Hansen's disease: the need for increased healthcare provider awareness and re-training

CONTEXT

Leprosy continues to be a challenge worldwide. In 2009, the World Health Organisation (WHO) reported 244,796 new cases worldwide. Of this, South East Asia, South Americas and Africa have the highest number of new cases.

OBJECTIVE

To highlight misdiagnosis of Hansen's disease as a drawback to eradication of leprosy.

MATERIALS

A retrospective study of cases of Hansen's disease misdiagnosed by clinicians who were seen in the skin clinics of two tertiary institutions in South-East Nigeria over a one year period.

RESULTS

Of the nine misdiagnosed cases, three were females while six were males. Apart from one child of six years old, the rest of the patients were adults. Referring diagnoses included chronic osteomyelitis, acromegaly, dermatitis and depression. One of the patients presented with a reversal reaction (erythema nodosum leprosum) following treatment in a peripheral health facility. Confirmation of the diagnosis was based on slit skin smears for Acid Fast Bacilli carried out in the side laboratory of skin clinic UNTH, Ituku-Ozalla, Enugu state (four patients) and mile four hospital, Abakaliki, Ebonyi State( three patients). All the smears were positive. Patients were commenced on multi drug therapy and all showed marked clinical improvement following drug therapy.

CONCLUSION

Eradication of leprosy may not be feasible if health care providers are ignorant of the different presentations of the disease. A high index of suspicion for leprosy is needed among health care workers in endemic areas. Development of tools for early diagnosis and detection of infection, improvement in existing tools for data collection, provision of guidelines and training materials on vital information for leprosy control will all contribute to the continued success of the National Tuberculosis and Leprosy Control Programme in Nigeria.

Vaginal discharge: aetiological agents and evaluation of syndromic management in Lagos

BACKGROUND

The WHO introduced the syndromic management to help in the control of STIs in resource-poor settings. This needs to be adapted to local settings taking into consideration the prevalence of the various organisms causing STIs. This has given rise to a need to validate the algorithm. The study aimed to correlate the syndromic management treatment algorithm for vaginal discharge with the aetiological diagnosis based on laboratory investigations. Specifically, the sensitivity, specificity and positive predictive values of the syndromic management against a gold standard laboratory diagnosis were evaluated.

METHODS

A total of 195 consecutive patients presenting to the study sites with vaginal discharge were enrolled in the study. Information on sociodemographic data was obtained with the aid of questionnaires. Samples were taken and examined for candida, trichomonas, bacterial vaginosis (BV), chlamydia and gonorrheal infections, after speculum and vaginal examinations.

RESULTS

The sensitivity and positive predictive values (PPV) of the syndromic management in detecting vaginal infections performed better than corresponding values for cervicitis. The algorithm for cervicitis improved on addition of speculum examination (36% and 32.1% for sensitivity and PPV respectively).

CONCLUSION

The study shows that the syndromic diagnosis for vaginal discharge fares better for vaginitis, especially with addition of speculum examination. The application of syndromic diagnosis for cervicitis resulted in omission of patients who had evidence of cervical infections by bacteriologic examination.

Pattern and visual outcome of eye injuries in children at Abakaliki, Nigeria

BACKGROUND

Most studies on ocular injuries have been conducted in urban areas to the neglect of other areas.

OBJECTIVE

To ascertain the pattern and visual outcome following eye injuries in children at Abakaliki, a largely agricultural communityy in Southern Eastern Nigeria

METHODS

A retrospective study of all the children aged 0-15 years, who had eye injuries and presented to the Federal Medical Center, Abakaliki, Nigeria, between May 2004 and June 2006. Their medical case records were retrieved and extracted data for analysis included age, sex, type and cause of eye injury and duration prior to presentation.

RESULTS

Of the 119 medical records of patients (adults and children) with eye injuries within the study period, 34 (28.6%) patients were those of children aged 0-15 years. There were 24 (70.6%) males and 10 (29.4%) females, giving a male to female ratio of 2.4:1.0. Blunt ocular injury constituted 27 (79.4%) cases whereas penetrating injury were 5 (14.7%) cases. Sharp or pointed objects accounted for 14 (41.2%) cases of agents of injuries, sticks being the commonest. While the most common place of trauma was at home 17 (50%) cases, followed by trauma at schools 9 (26.5%) cases, the commonest activity at occurrence of injuries was playing 13 (38.2%) cases. Only three (8.8%) cases presented to the hospital within 24 hours. Majority, 31 (91.2%) cases presented late. Visual prognosis was poorer in penetrating injuries than in mild blunt injuries. Final visual acuity (VA) could not be determined in 11 (32.4%) patients because they were either under age or defaulted from follow up. Of the remaining 23 (67.6%) patients, 12 (35.3%) had a final VA better than 6/18, 1 (2.9%) had VA in the range of 6/18-6/60, 6 (17.6%) had VA of < 6/60 while 4 (11.8%) had NPL. 8 (23.5%) patients needed hospital admission.

CONCLUSION

Blunt eye injury is the commonest type of injury in rural or agricultural Abakaliki, South-Eastern Nigeria. An increase in parental and care giver awareness and education is emphasized.

Congenital eye anomalies in Enugu, South-Eastern Nigeria

OBJECTIVES

To determine the types of congenital ocular anomalies seen in the eye clinic of the University of Nigeria Teaching Hospital Enugu, over an 8-year period from January 1992 to December 1999.

METHOD

In a retrospective non-comparative case-series study, the records of all patients with congenital ocular anomalies seen between January 1992 and December 1999, were analysed for types of anomalies, aetiology, sex and ages at presentation of all patients.

RESULTS

A total of 54 cases were analysed: 25 females; 29 males (M:F = 1: 1.2). Congenital cataract was the most frequently occurring congenital ocular anomaly (42.6%); followed by congenital glaucoma (22.2%) and anophthalmia/microphthalmia and congenital esotropia (9.3%) each.

CONCLUSION

In spite of the limitations of this study our findings are similar to those in other studies.