Renin-sodium profile and renal prostaglandins in the pathogenesis of systemic arterial hypertension in blacks

Thirteen black women with systemic (essential) arterial hypertension, age-matched with normotensives, were examined during two protocols inducing sodium depletion and sodium loading respectively. Changes in plasma renin activity (PRA), urinary aldosterone values and prostaglandin E2, (PGE2,) and F2a (PGF2a) excretion were simultaneously assessed. Renin profiles, obtained by the plotting of PRA against the urinary excretion of sodium, showed a 62% prevalence of low-renin hypertension, the remaining 38% of the patients having normal-renin hypertension.At basal level the hypertensives had suppressed renal synthesis of vasodilator PGE2, and a non-significant increase in venopressor PGF2a. This was reflected in the significant 32% decrease in the PGE2/PGF2a ratio. This finding was in keeping with their low-renin hypertension. During sodium depletion PG excretion wasincreased in both normotensive and hypertensive groups. The opposite effect was found during sodium loading.The results of this study do not support a natriuretic role for renal PGE2 but do support the hypothesis that there is decreased renal vasodepressor PGE2, synthesis in black hypertensive patients

Pathophysiological mechanisms of urbanisation-related hypertension and the sodium pressor response in black Zimbabweans

This study examined the role of endothelin (ET), the thromboxane A, (TXA2)-prostacyclin (PGI2) ratio (TXA2/PGI2), plasma renin activity (PRA) and urinary aldosterone excretion (ALDO) in urban hypertensive patients and in the sodium pressor response in normotensives. Twenty-seven urban hypertensive patients and the same number of normotensive controls were studied on baseline diet, after 5 days of sodium restriction and after 5 days of sodium loading. Mean arterial blood pressure, plasma and ET values, PRA, TXA2/PGI2 and ALDO were assessed on each diet.The results showed that baseline PRA was suppressed in the hypertensive patients; this indicates that urbanisation-related hypertension is of the low renin type. ET levels and TXA2/PGI2 were higher in hypertensive than in normotenisve subjects, suggesting an association between high blood pressure and these factors. Although the baseline PRA in hypertensives was suppressed, urinary ALDO was no different from that in the normotensive controls where PRA was normal. In addition, sodium restriction did not increase PRA in hypertensive subjects while it more than doubled it in the controls. However, ALDO in hypertensive patients increased to levels that were no different from those in the normotensive subjects. Sodium loading increased blood pressure, ET values and TXA2/PGI2 indicating an association between the latter two factors and the sodium pressor response in those with hypertension. ALDO decreased to similar levels on sodium loading in the two groups. This decrease in ALDO was accompanied by suppression of PRA only in normotensive subjects.In conclusion, the low-renin-activity urban hypertensives we studied had increased baseline ET levels and TXA2/PGI2. The observed pressor response was accompanied by increases in these two factors. This suggests an important role for the two factors in this form of hypertension and the sodium response in normotensives

Lung function of Zimbabwean farm workers exposed to flue curing and stacking of tobacco leaves

No Abstrac

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

Maternity waiting homes: A panacea for maternal/neonatal conundrums in Eritrea

Background: Maternal mortality which is partly due to low skilled care delivery is still less than 30% in most developing countries including Eritrea. Maternity waiting homes were introduced in Eritrea in 2007 as a strategy to mitigate against the attendant high maternal mortality rates in hard to reach regions. Objective: To assess pregnancy outcomes verified through maternal mortality and perinatal mortality rates since the introduction of maternity waiting homes in some hard to reach sub-zobas of Eritrea. Methods: A rapid assessment of the maternity waiting homes was conducted in six sub-zobas of Northern and Southern Red Sea Zones during the period April 20-29, 2009 using questionnaires administered to health workers, community members, traditional birth attendants and the beneficiaries. Results: Heads of a total of 11 health facilities, community leaders, TBAs and mothers who stayed in the maternity waiting homes were interviewed. A total of 862 mothers had delivered in the 20 months since the introduction of the maternity homes from September 2007 till April 2009 averaging 425 annually compared to 266 deliveries in the same facilities prior to introduction of the waiting homes. No maternal death was recorded in the health facilities during that period. There were seven neonatal deaths and seven still births during the same period making the peri-natal death rate of 1.6%. Conclusion: Deliveries in the maternal waiting homes increased deliveries by 56% with no maternal deaths reported, making it a successful strategy targeted at reducing maternal and perinatal mortality rates. The study recommends the upscaling of the strategy because it is costeffective and acceptable to the community as evidenced by the support provided by the community

Continuing communicable disease burden in Eritrea

Background and method

Use integrated management of childhood illnesses guidelines: a need for adaptation for use in Ghindae hospital, Eritrea

