective communication, the establishment of positive relationships and a demonstration of the critical role of local ownership and involvement in bringing about a positive change.

Pattern of severe maternal morbidity in a tertiary hospital of Delhi, India: a pilot study

Chhabra, P., Guleria, K., Saini, N. K., Anjur, K. T., Vaid, N. B. — 2008-09-26

Severe maternal morbidity also known as ‘near miss’ may be a good indicator of the quality and effectiveness of obstetric care, as it may identify priorities in maternal care more rapidly than mortality alone. The objective of the study was to observe the pattern of severe maternal morbidity and its associated factors in a tertiary care hospital in Delhi. All patients admitted to the obstetrics and gynaecology department who fulfilled the definition of severe maternal morbidity conditions were included. A proforma was used to record sociodemographic, obstetric, antenatal care treatment and outcome details. A total of 63 women were included for analysis. The incidence of severe maternal morbidity was 3.3/100 deliveries. The mean age of the patients was 26.3 ± 5 years. More than half (55.5%) were uneducated: almost one-third (32%) were from outside Delhi – the median distance travelled was 10 km. The majority were antenatal admissions (68.3%). The proportion of postdelivery or abortion cases were greater among women who came from outside Delhi. Only 38.1% were registered during the antenatal period. The diagnoses were: eclampsia/pre-eclampsia (35%); haemorrhage (35%); sepsis (13%); obstructed labour (9.5%) and other medical conditions (11%). Severe anaemia was observed in 22% of cases. Only 43.5% were normal vaginal deliveries and 54.5% were delivered by caesarean section or with the use of instruments; 61.3% were live births. Hysterectomy was performed in 14.8%: the proportion of hysterectomy was higher in obstructed labour. Severe maternal morbidity cases constitute a significant burden on health resources.

Maternal morbidity during postpartum period in a village of north India: a prospective study

Patra, S., Singh, B., Reddaiah, V P — 2008-09-26

This prospective community-based study was conducted in the village of Chhainsa, Haryana, India, in order to discover the incidence and types of postpartum morbidity and the factors associated with the morbidities. The subjects were followed up to 42 days of postpartum with a minimum of three visits; the first visit was within 14 days of delivery and subsequent visits were every 14 days. A first visit was made to 211 women and 174 (82.46%) completed the study. Seventy-four percent reported at least one morbidity and there were 1.75 reported morbidities per woman per postpartum period. Common problems reported were: weakness, lower abdominal pain, perineal pain, abnormal vaginal discharge, high fever, breast problems, excessive vaginal bleeding, etc. There was greater morbidity among women of lower socioeconomic status, parity >4, birth interval >36 months, having a breech or caesarean delivery or a delivery assisted by relatives/neighbours. A significant positive association was found between age and non-maintenance of the ‘five cleans’ during delivery. Seventy-five percent of those who had reported morbidity had taken some action, but only 20% sought help from a qualified doctor and 14% from other health workers.

Childhood cancer in Sudan: 1999-2007

Abuidris, D. O, Ahmed, M. E, Elgaili, E. M, Arora, R. S — 2008-09-26

There is paucity of information on childhood cancer from Sudan with the last studies published more than 20 years ago. This study aims to provide a current picture of childhood cancer in Sudan. Data was obtained from the hospital registry for the period May 1999 to June 2007 on all paediatric patients presenting to the Institute of Nuclear Medicine and Oncology, University of Gezira, Wad Madani, Sudan. There were 322 children with cancer during this time period with a male:female ratio of 1.6:1. Lymphomas (111, 35%), leukaemia (83, 26%) and Wilms' tumour (43, 13%) were the three most common groups of tumours. Thirty percent of all lymphomas were Burkitt's lymphoma; 3.4% of all childhood cancer cases were nasopharyngeal carcinomas.

Conservative management of splenic injury in the tropics

Kuzma, J., Atua, V. — 2008-09-26

We undertook this study in order to determine whether the conservative management of splenic injuries is a safe practice in a low-volume tropical hospital. We evaluated 69 consecutive patients with splenic injury prospectively. The outcome measures were morbidity and mortality rates, overall hospital stay and blood transfusion requirements. Spleen preservation was achieved in 85% (59) of cases. Of the 16 patients who underwent splenic surgery, six had splenorraphy (38%). The overall mortality was 4.3% (3) and the deaths were not related to the conservative management. Our findings suggest that not only is the conservative management of splenic injuries safe, but also that the repair of an enlarged spleen (splenorrhaphy) is safe and feasible in tropical hospital settings. The findings in this study provide further evidence that the conservative management of splenic injury in a tropical hospital without computed tomography scan is a safe practice.

Laparoscopic cholecystectomy in a small rural hospital in Kashmir Valley, India

2008-09-26

This study evaluates the feasibility of performing laparoscopic cholecystectomy in order to reduce the expenditure in a 28-bed sub-district hospital in Kashmir, India. We report on a prospective clinical trail involving patients with gall bladder disease reported to the hospital from June 2005 till May 2007.

A structured training module using an inexpensive endotrainer for improving the performance of trainee surgeons

Mir, I. S., Mohsin, M., Malik, A., Shah, A. Q., Majid, T. — 2008-09-26

Training in minimal access surgery has always been difficult in developing countries with limited resources, non availability of formal animal labs, inaffordability of conventional endotrainers and lack of trained endosurgeons to help the amateurs. It is always difficult to start a new procedure in such places where not only the patients but the orthodox surgical fraternity are reluctant to accept new ideas and newer trends in surgery. After thorough discussions with senior surgeons, the author (who was the only trained endosurgeon to begin with) developed a training policy to train the surgeons over a period of time through various exercises before allowing them to assist him in the actual surgeries. A homemade, inexpensive endotrainer was designed for these exercises. Audio-visual seminars were held in between the training sessions. This training module can be employed by other rural hospitals to improve the skills of surgeons who are new to the art of endosurgery.

The characteristics and causes of pleural effusions in Kumasi Ghana - a prospective study

Afful, B., Murphy, S., Antunes, G., Dudzevicius, V. — 2008-09-26

Fever of unknown origin in the elderly: nine years experience in China

Zheng, M., Lin, H., Luo, S., Xu, L., Zeng, Y., Chen, Y. — 2008-09-26

This is a retrospective study of older patients admitted to the First and Second Affiliated Hospitals of Wenzhou Medical College, China, with a diagnosis of fever of unknown origin. The study took place from January 1998 to December 2006 among 102 patients who fulfilled the criteria. Infections were responsible for 50 cases (49.1%), followed by no diagnosis in 27 (26.5%), miscellaneous in nine (8.8%), neoplasms in eight (7.8%) and connective tissue disease in another eight (7.8%). Mycobacterium TB was the most frequent type of infection diagnosed.

