Patterns of Musculoskeletal Diseases seen in Zambian Children

Background: Musculoskeletal disorders are a common cause of long-term pain and physical disability affecting many people worldwide and have an enormous economic and social impact on the individual, society and national health systems. Although the burden of disease due to musculoskeletal disorders is said to be on the rise in the developing world, the full extent of this burden remains unknown.Objectives: To describe the patterns of musculoskeletal disorders seen in Zambian children aged below 15 years as baseline for future orthopaedic research, training and health management policy.Methods: Through a hospital-based cross-sectional study design, relevant data was collected onto an evaluation form from medical records of 1246 patients at the University Teaching Hospital (UTH), Zambian-Italian Orthopaedic Hospital (ZIOH) and the Flying-Specialist (FLYSPEC) nationwide orthopaedic outreach. The data was then entered into a spreadsheet and imported into SPSS for analysis.Results: Congenital abnormalities, other noncongenital deformities, and traumatic fracture dislocations were the commonest conditions affecting the 1246 sampled children with prevalence rates of 0.49, 0.22 and 0.14 respectively. Most patients presented late (more than 3months from the onset of their condition) with 509 (42.2%) having travelled for more than 10 kilometres to get to their treatment sites. 561 (45.4%) had been treated conservatively prior to their presentation to orthopaedics with another 471 (38.1%) having received no treatment at all.Conclusion: congenital abnormalities, noncongenital limb deformities and traumatic conditions were the commonest musculoskeletal disorders in that order. More males than females were afflicted though this distribution was different within the age ranges. Most of these patients presented late and distance to health facility was strongly correlated to late presentation. Furthermore, at first presentation these children receive little or no appropriate treatment from the first-line health workers at local health centres.Keywords: Musculoskeletal diseases, Children, Zambia

Joint replacement in Zambia: A review of Hip & Knee Replacement surgery done at the Zambian-Italian Orthopaedic Hospital

Background: Incidence of major joint replacement surgery is on the rise in Africa but this trend has not been matched by proper audits in the form of National Joint Registries.Objective: This paper presents the short-term findings from a joint replacement register started at the Zambian-Italian Orthopaedic Hospital (ZIOH) in Lusaka and compares the variables entered in this register with those captured in the Malawian National Joint Register for purposes of synchronizing these in the near future in the East, Central and Southern African region .Methods: Data captured by the different variables entered into the Joint Register covering the pre-op, intra-op and post-op period of all total hip and knee replacement surgery done at the ZIOH from 1998 to 2010 was entered into a spreadsheet after verification with individual patient medical records. This was then imported into spss for analysis yielding the following results.Results: 44 total hips and seven total knee replacement operations were done on 46 patients, 59% of which were female and 41% male. The average age was 58 years. The HIV sero-status of 86.3% was unknown. 36 (70.6%) of the patients had primary osteoarthritis as the diagnosis with pain and joint stiffness being the indication for surgery. Three consultants and one senior registrar did the operations mainly using the Hardinge approach to the hip. 43 (84.3%) were primary Total Hip replacement with only one revision. The 28mm hip head size was the commonest fitted with most patients, 48 (94.1%) being functionally mobile at six weeks post operation.Conclusion: This audit clearly shows a rising trend of major joint replacement over the years and highlights the gaps in variables entered into the ZIOH joint register such as HIV status. It also helps us recognize the need for setting up a National Joint Register that is comparable to others that have been set up in the region such as is the case in Malawi which is key in improving orthopaedic training and patient care.Keywords: Joint replacement, National Joint Register, HI

Impact of changing diagnostic criteria for smear-positive tuberculosis: a cohort study in Malawi.

