Open Access Case Study

Intestinal Tuberculosis in Surgical Pathology - Experience from a Tertiary Care Hospital

Sandhya V. Poflee, Balaji D. Baste, Radha P. Munje

International Journal of TROPICAL DISEASE & Health, Page 1-9
DOI: 10.9734/IJTDH/2016/20553

Background: Intestinal tuberculosis (ITB) represents the most common type of abdominal TB. Definitive diagnosis of intestinal tuberculosis is made on the basis of morphological examination of surgical specimens in majority of cases as clinico-radiological features are non-specific in initial stages of the disease.

Aims: To analyze the surgical pathology data on intestinal tuberculosis of the hospital and to document findings of morphological examination.

Setting: A descriptive study of intestinal tuberculous lesions encountered in surgical specimens received during a period of three years in the histopathology section of a tertiary care hospital.

Materials and Methods: 40 cases of intestinal tuberculosis out of 250 consecutive, surgically excised specimens of small and large bowel were included in this study. One year retrospective and two years prospective data is included in the study.

Results: Intestinal obstruction was the most frequent clinical presentation followed by perforation peritonitis in ITB cases in this series.9 patients had past history of pulmonary and/or intestinal tuberculosis. Out of 31patients without past history of TB, 25.80% were suspected of having TB preoperatively on the basis of clinical and imaging findings. Ileal and ileo-caecal region was most frequently involved. The three gross morphological forms of tuberculous enteritis seen were ulcerative in 82.5%, ulcero-hypertrophic in 15% and hypertrophic in 2.5 %cases. Characteristic caseating granulomas were seen in 60% cases.

Conclusion: Changes in clinical presentation of Intestinal TB are being observed. High index of suspicion is needed at every step of diagnosis of intestinal TB as many non-tuberculous lesions share same clinical and radiological findings.

Open Access Case Study

Anthrax Outbreak Investigation among Humans and Animals in Northern Ghana: Case Report

John Koku Awoonor-Williams, Paschal Awingura Apanga, Maurice Anyawie, Thomas Abachie, Stephen Boidoitsiah, Joseph Larbi Opare, Martin Nyaaba Adokiya

International Journal of TROPICAL DISEASE & Health, Page 1-11
DOI: 10.9734/IJTDH/2016/22359

Background: Anthrax is a bacterial infection that affects both animals and humans. It is caused by gram positive bacterium, Bacillus anthracis. It is an acute, specific infectious disease of mainly grass eating animals including cattle, sheep, goats and pigs and common in areas where livestock are raised. It affects humans when exposed to the fur, blood or carcass of an infected animal. A single case of anthrax in any given geographical area has the potential to result in an outbreak in both humans and animals if not handled effectively and in a timely manner. Anthrax disease occurrence is irregular in the northern regions of Ghana with yearly outbreaks.

Case Presentation: We report an outbreak investigation of anthrax in both humans and animals in April, 2013. The outbreak was from Gbengo community in the Bawku West district of Upper East Region of northern Ghana. There were three human deaths due to this particular outbreak, representing a case fatality rate of 0.032 (per 1000 of a total district population 94,034). Laboratory confirmed anthrax (Bacillus anthracis) with a very high case fatality rate (100%) also affected domesticated herbivorous mammals (17 cattle 3 sheep, 2 goats) of all ages and sexes.

Conclusion: The case revealed that anthrax outbreaks remain a major problem in northern Ghana with high case fatality rate. It also highlights the importance of forecasting anthrax outbreak. In response, public health action to anthrax control with continued public health programming to avert future outbreaks is needed. In addition, both health systems and veterinary services need to collaborate in anthrax surveillance for early case detection and response to prevent deaths.

Open Access Short Research Article

An Evaluation of Meningitis Surveillance in Northern Ghana

Paschal Awingura Apanga, John Koku Awoonor-Williams

International Journal of TROPICAL DISEASE & Health, Page 1-10
DOI: 10.9734/IJTDH/2016/22489

Introduction: Public health surveillance is a key strategy in controlling and preventing meningitis outbreaks especially in northern Ghana which continues to suffer yearly focal outbreaks. The aim of this study was to evaluate the performance of the meningitis surveillance system and to determine whether the surveillance system as established within the Ministry of Health is achieving its objectives.

Design: This was a cross sectional study conducted in the Talensi District between February and March, 2015. The study employed a qualitative method approach. Nine In-depth interviews (IDIs) and two Focussed Group Discussions (FGDs) were held with key informants involved in meningitis surveillance. Surveillance records for meningitis were also reviewed and analysed at community, sub-district, district and regional levels.

