Prevalence of prolonged otitis media with effusion among 2 to 3 years old Cameroonian children in the era of 13-valent pneumococcal conjugate vaccines

Objectives

There is data scarcity on the overall effects of pneumococcal conjugate vaccines (PCVs) on otitis media (OM) in low- and middle-income countries. The impact of the 13-valent PCV (PCV13) program on OM was evaluated in Cameroon where infant vaccination was implemented in July 2011 using a 3-dose primary series at 6, 10 and 14 weeks of age.

Methods

Through community-based surveillance, we used a retrospective cohort study design to assess OM prevalence among PCV13-vaccinated children aged 24 to 36 months in 2015. This was compared with a 2013 age-matched cohort of PCV13-unvaccinated children. OM was diagnosed by clinical inspection for chronic suppurative OM (CSOM) and tympanometry for OM with effusion (OME). CSOM was defined as draining of the middle ear with duration of more than 2 weeks and prolonged OME was defined as a flat 'type B' tympanogram. PCV13-vaccinated and PCV13-unvaccinated cohorts were compared by calculating prevalence odds ratios for OM and baseline characteristics.

Results

Altogether, 111 OM cases were identified; 42/433 (9.7%) in the PCV13-unvaccinated in 2013 and 69/413 (16.7%) in the PCV13-vaccinated cohort in 2015. In the 2013 baseline survey, 3/433 (0.7%) children were identified with unilateral CSOM compared to 9/413 (2.2%) in the PCV13-vaccinated cohort in 2015. Bilateral prolonged OME was diagnosed in 7/433 (1.6%) PCV13-unvaccinated children and in 12/413 (2.9%) in PCV13-vaccinated children. Proportions of children with unilateral prolonged OME were 31/433 (7.2%) in the PCV13-unvaccinated group compared with 48/413 (11.6%) in the PCV13-vaccinated group. Multivariate logistic regression analysis showed evidence that PCV13-vaccinated children in 2015 had 40% less risk of contracting OM compared to PCV13-unvaccinated children in 2013 (adjusted prevalence odds ratios = 0.60 [95% confidence interval: 0.38 to 0.94], P = 0.025). Additionally, attributable proportion estimates show that, 58% of OM infections among the PCV13-vaccinated group would still have occurred despite PCV13 vaccination.

Conclusion

Our findings provide significant evidence on the effect of PCV13 in decreasing OM or OME among children in this age group. It also supports justification for government's continuation of PCV13 immunization program in the absence of GAVI's funding. Further research is needed to assess the long-term impact of the PCV13 program on in OM Cameroon.

Gender differences in the surgical management of trachomatous trichiasis: an exploratory analysis of global trachoma survey data, 2015-2019

BACKGROUND

Trachomatous trichiasis (TT) is a painful, potentially blinding eye condition that can be managed through epilation or surgery. Women are affected by TT approximately twice as often as men and are believed to face gendered barriers to receiving surgical care to prevent vision loss.

METHODS

We used data from 817 cross-sectional surveys conducted during 2015-2019 in 20 African countries to estimate the prevalence difference (PD) between female and male eyes for four outcomes potentially indicating gender-related differences in TT management: (1) received surgery and developed postoperative TT (PTT), (2) never offered surgery, (3) offered surgery but declined it, and (4) offered epilation but never offered surgery.

RESULTS

The prevalence was modestly elevated among female eyes compared with male eyes for having PTT (PD:1.8 [95% confidence limits (CL): 0.6, 3.0]) and having declined surgery for the eye (PD: 6.2 [95% CL: 1.8, 10.7]). The proportion offered epilation was similar by gender (PD:0.5 [95% CL: -0.4, 1.3]), while never having been offered surgery was somewhat more prevalent among male eyes (PD: -2.1 [95% CL: -3.5, -0.7]).

CONCLUSIONS

Our results suggest potential gender differences in TT management. More research is needed to determine the causes and implications of the observed differences.

Antimicrobial stewardship in the era of the COVID-19 pandemic: A systematic review protocol on the opportunities and challenges for Sub-Saharan Africa

BACKGROUND

Antimicrobial resistance (AMR) remains one of the leading threats to global public health and this may increase following COVID-19 pandemic. This is particularly the case in Africa where regulations on antimicrobial usage are weak. This protocol outlines the steps to undertake a systematic review to synthesize evidence on drivers of AMR and evaluate existing approaches to strengthening antimicrobial stewardship (AMS) programs in Sub-Saharan Africa (SSA). On the basis of the evidence generated from the evidence synthesis, the overarching goal of this work is to provide recommendations to support best practices in AMS implementation in SSA.