The rise and fall of epidemic Neisseria meningitidis from a tertiary care hospital in Delhi, January 2005-June 2007

Kumar, S., Kashyap, B., Bhalla, P. — 2008-09-26

Meningococcal meningitis is endemic in India. There has been a sudden surge of cases of meningococcal meningitis in 2005 in Delhi. Present study was undertaken to find out changing trends in incidence of this disease from a tertiary care hospital in New Delhi over a period of two and half years. All samples from suspected cases of meningococcal meningitis were subjected to Gram staining, culture and latex agglutination test for detection of Neisseria meningitidis (N.meningitidis). Antimicrobial susceptibility of all isolates was performed using the disc diffusion test. 78.6%, 71.4% and 100% of the samples were positive for N.meningitidis by smear examination, culture and latex agglutination test respectively. Except for resistance to Penicillin and Erythromycin in 8.8% and 5.9%, the isolates were sensitive to the commonly used antibiotics. Using simple, rapid and reliable methods for diagnosis, defining risk factors and continuing surveillance remain important public health goals for the control of meningococcal disease.

Frequency and determinants of the metabolic syndrome in apparently healthy adult Nigerians

Wahab, K. W., Sani, M., Gbadamosi, M., Yandutse, M. — 2008-09-26

Non-communicable disease conditions such as the metabolic syndrome further strain the already insufficient health resources in Africa, where communicable diseases such as malaria and HIV/AIDS are still causing significant morbidity and mortality. We studied the frequency and determinants of the syndrome in apparently healthy Nigerian volunteers in order to provide a basis for the establishment of a prevention programme.

Pigs are the most important animal reservoir for Tunga penetrans (jigger flea) in rural Nigeria

Ugbomoiko, U. S, Ariza, L., Heukelbach, J. — 2008-09-26

We examined the domestic animals and rodents in a community in rural Nigeria. Of the 133 animals examined, 29 (21.8%) were infested, the highest prevalence of infestation and highest parasite load was found in the pigs (prevalence 54.8%, median = nine embedded parasites), followed by dogs (45.5%; median = 4), Rattus rattus (29.4%; median = 2) and Mus minutoides (15.4%; median = 1.5). Of all the tungiasis lesions identified 83% were found in pigs. Our data confirm that tungiasis is a zoonotic disease, and that pigs are its most important animal reservoir in this endemic community.

The mental health consequences of intimate partner violence against women in Agaro Town, southwest Ethiopia

Tadegge, A. D. — 2008-09-26

There are very few population-based studies on the mental health consequences of intimate partner violence (IPV) from Ethiopia. This study was conducted among 510 ‘ever partnered’ women in Agaro Town in February 2007. Mental distress and depression were measured using self-reporting questionnaires and Kessler's Scales. All types of IPV (physical, sexual and emotional abuses) were significantly associated with mental distress and depression. Women who suffered from physical, sexual and emotional abuses were more likely to have mental distress. We recommend using information education communications to educate the community and thereby preventing IPV and the mental health consequences.

Risk perception and water purification practices for water-borne parasitic infections in remote Nepal

Kovalsky, A. N, Lacey, S. E, Kaphle, U. R., Vaughn, J. M — 2008-09-26

This study assesses water-borne infection risk perception and water boiling habits in a remote Sankhuwasava region of Nepal using a brief interview-style questionnaire. All subjects were aware of the risks associated with drinking unpurified water, but a majority (65%) reported they did not boil water regularly, and almost 60% of villagers interviewed had history of infection despite their boiling practices. In contrast to reports from other communities in Nepal, risk awareness was sufficient in this region. Water boiling alone did not confer protection. Future efforts should target sanitation, screening, and other sources of contamination.

Incidence of skeletal deformities in endemic fluorosis

A, S., M, K., M, B. — 2008-09-26

An investigation was undertaken in three endemic fluorotic areas of Punjab State, India, to assess the prevalence of skeletal deformities. The concentration of fluoride in drinking water varies from 2.3 to 22.5 mg/L. The patients affected with skeletal fluorosis revealed joint pain in both upper and lower limbs, numbing and tingling of the extremities, back pains and knock-knees. Prevalence of skeletal fluorosis was found to be 29% of grade-I, 51% of grade-II and 20% of grade-III and was higher in males (63%) compared with females (37%).

Epidemiology of nosocomial infections in medicine intensive care unit at a tertiary care hospital in northern India

2008-09-26

This prospective observational study describes the rates of nosocomial infections (NI), the sites of infection, the pathogens involved, their antibiogram and the risk factors at a tertiary care hospital in northern India. In 62 of the 182 enrolled patients 95 episodes of NI were recorded (incidence rate 28.6/1000 person days): pneumonia (77%); urinary tract infection (24%) and blood stream infection (24%). All isolates of Acinetobacter, Pseudomonas and Klebsiella and 83.3% of Escherichia coli were resistant to the third generation cephalosporins. An increased duration of the time spent in intensive care units and days of intervention were associated with incident NI.

Does breast feeding provide protection against acute appendicitis? A case-control study

Alves, J. G. B., Figueiroa, J. N., Barros, I. — 2008-09-26

Breast feeding stimulates a more tolerant lymphoid tissue at the base of the appendix and this could provide protection against acute appendicitis. Two studies reported that children and adolescents with appendicitis were less likely to have been breast fed. In a case-control study of 200 children with histologically confirmed acute appendicitis matched by 200 siblings with the same sex and difference age – up to three-year-old – we found breast feeding in at least the first two months of life and for more than four months provides protection against acute appendicitis. These findings suggesting that breast feeding may possibly give protection against the development of appendicitis.

High-risk behaviours and associated factors among HIV-positive individuals in clinical care in southwest Ethiopia

Deribe, K., Woldemichael, K., Wondafrash, M., Haile, A., Amberbir, A. — 2008-09-26

A hospital-based cross-sectional survey was conducted among 705 HIV-positive individuals. The result showed that 24% of the participants reported unprotected intercourse in their most recent sexual episode. Nine percent of these events were with partners perceived to be HIV-negative and 39% with those of unknown HIV status. Protected sex at recent episode was independently associated with knowing a partner's HIV status, disclosing HIV status to a partner, receipt of antiretroviral treatment and perceiving HIV as less stigmatizing. This highlights the need for interventions among HIV-positive individuals that will assist them in attaining and maintaining safer sex practices.

