Antiretroviral prophylaxis has a significant impact on the gut microbiota of HIV-exposed infants. This impact is particularly important because gut microbiota plays a crucial role in overall health and immune development. Understanding how antiretroviral prophylaxis affects the gut microbiota in HIV-exposed infants is important for optimizing their health outcomes and immune response. We carried out a narrative review of published literature on the gut microbiota of infants on antiretroviral prophylaxis, from subSaharan Africa including Malawi, South Africa, Tanzania, and Uganda. There were no previous reports on the gut microbiota of infants on antiretroviral prophylaxis from Zimbabwe. Hence, we included a 2020 study describing the microbial composition of Zimbabwean children on long-term antiretroviral therapy. The published reports agreed that HIV-exposed infected children have an altered gut microbiota and prolonged antiretroviral therapy may restore the richness of the microbiota closer to that of HIV-uninfected children.
Objective: Aflatoxin B (AFB1) and Fumonisin B (FB1) are toxins found in staple foods consumed in 1 1 resource-limited and high-HIV-prevalence settings. We aimed to assess the hepatotoxic, carcinogenic and genotoxic risks of AFB1 and FB1 exposure in HIV-infected and HIV-uninfected Zimbabwean women.Design: A retrospective longitudinal study was conducted in women during pregnancy and post-lactation. Urinary Aflatoxin M (AFM1) and FB1 measured via ELISA were used to determine the Median Probable 1 Daily Intake (MPDI), Margin of Exposure (MOE), combined Margin of Exposure (MOE ), and AFB1- T induced Hepatocellular Carcinoma (HCC) risk.Results: During pregnancy, the MPDI of AFB1 (μg/kg BW/day) was 0.10 in 49% of HIV-infected and 0.11 in 59% of HIV-uninfected (p=0.27). The MPDI of FB1 (μg/kg BW/day) was 8.27 in 91% of HIV-infected and 5.81 in 91% of HIV-uninfected (p=0.01). Post-lactation, the MPDI of AFB1 (μg/kg BW/day) was 0.08 in 71% of HIV-infected and 0.08 in 69% of HIV-uninfected (p=0.60). The MPDI of FB1 (μg/kg BW/day) was3.18 in 85% of HIV-infected and 4.01 in 93% of HIV-uninfected (p=0.42). During pregnancy and postlactation, the MOEs for AFB1 and FB1 were <10,000. During pregnancy and post-lactation, 49% and 66% of women, respectively, were exposed to the AFB1-FB1 combination, with MOE <100. During pregnancy, the T AFB1-induced HCC risk in HIV-infected and HIV-uninfected was 2.16 and 1.42 cases/100,000 people, respectively. Post-lactation, the AFB1-induced HCC risk in HIV-infected and HIV-uninfected was 3.12 and 2.89 cases/100,000 people, respectively.Conclusion: AFB1 and FB1 exposure in Zimbabwean women is potentially hepatotoxic, carcinogenic, genotoxic and HCC inducing.
Introduction: Multidrug resistant bacteria are a world-wide threat to humans, animals and the environment. Enterobacteriaceae are the most common cause of community and healthcare-associated infections. The presence of Extended Spectrum β Lactamase (ESBLs) enzymes in Gram negative bacteria contribute to multidrug resistance.Objective: To determine the colonization rate and characterize ESBL-producing E. coli isolated from the gut of healthy pregnant women in Harare.Design and Setting: A cross-sectional study was conducted between July and September 2020 on healthy pregnant women during their routine antenatal visits at Hatcliffe polyclinic, one of the biggest antenatal clinics under Harare City Health Department. ESBL-producing E. coli was confirmed using Modified double disk synergy test and Polymerase Chain Reaction (PCR).Subjects: Rectal swab samples were collected from 177 healthy pregnant women attending antenatal clinic at Hatcliffe polyclinic.Results: The colonisation rate of healthy pregnant women from the community clinic was 41.8% (74/177). All the 74 Escherichia coli isolates were susceptible to ertapenem and 68(91.9%) isolates were susceptible to gentamicin. The isolates had high resistance to nalidixic acid 36.5% (27/74), ampicillin 59.5% (44/74) and trimethoprim-sulphamethoxazole 85.1% (63/74). The prevalence of ESBL genes in E. coli was 31.08 % (23/74) with the bla gene being the most common with 78.26% (18/23) followed by bla gene 21.74% CTX-M1 TEM(5/23). The bla gene was not detected. Community carriage of ESBL-producing E. coli among healthy SHV pregnant women was 12.9%.Conclusion: The study showed that the gut of healthy pregnant individuals in the community, is a reservoir of ESBL-producing E. coli.
