BackgroundThe pattern of stroke in rural population differs from that in urban ones. Although there are many studies on this condition in sub-Saharan Africa, few studies about stroke pattern in a Kenyan rural area exist.. This study therefore aims at describing the characteristics of stroke in a rural Kenyan hospital.Patients and MethodsThe study was conducted on 227 consecutive patients admitted with a World Health Organization (WHO) diagnosis of stroke in Kangundo Hospital, a level IV facility in Machakos, Eastern Kenya, between April 2015 and September 2016. The sub-type and anatomical distribution of stroke as well as the age, gender of the patients were recorded prospectively. Diagnosis was made through physical neurological examination and confirmed by Computerized Tomography (CT) scan imaging. Only those with complete bio-data, past medical and social history, clinical and physical findings of the patients and imaging results were included. The data were entered into a pre-formatted questionnaire, analysed for means, standard deviations and frequencies, and are presented in tables and bar charts.ResultsOut of 3200 medical admissions, 227 (7.09%) had a confirmed diagnosis of stroke. Ischaemic stroke was more common (67.4%) than haemorrhagic stroke (32.6%). It affected mainly the anterior circulation, especially the middle cerebral artery (39%). The mean age of patients was 68.8 years, (Range 32 – 96). It was more common in females (62%) than in males (38%). Hypertension was the most common (74%) risk factor followed by alcohol abuse (63%), tobacco smoking (48%) and diabetes mellitus (42%).ConclusionIschaemic stroke was the more common major cause of morbidity in the rural hospital studied in Kenya. It occurred most commonly among elderly females, with the most frequent comorbidities being hypertension. In addition, modifiable lifestyle factors like alcohol abuse and cigarette smoking contributed to the prevalence; hence we recommend the control of blood pressure and glucose as well as lifestyle modification to reduce the scourge in our studied population

Shitandi, Ominde Beryl

English

BackgroundThe number of older persons in Sub-Saharan Africa is increasing.AimsWhat can Sub-Saharan Africa learn from other countries that may enhance the health and wellness of older persons? Canada was conveniently selected as the country which has endorsed the need for action on active ageing, given that by 2026, 1 in every 5 Canadians will have reached the age of 65 years and 4% of the overall population will be 85 years and older.MethodsEnglish language electronic searches of computerized databases (PubMed, MEDLINE, EMBASE, CINAHL, and PsychINFO) were done to locate relevant published studies on Canada, from January 2000 to August 2014. Keyword combination included: physical activity/activities, exercise/s, older person/s, elderly, ageing adults, seniors, and older people.Results8 out of 400 plus articles were reviewed, and 4 key approaches in ensuring active ageing in Canada were identified. From these, 5 public health-oriented plans are recommended for Sub-Saharan Africa: (1) there should be a shift in the conceptualisation of what physical activity entails, (2) it is necessary to build and strengthen collaboration between various stakeholders involved in planning, (3) raising awareness among older persons and the general population on the benefits in participating in physical activity, (4) encourage older persons to participate in culturally relevant physical activity, and (5) laying a better foundation for future generations of older persons.ConclusionThough more elaborate planning is required, these recommended plans will contribute to achieving average life expectancy beyond 60 years in Sub-Saharan Africa

Amosun, Seyi Ladele

AJOL - African Journals Online

What can Sub-Saharan Africa learn from Canada’s investment in active healthy ageing? A narrative view

BackgroundMost existing studies on unintended pregnancies tend to examine the influence of individual socio-demographic and health characteristics without sufficient attention to community characteristics. This study examines community characteristics influencing unintended pregnancies in Kenya. MethodsData were extracted from the 2014 Kenya Demographic and Health Survey (KDHS). The outcome variable was unintended pregnancy. The explanatory variables were selected individual and community level variables. The Multilevel mixed-effects logistic regression was applied. ResultsFindings show 41.9% prevalence of unintended pregnancies. Community characteristics such as community education, community timing for initiation of childbearing, community fertility norms, and community media exposure significantly influence the likelihood of unintended pregnancies. The Intra-Cluster Correlation (ICC) provided evidence that community characteristics had effects on unintended pregnancies. ConclusionThere is evidence that community characteristics influence the prevalence of unintended pregnancies in Kenya. Community sensitisation and mobilisation should be central to all efforts aiming to reduce prevalence of unintended pregnancies

Solanke, Bola Lukman

Do Community Characteristics Influence Unintended Pregnancies in Kenya?

