Clinical presentation and outcome of neurosurgical conditions at Butare Teaching Hospital, Rwanda

Background: Neurosurgical services have only been introduced in Rwanda recently. Consequently little information about spectrum of neurosurgical conditions in th country is available. This descriptive prospective study was aimed at determining the pattern, causes and outcome of management of neurosurgical conditions seen in Butare University Teaching Hospital (BUTH) in Rwanda.Methods: The study population consisted of 152 patients admitted at BUTH with neurosurgical conditions between October 1 2007 and May 31 2008. Patients were grouped into different neurosurgical conditions according to their clinical presentations. . Information collected included age, gender, cause and severity of injury, the time interval between injury Glasgow Coma Score, GOS scales were used to assess head injured patients.Results: The majority (70.4%) of patients came from rural areas. Their ages ranged from 15 days to 78 years with a mean of 31.98+/-18.75 years. The Male to female sex ratio was 2:1. Most (73.0%) of the patients suffered from trauma with 67.6% of them sustaining head injury and 32.4%, spinal trauma. Motor Vehicle crashes were the major cause of traumatic injuries (20% in spinal trauma and 70.7% of head trauma). Only 23% of the patients had CT scan performed. Only 12% of patients with traumatic brain injury (TBI) had CT scan.. A total of 78.7% of all head injuries were admitted in the first 24 hours following trauma. A significant number (44.4%) of spinal cord injury presented late (up to 7 days before referral to a neurosurgeon) and stayed longer in the hospital (52.7% up to 3 months). Laminectomy and fixation was the most common spinal operative procedure (58.7%) followed by discectomy (34.8%). The commonest cranial operation was for posttraumatic intracranial haemorrhage (41.4%) followed by surgery for depressed fracture (37.9%). One child had a shunt procedure for hydrocephalus. Good recovery was associated with GCS >13 on admission (P<0.001). The overall mortality rate was 13.2%. The mortality among patients admitted with GCS <8 was 52.4%.Conclusion: Neurological injuries were the most commonly seen conditions mainly in head injuries. This study confirms that neurosurgical procedures can still be done with fair results using very little equipment. Providing basic equipment to national neurosurgeons, however, and training them to work in an adverse environment remains a big challenge

Four years of natural history of HIV-1 infection in African women : a prospective cohort study in Kigali (Rwanda), 1988-1993

Clinical features and mortality due to human immunodeficiency virus type-1 (HIV-1) infection in women are described as part of a prospective 4-year cohort study on perinatal transmission of HIV in Kigali, Rwanda. Two hundred fifteen HIV-positive (HIV+) and 216 HIV-negative (HIV-) pregnant women were enrolled at delivery between November 1988 and June 1989. Clinical information collected during systematic quarterly examinations was compared. HIV antibody tests were performed at delivery and CD4/CD8 lymphocyte counts at 15 days' postpartum. HIV- women who seroconverted during the follow-up period were excluded from the analysis of the comparison group starting at the date of seroconversion. At enrollment, all HIV+ women were asymptomatic for acquired immune deficiency syndrome (AIDS). Incidence of tuberculosis was 2.9 per 100 women-years (WY) after 4 years of follow-up in HIV+ women versus 0.2 per 100 WY among HIV- women (relative risk. 18.2% ; 95% confidence interval 2.4-137.0). Among HIV+ women, the incidence of AIDS was 3.5 per 100 WY. The mortality rate was 4.4 per 100 WY among HIV+ women versus 0.5 per 100 WY among HIV- women. Clinical AIDS was present in only half of the fatalities. Tuberculosis was a major cause of morbidity and mortality in these HIV+ African women. An early diagnosis and an appropriate treatment or prevention of tuberculosis should improve the quality of life of HIV-infected patients in Africa. (Résumé d'auteur

The possible role of local air pollution in climate change in West Africa

The climate of West Africa is characterized by a sensitive monsoon system that is associated with marked natural precipitation variability. This region has been and is projected to be subject to substantial global and regional-scale changes including greenhouse-gas-induced warming and sea-level rise, land-use and land-cover change, and substantial biomass burning. We argue that more attention should be paid to rapidly increasing air pollution over the explosively growing cities of West Africa, as experiences from other regions suggest that this can alter regional climate through the influences of aerosols on clouds and radiation, and will also affect human health and food security. We need better observations and models to quantify the magnitude and characteristics of these impacts