Introduction: Campylobacter species are a major cause of foodborne infections worldwide.Objective: To determine the antimicrobial susceptibility patterns and prevalence of virulence genes of Campylobacter species isolated from chickens and children under the age of five in Zimbabwe.Design, Setting and Subjects: A cross-sectional study with 189 chicken rectal swabs collected from a distributor chicken farm in the month of August 2020and 126 human stool samples from children under the age of 5 years presenting with diarrhoea attending Parirenyatwa group of Hospitals, a central referral hospital and two private laboratories between June and November 2020in Harare. DNA was extracted using the boiling method, and Polymerase Chain Reaction (PCR) was employed to screen for target genes in the isolates.Results: Overall, 18.3% (23/126) of the children specimens were positive for Campylobacter, of which 78.3% were C. jejuni and 21.7% were C. coli. The prevalence of Campylobacter in chickens was 23.8% (45/189), of which 76.9% were C. jejuni and 23.1% were C. coli. The isolates showed a wide variation in the presence of the virulence genes with notable high prevalence in the detection of cadF, flaA and the cdt genes. In children, the prevalence of the virulence genes; cadF, cdtA, cdtC, dnaJ, flaA, ciaB , and cdtB were 91.3%, 82.6%, 73.9%, 69.6%, 65.2%,47.8%, and 34.8%respectively. In chickens, the prevalence of the virulence genes; cdtA, cdtC cadF, cdtB, flaA, dnaJ, and ciaB were 97.4%, 89.7%, 82.1%, 82.1%, 66.7%, 59.0%, and 30.1%, respectively.Conclusion: This study revealed a higher prevalence of Campylobacter in children than previously reported locally and a moderate prevalence in chickens, with widespread virulence genes and high resistance to multiple antibiotics, underscoring the urgent need for strengthened public health, food safety, and antimicrobial stewardship measures to mitigate zoonotic transmission.
Background: The process of de-institutionalisation has led to a shift in care roles from mental health professionals who provide institutionalised care to an integrated community-based approach, with family members now being the primary caregivers. Caring for a family member with a Severe Mental Disorder (SMD) can be a challenging experience. However, the extent of the burden is often difficult to assess and quantify, and as a result, it is frequently ignored, yet caregiver burden can significantly impact the family's quality of life. This study explored family caregiver experiences, burden and needs among caregivers of family members living with severe mental disorders.Materials and Methods: Data were collected through 14 semi-structured individual interviews and two focus group discussions of family caregivers who cared for relatives with SMD who were being followed up at two randomly selected local municipality polyclinics. An exploratory qualitative research design was used, which was descriptive.Results: Caregivers experienced physical, psychological, social and financial burdens due to caregiving. The majority of caregivers used alcohol as one of the negative coping strategies and had poor quality of life. The findings also showed over-reliance on traditional and faith healers, which negatively influenced caregivers' help-seeking, resulting in delays, further reflecting alternative belief systems and health-seeking behaviour rather than medicalised care.Conclusions: Caregivers experience various burdens and use both negative and positive coping strategies. They require support from both health professionals and the Government to cope better. Culturally sensitive intervention strategies for family caregivers are critical in mitigating caregiver burden.