Osteomyelitis of the ribs: a strategy for prompt diagnosis and effective management

Mohanty, D., Agrawal, V., Jain, B. K., Gupta, R., Rathi, V., Gupta, A. — 2008-09-26

Seven patients were treated for osteomyelitis rib (OR). Discharging sinuses and painful swellings were the presenting symptoms. An initial chest X-ray was unremarkable in all patients. Fine needle aspiration cytology and microscopy of pus did not reveal acid-fast bacillus in any patient. Computerized tomography (CT) of thorax was consistent with the diagnosis of OR in five patients. The patients underwent a subperiosteal excision of the affected part of the ribs or an excision biopsy of the unhealthy granulation tissue. Histopathological diagnosis was consistent with the diagnosis of tuberculosis (TB) OR in six patients. The patients received anti-TB drugs or appropriate antibiotics following surgery. All responded to treatment except one with a non-TB OR, who required further excision of the unhealthy rib ends. Inclusion of a CT of the thorax and an excision biopsy in the diagnostic process facilitates prompt diagnosis and effective management of OR.

A study of clinico-haematological profiles of pancytopenia in children

Gupta, V, Tripathi, S, Tilak, V, Bhatia, B D — 2008-09-26

We report on the clinico-haematological profile of pancytopenia in children from the Departments of Pediatrics and Pathology, Institute of Medical Sciences, Banaras Hindu University, India, over a period of 30 months. Pancytopenia was defined as: haemoglobin <10 g/dL, absolute neutrophil count 1.5 x 10⁹/L and platelet count <100 x 10⁹/L. A detailed history, clinical examination and haematological parameters were recorded. Bone marrow aspiration and trephine biopsy were carried out in all cases. One hundred and five cases aged 1.5–18 years, with a mean age of 8.6 years, were included in the study. Aplastic anaemia was the most common cause of pancytopenia (43%) followed by acute leukaemia (25%). Infections were the third most common cause of pancytopenia of which kala azar was the most common. Megaloblastic anaemia was seen in 6.7%.

Clinical patterns and major causes of infertility among Sudanese couples

Elussein, E. A, Magid, Y. M, Omer, M. M, Adam, I. — 2008-09-26

An understanding of the medical causes of infertility is crucial in order to reduce incidences of Infertility and for improving the clinical management of infertility. Although there were much data on infertility in other African countries, no data exist on infertility in Sudan. Seven hundred and ten Sudanese couples were investigated for the infertility in Khartoum Fertility Center, Sudan: 443 (62.4%) had primary infertility and 267 (37.6%) had secondary infertility. The mean (standard deviation) duration of the infertility was 5.2 (4.3) years. A positive male factor alone was found in 257 (36.2%) couples and a female factor in 350 (49.3%) couples: eleven (1.5%) couples had a combination of male and female factors: and the cause of infertility was unexplained in 92 (13.0%) couples. Oligozoospermia and asthenozoospermia were factors responsible for 16.8% and 17.5% of male infertility, respectively. Failure of ovulation (60.3%) was the most common cause of female infertility. The study revealed a high proportion of secondary infertility and a greater contribution of the female factors to infertility.

Fine needle aspiration cytology in the investigation of breast lumps at the University Teaching Hospital in Lusaka, Zambia

Bowa, K., Jewel, J., Mudenda, V. — 2008-09-26

The study was undertaken to determine the value of fine needle aspiration cytology (FNAC) in the investigation of breast lumps at the University Teaching Hospital (UTH) in Lusaka, Zambia. This technique, which has been shown to be cheap, simple and accurate has not been in common use at this institution. FNAC and open biopsy (OB) were performed on 56 patients who presented with a breast lump and the results compared, in order to determine the accuracy of FNAC. FNAC was found to have a sensitivity of 72% and specificity of 100%. This level of accuracy compares favourably with the quality assurance criteria set for breast FNAC by the Royal College of Pathologists in the British National Health Service (NHS).

The incidence of urinary tract infections in febrile children during a two-year period in Tehran, Iran

Panahi, Y., Beiraghdar, F., Moharamzad, Y., Matinzadeh, Z. K., Einollahi, B. — 2008-09-26

Of 433 febrile children examined in the paediatric clinics of two university hospitals in Tehran, Iran, 39 (9%) children (27 girls and 12 boys) were diagnosed as having urinary tract infection in which Escherichia coli was the most frequently detected pathogen (84.6%). According to the voiding cystourethrogram, nine (75%) boys and 17 (63%) girls had urinary tract abnormalities. This result is slightly higher than seen in other reports from developing countries.

Risk of hepatitis B virus in the slaughter house

Ola, S O, Otegbayo, J A, Yakubu, A, Odaibo, G N, Olaleye, D O — 2008-09-26

The study involved 180 Nigerian butchers and 180 traders (controls) selected by multistage stratified sampling who had their sera assayed for HBsAg (hepatitis B surface antigen) by enzyme-linked immunosorbent assay method. The butchers and the controls had an HBsAg sero-prevalence rate of 9.4% and 3.3%, respectively. Various risky practices were more common among the butchers but their hepatitis B antigenaemia was not related to the duration of their occupational exposure. The study shows that the butchers constitute a high risk occupation for hepatitis B viral infection.

Concomitant TB and cryptococcosis in HIV-infected patients

Rawat, D, Capoor, M R, Nair, D, Deb, M, Aggarwal, P — 2008-09-26

Four cases of concomitant tuberculosis and cryptococcosis infection in HIV-positive patients are described. As the HIV pandemic progresses and the proportion of patients with end-stage disease increases, a high suspicion of incidence and unusual forms of infections must always be kept in mind.