METHODS

A systematic search will be conducted using the following databases: Global Health Library, PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, Google Scholar, Global Health, Embase, African Journals Online Library, Web of Science, antimicrobial databases (WHO COVID-19, TrACSS, NDARO, and JPIAMR), and the Cochrane databases for systematic reviews. Studies will be included if they assess AMR and AMS in SSA from January 2000 to January 31, 2023.

RESULTS

The primary outcomes will include the drivers of AMR and approaches to AMS implementation in SSA. The Preferred Reporting Items for Systematic Reviews and Meta-analyses will guide the reporting of this systematic review.

CONCLUSIONS

The findings are expected to provide evidence on best practices and resource sharing for policy consideration to healthcare providers and other stakeholders both at the local and international levels. Additionally, the study seeks to establish drivers specific to AMR during the COVID-19 era in the SSA, for example, with the observed increasing trend of antimicrobial misuse during the first or second year of the pandemic may provide valuable insights for policy recommendation in preparedness and response measures to future pandemics.

PROSPERO REGISTRATION NUMBER

CRD42022368853.

Exploring water, sanitation, and hygiene coverage targets for reaching and sustaining trachoma elimination: G-computation analysis

BACKGROUND

Trachoma is the leading infectious cause of blindness. To reduce transmission, water, sanitation, and hygiene (WaSH) improvements are promoted through a comprehensive public health strategy. Evidence supporting the role of WaSH in trachoma elimination is mixed and it remains unknown what WaSH coverages are needed to effectively reduce transmission.

METHODS/FINDINGS

We used g-computation to estimate the impact on the prevalence of trachomatous inflammation-follicular among children aged 1-9 years (TF1-9) when hypothetical WaSH interventions raised the minimum coverages from 5% to 100% for "nearby" face-washing water (<30 minutes roundtrip collection time) and adult latrine use in an evaluation unit (EU). For each scenario, we estimated the generalized prevalence difference as the TF1-9 prevalence under the intervention scenarios minus the observed prevalence. Data from 574 cross-sectional surveys conducted in 16 African and Eastern Mediterranean countries were included. Surveys were conducted from 2015-2019 with support from the Global Trachoma Mapping Project and Tropical Data. When modeling interventions among EUs that had not yet met the TF1-9 elimination target, increasing nearby face-washing water and latrine use coverages above 30% was generally associated with consistent decreases in TF1-9. For nearby face-washing water, we estimated a ≥25% decrease in TF1-9 at 65% coverage, with a plateau upon reaching 85% coverage. For latrine use, the estimated decrease in TF1-9 accelerated from 80% coverage upward, with a ≥25% decrease in TF1-9 by 85% coverage. Among EUs that had previously met the elimination target, results were inconclusive.

CONCLUSIONS

Our results support Sustainable Development Goal 6 and provide insight into potential WaSH-related coverage targets for trachoma elimination. Targets can be tested in future trials to improve evidence-based WaSH guidance for trachoma.

Clinical profile and factors associated with COVID-19 in Yaounde, Cameroon: A prospective cohort study

BACKGROUND

A year after the COVID-19 pandemic started, there are still few scientific reports on COVID-19 in Africa. This study explores the clinical profiles and factors associated with COVID-19 in Cameroon.

MATERIALS AND METHODS

In this prospective cohort study, we followed patients admitted for suspicion of COVID-19 at Djoungolo Hospital between 01st April and 31st July 2020. Patients were categorised by age groups and disease severity: mild (symptomatic without clinical signs of pneumonia), moderate (with clinical signs of pneumonia without respiratory distress) and severe cases (clinical signs of pneumonia and respiratory distress not requiring invasive ventilation). Demographic information and clinical features were summarised. Multivariable analysis was performed to predict risk.