Pattern of stroke in a rural Kenyan hospital

BackgroundThe family provides support in the care of their ill members and suffers some burden during caregiving. This study assessed the burden of family caregivers and associated factors in an ophthalmic clinic situated in a university teaching hospital in southwest Nigeria.MethodsThis was a descriptive cross-sectional study where consenting family caregivers of ophthalmic patients completed a semi-structured questionnaire containing information on their socio-demographic characteristics and caregiving burden using the Zarit burden interview. Descriptive and inferential statistics analyses were done.ResultsA total of 273 caregivers completed the study. The caregivers were parents (23.5%), spouses (20.1%), siblings (3.3%), children (35.9%) and other relatives (14.2%) with mean age (SD) of 38.9 (14.9) years (range 8-79 years). Majority (81.2%) experienced caregiver burden with prayer (89%) as a coping strategy. Financial support (56%) was a major caregiver need with majority (59.3%) satisfied with their relatives’ hospital care. Neither the patients nor their caregivers were on health insurance scheme. Statistical significant factors associated with caregivers’ burden included young age (AOR=4.63, 95%CI=1.55-13.90; p=0.01), higher education (AOR=5.51, 95%CI=2.30-13.2, p=0.01), being employed (AOR=1.72, 95CI=1.30-4.76, p=0.04), longer caregiving (AOR=3.37, 95%CI=1.27-7.02, p=0.02), and having patient on hospital admission (AOR=1.90, 95%CI=1.26-3.09, p=0.02).ConclusionFamily caregivers of ophthalmic patients experienced significant burden. Hence, they need more assistance from the health care institutions and community, including policy makers, so that they can cope with their caregiving activities. Enrollment in the social health insurance scheme will reduce out of pocket payment of hospital bills

Olowookere, Samuel

Burden of family caregivers of ophthalmic patients in a university teaching hospital in south-west Nigeria

Bowel obstruction in early infancy may result from a variety of congenital anomalies involving  parts of the small and large bowel. However, in infancy, chronic bowel obstructions from congenital or acquired stenosis of the colon  are rare and can cause diagnostic quandary. We present two cases of an eleven-week old male and a nine–week old male with massive abdominal distension and features of chronic bowel obstruction dating from neonatal period. In the first case investigations were inconclusive and laparotomy revealed isolated stenosis of the ascending colon. In the second case colonic stenosis was suspected preoperatively and a barium enema done showed multiple colonic stenosis confirming our working diagnosis. The diagnostic dilemmas encountered in managing the first patient are discussed to highlight the need for high index of suspicion of this condition in infants with chronic constipation. The way experience in managing the first case influenced diagnosis of the second case is also highlighted