Introduction: Children with sickle cell disease are at risk of stroke, neuro cognitive impairment and mortality if prophylactic interventions are not instituted early. Transcranial Doppler scan (TCD), a screening tool for cerebral vasculopathy, provides an opportunity for early intervention in stroke prevention and management.Objectives: To determine the relationship between Cerebral Vascular Blood Flow Velocities (CBFv) and neurodevelopmental impairment among children with SCD.Materials and Methods: A hospital based cross sectional study were children aged 1-5 years with SCD without clinical symptoms of stroke were recruited from the paediatric haematology clinic at Parirenyatwa Hospital. Children with stroke, receiving chronic therapeutic blood transfusion, acute illnesses, infections, and those admitted were excluded. TCD and neurodevelopment assessment were performed on children within 6 weeks of each assessment. Cerebral Blood Flow Velocity (CBFv) was classified as normal, conditional and high. Ethical approval was granted from Medical Research Council of Zimbabwe.Results: Of the 37 children enrolled with sickle cell disease, 32 had neurodevelopmental assessment done. The common presenting clinical features were jaundice, pallor, fever, joint swelling, chest infection and poor weight gain. Thirteen children had a haemoglobin electrophoresis confirmatory test done. Most of the children were on hydroxyurea prophylaxis 28(76%), with 10(27 %) on both penicillin and folate. The prevalence of abnormal cerebral blood flow velocity was 5%. Cognitive impairment was identified in 4(13%) children, of whom, one also had high CBFv. Children with high CBFv tended to have lower scores on receptive and expressive language scales, although differences were not statistically significant.Conclusion: One in eight of the children with SCD aged one to five years exhibited cognitive impairment and 5% had abnormal CBFv. The findings highlight the need for a bigger study to examine the relationship between CBFv and neurodevelopmental function of children < 5 years with SCD.
Objective: To determine whether ultrasound imaging in suspected extra-pulmonary Tuberculosis adds diagnostic value beyond that provided by laboratory testing strategies.Design: A retrospective cross-sectional descriptive study of immunocompromised patients admitted to st st Hospital between 1 January and 31 December 2022 with suspected extra-pulmonary TB was performed to ascertain whether abdominal ultrasound added diagnostic value to that provided by TB Urine LAM, PCR and culture.Setting: In a resource constraint tertiary hospital in the Eastern Cape province of South Africa.Subjects: All of the 204 HIV-positive patients 13 years of age, with recorded CD4 counts, who were referred for abdominal ultrasound as part of the work-up for disseminated TB were included, except for 8 who did not meet the inclusion criteria.Main Outcome Measures: A description of the participants and a determination of the proportion of participants with a negative initial TB work-up who exhibited ultrasound features suggestive of disseminated TB.Results: More than one third of patients were referred for abdominal ultrasound with a negative initial TB work-up. All the ultrasound features regarded as supportive of abdominal tuberculosis were seen in 9% of 3 participants with a negative initial work-up, of which 78% had a CD4 count of <100 cell/mm . Some 3 ultrasound features suggestive of tuberculosis were found in 37% of patients with a CD4 count <100 cell/mm and a negative initial work-up, and 10% of this group had all three key ultrasound findings.Conclusion: Abdominal ultrasound adds diagnostic value to the work-up of extra-pulmonary TB in severely immunocompromised patients when the initial laboratory work-up is negative, but is not needed if the diagnosis has already been made by other means.
Introduction: Puberty is a complex biological process involving physical and hormonal changes in which the body transitions to sexual maturity. Objective: The objective of the study was to determine the magnitude of delayed puberty in older children at an opportunistic disease clinic in Harare, Zimbabwe. Design: A retrospective data review nested within the clinical outcomes in children and adolescents with chronic HIV in a Zimbabwe Study. Setting: The opportunistic disease clinic at Parirenyatwa Group of Hospitals, Harare, Zimbabwe. Subjects: The sample size was 279 adolescents. Inclusion Criteria: HIV positive boys 14 years and older and HIV positive girls 13 years and older. Children with Tanner stage assessment. Main Outcome Measure: The prevalence of delayed puberty was the main outcome measure. Results: Two hundred and seventy nine (279) adolescents between 13 and 19 years were enrolled. One hundred and sixty, (57.4%) were female and 119 (42.7%) were male. Mean age at enrolment was 16.1 +/-1.9 years. Median CD4 count was 446 (IQR 281- 652) cells/mm3. A total of 96 (54.2%) had undetectable viral load at enrolment. Delayed puberty in males 6/160 (3.75%). Delayed puberty in females 4/119 (3.36%). Conclusion: The prevalence of delayed puberty was 3.75% in males and 3.36% in females.