Crimean Congo hemorrhagic fever and diffuse alveolar haemorrhage

Doganci, L., Ceyhan, M., Tasdeler, N. F., Sarikayalar, H., Tulek, N. — 2008-09-26

Although the pathology of Crimean Congo haemorrhagic fever (CCHF) is mainly related to a haemorrhagic process with secondary cytokine storm, there have been no published reports of this fatal disease being a cause of diffuse alveolar haemorrhage (DAH). There are many aetiological factors emphasizing the direct role of endothelial injury on DAH. We present the case of a young adult Turkish man with diffuse bilateral alveolar haemorrhage without an episode of gross haemoptysis caused by the CCHF virus. Successful clinical results and a rapid clinical and radiological clearance were obtained within few days after starting daily oral ribavirin treatment. This fatal infection should be considered to exist in any patient presenting with DAH, and should rapidly be treated with ribavirin. Another very important factor which should always be borne in mind is the contagious character of the CCHF virus. It is one of the most dangerous microorganisms transmitted from person to person. Even the bronchoscopes contaminated with patient blood carry a high risk for nosocomial spread to medical staff and other patients.

Pyomyositis mimicking leptospirosis: two cases in a Brazilian tertiary care hospital in a non-tropical area

Luz, L. P., Dora, J. M., Goldani, L. Z. — 2008-09-26

Pyomyositis is a subacute, deep suppurative bacterial infection of skeletal muscle not arising from contiguous infection. It is presumably haematogenous in origin, and characterized by muscle pain and swelling. We report on two patients who presented with pyomyositis in a tertiary care hospital in temperate region located in southern Brazil with a clinical presentation, which was initially suggestive of leptospirosis. This report discusses the pathogenesis, clinical presentation, diagnosis and management of pyomyositis. Physicians living in non-tropical areas should note that pyomyositis might occur in those areas, and its initial clinical presentation may be similar to leptospirosis

Primary amoebic meningoencephalitis: a new case from Venezuela

Caruzo, G., Cardozo, J. — 2008-09-26

Primary amoebic meningoencephalitis (PAM) is not often seen. To date, less than 300 cases have been communicated to the medical literature since the disease was first discovered in 1965. Six of these reports originated in Venezuela. The authors describe a new spontaneous case of PAM in a 33-year-old previously healthy Western-Venezuelan man.

Childhood epilepsy and school absence

Ibekwe, R. C, Ojinnaka, N. C — 2008-09-26

Epilepsy is one of the most common diseases encountered among school children. Its effect on school attendance and academic performance is a major cause of concern to both parents and clinicians. In this communication, the absence rate and academic performance of 50 school children with epilepsy attending normal schools was compared with that of their age- and sex-matched classmates using the class attendance register and overall score of the 2001/2002 academic year. The mean and standard deviation of the number of days an epileptic child was absent in the 2001/2002 session was 15.3 + 13.8 days while that of the controls was 9.4 + 9.6 days (x2 = 3.4,df = 49, p < 0.001). There was no significant relationship between the rate of absenteeism and overall score among both epileptic children (x2 = 6.34, df = 2, p = 0.18) and the controls (x2 = 1.43, df = 2, p = 0.49). School absenteeism was therefore more common among epileptic children, though there was no observed negative effect of this increased absence on academic performance.

Unforeseen difficulties faced by a hospital in dealing with mass disaster victims

Dhar, S. A., Hamid, A., Khan, S. M. S., Butt, M. F. — 2008-09-26

Every major mass disaster challenges the health care services, especially in the third world. These challenges include the expected situations mainly pertaining to the overload of patients and the stretching of hospital facilities. We report our experiences about several unforseen challenges faced by our hospital in the 2005 earthquake that struck the Kashmir region.

Malabsorption in wasting HIV disease: diagnostic and management issues in resource-poor settings

Isaac, R., Alex, R. G, Knox, T. A — 2008-07-15

A risk assessment for pregnancy using the World Health Organization classifying form in primary health-care facilities in Enugu, Nigeria

Aniebue, U U, Aniebue, P N — 2008-07-15

We present a cross-sectional survey of the pattern of high-risk pregnancies in randomly selected primary health-care facilities in Enugu, Nigeria, using the World Health Organization's classifying form. None of the 10 maternity homes studied had a standard risk screening tool. The age of the 299 women studied ranged from 16 to 42 years with a mean of 27.8 ± 6.7 years. Eighty-eight (29.4%) of them were nulliparous, 160 (53.5%) were multiparous and 51 (17.1%) grandmultiparous. One hundred and twenty (40.1%) respondents were in the high-risk category. Rhesus D-negative blood group parturients (42, 35.0%), previous perinatal deaths (29.2%) and multiple pregnancies (9.2%) were the most common risk factors. The prevalence of high-risk pregnancies significantly increased with maternal age and parity and was not influenced by an improved maternal educational attainment. The institution of screening for high-risk pregnancies is vital at the primary health-care level and must be emphasized and must be regularly audited.

Baseline assessment of collaborative tuberculosis/HIV activities in Kinshasa, the Democratic Republic of Congo

2008-07-15

Ninety-two clinics were surveyed in 2005 as part of a baseline assessment of HIV activities in Tuberculosis (TB) clinics in Kinshasa, Democratic Republic of Congo. Some HIV activities were implemented in 58% of TB clinics. The majority of health had ≥ 1 health care worker (HCW) trained in either HIV counseling or testing (71%). Fifty-three clinics offered counseling and testing to TB patients; twenty-two (42%) routinely offered HIV CT to all patients, while others used selective criteria. While most offered on-site counseling (92%) and testing (77%), not all 53 clinics had a HCW trained in counseling and only 31 had access to a counseling room. Cotrimoxazole prophylaxis was offered in 51% of clinics; antiretroviral treatment in 17%. Shortcomings in human resources, infrastructure and quality of services were revealed. Strengthening those clinics already implementing HIV activities could be prioritized to achieve the goals set forward by the Global Plan to Stop TB.

Rotational rural surgery for the poor in developing countries

2008-07-15

Radio and television announcements advised patients with surgical problems in the rural areas of Osun State, Nigeria, to report at any of the nine zonal headquarters of the state which were closest to their homes in order to receive free treatment. Over 1000 patients reported and 801 received operations on a rotational basis within nine weeks. We studied 719 of these patients, ages between 4 months and 87 years, who had detailed follow-up records. There were 14 different procedures ranging from a hernia repair to the separation of syndactyly. Complications included postoperative pain, haematoma and late superficial wound infection. We concluded that rotational free surgery can help the poor in the third-world countries to receive treatment that they would otherwise not be able to afford.