Results: The study revealed that the surveillance system was simple, flexible and highly accepted by healthcare workers. The system was fairly representative, stable with good data quality. However, it had a low sensitivity and a low positive predictive value in detecting/reporting cases of meningitis. Cerebrospinal fluid samples of suspected cases were timely presented to the public health reference laboratory. On the contrary, feedback of confirmation results was delayed. Also, lack of funding and motivation for surveillance activities, inadequate technical personnel to carry out lumbar puncture and unavailability of case definition at health facilities were system challenges that affected meningitis surveillance.

Conclusion: Relatively, some of the primary objectives of the surveillance system were met. However, we believe that motivation of the community-based surveillance volunteers, a construction of a regional public health laboratory and an effective training for healthcare workers would strengthen the surveillance system in northern Ghana. Consequently, adequate financial investment (especially through the government and other health-related international organisations) is required.

Open Access Original Research Article

Breast Cancer and Breast Self-examination: Awareness and Practice among Secondary School Girls in Nyarugenge District, Rwanda

Josephine Ndikubwimana, Jean Baptiste Nyandwi, Marie Françoise Mukanyangezi, Justin Ntokamunda Kadima

International Journal of TROPICAL DISEASE & Health, Page 1-9
DOI: 10.9734/IJTDH/2016/22601

Aims: To assess the level of early sensitization and education of adolescent high school girls in Rwanda about Breast Cancer (BC) and Breast Self-Examination (BSE) as one of strategic approaches to reduce the risk of late intervention and thence the BC related deaths.

Methods: 239 girls aged 17-20 years old, randomly selected from Nyarugenge secondary schools during the academic year 2013-2014 participated in this prospective cross-sectional survey using a structured self-administered questionnaire.

Results: Overall 94.6% of surveyed girls had heard about BC, but only few had limited knowledge about BC risk factors, diagnostic methods and BSE. Less than 24% practiced breast palpation and not more than 10% knew the correct frequency and technique of BSE performance. No formal education is planned in educational curriculum. The awareness was acquired through mainly media (58.4%) and classmates (17.2%), and lightly from parents (5.4%). The level of parents’ education, familial history of cancer and attendance to educational workshops may contribute to high alertness.

Conclusions: Evaluating the actual level of education given to adolescent high school students will help decision-makers drawing appropriate action. There is need to establish coordinated cooperation between parents, educators, and the media in dissemination of adequate information.

Open Access Original Research Article

Burden of Urinary Tract Infection (UTI) among Female Students: South Eastern Nigeria Side of the Story

Ani Ogonna Christiana, Odeta Nwamaka Perpetua, Onwe Sunday Obasi

International Journal of TROPICAL DISEASE & Health, Page 1-7
DOI: 10.9734/IJTDH/2016/22390

Aims: This study investigated the prevalence of infection, implicated bacteria species and antibiotics for better treatment of Urinary Tract Infection (UTI) among undergraduate female students of the Ebonyi State University Abakaliki, South East Nigeria.

Study Design: The study was a laboratory - based investigation.

Place and Duration of the Study: The investigation was carried out at the Applied Microbiology Laboratory, Ebonyi State University, Abakaliki, Nigeria between April and August 2014.

Methodology: Microscopy and culture of 150 urine samples of female undergraduates were carried out using standard methods to isolate bacteria causing UTI. Sensitivity tests were also conducted to identify susceptibility of the isolates to selected antibiotics.

Results: The results obtained showed that 117 (78%) out of the 150 females students screened were positive for significant (UTI). The micro-organisms isolated in order of prevalence included; E.coli (35.9%), Staphylococcus Spp (29.9%), Streptococcus spp (12.8%), Proteus spp (11.1%) and Pseudomonas aeruginosa (10.3%). Among the different antibiotics used against the isolates, ciprofloxacin was the most effective, followed by augumentin and gentamicin while the isolates were resistant to ampicillin and tetracycline.

Conclusion: The prevalence of UTI is high in the study population and females at the peak of their sexually active years are more prone to infection than the younger ones. Bacteriuria is therefore still an issue of serious public health importance in Nigeria. E. coli was implicated as the greatest causative agent of bacteriuria and ciprofloxacilin was the most sensitive antibiotic against the bacteria isolates. To successfully control the transmission and menace caused by UTIs, improvement of both personal and environmental hygiene and health education on the transmission and causes of this infection are recommended. Proper diagnosis and treatment of infected individuals with highly sensitive antibiotics such as ciprofloxacin, augumentin and gentamicin are also encouraged.