Introduction: Since time immemorial glucose has been used as front line biomarker in the management of diabetes. Glucose has probably the highest number analytical methods developed in an attempt to optimally monitor and manage diabetes. Most of these analytical methods are in-cooperated in Point-of-Care Testing (POCT) devices and central laboratory analysers. Therefore, most healthcare facilities in South Africa depend on the results of random glucose from glucometer POCT devices. Since the introduction of glycated Haemoglobin (HbA1c), which is now accepted as a better diagnostic and monitoring biomarker for diabetes, the aim of the study was to determine if glucose measurement still has a role in the monitoring and management of diabetes. Design: A comparative study between glucose and HbA1c was conducted at an academic hospital diabetes outpatients' clinic. Based on the clinic's protocol, patients had random capillary finger prick blood for both glucose and HbA1c tested on site by a medical laboratory scientist before consultation with the attending clinicians. Results: Ninety one percent of the 171 patients had abnormal HbA1c results and 41.5% (70 of the171) patients had abnormal random blood glucose levels. Bland-Altman scatter plot analysis had a mean glucose concentration of 1.984, with limits of acceptance of -5.527 and 9.495. An agreement of 42.7% was calculated. Spearman's correlation was also performed and revealed a statistically moderate correlation between random capillary glucose and HbA1c (r = 0.60, p=< 0.001). Conclusion: There is a low-to-moderate correlation between HbA1c and random glucose levels. Therefore, the age old measurement of glucose has lost its central role in the management and monitoring of patients with diabetes.
Introduction: High-risk Human Papilloma viruses (hr-HPVs) are one of the most important causative agents of cervical cancer. Genotype testing for hr-HPV DNA is a valuable cervical cancer screening tool. It is used for the determination of HPV prevalence and subtype distribution, which are useful in evaluating the impact of HPV vaccines and possibly policy formulation for national cervical cancer vaccination programs. Objective: This study aimed to determine the prevalence and distribution of hr-HPV genotypes and their association with cytology amongst HIV-positive and negative women in Harare, Zimbabwe. Design and Setting: A cross-sectional study was conducted between 2017 and 2019 among HIV-infected and uninfected Zimbabwean women who presented for cervical cancer screening at the Family Planning Clinic at Parirenyatwa Hospital, Harare. Nurses obtained the cervical samples and Liquid-Based Cytology and hr-HPV DNA testing were performed using automated BD SurePathTM liquid based Pap test and Cepheid GeneXpert (Sunnyvale, California) respectively. Subjects: Two hundred and twenty-eight (228) women were enrolled in to the study and47.8% were HIV-infected. The participants were selected randomly as they walked into the clinic and were not necessarily indisposed. The median age was 40 years and 39 years for HIV-infected and HIV-uninfected participants, respectively. Results: The overall prevalence of hr-HPV was 41.1% with higher prevalence observed in HIV-infected (57.9%) when compared to HIV-uninfected women (25.6%), p=<0.001. Multiple hr-HPV infections were higher in HIV-infected (16.0%) than HIV-uninfected (4.3%) women, p=<0.001. The most common types were hr-HPV 16 and hr-HPV 18/45, with each exclusively observed in 12.0.9% and 15.2% of infections respectively. About48.9% of women infected by hr-HPV “other” had at least one type of hr-HPV type not covered by the bivalent vaccine. This category included 64.4% of HIV-infected and 35.5% of HIV-uninfected women. The prevalence of hr-HPV increased with the severity of the cytological lesions. In HIV-infected women, the hr-HPV prevalence was 44.8% in ASCUS, 74.1% in LSIL and 84.6% in HSIL/ASC-H, while in HIV-uninfected women it was 15.4% in ASCUS, 37.9 % in LSIL and 55.0% in HSIL/ASC-H (p=<0.001). Conclusion: In both HIV infected and uninfected groups, HPV infection peaked in middle-aged women (30 to 40 years). However, hr-HPV infection increased with age in HIV-infectedwomen and decreased with age in HIV-uninfected women. The hr-HPV prevalence was two times higher among HIV-infected than uninfected women with the prevalence increasing with severity of cytological lesions in both HIV-infected and uninfected women. Infection with multiple hr-HPV types and a strong association between abnormal cytology and HIV infection was observed. Other hr-HPV types besides types 16 and 18/45 were also prevalent in significant proportions. Further investigation is recommended to ascertain the cross protection of the cervical cancer vaccine available in Zimbabwe against the high-risk types other than 16 and 18/45. We also recommend a more systematic approach to hr-HPV data collection for a successful cervical cancer prevention program.