FINDINGS

A total of 313 patients were admitted during the study period; 259 were confirmed cases of COVID-19 by Polymerase Chain Reaction (PCR). Among the confirmed cases, the male group aged 40 to 49 years (13.9%) was predominant. Disease severity ranged from mild (26.2%; n = 68) to moderate (59%; n = 153) to severe (14.7%; n = 38); the case fatality rate was 1% (n = 4). Dysgusia (46%; n = 119) and hyposmia/anosmia (37.8%; n = 98) were common features of COVID-19. Nearly one-third of patients had comorbidities (29%; n = 53), of which hypertension was the most common (18.9%; n = 49). Participation in mass gatherings (Odds Ratio (OR) = 2.37; P = 0.03) and dysgusia (OR = 2.09, P = 0.02) were predictive of diagnosis of COVID-19. Age groups 60 to 69 (OR = 7.41; P = 0.0001), 50 to 59 (OR = 4.09; P = 0.03), 40 to 49 (OR = 4.54; P = 0.01), male gender (OR = 2.53; P = 0.04), diabetes (OR = 4.05; P = 0.01), HIV infection (OR = 5.57; P = 0.03), lung disease (OR = 6.29; P = 0.01), dyspnoea (OR = 3.70; P = 0.008) and fatigue (OR = 3.35; P = 0.02) significantly predicted COVID-19 severity.

CONCLUSIONS

Most COVID-19 cases in this study were benign with low fatality. Age (40-70), male gender, HIV infection, lung disease, dyspnoea and fatigue are associated with severe COVID-19. Such findings may guide public health decision-making.

[Neglected childhood strabismus: Epidemiological, clinical and therapeutic aspects]

INTRODUCTION

In an environment where strabismus is poorly understood and management centers rare, we studied the epidemiological, clinical and therapeutic aspects of neglected childhood strabismus.

MATERIALS AND METHODS

This was a retrospective study carried out from March 1st, 2013 to September 30, 2018. Neglected childhood strabismus was defined as strabismus occurring in the first 5 years of life, for which the patient was over 7-years-old at the time of first consultation. The variables studied were age at first consultation, gender, age of onset, type of strabismus, etiology of strabismus, angle of deviation and rate of surgery.

RESULTS

We found 113 cases of neglected childhood strabismus among the 430 cases of strabismus seen during the study period. There were more females (n=64) than males. The mean age was 17.7±10.5 years. There were 73 exotropias (64.6 %). The mean angle of deviation was 41.2±12.2PD. Strabismus was early in 70.8 % of cases. Innervational strabismus accounted for 86.7 % of cases. The most frequent refractive error was hyperopic astigmatism (55.3 %). Of the 45 patients who were seen again after full-time wear of their full cycloplegic correction, 2 were orthotropic. Surgery was performed in 60.5 % of cases. The average postoperative angle of deviation was 6.6±9.4PD.

CONCLUSION

Management of neglected childhood strabismus provides good results and should therefore be encouraged in order to improve the quality of life of affected patients.

[Measurement of pupillary diameter in diabetic and non-diabetic patients: a case-control study]

PURPOSE

To study the effect of type 2 diabetes on pupil diameter.

PATIENTS AND METHODS

We carried out a case-control study at the Douala Obstetrics, Gynecology and Pediatric Hospital over a 5-month period. The cases were type 2 diabetic patients, and the controls were non-diabetic patients paired for age and gender. We studied the correlation between the duration of diabetes, fasting blood sugar and the horizontal pupil diameter.

RESULTS

We included 35 patients in each group. The mean age was 56.6±10.01 years. Both groups included 17 males and 18 females. The mean duration of diabetes was 2.72±4.31 years, and the mean fasting blood sugar was 2.02±0.69g/L. The mean pupil diameter was similar in the two groups. On the right side, it was 4.75±0.73mm for controls and 4.52±0.69mm for cases (P=0.179). On the left side, it was 4.70±0.68mm and 4.42±0.73mm respectively for each group (P=0.101). The duration of diabetes was correlated to pupil diameter in the right eye (r=-0.43; P=0.01) and left eye (r=-0.45; P<0.01). No additional risk was found to be associated with diabetes for right pupil diameters (OR=0.79; P=0.33), or for left ones (OR=0.76; P=0.24).

CONCLUSION

Pupil diameter is similar in diabetic and non-diabetic patients. However, the duration of diabetes appears to affect pupil diameter.