HIV and obstetric complications and fetal outcomes in Vellore, India

2008-07-15

Antenatal prevalence is more than 1% in parts of India, yet little is known about the complications and fetal outcomes in this region. We reviewed the records of 23,386 women who delivered at the Christian Medical College Hospital in Vellore, India from 2000 through 2002. HIV-infected women were more likely than HIV-uninfected women to have pregnancy-induced hypertension, anaemia, breech presentations, stillborn babies and fetal deaths. HIV-infected women who did not receive mother-to-child transmission prophylaxis or had breech fetal presentation were more likely to have fetal deaths (P = 0.001). HIV prophylaxis and optimal prenatal care should be a priority for HIV-infected pregnant women in resource-limited countries.

Exploring the pattern of complications of induced abortion in a rural mission tertiary hospital in the Niger Delta, Nigeria

Igberase, G O, Ebeigbe, P N — 2008-07-15

Unsafe abortion remains a major cause of maternal morbidity and mortality in developing countries including Nigeria. We report a 10-year descriptive review of 118 consecutive cases of complicated induced abortions. At our centre, complications of induced abortion constituted 2.3% of maternal admissions, 5.6% of gynaecological admissions and 22.6% of maternal deaths. Fifty-nine percent of the women were married and the mean age was 25.6 ± 7.9 years. Doctors performed 51.7% of the induced abortion and nurses performed 13.9%. Of the mortalities, medical doctors did 61 of the abortions in which 18 died (29.5%); traditional medical practitioners were responsible for 13 of the abortions in which two died (15.4%); of the 16 abortions performed by nurses, two died (12.5%). Sepsis was the most common cause of death (73%).

There is an urgent need to improve the knowledge and utilization of modern contraception by rural women in order to prevent unwanted pregnancies. Doctors need to be continuously trained inn the basic principles of postabortion care.

Non-doctor anaesthesia in Nepal: developing an essential cadre

Zimmerman, M., Lee, M., Retnaraj, S. — 2008-07-15

Nepal is a mountainous country of 27 million people where the widespread lack of access to operative services is a major cause of morbidity and mortality. One critical reason for this is the lack of trained, appropriately distributed anaesthesia providers. We discuss the evolution of the ‘anaesthesia assistant’ in Nepal, review the international literature concerning the development of non-doctor anaesthetists, and invite links with others working in this field.

Traditional medicine, delays and hospital mortality of children under five years of age in the rural district of Kigoma, western Tanzania: an observational hospital-based study

Blanke, C. H, Naisabha, G. B, Lange, C. R — 2008-07-15

The use of traditional medicine in the treatment of 596 children aged 0–60 months before admission was common (41.4 %). Children were more likely to die if they had first been treated with traditional medicine (50/244; 20.5% vs 29/342; 8.5%) or were younger (median 9 vs 12 months old.) Children who had received traditional medicine were younger (median 11 vs. 13 months), came later for hospital treatment (median three vs. five days), had a longer journey on foot to reach the health centre (3.4 vs. 2.9 h), and died from common diseases and not from an obvious toxic syndrome.

The proctoscope

Ray, D. — 2008-07-15

A cheaper version of a self-illuminated proctoscope which suitable for use in developing countries designed for diagnosis and intervention in anorectal diseases is described.

Histopathology slide projector a simple improvisation

Agarwal, A. K., Bhattacharya, N. — 2008-07-15

The ability to examin histopathology and other hematological slides under microscope is a necessary and important service which should be available in every health facility. The slides need to be projected on to a screen. We describe an inexpensive and eaily constructed technique for projecting magnified images of slides using a simple microscope. It is effective both for making observations and for use as a teaching aid.

Hyponatraemia and hypokalaemia in adults with uncomplicated malaria in Thailand

2008-07-15

In a retrospective study of 1415 patients aged 15 and over, we determined the incidence of clinically important hyponatraemia and hypokalaemia in adults with uncomplicated malaria. On admission, serum concentrations of sodium (135–145 mmol/L) and potassium (3.5–5.0 mmol/L) were found outside these reference ranges in 81% of patients. Severe hypokalaemia (K+ <3.0 mmol/L) and severe hyponatraemia (Na+ <125 mmol/L occurred in 4.4% and 0.6% of the patients, respectively. For hypokalaemia (43%) and hyponatraemia (37%), hypovolaemia, blood urea to creatinine ratio and high serum glucose (>100 mg/dL) were all independent factors (P < 0.001). Other independent predictors for hypokalaemia were Plasmodium vivax infection, female gender; and for hyponatraemia, P. falciparum infection, male gender, concentrations of G-6-PD and serum bicarbonate.

Prevalence of depressive symptoms among Nigerian medical undergraduates

Aniebue, P N, Onyema, G O — 2008-07-15

This study assessed the epidemiology of depressive symptoms in Nigerian medical students. A cross-sectional study of 262 medical students from University of Nigeria, Enugu campus, one of the foremost medical schools in Nigeria was studied. Data were collected using structured self-administered questionnaires and the Zung self-rating depression scale developed by Zung as an instrument, which measures the subjective experience of depression. The age range of students was 16–30 years. The prevalence of depression among the students was 23.3%. Students aged 16–20, females, and those who had a professional examination during the period of the study had higher levels of depression, although these findings were not significant. However, students who smoked regularly had significantly higher levels of depression than those who did not smoke. Medical educators in Nigeria need to be aware of the vulnerability of medical students to depression.

World Health Organization Clinical Stage 3 disease conditions in HIV-infected patients who start antiretroviral therapy in Malawi

Ngoma, D., Makombe, S. D, Kamoto, K., Harries, A. D — 2008-07-15

There is little information about disease conditions that are diagnosed in patients diagnosed as having World Health Organization Clinical Stage 3 HIV who are started on antiretroviral therapy (ART) in Africa. We therefore conducted an audit in the central region of Malawi of patients registered for ART between January and September 2006. There were 4299 patients in Stage 3 of whom 4154 had data about their disease conditions. Only one condition was listed for 3880 patients. Of these, 1892 (48.8%) had unexplained weight loss, chronic fever or chronic diarrhoea, 822 (21.2%) had active/previous tuberculosis (TB) and 671 (17.3%) had a severe presumed bacterial infection. No patient was diagnosed as having haematological abnormalities. Nearly half the patients started on ART had a symptomatic, unspecified disease, (which may be obscuring important pathologies such as TB) and almost no laboratory assessment had taken place before the commencement of ART. These two areas need to be addressed in order to improve the management of patients starting on ART.