Main Objective: To document clinical characteristics and outcomes of patients admitted with bronchiolitis at the Children's Hospital, Harare March 2018 to February 2019. Study Design: A hospital based analytical cross sectional study. Study Setting: The study was conducted at the Children's Hospital, Sally Mugabe Hospital. Materials and Methods: Children aged 2months to 2 years hospitalised with bronchiolitis Results: A total of 206 children were recruited. Mean age was 5.4 (SD ±4.3) months with 148 (72%) less than six months. The male to female ratio of 1.8:1. Only 15% of the children were born preterm (85%). The main symptoms were cough (91%), rhinorrhoea (69%) and hot body (66%). Thirteen percent had a comorbid condition. Physical examination findings were mainly tachypnoea (89%) and hypoxia (83%). A severe modified Tal (mTal) score was noted in 116(56%) children at admission and 51(25%) still had a severe mTal score when repeated within 12 hours of admission. The median length of hospital stay was 4 days (IQR 3; 6) and 90(44%) children had a prolonged stay (>4 days). Only 3 (1.5%) children died. A high repeat mTal score, wasting, hypoxia and expiratory/inspiratory wheezes, were associated with a prolonged hospital stay. (p= 0.025, p= 0.004, p=0.001, p= 0.007 respectively). Conclusion: Majority of children admitted with bronchiolitis were less than 6 months of age. There was a male predominance. Bronchiolitis causes high morbidity but low mortality in children from this low-income setting.
Objective: To investigate any gains made in Tuberculosis (TB) case detection during Genexpert MTB/Rif universal access to Drug Susceptibility Testing (DST) Algorithm roll out in Manicaland Zimbabwe, 2017 to 2018. Design: Retrospective study design. Setting: The study setting was the eastern province in Zimbabwe called Manicaland which has 304 health facilities served by 15 Genexpert testing sites. Participants: Total of 36 056 Mycobacterium Tuberculosis (MTB) results generated from 15 Genexpert sites were enrolled. Interventions: The intervention was the universal access Genexpert MTB/Rif algorithm rollout. Early TB detection occurs with Genexpert MTB/Rif because it has lower limit of detection compared to less superior smear microscopy, which was replaced as roll out occurred. Main Outcome Measures: Semi quantitative MTB/Rif test results and the rifampicin resistance pattern. Results: The study revealed that 5769/36056 (16%) were analysed using targeted MTB diagnostic algorithm versus 30286/36056 (83.7%) analysed using universal access to Drug Susceptibility Testing (DST) MTB diagnostic algorithm. Among the positives the percentage positivity contributed by the semi quantitative measure of between MTB detected trace and MTB detected low was 1043 out of 2222(46.9%), suggesting early TB detection. There was a statistically significant increase in Rifampicin (RR) detection. Conclusion: As roll out occurred more tests were analysed using the superior diagnostic tool Genexpert MTB/Rif, thus addressing early TB detection. There was statistically significant more rifampicin resistance detected during roll out.