Worldwide inequality in access to full text scientific articles: the example of ophthalmology

Background

The problem of access to medical information, particularly in low-income countries, has been under discussion for many years. Although a number of developments have occurred in the last decade (e.g., the open access (OA) movement and the website Sci-Hub), everyone agrees that these difficulties still persist very widely, mainly due to the fact that paywalls still limit access to approximately 75% of scholarly documents. In this study, we compare the accessibility of recent full text articles in the field of ophthalmology in 27 established institutions located worldwide.

Methods

A total of 200 references from articles were retrieved using the PubMed database. Each article was individually checked for OA. Full texts of non-OA (i.e., “paywalled articles”) were examined to determine whether they were available using institutional and Hinari access in each institution studied, using “alternative ways” (i.e., PubMed Central, ResearchGate, Google Scholar, and Online Reprint Request), and using the website Sci-Hub.

Results

The number of full texts of “paywalled articles” available using institutional and Hinari access showed strong heterogeneity, scattered between 0% full texts to 94.8% (mean = 46.8%; SD = 31.5; median = 51.3%). We found that complementary use of “alternative ways” and Sci-Hub leads to 95.5% of full text “paywalled articles,” and also divides by 14 the average extra costs needed to obtain all full texts on publishers’ websites using pay-per-view.

Conclusions

The scant number of available full text “paywalled articles” in most institutions studied encourages researchers in the field of ophthalmology to use Sci-Hub to search for scientific information. The scientific community and decision-makers must unite and strengthen their efforts to find solutions to improve access to scientific literature worldwide and avoid an implosion of the scientific publishing model. This study is not an endorsement for using Sci-Hub. The authors, their institutions, and publishers accept no responsibility on behalf of readers.

[Retinal manifestations of neuro-malaria or "malarial retinopathy" in Yaoundé]

AIM

Contribute to the improvement of diagnostic and prognostic approaches to treating children with neuro-malaria in Yaoundé.

PATIENTS AND METHOD

A prospective and analytical study carried out in 2 hospitals of Yaoundé from October 2015 to March 2016. All patients aged 3 months to 15 years hospitalized for neuro-malaria in one of the 2 hospitals benefited from a fundus examination. The variables studied were: age, sex, Glasgow or Blantyre score, fundus examination and parasitaemia. For statistical analysis, we used the software R 3.3.0, Chi², exact of Fisher or Kolmogorov-Smirnov tests with a significance P<5%.

RESULTS

Out of the 178 children hospitalized during the study period, 44 had neuro-malaria (24.71%) and 26 (46 diseased eyes) among them presented retinal lesions at a frequency of 14.60%. The mean age was 5.54±3.49 years with a sex ratio of 1.09. The under 5-years-old were the most affected with 31 (70.45%) cases. The fundus lesions of 26 (59.09%) were retinal hemorrhages in 24 (54.54%), retinal whitening and vessel discoloration in 8 (18.18%) respectively. Papillary edema was associated in 4 (9.09%). Macular involvement was noted in 9 cases. These lesions were correlated with age, depth of coma, duration, and clinical course. The rate of parasitaemia did not affect their occurrence.

CONCLUSION

Retinal lesions are frequent and serious during neuro-malaria in our environment, especially in children under five. They must therefore be an emphasis in the systematic exam to rule it out for a better prognostic evaluation and a fast and adequate multidisciplinary management.

Visual outcome of surgically managed pituitary adenomas followed-up at the Yaoundé Central Hospital

INTRODUCTION

Pituitary adenomas are benign brain tumours arising from the adenohypophysis; representing 10-15% of all intra-cranial tumours. Despite improved management, they are still related to high morbidity. Visual impairment is a common presentation and visual field defects representing 37-96%. We aimed at describing the clinical presentation of operated patients and their visual outcome.

METHODS

We conducted a cross-sectional study for 6 months at the Yaoundé Central Hospital's Neurosurgery, Endocrinology and Ophthalmology departments. We included all patients with histopathological confirmation, having pre-operative visual assessment and operated from January 2010 to June 2016.

