Thoracopagus: a first case of incomplete conjoint twins in Eritrea

An eight hour old boy with incomplete duplication of the head was admitted in a tertiary paediatric referral hospital in Asmara, the capital city of Eritrea. The incompletely developed head with the neck of one twin was attached to the much larger and more fully developed one on the anterior aspect (ventral) of the chest. This abnormal union or fixation is termed thoracopagus which is the second most common distribution of ventral unions, parapagus (pelvis and variable trunk) being the most common. Although thoracopagus twins are more frequent, omphalopagus twins are more commonly encountered at birth, due to lower fetal mortality. The neonate also presented with multiple abnormalities, omphalocele, and congenital heart disease with VSD, deformed left external ear, high arched palate and supernumerary digit on the left 5th finger of the hand

Pattern of neurological diseases as seen in outpatient children: the experiences from Orotta Referral Hospital Asmara, Eritrea.

Objective: To determine the pattern of neurological diseases in children. Methods: This was a prospective cohort study of paediatric patients reporting to the Paediatric Neurological Clinic at Orotta Referral Hospital with neurological diseases. The systematic evaluation of patients was carried out from 2002 to 2005. Results: Altogether 736 children with age ranging from 3 months to 15 years being 61% boys and 39% girls, presented with different neurological disorders. Although the cases may have presented with more than one diagnosis (29.6%), the most frequent neurological diseases were epilepsy (25.9%), cerebral palsy(C/P) (19.3%) and post febrile neurological diseases (12.5%) and others. Out of all epileptic cases, grand mal(GTCS) (74%), partial seizures (5.6%), akinetic attacks(drop attacks) (5.6%) and petit mal (absence siezures) (3.2%) were the commonest types of epilepsy. In the majority of epilepsy (63.5%) no cause was found. There was no gender difference in all neurological disorders studied. Discussion and Conclusion: Epilepsy is a common disease in children. The prevailing enigma that epilepsy is rare in children is an unfounded myth making it imperative for appropriate index of clinical suspicion whenever a paediatric patient presents with unusual clinical pattern. The increased number of epileptic cases at first attendance with age calls for aggressive treatment at the early stages when neurological deficits are likely to occur as the disease may have spontaneously permanent remission. The high number of cases with cerebral palsy and post febrile illness neurological diseases necessitates urgent preventive measures and appropriate management in the country

Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project.

Postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. The Missed Opportunities in Maternal and Infant Health project developed and implemented a context-specific package of health system strengthening and demand generation in four African countries, aiming to improve access and quality of PPC. A realist evaluation was conducted to enable nuanced understanding of the influence of different contextual factors on both the implementation and impacts of the interventions. Mixed methods were used to collect data and test hypothesised context-mechanism-outcome configurations: 16 case studies (including interviews, observations, monitoring data on key healthcare processes and outcomes), monitoring data for all study health facilities and communities, document analysis and participatory evaluation workshops. After evaluation in individual countries, a cross-country analysis was conducted that led to the development of four middle-range theories. Community health workers (CHWs) were key assets in shifting demand for PPC by 'bridging' communities and facilities. Because they were chosen from the community they served, they gained trust from the community and an intrinsic sense of responsibility. Furthermore, if a critical mass of women seek postpartum healthcare as a result of the CHWs bridging function, a 'buzz' for change is created, leading eventually to the acceptability and perceived value of attending for PPC that outweighs the costs of attending the health facility. On the supply side, rigid vertical hierarchies and defined roles for health facility workers (HFWs) impede integration of maternal and infant health services. Additionally, HFWs fear being judged negatively which overrides the self-efficacy that could potentially be gained from PPC training. Instead the main driver of HFWs' motivation to provide comprehensive PPC is dependent on accountability systems for delivering PPC created by other programmes. The realist evaluation offers insights into some of the contextual factors that can be pivotal in enabling the community-level and service-level interventions to be effective

Haemolytic disease of the newborn caused by high frequency antigen-"U" identified in Asmara, Eritrea: A case report

No Abstract