Background: Perinatal asphyxia is failure to establish breathing at birth. It is a common cause of neonatal mortality in developing countries. Hypoxic Ischemic Encephalopathy (HIE) is the major complication of asphyxia, resulting in permanent neurological and other multi-organ damages. Some haematological changes have also been observed in patients with this disease. Objectives: The objective of this study was to investigate the haematological features in babies with perinatal asphyxia in Zimbabwe. Methodology: A prospective laboratory based cross sectional study was carried out at the Sally Mugabe Hospital Neonatal Unit from December 2018 to April 2019. Routine full blood counts on samples from babies with perinatal asphyxia on their first day of life. Peripheral blood smears were examined on all those with abnormal full blood count results. Results: Full blood counts were done on 180 babies with perinatal asphyxia of whom 103 (57%) and 77 (43%) were females and males respectively. The median white cell count and nucleated red cell count were elevated. The platelet and red cell count were decreased. Haemoglobin, haematocrit, and Mean Corpuscular Haemoglobin Concentration (MCHC) were within normal range. The Mean Corpuscular Volume (MCV) and Mean Corpuscular Haemoglobin (MCH) were increased. There was a correlation between increased nucleated red blood and white cell counts with the severity of perinatal asphyxia in the order of Asphyxia Without Hypoxic Ischemic Encephalopathy (AWHIE), Hypoxic Ischemic Encephalopathy (HIE I), HIE II, and HEI III. The most common haematological abnormalities were thrombocytopaenia 52(29%), anaemia 51(28%) and leukopaenia 28(16%). Twenty-four (47%) of anaemia patients had microcytic hypochromic anaemia. Thirty-one (47%) of 65 blood films examined exhibited immature granulocytes and 28(43%) had burr red blood cells. Conclusion: Babies with perinatal asphyxia may present with haematological abnormalities such as anaemia, thrombocytopaenia, leukocytosis and elevated nucleated red cell count as complications of sever hypoxia. Full blood count may be a useful in the effective management of perinatal asphyxia.
Objective: To determine the predictability of rise in Blood Pressure (BP) parameters, by the various components of excessive weight gain, in a population-based sample of adults in Sokoto, Nigeria. Design: A cross-sectional descriptive study carried out on a community sample of adults attending a free medical screening. Setting: An open-space free medical service carried out in a Sokoto community. Subjects: All consenting, non-pregnant adults that participated in the event were included. Main Outcome Measures: Stepwise multivariate regression analysis was applied to determine the variability strengths of body weight, height, Body Mass Index (BMI), Lean Body Mass (LBM) and Body Fat (BF), on Systolic BP (SP), Diastolic BP (DP), Pulse Pressure (PP), Mean Arterial Pressure (MAP) and Pulse Rate (PR). Slope of the relationship between dependent and independent variables were also determined. Results: BF was a more consistent influencer of BP rise beyond other anthropometric parameters. BF versus SP and MAP are respectively; β-coefficient =0.357, CI =0.264 1.162, p=.002 and β-coefficient = 0.455, CI =0.324 0.890, p=.000. The influence of BMI on DP was β-coefficient =0.457, CI =0.564 1.555, p=.000 and influence of body weight on PR was β-coefficient =0.270, CI = 0.037 0.471, p=.023. Conclusion: To assess the risk of excess weight gain on BP elevation, the BF component of body weight or BMI be given more attention and should be part of the targets of lifestyle modifications aimed at controlling hypertension and forestalling its complications.
Objectives: Data on histological patterns in native kidney biopsies in Zimbabwe is sparse. We sought to describe these histological patterns over a 12 year period. Study Design: We retrospectively evaluated the histological patterns on kidney biopsies at the largest private pathology laboratory in Zimbabwe from 1 January 2008 to 31 January 2020. Setting: Histopathological data on all percutaneous native kidney biopsy specimens received at the pathology lab was recovered from electronic records. Indications for the kidney biopsy were then reviewed and patient demographics collected. Subjects: All patients who had a histopathological report identified from the electronic records and who had had a kidney biopsy for nephrological indications were included. Results: Sixty four 64 reports in total were identified and 18 were excluded (17biopsies done to evaluate renal masses and 1 kidney transplant biopsy). Thus 46 percutaneous native kidney biopsies were evaluated in the final analysis. Ninety six percent of the patients biopsied were of African descent. Primary FSGS was the commonest primary glomerular disease (26%) and lupus nephritis the commonest secondary glomerular disease (24%). The commonest indication for kidney biopsy was nephrotic syndrome (61%). Conclusions: FSGS was the commonest primary GN in this study of adult patients and the commonest indication for kidney biopsy was nephrotic syndrome. This finding is useful for guiding clinicians on managing patients presenting with nephrotic syndrome in low resource settings as often patients lack access to kidney biopsy services and empiric use of steroids may be considered in appropriate individual cases.
