Violence against Women in Northern Uganda: The Neglected Health Consequences of War

This article presents a summary of research intervention work carried out in war-affected Northern Uganda by Isis-WICCE, a women’s international non-government organisation, in conjunction with the Ugandan Medical Association and funded by Medica Mondiale, a German-based foundation. The findings of this research demonstrate the serious effects of sexual violence and torture experienced on women’s physical and psychological health. However, this paper also describes women’s key role in trying to bring peace to this region, as well as their resistance and survival strategies. It is recommended that funding is urgently required for the provision of sustainable, gender sensitive physical and psychological health services in this region. Women’s campaign for justice for the atrocities they have suffered should be heard by the International Criminal Court. Further recommendations are made with respect to policy changes in line with enhancing women’s roles and furthering the empowerment of these women war survivors

Cognitive deficits following exposure to pneumococcal meningitis: an event-related potential study

<p>Abstract</p> <p>Background</p> <p>Pneumococcal meningitis (PM) is a severe and life-threatening disease that is associated with cognitive impairment including learning difficulties, cognitive slowness, short-term memory deficits and poor academic performance. There are limited data on cognitive outcomes following exposure to PM from Africa mainly due to lack of culturally appropriate tools. We report cognitive processes of exposed children as measured by auditory and visual event-related potentials.</p> <p>Methods</p> <p>Sixty-five children (32 male, mean 8.4 years, SD 3.0 years) aged between 4-15 years with a history of PM and an age-matched control group of 93 children (46 male; mean 8.4 years, SD 2.7 years) were recruited from a well-demarcated study area in Kilifi. In the present study, both baseline to peak and peak-to-peak amplitude differences are reported.</p> <p>Results</p> <p>Children with a history of pneumococcal meningitis had significantly longer auditory P1 and P3a latencies and smaller P1 amplitudes compared to unexposed children. In the visual paradigm, children with PM seemingly lacked a novelty P3a component around 350 ms where control children had a maximum, and showed a lack of stimulus differentiation at Nc. Further, children with exposure to PM had smaller peak to peak amplitude (N2-P1) compared to unexposed children.</p> <p>Conclusion</p> <p>The results suggest that children with a history of PM process novelty differently than do unexposed children, with slower latencies and reduced or absent components. This pattern suggests poorer auditory attention and/or cognitive slowness and poorer visual attention orienting, possibly due to disruption in the functions of the lateral prefrontal and superior temporal cortices. ERPs may be useful for assessment of the development of perceptual-cognitive functions in post brain-injury in African children by providing an alternate way of assessing cognitive development in patient groups for whom more typical standardized neuropsychological assessments are unavailable.</p

Quality of life in a cohort of Kenyan children with cerebral palsy

Aim: The objective of the study was to evaluate the quality of life in Kenyan children (age 4–18 years) with cerebral palsy (CP). Methods: A cross-sectional descriptive study was conducted. Children with CP were recruited from the pediatric clinics at the Aga Khan hospital Nairobi (AKUHN). Parent proxy-reports using CPQoL-child and CPQoL-adolescents were obtained. Clinical and demographic data were compiled from medical records and parent interviews. A Likert scale was utilized to determine QoL across several domains. Results: One hundred and fourteen child–parent dyads with CP were recruited. The median age of study participants was 8 years (IQR 3–13 years), with males being the majority (57.02 %). Parent proxy-reports using CPQoL-child scale were obtained for n = 93 and CPQoL-adolescents for n = 21 respondents. Parents in both groups reported low domain QoL scores pertaining to function, family health and rehabilitation service accessibility. Interpretation: Stigma, accessibility to services, therapies and schooling, particularly for children with severe functional limitations, remains a concern. Caregivers would benefit from awareness campaigns of available supports and from local community respite programs. Where national support systems exist, there are critical inefficiencies in service delivery to target population

Women War Survivors of the 1989-2003 Conflict in Liberia: The Impact of Sexual and Gender-Based Violence