Ekenze, Sebastian Okwuchukwu

Ekenze et al; Malawi Medical Journal 31 (1): 82-85 March 2019               Chronic bowel obstruction from colonic stenosis 82  https://dx.doi.org/10.4314/mmj.v31i.14Chronic bowel obstruction from colonic stenosis in early infancy-A report of  two casesSebastian Okwuchukwu Ekenze, Uchechukwu Obiora Ezomike, Ijeoma Esther Nwachukwu,  Anthony Ifeanyi Ariom, Kevin Emeka Chukwubuike,  Emmanuel Ifeanyi Nwangwu, Uchenna Sunday Onoh,  Ebere A UwahSub-Department of  Paediatric Surgery, College of  Medicine, University of  NigeriaAbstractBowel obstruction in early infancy may result from a variety of  congenital anomalies involving  parts of  the small and large bowel. However, in infancy, chronic bowel obstructions from congenital or acquired stenosis of  the colon  are rare and can cause diagnostic quandary. We present two cases of  an eleven-week old male and a nine–week old male with massive abdominal distension and features of  chronic bowel obstruction dating from neonatal period. In the first case investigations were inconclusive and laparotomy revealed isolated stenosis of  the ascending colon. In the second case colonic stenosis was suspected preoperatively and a barium enema done showed multiple colonic stenosis confirming our working diagnosis. The diagnostic dilemmas encountered in managing the first patient are discussed to highlight the need for high index of  suspicion of  this condition in infants with chronic constipation. The way experience in managing the first case influenced diagnosis of  the second case is also highlighted.Introduction Congenital colonic stenosis is a variant of  colonic atresia with varying severity of  colonic lumen narrowing1. It is a rare congenital anomaly of  the gastrointestinal tract with a reported incidence of  1 in 40,000 births2. The aetiology is largely unknown, but the development of  the condition has been associated with fetal mesenteric vascular accidents from fetal intestinal kinks, internal herniation, intussusception, volvulus, and maternal use of  cocaine2-4. Colonic stenosis has also been reported from acquired conditions like necrotizing enterocolitis (NEC), however such stenosis commonly involves multiple areas of  the large bowel5, 6. Reports indicate that any of  the segments of  the colon may be affected by the congenital stenosis, but it is commoner in the ascending and descending colon1, 2, 4. Congenital colonic stenosis may present early or late in life depending on the severity of  the stenosis2, 7. Reported symptoms include passage of  small quantity of  faeces, abdominal distension, colicky abdominal pains, occasional vomiting, and failure to gain weight1, 2, 4, 5. As a result of  this there may be diagnostic uncertainty as most of  the reported cases were diagnosed intraoperatively following laparotomy for intestinal obstruction7. We report a case of  congenital solitary stenosis involving the ascending colon that presented with severe abdominal distension and intermittent constipation that dated back to the newborn period in an 11-week old male and a second case of  multiple long segment strictures involving cecum, ascending colon, transverse colon and descending colon in a 9-week old male. The focus of  this article is to highlight the diagnostic challenges encountered in managing these patients, as well as  the need to consider the diagnosis of  colonic stenosis in infants with intermittent constipation and abdominal distension that commenced during newborn period.Case Report 1An eleven-week old male presented with progressive generalized abdominal distension that commenced during the neonatal period. He was the first of  a set of  monozygotic twins delivered via emergency Caesarean section at 35 weeks gestational age due to  antepartum haemorrhage. There was no history of  maternal smoking, cocaine use or ingestion of  any other vasoconstrictors. His birth weight was 2.3kg and he spontaneously passed meconium within the first 24 hours of  life. Subsequently, however, his stools became of  small volume with associated abdominal distension and intermittent episodes of  non-projectile, non-bilious vomiting. Despite regular feeds, his weight gain lagged behind that of  his twin. Figure 1: Supine view, plain abdominal radiograph showing markedly dilated bowel loopsCASE REPORT© 2019 The College of  Medicine and the Medical Association of  Malawi. This work is licensed under the Creative Commons Attribution 4.0 International License.This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Date Received: 25-May-2018Revision Received: 10-Dec-2018Date Accepted: 31-Dec-2018Correspondence:uchechukwu.ezomike@unn.edu.nghttps://dx.doi.org/10.4314/mmj.v31i.14Ekenze et al; Malawi Medical Journal 31 (1): 82-85 March 2019                Chronic bowel obstruction from colonic stenosis 83https://dx.doi.org/10.4314/mmj.v31i.14Figure 2: Intra-operative picture showing stenosed ascending colon (left arrowe), dilated caecum and distal ileum(right arrow)Clinical examination at presentation revealed moderate pallor, weight of  3.2Kg, markedly distended and tense abdomen with visible peristalsis, tympanitic percussion notes and hyperactive bowel sounds. Digital rectal examination was unremarkable. Laboratory investigations revealed haemoglobin level of  8.6g/dl and normal serum electrolytes. Plain