Background: Acute asthma is among the commonest medical emergencies that cause repeated presentation to the emergency department and hospitalisation. Several guidelines exist on the management of acute asthma in children. Despite this, evidence from high income countries suggests that practice deviates from standard of care. In low-income countries including most African countries there is paucity of data on the clinical profiles, healthcare given and hospital outcomes of children hospitalised for acute asthma. Objectives: This retrospective chart review reports on the clinical profiles, health care given and hospital outcomes of children presenting with acute asthma at a tertiary hospital. Materials and Methods: A retrospective chart review was done on consecutive case files of patients hospitalised for acute asthma in the period January 2010 to December 2020. A standardized electronic data collection tool (REDCap) was used for data abstraction. The data was uploaded onto a REDCap server then onto an excel spreadsheet. Statistical Package for Social Sciences version 16 (SPSS 16.0) was used for descriptive statistics and to test for association between clinical profiles and length of hospital stay. This review was approved by the Medical Research Council of Zimbabwe and Institutional Joint Research Ethical Committee. Results: A total of 214 case files were reviewed. The ages of the study participants ranged from2months to 17 years, the median was 3years (Q1=1, Q3=6) and 69% were below 5 years. Of the study population, 15% had their asthma diagnosis made before one year of age and 94% by 6 years. Newly diagnosed asthmatics accounted for 101(47%) of the study population while111(52%) were known asthmatics. Cough, fast breathing, and wheeze were universal presenting symptoms. Severe acute asthma was present in 81% of those who had their asthma severity assessed. Up to 73% of the study population had comorbidities. All patients received nebulised Short Acting B2 Agonist (SABA) in the emergency department and in hospital. Oxygen therapy was given to all the patients who had SpO2 measurement less than 92%. However, assessment of asthma severity was done in only 42%, looking for triggers in only 9%, health education was given to 52%, asthma action plan was given to only 5% and review dates were given to 77% of the study population. The median hospital stay was 3 days (Q1=2,Q3=4) and 2 patients died during the period under review. Having newly diagnosed asthma, younger age, low oxygen saturation at presentation and presence of comorbid conditions was significantly associated with severe acute asthma. Patients with severe acute asthma had longer hospital stay. Discussion: This review has revealed that most children with asthma present by 6 years, most have severe acute asthma, co-morbidities, and recurrent hospitalizations due to acute asthma. The care given to children with acute asthma fell short of the standard of care. Conclusions: The chart review acts as the basis for corrective interventions including; development of clinical decision-making algorithms, education of health workers, capacitation of health facilities and guidance of future research.
Background: Aneuploidies pose a diagnostic challenge in low resource settings where diagnostic tests are unavailable or costs are beyond the reach of many. This provides a clinical challenge in case management and counselling for women with foetuses carrying multiple congenital anomalies. A pragmatic approach in the management of foetal medicine cases in these settings becomes imperative. Design: Screening survey and diagnostic test, the well accepted standard for Aneuploidy screen and laboratory tests. In this case we seek to illustrate the use of ultrasound in low resource setting where diagnostic tests are expensive and inaccessible. Setting: This was a hospital-bases case in a low-income setting. Subjects: A 45-year-old woman in her first pregnancy was referred at 20 weeks gestation to the Fetal Medicine Unit (FMU) with an ultrasound scan diagnosis of exomphalos. Intervention: A syndromic pattern approach was used in making a clinical diagnosis of trisomy 18 in a setting with ultrasound equipment and well-trained personnel. The syndromic pattern approach recognises that the common aneuploids such as Trisomy 21, 18 and 13, Monosomy X and Triploidy have a set of foetal malformations that accompany each of the syndromes. Main Outcome Measures: Diagnosis of Aneuploidy Results: A large exomphalos containing bowel and liver was identified. Additional abnormalities were identified which included bilateral mild ventriculomegaly, choroid plexus cysts, left diaphragmatic hernia, atrioventricular septal defect, and kyphoscoliosis of the thoracolumbar vertebrae. Conclusion: The case illustrates the utility of the sonographic syndrome approach in managing pregnancy with multiple foetal defects in low-resource settings. Core Tip: Aneuploidies pose a diagnostic challenge in low resource settings where diagnostic tests are unavailable or costs are beyond the reach of many. We report a case in which a sonographic syndromic pattern approach was used in making a clinical diagnosis of trisomy 18 in a setting with ultrasound equipment and well-trained personnel. This approach helps with case management and patient counselling.