This article presents a summary of the qualitative data from research carried out in post-conflict Liberia by Isis-WICCE, a women’s international non-government organisation, in conjunction with the Ministry of Gender and Development of Liberia and Women in Peace-building Network, WIPNET. Analysis of research findings detail women’s experiences of conflict and the serious effects of sexual violence and torture on their physical and psychological health. The paper also describes the omission of women from justice and rehabilitation processes. In support of women participants’ views, the author’s recommend that funding is urgently required for the provision of holistic and sustainable, gender-sensitive services. Additional recommendations are made with respect to health, justice and policy changes in line with enhancing women survivor’s roles and utilising their skills and resilience

Clinical indicators of bacterial meningitis among neonates and young infants in rural Kenya

<p>Abstract</p> <p>Background</p> <p>Meningitis is notoriously difficult to diagnose in infancy because its clinical features are non-specific. World Health Organization (WHO) guidelines suggest several indicative signs, based on limited data. We aimed to identify indicators of bacterial meningitis in young infants in Kenya, and compared their performance to the WHO guidelines. We also examined the feasibility of developing a scoring system for meningitis.</p> <p>Methods</p> <p>We studied all admissions aged < 60 days to Kilifi District Hospital, 2001 through 2005. We evaluated clinical indicators against microbiological findings using likelihood ratios. We prospectively validated our findings 2006 through 2007.</p> <p>Results</p> <p>We studied 2,411 and 1,512 young infants during the derivation and validation periods respectively. During derivation, 31/1,031 (3.0%) neonates aged < 7 days and 67/1,380 (4.8%) young infants aged 7-59 days (p < 0.001) had meningitis. 90% of cases could be diagnosed macroscopically (turbidity) or by microscopic leukocyte counting. Independent indicators of meningitis were: fever, convulsions, irritability, bulging fontanel and temperature ≥ 39°C. Areas under the receiver operating characteristic curve in the validation period were 0.62 [95%CI: 0.49-0.75] age < 7 days and 0.76 [95%CI: 0.68-0.85] thereafter (P = 0.07), and using the WHO signs, 0.50 [95%CI 0.35-0.65] age < 7 days and 0.82 [95%CI: 0.75-0.89] thereafter (P = 0.0001). The number needed to LP to identify one case was 21 [95%CI: 15-35] for our signs, and 28 [95%CI: 18-61] for WHO signs. With a scoring system, a cut-off of ≥ 1 sign offered the best compromise on sensitivity and specificity.</p> <p>Conclusion</p> <p>Simple clinical signs at admission identify two thirds of meningitis cases in neonates and young infants. Lumbar puncture is essential to diagnosis and avoidance of unnecessary treatment, and is worthwhile without CSF biochemistry or bacterial culture. The signs of Meningitis suggested by the WHO perform poorly in the first week of life. A scoring system for meningitis in this age group is not helpful.</p

War related sexual violence and it's medical and psychological consequences as seen in Kitgum, Northern Uganda: A cross-sectional study

BACKGROUND: Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cessation of war related sexual violence against civilians in conflict zones, Africa continues to see some of the worst cases of war related sexual violence including the mass sexual abuse of entire rural communities particularly in the Great Lakes region. In addition to calling for a complete halt to this abuse, there is a need for the systematic study of the reproductive, surgical and psychological effects of war related sexual violence in the African socio-cultural setting.This paper examines the specific long term health consequences of war related sexual violence among rural women living in two internally displaced person's camps in Kitgum district in war affected Northern Uganda who accessed the services of an Isis-Women's International Cross Cultural Exchange (Isis-WICCE) medical intervention. METHODS: The study employed a purposive cross-sectional study design where 813 respondents were subjected to a structured interview as part of a screening procedure for an emergency medical intervention to identify respondents who required psychological, gynaecological and surgical treatment. RESULTS: Over a quarter (28.6%) of the women (n = 573) reported having suffered at least one form of war related sexual violence. About three quarters of the respondents had 'at least one gynaecological complaint' (72.4%) and 'at least one surgical complaint' (75.6%), while 69.4% had significant psychological distress scores (scores greater than or equal to 6 on the WHO SRQ-20). The factors that were significantly associated with war related sexual violence were the age group of less than or equal to 44 years, being Catholic, having suffered other war related physical trauma, and having 'at least one gynaecological complaint'. The specific gynaecological complaints significantly associated with war related sexual violence were infertility, chronic lower abdominal pain, abnormal vaginal bleeding, and sexual dysfunction. In a multivariable analysis the age group of less than or equal to 44 years, being Catholic and having 'at least one gynaecological complaint' remained significantly associated with war related sexual violence. CONCLUSION: The results from this study demonstrate that war related sexual violence is independently associated with the later development of specific gynaecological complaints