Le développement du monde rural par les Centres d'appui. L'exemple de Musambira (Rwanda)

Rural development based on management sub-centres. The example of Musambira. The presence of Campylobacter fetus subsp. venerealis infection has been investigated in 3 ranches of the Shaba region. A total of 275 sexually active buIls has been examined using the direct immunofluorescence technique on preputial washings. From these 275 buIls 67 (24.3 %) were found to be infected. The technique of direct immunofluorescence proved to be very usefull under tropical conditions because smears could be prepared from the preputial washings in the field, fixed and stored for months before being examined in a specialized laboratory. Suggestions for prevention and treatment are briefly discussed

Clinical Presentation and Outcome of Neurosurgical Conditions at Butare Teaching Hospital, Rwanda

Background: Neurosurgical services have only been introduced in Rwanda recently. Consequently little information about spectrum of neurosurgical conditions in th country is available. This descriptive prospective study was aimed at determining the pattern, causes and outcome of management of neurosurgical conditions seen in Butare University Teaching Hospital (BUTH) in Rwanda. Methods: The study population consisted of 152 patients admitted at BUTH with neurosurgical conditions between October 1 2007 and May 31 2008. Patients were grouped into different neurosurgical conditions according to their clinical presentations. . Information collected included age, gender, cause and severity of injury, the time interval between injury Glasgow Coma Score, GOS scales were used to assess head injured patients. Results: The majority (70.4%) of patients came from rural areas. Their ages ranged from 15 days to 78 years with a mean of 31.98+/-18.75 years. The Male to female sex ratio was 2:1. Most (73.0%) of the patients suffered from trauma with 67.6% of them sustaining head injury and 32.4%, spinal trauma. Motor Vehicle crashes were the major cause of traumatic injuries (20% in spinal trauma and 70.7% of head trauma). Only 23% of the patients had CT scan performed. Only 12% of patients with traumatic brain injury (TBI) had CT scan.. A total of 78.7% of all head injuries were admitted in the first 24 hours following trauma. A significant number (44.4%) of spinal cord injury presented late (up to 7 days before referral to a neurosurgeon) and stayed longer in the hospital (52.7% up to 3 months). Laminectomy and fixation was the most common spinal operative procedure (58.7%) followed by discectomy (34.8%). The commonest cranial operation was for posttraumatic intracranial haemorrhage (41.4%) followed by surgery for depressed fracture (37.9%). One child had a shunt procedure for hydrocephalus. Good recovery was associated with GCS >13 on admission (P<0.001). The overall mortality rate was 13.2%. The mortality among patients admitted with GCS <8 was 52.4%. Conclusion: Neurological injuries were the most commonly seen conditions mainly in head injuries. This study confirms that neurosurgical procedures can still be done with fair results using very little equipment. Providing basic equipment to national neurosurgeons, however, and training them to work in an adverse environment remains a big challenge

SUSTAINABLE DEVELOPMENT OF AFRICAN NATURAL PLANT PRODUCTS

The development of sustainable agricultural businesses in high-value niche sectors can stimulate agricultural growth that could improve the livelihoods of rural Africa and have a multiplier effect on the rest of the economy. The natural plant product (NP) industry is one that can offer higher income and niche markets for resource limited farmers in developing countries compared to traditional agronomic crops. However, the NP industry is beset with challenges hindering the realization of its full contribution to economic development and poverty reduction. Among these challenges are: (1) limited appropriate germplasm; (2) lack of quality control and quality assurance systems for production and processing; (3) Lack of knowledge and understanding of international markets and markets channels; (4) Limited processing infrastructure which constrains value-added opportunities; (5) variable market prices, and (6) weak enterprises with low technical and managerial skills to meet the requirements of buyers. In 1999, we began to develop models for the sustainable commercialization of NP in sub-Sahara Africa using a market-first and scientific-driven approach. This program implemented under ASNAPP (www.asnapp.org) is conducted in partnership with the public and private sector to facilitate diversification of agricultural commodities and marketing channels. Sustainable development incorporates good environmental stewardship from the bush to final product, GAP and robust quality assurance and quality control systems for collection or cultivation to ensure high quality and food safety. This evolving model consists of a multi step value-addition process through the commodity chain to provide safe and high quality NPs and economic opportunities to those rural communities