RESULTS

Twenty-five participants (50 eyes) were enrolled. Three subtypes of pituitary adenomas were identified: Non-functional pituitary adenomas (64%) > Somatotropinomas (20%) > Prolactinomas (16%). All cases were macroadenomas. The median duration of symptoms was 14 months. All participants presented with vision impairment and 80% with headaches. Craniotomy was used in 88% of cases. The temporal hemifield was the most quantitatively affected; 76% of eyes presented with visual acuity (VA) < 6/12 and 24% of eyes a visual acuity ≥6/12. Thirty percent of eyes presented with optic atrophy; cranial nerve III palsy was the most observed. The Mean deviation (MD), an automated visual field index, improved though non-significant and 16% of eyes had a normal visual field printout after surgery. Left eye mean deviation improved significantly (p = 0.04). After surgery, there was a mild improvement of VA with 62% of eyes having a VA< 6/12 and 38% a VA ≥6/12. There was no ophthalmoplaegia after surgery. Long delay before diagnosis significantly jeopardizes pre-operative and post-operative visual acuity (r = 0.5; p = 0.01).

CONCLUSION

Quantitative vision parameters comparison are suggestive of a potential improvement of vision. This conclusion will be better ascertained on a large-scale sample size. Long delay before diagnosis is associated to poor visual outcome.

Color vision deficiency among biomedical students: a cross-sectional study

PURPOSE

To determine the prevalence of color vision deficiency (CVD) among first-cycle students of the Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I.

PATIENTS AND METHODS

A cross-sectional descriptive study was carried out between October 1, 2015 and May 31, 2016. Distant visual acuity was measured and color vision test done for all consenting students. Ishihara's plates were used to test all the participants. Those who failed the test were tested with the Roth's 28 Hue test for confirmation of CVD and classification.

RESULTS

A total of 303 students were included, among whom 155 were males (50.8%) and 148 were females (49.2%). The mean age was 20.2±2 years. Five students (1.6%) failed the Ishihara's plate testing. Roth's 28 Hue test confirmed CVD in 4 of those cases, giving a prevalence of 1.3%. There were equal numbers of protan and deutan CVD.

CONCLUSION

Despite its low prevalence among first-cycle students of the Faculty of Medicine and Biomedical Sciences, CVD screening should be performed in order to raise awareness, which will go a long way to help orientate the choice of future specialty.

Phthirus pubis Infestation of the Eyelids Presenting as Chronic Blepharoconjunctivitis in a 6-Year-Old Girl: A Case Report

Purpose

To report the case of Phthirus pubis infestation of the eyelashes presenting as chronic blepharoconjunctivitis.

Case Report

A 6-year-old girl presented with a 2-month history of blepharoconjunctivitis unresponsive to topical antibiotics in the left eye. Slit-lamp examination revealed the presence of nits and adult parasites on the eyelashes. Parasitological examination confirmed adult forms and nits of Phthirus pubis. There was no evidence of infestation elsewhere. Outcome was favourable with mechanical removal and application of petroleum jelly.

Conclusion

Careful slit-lamp examination of the eyelashes should be done in all patients presenting with ocular irritation symptoms.

Partially absorbed cataractous lens in the anterior chamber revealing neglected severe ocular contusion: a case report

Background

Ocular contusion can produce severe lesions, which if not treated appropriately and promptly, can lead to visual impairment. Ocular contusion in childhood may not be reported by children.

Case presentation

A 27 year old female presented with a partially absorbed cataractous lens that was dislocated into the anterior chamber of her left eye. There was mild anterior chamber reaction. She reported no history of ocular trauma; but associated findings and further investigations were in favour of a post-traumatic aetiology.

Conclusion

All ocular injuries require a detailed ophthalmological examination to assess vision and the extent of lesions.

Bilateral intraorbital abscesses with intracranial complications in a young Cameroonian girl: a case report

Background:

Intraorbital abscess is a very severe infection with ophthalmologic and neurologic complications that are sometimes life-threatening.

Objective:

To report the etiologic, clinical, radiologic, and prognostic features of one case of bilateral intraorbital abscesses with intracranial complications.

Case report:

A 15-year-old Cameroonian girl in a comatose state (11/15 on the Glasgow Coma Scale) with meningeal signs, right hemiplegia, right facial palsy, and bilateral exophthalmia was admitted for meningitis and cerebral abscess secondary to orbital cellulitis. A lumbar tap was carried out, no organisms were seen by Gram stain, and culture was negative due to previous antibiotic therapy. A computed tomography scan showed a left internal capsule infarct and a pansinus opacification. Bilateral superior orbitotomies were performed and the abscess evacuated. Microscopy and culture of surgical material were negative. The patient was discharged 4 weeks after hospital admission with a visual acuity of 0.1 in both eyes, aphasia, and right hemiplegia. Nine months later, there was complete visual recovery (visual acuity 1.0 in both eyes). Anterior and posterior segments were normal on slit-lamp examination. There was no aphasia, but right-sided hemiparesis persisted.