The 1991 Nobel Prize Winners--from Patch Clamps (Neher and SAmann) to Spaghetti Theory (de Gemes), Social Costs (Cease), and

Each year, we review the citation records for the current group of Nobel Prize winners. This series of essays bsgan over a decade ago. In 1991, unlike the previous year, all of the winners proved to be citation superstars. We”ve listed their mos[-cited papers, discussed the impact of their work, and reviewed Citation Cfamic@ commentaries, written by the winners or their collaborators. These provide a unique perspective on the resesrch that led to ttreNobel Prize. As 1 said nearly 30 years ago, it would be absurd to claim that a researcher deserves the Nobel Prize simply Ixcause he or she is a citaticmsuperstar.]Oures.sayotrthe 1990Nobel Prizes*noted that several of the sciencepriz.ewinnem,althoughwell cited,had receivedrelativelyfewereitadonswhencompamdwithmost Nobelists.‘his wotddbe qrecidly hue in fields where the work was done many years ago. However, scientific work of Nobel class, unaccompanied by high citation impact, deserves some explanation, such as &amp;layed recognition or whatever. It is the exception rather than the rule. In 1991, the rule prevailed, and all recipients are citation Superwars. Physiology or Medicin

The spectrum of rheumatic in-patient diagnoses at a pediatric hospital in Kenya

Abstract Background Pediatric rheumatic diseases are chronic illnesses that can cause considerable disease burden to children and their families. There is limited epidemiologic data on these diseases in East Africa. The aim of this study was to assess the spectrum of pediatric rheumatic diagnoses in an in-patient setting and determine the accuracy of ICD-10 codes in identifying these conditions. Methods Medical records from Gertrude\u2019s Children\u2019s Hospital in Kenya were reviewed for patients diagnosed with \u201cdiseases of the musculoskeletal system and connective tissue\u201d as per ICD-10 diagnostic codes assigned at discharge between January and December 2011. Cases were classified as \u201crheumatic\u201d or \u201cnon-rheumatic\u201d. Accuracy of the assigned ICD-10 code was ascertained. Death records were reviewed. Longitudinal follow-up of \u201crheumatic\u201d cases was done by chart review up to March 2014. Results Twenty six patients were classified as having a \u201crheumatic\u201d condition accounting for 0.32% of patients admitted. Of these, 11 (42.3%) had an acute inflammatory arthropathy, 6 (23.1%) had septic arthritis, 4 (15.4%) had Kawasaki disease, 2 (7.7%) had pyomyositis, and there was one case each of septic bursitis, rheumatic fever, and a non-specific soft tissue disorder. No cases of juvenile idiopathic arthritis (JIA) were identified. One case of systemic lupus erythematosus was documented by death records. The agreement between the treating physician\u2019s discharge diagnosis and medical records ICD-10 code assignment was good (Kappa: 0.769). On follow-up, one child had recurrent knee swelling that was suspicious for JIA. Conclusions Pediatric rheumatic conditions represented 0.32% of admissions at a pediatric hospital in Kenya. Acute inflammatory arthropathies, septic arthritis and Kawasaki disease were the most frequent in-patient rheumatic diagnoses. Chronic pediatric rheumatic diseases were rare amongst this in-patient population. Despite limitations associated with the use of administrative diagnostic codes, they can be a first step in evaluating the spectrum of pediatric rheumatic conditions in Kenya and other countries in East Africa