Open Access Case Study

Pyo-adipocytolytic –Necrolysis Subcutis and Pan-necrotizing Subcutis: Unusual Dermato-Pathological Entities, Complications of Injection Abscess Given by Unskilled Personnels- Management and Outcome

Mukoro Duke George

International Journal of TROPICAL DISEASE & Health, Page 1-11
DOI: 10.9734/IJTDH/2017/38284

Injection abscess are becoming common complications seen in sub-Saharan Africa. The abscess may further become a root for unusual dermato-pathological clinical findings when they are not initially managed properly. Pyo-adipocytolytic-necrolysis subcutis and Pan-necrotizing subcutis were unusual subcutaneous pathologies that emanate from unsafe injections in the clinical reported cases seen in a child and a 3rd trimester pregnant woman. The terms describes the extensive complications arising from extension of injection abscess, as a result of inoculation of antibiotics low sensitive and resistant Staphylococcus sp and Proteus sp during intramuscular injections. Catalyst to the pathogenesis including lack of handwashing, lack of swabbing of injection site with antiseptics before procedure, poorly selected anatomical locations, reusing unclean disposable gloves. The retrospective review  revealed  some observational finding that affirm the pathological terms which can be used by clinicians to identify these entities such as adipocytolysis, abscess local invasiveness, distant metastasis of necrolysis and recurring  pathology from site of injection abscess, Pan-Adipo necrolysis of the subcutaneous layer. The presence of these entities usually occur on background of immunosuppression as in pregnancy and in severe acute malnutrition as seen in the reviewed  cases. Their prognosis is favorable when adequate and high quality nutrients are available, aseptic incision and drainage, highly sensitive and specific antibiotics, protocols for injection are duly followed and psychosocial support is available.

Open Access Original Research Article

A Study of Neonatal Mortality in a Specialist Hospital in Gusau, Zamfara, North-Western Nigeria

B. I. Garba, A. S. Muhammad, B. A. Mohammed, A. B. Obasi, A. O. Adeniji

International Journal of TROPICAL DISEASE & Health, Page 1-6
DOI: 10.9734/IJTDH/2017/38337

Introduction: The first 28 days of life is a critical time for survival of any child; more than 4 million newborns die yearly within the first four weeks of life with 3 million of these deaths occurring in the early neonatal period. Nigeria’s neonatal mortality rate is the highest in Africa and second highest in the world.

Objectives: This study was done to determine the causes of neonatal mortality and mortality rate among newborns admitted to the special care baby unit (SCBU) of a specialist hospital in Gusau, Zamfara State, Nigeria.

Materials and Methods: A retrospective descriptive study of causes of mortality among newborns admitted into the SCBU over a three year period. The case notes of all mortalities were reviewed and data on place of birth, age on admission, diagnosis and duration of hospital stay were extracted.

Results: A total of 853 neonates were admitted, of which 20.4% died. Males predominated (56.9%) and 56.3% died within the first 24 hours. The leading causes of death were birth asphyxia 65(37.4%), prematurity 45(25.9%) and neonatal sepsis 42(24.1%). Odds of mortality when born outside the hospital was not significant when compared with those born inside the hospital (OR=1.26, 95% CI= 0.86-1.85, P=.22).

Conclusion: The mortality rate observed in this study was high, majority occurred within the first 24 hours of life and attributable to preventable causes. Health education on importance of hospital delivery by trained personnel with training of healthcare personnel on neonatal resuscitation is advocated is advocated.

Open Access Original Research Article

Assessment of Some Physico-chemical Properties and Bacteriological Status of Sachet Water Consumed in the Hohoe Municipality, Ghana

Eric Agboli, Emmanuel Egu, Margaret Kweku, Momodou Cham, Francis Zotor, Fred Binka

International Journal of TROPICAL DISEASE & Health, Page 1-8
DOI: 10.9734/IJTDH/2017/37744

Sachet water has become an important source of drinking water but little is known about bacteriological quality and quality control improvements with the rapid development of the industry. The study assessed the bacterial load and physical properties of sachet water sold in the Hohoe municipality of Ghana. The study was done in October 2016 and involved nine sachet water manufacturing sites within the municipality. Two (2) samples of each brand of sachet water were randomly selected from the manufacturing sites and the market. Therefore, a total of 36 sachet water samples were processed for Total Coliforms (TC) and Escherichia coli (EC) in colony-forming units (cfu) per 100 ml using membrane filtration method and Compact Dry EC media. Physical characteristics of the samples such as temperature, colour, odour, hydrogen ion concentration (pH), conductivity, and Total Dissolved Solids (TDS) were also investigated. The mean values for pH, Conductivity and TDS were 6.8, 41.7 µS/cm, 23.0 mg/L respectively.  Four (11.1%) samples with blinded labels AV4, EM1, FM1, and IV4 had TC of 5 cfu/100 ml each. Two (5.6%) samples with labels EM1 and FM1 had E. coli of 4 cfu/100 ml and 5 cfu/100 ml respectively. Colour was similar (5 HU) for all the samples with unobjectionable odour. Contamination with E. coli was statistically dependent on the growth of TC (P < .05). The presence of E. coli is an indication and presence of faecal elements in the sachet water. This is critical and various stakeholders should sensitize and monitor production of sachet water in the municipality and in the country, Ghana. Further study into causes of contamination is recommended.