Background: Diarrheal diseases are among the commonest causes of morbidity and mortality among infants and young children in the developing world and most commonly in the sub-Saharan including Eritrea. Integrated Management of Childhood Illnesses (IMCI) is a strategy developed by UNICEF and WHO for developing countries and other resource poor countries currently being practiced in Africa, Asia, and South America. IMCI guidelines are simplified system of diagnosis and treatment that is designed for use by health workers with limited training and little or no laboratory support. According to this guideline bloody diarrhea is treated with ORS, additional fluid support and cotrimoxazole empirically with the assumption that the etiologic agent is shigella. If the child does not improve on follow up then metronidazole is added with the assumption that the etiologic agent is parasitic mainly amoeba and giardia. Objective: The objective of this study was to assess the use of IMCI guidelines in children presenting with diarrhea at Ghindae Hospital. Methods: The study was a prospective in which all children below the age of 5 years, who presented primarily with all forms of diarrhea during the one month period from June 1st 2008 to June 30 2008, were included in the study. All stool samples were subjected to laboratory analysis. Results: Eighty seven children who presented with all forms of diarrhea to the IMCI OPD or as IPD were included in the study. More than 50% of the cases had parasitic infestation mainly Amoeba and Giardia. Less than 5% of the children presented with mild or severe dehydration. The majority (92%) of the cases had no dehydration had diarrhea with no dehydration. Conclusion: In Ghindae community there is a justification for use of metronidazole as a first line treatment of bloody diarrhea, because of the preponderance of parasitic infestation instead of bacterial causes for the majority of cases of children presenting with diarrhea, a clear need for adaptation of IMC

Knowledge, attitudes and practices (KAP) about malaria among people visiting referral hospitals of Eritrea in 2008

Background: Knowledge, attitudes, awareness, practices and beliefs of communities contribute immensely to sustainable control of endemic diseases such as malaria. Strategic malaria control involves primary prevention which focuses on vector elimination and personal behavior change specifically through the consistent use of insecticide-treated nets (ITNs) and prompt and effective case management. This health facility based study was conducted to investigate the knowledge, attitudes and practices toward malaria among people visiting referral Hospitals of Eritrea, so as to develop a cost effective behavioral change communication strategy for community based malaria control. Methods: The study was conducted in the Referral Hospitals of the four Zobas as well as Teseney Hospital where there was the highest malaria morbidity and mortality. A total of 250 people with 50 people from each hospital were randomly selected. A structured questionnaire covering information on respondent demographics, knowledge, attitudes and practices was administered upon receipt of an informed consent for participation. Results: All the study subjects knew at least one of the symptoms of malaria with nearly three quarters mentioning three or more of the classical symptoms including fever. More than 80% knew that mosquitoes were the vector for the disease with a similar proportion having participated in environmental preventive control measures. Nearly half (44.6%) of the respondents gave priority for usage of ITNs to children under 5 years, to both children and pregnant mother and 11.2% to pregnant mothers. Conclusion: The majority of the respondents in this study knew enough information about malaria, and had participated in environmental preventive measures. The primary prevention of malaria through uninterrupted use of ITNs and transformation of knowledge into practices requires emphasis on the development of a community based behavioral change communication strategy. Key words: KAP, malaria, Behavioral change communication strategy, Eritrea, ITN

Bottlenecks in the provision of quality mental health services in Eritrea

Background: The prevalence of mental disorders is increasing significantly in developing countries due to the frequently occurring major risk factors. There is no published information on the profile of mental health disorder and services in Eritrea. Objective of the study: Follow-up descriptive study was conducted on one hundred and one consecutive children with advanced HIV disease who were put on antiretroviral therapy from September 2005 to October 2006. These patients were followed up at the antiretroviral therapy (ART) clinic of the hospital. Methods: A descriptive cross sectional study was conducted using the WHO-AIMS questionnaire that was administered to relevant stakeholders. Results: There was no comprehensive mental health policy and legislation in Eritrea. Only 5% of the health services budget is allocated for mental health services. Mental health services is free of charge and were provided integrated with Primary Health Care services. Inadequate human resources and inadequate training on mental health for the health workers were among the constraints. Conclusion: The status of mental disorders and the mental health services in Eritrea from the policy to management guidelines requires urgent review. Significant Outcomes: a) In resource limited settings, the integrated primary health care approach for mental health services is cost effective and avoids associated stigma. b) WHO/AIMS tool is a simple tool that provides complete picture of the mental health system of a country, c) Lack of policies and legislation in a country severely affects the mental health system of a country Limitations: This was a cross sectional study where data collection and analysis was partially restricted by the level and quality of information available in the registry books of the health facilities. Key words: WHO-AIMS, integrated primary health care, mental health services

The quality of water served in the Orotta National Referral Hospital

Background: The principal risks to human health associated with the consumption of unsafe drinking water are microbiological. According to the WHO and UNICEF report 2.6 billion people do not have access to good quality of water. About 1.1 billion people globally do not have access. About 2 million people mostly of less than 5 years children also die as a result of diarrheal diseases related to consumption of water that is microbiologically contaminated. Objective: The objective of this study was to measure the quality of water served to the different sections of Orotta National Referral Hospital using WHO protocols. Methods: Water samples were collected from different sources in the National Referral Orotta Hospital compound according to the WHO guidelines and the multi-tube method or most probable number method was used for the microbiological count. Results: The findings from the study showed that some of the samples of water from National Referral Pediatric Hospital, and National Medical and Surgical Referral Hospital reservoirs did not meet some of the WHO guidelines for safe drinking water. Conclusion and recommendations: The water contamination emanated from the reservoirs of the Orotta Hospital, because the samples taken as a control from outside the Hospital compound were free of contamination. Water reservoirs should be washed on regular basis. Chlorination and other treatment modalities for the water in the reservoir should also be considered and applied. Water quality surveillance should be done several times in a year not only just once