Conclusion:

The authors emphasize the need for prevention, early diagnosis, and adequate treatment of orbital cellulitis in order to avoid complications.

[Tropical endemic limboconjunctivitis (vernal conjunctivitis) in northern Cameroon]

INTRODUCTION

A retrospective study was conducted in the ophthalmology unit of the Garoua regional hospital on children examined from January 2001 to December 2007. We aimed to determine the epidemiological aspects of tropical endemic limboconjunctivitis in northern Cameroon. Included were all the files of patients aged 0-15 years seen with a positive diagnosis of tropical endemic limboconjunctivitis. The data analyzed were obtained through inspection, interview, and a comprehensive ocular exam done for every case, assessing far visual acuity, slit lamp biomicroscopy, and funduscopy when possible. The variables analyzed were age, sex, signs and symptoms, residential area, associated pathologies, and the month and the year of the diagnosis. The data were analyzed with Epi-Info, version 6.04d (French) and the results compared with the Chi(2) test with a 95% confidence interval.

RESULTS

A total of 6453 children were included: 2036 had a positive diagnosis of tropical endemic limboconjunctivitis, with a frequency of 31.55%. The mean age was 6.5 years. The 1- to 4-year-old age group had the highest number of patients, with a frequency of 33.25%. There were 1120 males (55%). Itching was the most frequent complaint encountered in 60.90% of the patients. Ocular involvement was always bilateral. Tropical endemic limboconjunctivitis is an allergic conjunctivitis present throughout the year with two peaks in March and July.

DISCUSSION

Tropical endemic limboconjunctivitis can be considered an allergic conjunctivitis affecting boys more frequently than girls in warm and dry environments. It is frequent in children less than 5 years old and regresses with age.

CONCLUSION

Tropical endemic limboconjunctivitis is a tropical disease with an intertropical aspect.

[Pterygiun in a tropical region. Analysis of 344 cases in Cameroon]

PURPOSE

The aim of this study was to report the epidemiological, clinical and therapeutic aspects of pterygium in a Cameroonian population.

MATERIAL, METHODS

Over a period of three years, 344 patients (132 female, 212 males) with pterygium were recruited in a prospective study in the Eye Department of the University Teaching Hospital (UTHY).

RESULTS

The prevalence of pteygium among the consulted patients during this period was 1.28%. The mean age was 40 years and 92% of the patients were older than 30 years. The clinical forms were various with a predominance of quiet non progressive forms. The recurrences and the complicated forms were frequent among the patients whose occupation was linked to exposure of the ocular surface. With respect to therapeutical aspects, the excision of the lesion associated with a transplantation of the conjunctiva had greatly improved the results, with a rate of recurrence of 12%.

CONCLUSION

The treatment of pterygion should be adapted to individual cases. A long-term follow-up of surgical cases is advised. We recommend that the public could be informed on this pathology through the media and suggest that this study would be initiated in the sahelian region of the country in the future.

The rate of and indications for enucleations at Sekuru Kaguvi Eye Unit in Harare: a comparative analysis

OBJECTIVES

To determine the rate of and indications for enucleation at Sekuru Kaguvi Eye Unit (SKEU) in Zimbabwe and compare the findings with those from other tertiary eye care centres in the developing world.

DESIGN

Descriptive retrospective cross sectional study.

SETTING

Sekuru Kaguvi Eye Unit, Parirenyatwa Hospital, Harare, Zimbabwe.

SUBJECTS

Records of patients who had undergone enucleation at Sekuru Kaguvi Eye Unit, between January 1988 to December 2000.

MAIN OUTCOME MEASURES

Rate and indications of enucleations done at SKEU during the study period.

RESULTS

Ocular tumours (64.2%) and ocular infections (26.4%) were the leading indications for enucleation and the crude incidence rate for enucleation at SKEU was 0.17%

CONCLUSION

Indications for enucleation at the SKEU in Harare are similar to those experienced by other developing countries.