We assessed the impact on measured burden and outcomes of the revised World Health Organization and Malawi guidelines reclassifying people with single (including 'scanty') positive smears as smear-positive pulmonary tuberculosis cases. In a retrospective cohort in rural Malawi, 567 (34%) of 1670 smear-positive episodes were based on single positive smears (including 176 with scanty smears). Mortality rates and the proportion starting treatment were similar in those with two positive smears or single, non-scanty smears. Those with single scanty smears had higher mortality and a lower proportion starting treatment. The reclassification will increase the reported burden substantially, but should improve treatment access

Endoscopic third ventriculostomy and choroid plexus cauterization in childhood hydrocephalus in Zambia

Background: Endoscopic third ventriculostomy (ETV) and Choroid Plexus Cauterization (CPC) have been recommended as reliable surgical options in developing countries for childhood hydrocephalus owing to reported shunt failures in shunt dependency.Objective: To evaluate outcomes of the ETV and ETV-CPC procedures as surgical options for selected forms of hydrocephalus in Zambia.Methods: Between 2007 and 2010, 131 children with hydrocephalus underwent the ETV or ETVCPC procedures at Beit Cure Hospital (BCH) and were eligible for the analysis. Failed ETV was defined as cases that needed subsequent surgical procedures within 6 months of operation.Results: A total number of 110 (84%) children underwent ETV-CPC and 21 (16%) had ETV alone. The overall success rate was 74%, whereas ETV-CPC was 76% and ETV alone was 62% (p < 0.0001). ETV success rate was more likely with children aged one year and above (p < 0.06) and with non-post infectious hydrocephalus (p < 0.29). Age and etiology were not significantly associated with the outcomes.Conclusions: Endoscopic third ventriculostomy is a safe, reliable and effective option for selected forms of hydrocephalus in Zambia. The combination of ETV and CPC was more effective than ETV alone. It is highly recommended that such services be extended to other referral hospitals as options to shunt placement, especially in cases where access for treatment failure is likely to be delayed.Keywords: Hydrocephalus, endoscopic third ventriculostomy, choroid plexus cauterization, Outcomes, Physiotherapy, Zambi

What happens to ART-eligible patients who do not start ART? Drop out between screening and ART initiation: a cohort study in Karonga, Malawi

BACKGROUND: Routine ART programme statistics generally only provide information about individuals who start treatment. We aimed to investigate the outcome of those who are eligible but do not start ART in the Malawi programme, factors associated with this dropout, and reasons for not starting treatment, in a prospective cohort study.METHODS: Individuals having a first screening visit at the ART clinic at Karonga District Hospital, northern Malawi, between September 2005 and July 2006 were interviewed. Study follow-up to identify treatment outcomes was conducted at the clinic and in the community. Logistic regression models were used to identify factors associated with dropout before ART initiation among participants identified as clinically eligible for ART.RESULTS: 88 participants eligible for ART at their first screening visit (out of 633, 13.9%) defaulted before starting ART. Participants with less education, difficulties in dressing, a more delayed ART initiation appointment, and mid-upper arm circumference (MUAC) < 22 cm were significantly less likely to have visited the clinic subsequently. Thirty-five (58%) of the 60 participants who defaulted and were tracked at home had died, 21 before their ART initiation appointment.CONCLUSIONS: MUAC and reported difficulties in dressing may provide useful screening indicators to identify sicker ART-eligible individuals at high risk of dropping out of the programme who might benefit from being brought back quickly or admitted to hospital for observation. Individuals with less education may need adapted health information at screening. Deaths of ART-eligible individuals occurring prior to ART initiation are not included in routine programme statistics. Considering all those who are eligible for ART as a denominator for programme indicators would help to highlight this vulnerable group, in order to identify new opportunities for further improving ART programmes

The impact of HIV on morbidity and mortality from tuberculosis in sub-Saharan Africa: a study of rural Malawi and review of the literature

Since the mid-1980s tuberculosis (TB) case numbers and HIV seroprevalence have both risen sharply in sub-Saharan Africa. Estimates for the relative risk of TB in those infected with HIV have ranged from less than five to more than 20. The proportion of TB cases attributable to HIV (the population attributable fraction) has been calculated for several populations but is difficult to interpret if no account is taken of the age and sex distribution of the cases. In a rural area of Malawi we have studied the proportion of TB attributable to HIV over time. Nearly 40 per cent of smear-positive TB cases in this rural area of Malawi can now be attributed directly to HIV. The actual effect of HIV on TB is even greater than this because increased case numbers increase transmission of tuberculosis infection to both HIV-infected and non-infected sections of the population. We compare our findings with others from sub-Saharan Africa and discuss reasons for the differences, and methodological issues in interpretatio