Open Access Original Research Article

Clinical Profile and Outcome of Paediatric Severe Malaria in a North-Eastern Nigerian Tertiary Hospital

Iragbogie Al-Mustapha Imoudu, Hayatu Ahmad, Maimuna O. Yusuf, Tijjani Umara, Yusuf Y. Oloriegbe

International Journal of TROPICAL DISEASE & Health, Page 1-9
DOI: 10.9734/IJTDH/2017/38818

Aims: The following cross-sectional study is performed to describe the clinical manifestations and outcome of severe malaria among children admitted into the Federal Medical Centre Azare, Nigeria.

Study Design: The study was a cross-sectional study.

Place and Duration of Study: The study was conducted at the Department of Paediatrics, Federal Medical Centre, Azare, Bauchi state, Nigeria from 1st August to 31st October 2013.

Methodology: Children aged 6 months to 12 years diagnosed with severe malaria were consecutively recruited from the Emergency Paediatric Unit. The information obtained included age, sex, weight, presenting complaints and associated symptoms. Elicited clinical signs, as well as the outcome were also documented. The data was analysed using SPSS version 16.0.

Results: Ninety- eight patients diagnosed with severe malaria were recruited into the study. There were 57 (58.2%) boys and 41 (41.8%) girls giving a male to female ratio of 1.4: 1. The mean age of the patients was 4.2± 2.8 years, with a median and modal age of 3 years. Ninety patients (91.8%) survived and were discharged home while 8 died, giving a case fatality rate of 8.2%. Cough (P = .04), breathlessness (P = .001), reduction in urine output (P = .003), loss of consciousness (P = .01) and abdominal swelling (P = .03) were significantly more common in children aged 3 years and below. There were also statistically significant relationships between age and nutritional status (P =.03), hepatomegaly (P =.02), coma (P˂.001) as well as severe anaemia (P =.03). Six (6.1%) and 3 (3.1%) of the 8 deaths had convulsions and severe anaemia respectively. Nevertheless, binary logistics regression analysis showed that coma (P =.03) and dehydration (P =.02) were the most likely to predict death.

Conclusion: Prompt identification and management of fluid and electrolyte deficits may significantly reduce mortality in children with severe malaria managed at the Federal Medical Centre, Azare, Nigeria.

Open Access Original Research Article

Curbing Polypharmacy among Primary Health Care Workers: The Impact of an Educational Intervention

V. N. Omole, O. Audu, J. S. Ogboi, A. A. Gobir, F. Adiri

International Journal of TROPICAL DISEASE & Health, Page 1-9
DOI: 10.9734/IJTDH/2017/38452

Introduction: Polypharmacy, the concurrent prescription or use of multiple numbers of drugs per patient, has been identified as a significant channel of drug wastage in the health sector. Its habitual practice has been associated with lower cadres of healthcare workers, operating mainly at the grassroots or primary health care (PHC) levels.

Objective: To assess the impact of a two-phased educational intervention on the practice of polypharmacy amongst rural workers of PHC in Kaduna State, north-western Nigeria.

Methods: A quasi-experimental study design was employed in 2 Local Government Areas (LGAs)-one study and one control. A two-phase educational intervention was carried out in the study of LGA. Pre- and post-intervention audit and analysis of the prescription records of the selected facilities was done with SPSS version 20.0. A bi-variate analysis was carried out to test the relationship between the independent and outcome variables with p-value of 0.05 as the level of significance.  

Results: Both study and control facilities had baseline (pre-intervention) evidence of polypharmacy, with means (averages) of 4.3±1.56 and 3.85±1.14 drugs per patient, respectively (and ranges of between 1-13 drugs per patient and 1-10, respectively). This falls by about 43.5%, to an average of 3.26±1.19 and later, to 2.43±0.29 drugs per patient in the study group, following the first and second phases of the intervention, respectively (p<0.05). No statistically significant changes were observed in the control facilities.

Conclusions: Following the intervention, a significant improvement was observed in the prescribing pattern of the health workers in the study area, with regards to polypharmacy. This evidence emphasizes the place, priority, and potential of in-service training and continuous education of healthcare workers to promote the optimum level of practice and curtail unnecessary wastage of limited resources in the health sector, particularly in developing countries.