Quality of life for families with spina bifida in Kenya

2008-07-15

Spina bifida (SB) affects children worldwide. Studies from developed nations have explored the impact of SB on the quality of life of children and their parents. However, there are no such studies available from developing countries. We have therefore undertaken to document the impact of the disability on the families of affected children in Kenya. A questionnaire was administered to 40 mothers and their children, who were receiving treatment for SB at our institution. The results of this study should indicate where community and governmental resources and educational efforts for the disabled should be directed.

An audit of obstetric fistulae in a teaching hospital in South Africa

Ramphal, S R, Kalane, G, Fourie, T, Moodley, J — 2008-07-15

Obstetric fistulae are still common in the rural areas of South Africa. This study describes the demographic and clinical characteristics of 41 women with obstetric urinary fistulae. All were from poor socioeconomic backgrounds and had limited or no access to antenatal care.

Postmortem trucut transnasal brain biopsy in the diagnosis of encephalitis

Sudarsanam, T. D., Chacko, G., David, R. D. — 2008-07-15

Diagnosing encephalitis is often difficult with a definitive diagnosis being reached at best in only 40% of cases. This clinical condition is associated with a high morbidity and mortality. A brain biopsy is the gold standard for the diagnosis of this disease. However, this procedure is rarely done, resulting in the cause of death being largely speculative. We propose a simple procedure for postmortem brain biopsy through the transnasal transcribriform route that will possibly be more acceptable to clinicians and relatives alike due to lack of external disfigurement, relative ease of the procedure and economy of time and manpower. This could also prove to be of immense benefit in an epidemic of encephalitis, especially in remote areas.

Haemolytic uraemic syndrome in children admitted to a rural district hospital in Kenya

Olotu, A. I., Mithwani, S, Newton, C R J C — 2008-07-15

We studied children admitted to Kilifi District Hospital, Kenya, between 1997 and 2005 with haemolytic uraemic syndrome (HUS) and reviewed their records in order to determine the clinical features and outcomes of the disease. Thirty-one children fulfilled the criteria: 21 (68%) had diarrhoea-associated HUS (D + HUS), the remainder did not (D-HUS); five had involvement of the central nervous system. Those with D-HUS had lower haemoglobin and platelet counts when compared with those with D + HUS. The overall mortality rate was 55% (17/31) with no significant difference between the two groups. Severe hyponatraemia ([Na⁺] <120 mmol/L) predicted a poor outcome. Shigella dysenteriae was the most common isolated organism in the stool and Escherichia coli and S. dysenteriae were the most common blood isolates. HUS carries a high mortality rate and D-HUS is as common as D + HUS.

Frontoethmoidal meningoencephalocoele repair in Cambodia: outcomes and cost comparisons

2008-07-15

In Cambodia, spina bifida is rare, but frontoethmoidal meningoencephalocoeles (MECs) are common. Mean life expectancy for patients with congenital MECs may be <20 years, but the complex treatment required has not been available in the country until recently. During visits by combined neurosurgical/craniofacial teams from both Germany and France, a method of repair has been developed that is suitable for the local conditions, affordable and has allowed Cambodian surgeons to learn how to successfully treat MECs. The surgical technique and initial results with 30 patients have been described in a previous publication. This paper presents the outcomes of 128 cases and illustrates that it is cost-effective for these patients to be treated in Cambodia.

The unreported morbidity of suicidal poisonings during an insurgency: a 16-year Kashmir experience

Wani, Z. A., Dhar, S. A., Hussain, A., Qureshi, W. — 2008-07-15

Around a million people commit suicide, and at least 10 times this number attempt suicide, worldwide every year. No nationwide epidemiological studies have been undertaken in India but a significant rise in suicides has been observed in Kashmir in recent years. This study was carried out on patients reporting to the Government SMHS Hospital in Srinagar with a history of suicidal poisoning.

Prevalence of opportunistic infections in AIDS patients in Mangalore, Karnataka

Saldanha, D., Gupta, N., Shenoy, S., Saralaya, V. — 2008-07-15

A study was conducted to determine the prevalence of opportunistic infections in HIV-seropositive patients at Kasturba Medical College Hospital, Mangalore. Three hundred and seven HIV-positive patients were screened for various opportunistic pathogens. Tuberculosis was the most common infection followed by candidiasis, cryptosporidiosis and cryptococcal meningitis.

Paralytic poliomyelitis during the pre-, peri- and post-suspension periods of a polio immunization campaign

Lamina, S, Hanif, S — 2008-07-15

A total of 744 paralytic poliomyelitis patients (0–59 months old) were reviewed and results showed a critical and perpetual surge during 2003 (20.2%), 2004 (27.4%) and 2005 (41%). A slight male predominance (56%) was reported and a high incidence was reported in the low socioeconomic (68.3%) and urban setting (60.3%) groups. It was concluded that the polio eradication campaigning programmes in Nigeria had not been successful and that legislation on poliomyelitis was required.

Clinico-laboratory findings of patients during dengue outbreak from a tertiary care hospital in Delhi

2008-07-15

There are outbreaks of dengue every year in India. They vary in the predominant serotype involved, clinical features and predominant laboratory findings. This study of the 2006 outbreak in Delhi highlights clinical features and laboratory parameters of dengue cases and compares the clinical features among the adult and paediatric age groups. The 2006 outbreak had higher bleeding manifestations and a greater involvement of the adult male population than in previous outbreaks. No correlation was observed between platelet count and different bleeding manifestations until they dropped <20,000 per µL. Few patients developed a florid picture before seroconversion, highlighting a greater stress on the haematological rather than immunological profile of such patients. Atypical symptoms, such as diarrhoea, menorrhagia and seizures were often the presenting complaints rather than the typical clinical features of dengue.

Neurocysticercosis in a north Indian hospital

Mohanty, S., Deb, M., Aggarwal, P. — 2008-07-15

In endemic regions, neurocysticercosis (NCC) is the most commonly diagnosed parasitic disease of the central nervous system, and the most common cause of convulsions and hydrocephalus in adults. During January 2000–December 2006, serum samples collected from patients presenting with various manifestations with a clinical diagnosis of cysticercosis and/or relevant computed tomography findings were subjected to an enzyme-linked immunosorbent assay test for NCC. Anti-cysticercus antibodies were detected in 155 of the 1096 (14.1%) cases. Generalized seizure (33.9%) was the most common presenting symptom. Solitary lesion (74.2%) was the most common radiological finding. This study provides an assessment of the epidemiology of NCC in Delhi and stresses the need for its prevention.