abdominal radiograph showed markedly dilated bowel loops filling the entire abdomen with gas in the rectum (Figure 1). Abdominal sonogram revealed gaseous bowel dilatation with minimal free intraperitoneal fluid. Contrast enema was not done because of  the markedly distended and tense abdomen. An initial attempt was made to decompress the bowel non-operatively by insertion of  dulcolax suppository while patient was placed on appropriate intravenous fluid and nil per oral.. When this failed to increase the stool volume or reduce the abdominal distension, the patient underwent exploratory laparotomy. Intraoperative findings included stenosis involving  5cm of  the ascending colon commencing at a point 6cm from the ileocaecal valve with marked gaseous dilation of  the distal jejunum, ileum and caecum (Figure 2). The proximal jejunum was collapsed and the duodenojejunal junction was at the normal position. A right hemicolectomy with ileo-transverse anastomosis was done. Immediate postoperative period was uneventful and patient had good recovery. He has been gaining adequate weight on follow-up.Case report 2A 9-week old male infant who presented with 7 weeks history of  recurrent generalized abdominal distension but has been passing normal volume stools daily . There were also histories of  failure to thrive, bilateral leg swellings and blood transfusion due  probably to nutritional anaemia.Delivery was via spontaneous vertex delivery at gestational age of  about 34 weeks due to preterm onset of  labour. There is no history maternal use of  cocaine,  tobacco, unorthodox medications during pregnancy. His birth weight was 2kg, he cried immediately after birth, spontaneously passed meconium within the first 24hours of  birth and was fed with breast milk and artificial milk. He was not admitted in newborn special care baby unit. Clinical examination revealed an irritable 2.3kg male infant, moderately pale, with grade 5 bilateral pitting lower limb oedema and depressed anterior fontanelle.Figure 3: Barium enema showing multiple colonic stenosis in case report 2Figure 4: The segment of  resected stenosed ascending,transverse and descending colonFigure 5: The segment of  resected stenosed ascending,transverse and descending colonAbdominal examination revealed uniformly distended abdomen with visible peristalsis, everted umbilicus, tympanitic percussion notes and hyperactive bowel sounds. Digital rectal examination was unremarkable. Plain abdominal radiograph showed gaseous distension of  bowel loops in the entire abdomen and gas in the rectum. Barium enema revealed multiple areas of  colonic stenosis [figure 3 ]. Serum electrolytes were within normal limits and haemoglobin estimation was 5.7g/dl. He was transfused and optimized prior to surgery.Patient underwent exploratory laparotomy and intra-operative findings include extensive stenosis involving the caecum, ascending colon, proximal and distal parts of  transverse colon and descending colon [figure 4 ]. Patient had resection of  stenotic colonic segments with ileo-sigmoid Ekenze et al; Malawi Medical Journal 31 (1): 82-85 March 2019               Chronic bowel obstruction from colonic stenosis 84  https://dx.doi.org/10.4314/mmj.v31i.14colon anastomosis. Postoperatively, patient had uneventful recovery and on follow-up has been gaining adequate weight. Histopathology report on the resected bowel segment excluded Hischsprung’s disease. DiscussionColonic stenosis is a rare but established cause of  pediatric intestinal obstruction   and the presentation may be in neonatal age, early infancy (as in our two case reports) or less commonly in older children2, 7. They may be congenital or acquired. The congenital types are thought to occur when there is incomplete bowel injury as may be the case when injury occurs close to the bowel wall, allowing collateral blood flow to preserve the injured tissue or when there is limited ischemia, in which the blood supply is partially or intermittently occluded. The acquired types are mainly from strictures following Necrotizing Enterocolitis(NEC)8,9.The factors that determine the time of  presentation are largely unknown, but may be related to the severity of  the stenosis and whether it is congenital or acquired. The common clinical features in the reported cases include passage of  small quantity of  faeces, abdominal distension, colicky abdominal pain, occasional vomiting, and failure to gain adequate weight1,2, 4, 5, 7. Although most of  these symptoms were exhibited in the index cases, they are not pathognomonic and can be manifestations of  other diseases like Hirschsprung’s disease, Necrotizing EnteroColitis(NEC), distal small bowel atresia, and intestinal malrotation that may present in the same age group1, 5. Perhaps it is for this reason that the clinical diagnosis of  this disease is difficult, and most of  the reported cases were initially managed with the preceding diagnoses pending imaging or laparotomy7. Studies have shown that preoperative diagnosis of  congenital colonic stenosis may be facilitated by the use of  contrast enema and colonoscopy1, 2, 4, 5, 10. Contrast enema delineates small caliber distal colon and a distended proximal colon in cases of  colonic stenosis.  