Intra-family transmission of Vibrio cholerae during a cholera epidemic in rural south-southern Nigeria

Udonwa, N. E, Udoh, S. M, Ikpeme, B., Andy, I. — 2008-07-15

The sixteen-year trend of syphilis in Turkey: data from blood donors

Oncul, O., Emekdas, G., Cavuslu, S., Artuk, C., Aksoy, A. — 2008-07-15

This study was conducted in order to determine the prevalence and trends of antibodies to syphilis among Turkish blood donors (BDs) at the 22 National Blood Transfusion Service, Kizilay, between 1989 and 2004. Among the 6,240,130 BDs, a reactive result was obtained with the rapid plasma reagin test for 6864 donors (0.11%). A serious increasing trend was observed between 1989 and 1992 (41/100.000 versus 92/100.000 cases, P = 0.003, CI 95, 33–107), in 1998, the rates were observed to have increased approximately 4.01 times compared with that of 1989 (41/100,000 versus 168/000,000, P = 0.001, CI 95, 28–183). After 2002, syphilis seropositivity showed a marked decreasing trend (P = 0.002, CI 95, 36–118). However, as this survey shows, the rate of seropositive donors for syphilis has been greatly reduced but it is believed that a more thorough management strategy is necessary in order to cause a further reduction in Turkey.

Seroprevalence of human immunodeficiency virus among blood donors in a rural Ethiopian Hospital

Ramos, J. M., Reyes, F., Tesfamariam, A. — 2008-07-15

We describe our experience of the HIV seroprevalence among blood donors in a rural general hospital in Ethiopia during an eight-year period (January 1998–December 2006). From 3305 blood donors screened, 51 (1.4%) were positive for HIV antibodies.

Predictors of survival in very low birth weight infants at the University Hospital of the West Indies, Jamaica

Trotman, H, Lord, C — 2008-07-15

The use of prenatal steroids is an effective, simple clinical intervention that can be implemented in developing countries to help decrease mortality in very low birth weight infants.

Visceral leishmanisis in paediatrics: a study of 367 cases in southwest Iran

Ashkan, M. M., Rahim, K. M. — 2008-07-15

Kala-azar (visceral leishmaniasis [VL]) is endemic in southern Iran. We retrospectively evaluated 367 infants and children suffering from VL at hospitals affiliated to the Shiraz University of Medical Sciences in Fars Province, southwest Iran). Seasonal variations were observed with more cases presenting in late winter, spring and fewer in summer. The predominant clinical features in these patients were chronic fever, pallor, weight loss, abdominal distention and hepatosplenomegaly. Lymphadenopathy was less common. Common laboratory abnormalities included anaemia, leukopenia, thrombocytopenia, hypoalbuminaemia and hypergammaglobulinaemia. Liver function tests were deranged in two-thirds of the patients. The immunofluorescence antibody test was positive in all patients and all of them had a positive bone marrow smear or a culture for Leishmania donovani. Patients responded well to glucantim therapy with a cure rate of 96.7%. Relapse was observed in 8.2% (30). Mortality in this series was 7.3%. Twenty patients died during their therapy period. Jaundice and grossly deranged liver function tests were found to be bad prognostic signs.

Accidental childhood fatalities in Manipal, India

Kanchan, T., Menezes, R. G — 2008-07-15

Children in the first decade of life are extremely vulnerable to accidents. Seventy-five cases of accidental deaths in children aged less than ten years were identified in a retrospective review of medicolegal autopsies during 1993–2006 in Manipal, India. Boys were more likely to suffer accidental death that girls (male–female ratio 2.3:1). Road traffic accidents accounted for the majority of the deaths (56%), followed by burns (21.4%).

Caesarean myomectomy in Aba, southeastern Nigeria

Umezurike, C. C — 2008-07-15

Bullous erythema multiforme after treatment with Malarone(R), a combination antimalarial composed of atovaquone and proguanil hydrochloride

Remich, S. A, Otieno, W., Polhemus, M. E, Ogutu, B., Walsh, D. S — 2008-07-15

We report on a Kenyan woman who developed bullous erythema multiforme, in association with Malarone treatment.

Clinical analysis of 52 cases of neurocysticercosis

Chaoshuang, L., Zhixin, Z., Xiaohong, W., Zhanlian, H., Zhiliang, G. — 2008-07-15

We studied 52 cases of neurocysticercosis from January 1991 to December 2006 in order to increase our understanding of the diagnosis and treatment of the disease. The majority of patients were between 18 and 45 years old (78.8%). Men were more subject to the disease than women. The urban population was more at risk than the rural population. The treatment involved the use of mannitol, dexamethasone and oral administrations of albendazole or praziquantel. The effectiveness rate was 57.7% (30), the improvement rate was 28.8% (15), and the inefficacy rate was 14.0% (6). Neurocysticercosis was easy to misdiagnose. Praziquantel and albendazole are effective drugs for neurocysticercosis.

From home delay to institutional neglect: an emerging trend in obstructed labour

Abiodun, O M, Aboyeji, A P — 2008-07-15

Analysis of 146 patients managed for obstructed labour at a referral tertiary hospital in South West Nigeria shows that labour became obstructed in a lower cadre health facility among majority (76.7%) of the women. This calls for improved maternity service delivery in our locality.

Prolactin and alternative medicines: a word of caution

Kannan, S., Mahadevan, S., Sathya, A., Sriram, U. — 2008-07-15

Professor Eldryd Parry Chairman, Tropical Doctor Editorial Board (1986-2008)

Molyneux, M. — 2008-04-01

Chikungunya: a review

Jain, M., Rai, S., Chakravarti, A. — 2008-04-01

The Chikungunya virus (CHIKV) is a mosquito-borne Alphavirus, which causes epidemics of fever, rash and polyarthralgia in Africa and Asia. First isolated in 1953 in Tanzania, CHIKV has caused numerous well-documented outbreaks and epidemics in both Africa and South-East Asia. The epidemic of Chikungunya fever that affected the population of La Reunion at Christmas in 2005 will be remembered as the most serious public health crises in the island's history. A widely circulating mutant CHIKV is a possible explanation for the epidemiological pattern of the disease in this region. In this review, we have tried to give the latest information about the present outbreak and have tried to analyse the possible reasons for the same.

The prevalence of congenital malaria among neonates with suspected sepsis in Calabar, Nigeria

Ekanem, A D, Anah, M U, Udo, J J — 2008-04-01

We studied the prevalence of congenital malaria among neonates with suspected sepsis and its outcome at the University of Calabar Teaching Hospital, Calabar, Nigeria. All in-born neonates admitted to the newborn unit with clinical features suggestive of sepsis were recruited. They were screened for bacterial sepsis and malaria. The mothers of the neonates that had parasitaemia were further screened for malaria and anaemia.

A total of 546 in-born neonates were admitted to the neonatal unit and 202 (37%) presented with clinical signs suggested of sepsis. Of these, 71 babies (35% of 202 or 13% of the total in-born nursery admissions) had congenital malaria and 14 also had sepsis. Sixty-three (88.7%) of the parasitaemic babies were delivered by mothers who received antenatal care at our centre. Eighty-six percent of the mothers of the 71 babies also had the malaria parasite in their blood. The majority (67%) of the 71 mothers were gravidae 2 and below. Thirty (42.3%) of the affected neonates were anaemic and 5 (7%) of them required a blood transfusion.

Congenital malarial is not uncommon in Calabar among babies with suspected sepsis. It appears that the antenatal chemoprophylaxis with pyrimethamine (25 mg weekly) currently used for malaria in our centre no longer protects the mother and fetus. An alternative is needed in order to stem maternal, fetal and neonatal morbidity and wastage. Babies with features of sepsis should be routinely screened for malaria.

Causes of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu, Nigeria

Nwankwo, O. E. — 2008-04-01

Gas gangrene (clostridial myonecrosis) is rarely seen and this rarity, coupled with its dramatic presentation and often devastating outcome, makes each case of gas gangrene a spectacular and memorable experience. This study analyses the cases managed, the causes and outcome. Gunshot wounds, compounded by late presentation with its accompanying florid infections, were seen as the causes in 14 cases of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu during the four-year study period from July 2000 to June 2004.

An overnight sedimentation method: improving the diagnosis of tuberculosis when electrical centrifuge is not available

Rasheed, M U, Dechu, T. — 2008-04-01

An experimental comparative study was conducted in order to compare the positivity pattern of sputum microscopy using the direct and overnight sedimentation Ziehl-Neelsen (ZN) smears, direct and NaOCl pretreated centrifuged ZN smears and overnight sedimentation and NaOC1 pretreated centrifuged ZN smears methods. We examined 660 sputum smeared slides for the presence of acid-fast bacillus from 220 sputum samples. Compared with the direct microscopy method, positivity increased by 91.1% after centrifugation (P < 0.001, ² = 18.27) and by 71.1% after overnight sedimentation (P < 0.001, ² = 11.61). No statistical significant difference was observed between the results of two different concentration techniques (P > 0.05, ² = 0.789).

The application of overnight sedimentation (in a laboratory without electricity) and/or the centrifugation technique could make a positive impact on the effectiveness of national tuberculosis control programmes.

The role of antibiotic prophylaxis in mesh repair of primary inguinal hernias using prolene hernia system: a randomized prospective double-blind control trial

Jain, S K, Jayant, M, Norbu, C — 2008-04-01

Antibiotic prophylaxis is being commonly used in mesh repair of inguinal hernia but its role has been questioned in a recent Cochrane analysis performed in 2003. Routine use of antibiotic prophylaxis in mesh repair of inguinal hernia can lead to bacterial resistance and increase in cost. In a present double-blind placebo controlled trial involving 120 patients undergoing inguinal hernia repair using prolene hernia system, we did not find any benefit of the routine use of antibiotic prophylaxis in terms of wound infection rate.

Assessment of the therapeutic efficacy of chloroquine in the treatment of uncomplicated Plasmodium falciparum malaria in a tribal block of the Kalahandi district of Orissa, India

Kerketta, A S, Mohapatra, S S S, Kar, S K — 2008-04-01

The study on therapeutic efficacy of chloroquine was carried out in a tribal dominated block of Kalahandi district of Orissa, India. It revealed 94% treatment failure with standard dose of chloroquine in the treatment of uncomplicated P. falciparum malaria cases. The study warrants the change to alternate antimalarials in this region.

The use of the condom-catheter for the treatment of postpartum haemorrhage - the Sokoto experience

Airede, L. R, Nnadi, D. C — 2008-04-01

Postpartum haemorrhage (PPH) is the most common cause of maternal mortality globally. In about 50% of cases PPH is due to uterine atony. When conservative and medical methods of treating PPH due to uterine atony fail, surgical intervention is required to save the woman's life. As an alternative in such cases, intrauterine tamponade has been used successfully to stop bleeding, thus avoiding surgery. We report four cases of PPH due to uterine atony in which intrauterine tamponade with an inflated condom was effective in arresting haemorrhage. We advocate the use of a similar device in carefully selected cases, especially in low-resource settings.

Child maltreatment at a violence recovery centre in Kenya

Saidi, H., Odula, P., Awori, K. — 2008-04-01

Kenyan media reports indicate escalating levels of child maltreatment, but the characteristics of the offence are undefined. At the Gender and Violence recovery Center of the Nairobi Women's Hospital, we analysed 342 consecutive children for age, gender, perpetrator characteristics, time and scene of assault and the nature of injuries between February 2003 and April 2004. The children comprised 43.5% of all assault survivors. The mean age was 10.0 years and about 20% of the children were ≤5 years. Most (71.5%) of the child sexual abuse (CSA) was perpetrated by people known to the victim. Intra-family CSA (incest) was highest among the one to five year olds. The proportion of assaults committed against boys reduced with the age of the child. Older children were more likely to be assaulted later in the day and by multiple perpetrators. Most recorded injuries were perineal. The majority of children are assaulted by people they had trusted. The epidemiological correlates of maltreatment differ for younger and older children. More effort is needed to further characterize child violence and protect this vulnerable section of the population.

Epidemiological shift, seasonal variation and antimicrobial susceptibility patterns among enteric fever pathogens in south India

2008-04-01

Between January 2005 and December 2006, a higher incidence of paratyphoid fever (53.8%) compared to typhoid fever (44.9%) has been observed at a tertiary hospital in South India. A definite seasonal pattern of incidence is seen in paratyphoid fever (peak incidence during October–December, i.e., post monsoon period) but not in typhoid fever. Decreased fluoroquinolone susceptibility is much higher in S. Paratyphi A (98.8%) as compared to S. Typhi (46.5%). These findings are of importance in therapeutic decision making, development of vaccination strategies and implementing public health measures for disease control.