It also differentiates colonic stenosis from colonic atresia in which there is a cut- off  point between a distal colon filled with contrast and a dilated proximal bowel filled with luminal air. In the first case  we did not obtain a barium enema as there was marked abdominal distension prompting fears that retention of  rectally delivered contrast may worsen symptoms or may lead to perforation4. In the second case report barium enema revealed multiple colonic stenosis (figure 4). Colonoscopy will reveal an abrupt change in caliber in the affected area of  the colon. Definitive treatment of  congenital or acquired colonic stenosis is surgery1-5. The stenosis may be single( as in the first case report) or multiple(as in second case report)1,4,7.  It may affect ascending colon, transverse colon, descending colon or sigmoid colon in isolation or in various combinations as multiple stenoses1, 2, 4. It is therefore imperative to thoroughly examine the entire length of  the bowel to assess patency and ensure that no affected part of  the bowel is missed. Surgical treatment can be undertaken either by open or by laparoscopic procedure1 – 5, 10,11 and involves resection of  the stenotic segment(s) and primary anastomosis for the right colonic stenosis2, 10. This was performed in our first case report.  Intraoperatively we resected the stenotic segment as well as adjoining bowel thought to have had precarious blood supply due to the preceding causative vascular accident. These areas with uncertain blood supply may have some degree of  hypomotility and if  not excised may lead to delayed return of  bowel function postoperatively. In left sided colonic stenosis, it may be expedient to perform proximal protective enterostomy after the resection and anastomosis1, 5, 7.  In multiple colonic stenosis, enteroplasties may be considered in some cases to avoid the risk of  excessive colonic loss with multiple resection1, 7. In the second case we carried out an extensive large bowel resection   involving both right and left colon and with no proximal protective enterostomy. There was also no evidence of  short bowel syndrome which may be due to the great ability of  neonatal ileum for adaptation.Advances in resuscitation and peri-operative care have led to high survival rates   and postoperative period is often uneventful with good outcome in most of  the reported cases 12,13.ConclusionColonic stenosis is a rare cause of  lower intestinal obstruction in early childhood. The clinical manifestations of  the disease are not pathognomonic and may mimic some other disorders in this age group. It is imperative to have high index of  suspicion for this disease and institute appropriate diagnostic workup in neonates and infants with progressive abdominal distension that dates back to newborn period despite regular passage of  small quantity of  stools and absence of  bilious vomiting. References1. Elisa Z, Cinzia C, Sergio S, Giuseppe LV, Fortunato S. Multiple Congenital Colonic Stenosis: A Rare Gastrointestinal Malformation. Case Rep Pediatr 2016; 2016;2016:6329793. doi: 10.1155/2016/6329793.2. Galván-Montaño A, Suárez-Roa Mde L, Carmona-Moreno E. Congenital stenosis of the colon  with foreign bodies. Case report. Cir Cir 2010; 78(3): 259-61.3. Hajivassiliou CA. Intestinal obstruction in neonatal/pediatric surgery. Semin Pediatr Surg 2003; 12(4): 241 – 53.4. Hamid R, Shera AH, Bhat NA, Baba A, Rashid A. Congenital Descending Colonic Stenosis with Perforation of Transverse Colon in a Neonate: A Case Report. J. Nepal Paediatr. Soc  2012; 32(1): 73 – 75.5. Mirza B, Iqbal S, Ijaz L. Colonic atresia and stenosis: our experience. J Neonat Surg 2012; (1):4.  6.Schimpl G,Höllwarth ME,Fotter R, Becker H.  Late intestinal strictures following successful treatment of necrotizing enterocolitis. Acta Paediatr Suppl.1994; 396:80-3. 7. Hamid R, Ali I, Bhat N, Baba AA, Mufti G, Wani SA. Management Congenital Colonic Stenosis. J Neonatal Biol 2015; 4: 166.8. Heida FH, Loos MH, Stolwijk L, Te Kiefte BJ, van den Ende SJ, Onland W et al. Risk factors associated with postnecrotizing enterocolitis strictures in infants. J Pediatr Surg. 2016 ;51(7):1126-30. doi: 10.1016/j.jpedsurg.2015.09.015.9. Burnand KM, Zaparackaite I, Lahiri RP, Parsons G, Farrugia MK, Clarke SA et al. The value of contrast studies in the evaluation of bowel strictures after necrotising enterocolitis. Pediatr Surg Int. 2016 ;32(5):465-70. doi: 10.1007/s00383-016-3880-7.10.Ruggeri G, Libri M, Gargano T, Pavia S, Pasini L, Tani G, et al. Congenital colonic stenosis: a case of late-onset. Pediatr Med Chir 2009; 31(3): 130 – 3.11. García Vázquez A, Cano Novillo I, Portela Casalod E, Benavent Ekenze et al; Malawi Medical Journal 31 (1): 82-85 March 2019                Chronic bowel obstruction from colonic stenosis 85https://dx.doi.org/10.4314/mmj.v31i.14Gordo MI, Berchi García FJ. Congenital colonic stenosis. An Esp Pediatr 2002; 56(3): 258 – 60.12. Phad N, Trivedi A, Todd D, Lakkundi A. Intestinal strictures post-necrotising enterocolitis: clinical profile and risk factors. J Neonatal Surg. 2014; 20;3(4):44.13.Abu-Judeh HH, Methratta S, Ybasco A, Garrow E, Ali S. Congenital colonic stenosis. South Med J. 2001; 94(3): 344-6. 

Chronic bowel obstruction from colonic stenosis in early infancy-A report of two cases

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Pattern of stroke in a rural Kenyan hospital

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