SSMJ February 2018

Editorials

Editorial: The call to battle cancer in South Sudan

News, Reports and Policy

Establishing the Africa Centres for Disease Control and Prevention: responding to Africa's health threats

In 2017, heads of states and governments of the African Union and the leadership of the African Union Commission officially launch the Africa Centres for Disease Control and Prevention (Africa CDC) in Addis Ababa, Ethiopia.

INTERVIEW: Volunteering in South Sudan: creating partnerships, making a difference

I spoke with Martin Michel, a general surgical registrar in Huddersfield Royal Infirmary, UK. In November 2017, he was part of a volunteer trip to Juba with St. Paul Medical Missions. I asked him about their experiences and what advice he would give to those considering volunteering in South Sudan. These excerpts have been edited for length and clarity.

News: SSMJ is now on the Directory of Open Access Journals (DOAJ)

Obituary: Dr Albino Mayom Kuel – the gift God sent to Italy

On Sunday 21 January 2018, Dr Albino Mayom Kuel, passed away after nearly 60 years of continuous living in Abio in the northern region of Torino, Italy.

Clinical Guidance

No documents found.

Research

Knowledge, Attitude, and Practice and service barriers in a tuberculosis programme in Lakes State, South Sudan: a qualitative study

Background: The World Health Organisation (WHO) estimates the incidence of tuberculosis (TB) in South Sudan to be 79 per 100,000 for new sputum smear positive TB and 140 per 100,000 for all forms of TB cases. The case detection rate of 53% for all forms of TB in South Sudan is below the WHO target of 70%. Objective: To explore knowledge, attitude, and practice barriers as well as service barriers to implementing TB programme in Lakes State, South Sudan. Method: This was a qualitative study conducted in May 2015. Results: Despite some understanding of the symptoms, causes, and consequences of TB, the stigma for TB and lack of disclosure of the disease, is very high among the local community. The limited network of TB facilities for case detection, lack of community distribution of TB drugs and lack of food at hospitals when patients were admitted for treatment, are key barriers to TB service delivery. Conclusion: To overcome barriers it is recommended that the local community worldview should be incorporated into TB awareness, testing, and treatment, and attention should be paid to areas where traditional practices, such as elimination of maize, clash with modern treatments.

Knowledge of tuberculosis and factors responsible for low case detection in the Amansie Central District, Ghana

Background: Tuberculosis (TB) case detection rate has remained consistently low in the Amansie Central District despite the implementation of the National TB Programme (NTP). Objective: To assess the factors influencing this low case detection of TB. Method: Information was collected from 120 individuals and 40 health workers were randomly selected from four health facilities that provided TB treatment. Results: All patients had a good knowledge of TB. There was no statistical association between patients knowledge and educational level (p>0.05). However, knowledge on the causes of TB was strongly associated with occupation (p<0.05). 53% of patients indicated health facilities as the first place of visit when sick and how they are received was dependent on education (p=0.005) and marital status(p<0.05); 60% of health workers were not trained on the NTP despite 93% being aware of the programme, and 62.5% reported not initiating contact tracing after disease confirmation. Only 34 of the 120 patients reported health workers visiting them regarding TB. Conclusion: Development of interventions such as HCW training on TB treatment and care, and establishing referral networks that bring TB information and services closer to community members can contribute to improved TB case notification.

HIV/AIDS: Knowledge, attitudes and practices among adolescents in Nimule, South Sudan

Background: HIV is an infectious virus commonly transmitted through body fluids mostly semen and blood. It causes a serious and non-curable disease with grave consequences especially in sub-Saharan Africa. In South Sudan the prevalence rate of HIV was estimated at 2.6% in 2016. The treatment options are scarce and educational programs limited. This is of great concern since limited knowledge and awareness of HIV is a major risk factor particularly, among young people. Method: A cross-sectional survey using self-administered questionnaires among adolescents was carried out in November 2016. Results: Sixty-five students participated in the study. In general they had good knowledge about HIV/AIDS with the majority having heard of HIV. Majority stated that HIV spreads through sex (82%), blood transfusion (95%), and from mother to child during pregnancy and delivery (66%). Several misconceptions were present with 43% responding that HIV can be transmitted through mosquito bites and 18% stating that the virus can be spread through shaking hands, hugging and living in the same house. Conclusion: Though the respondents showed fair knowledge about HIV/AIDS, there are still some areas in which they lack knowledge especially regarding spread of the disease and practice. More information about HIV/AIDS and sexual education should be made available.

Epidemiology of tuberculosis in South Sudan

Case Reports

Bladder exstrophy – epispadias complex in a newborn: a case report and review of literature

Background: Bladder exstrophy-epispadias complex (BEEC) is a rare congenital malformation of the genitourinary system usually associated with other malformations. Case summary: We report the case of a new born delivered vaginally at 39 weeks and 2 days of gestation with BEEC. Three prenatal ultrasound scans missed the diagnosis. Medical management was provided and the patient was discharged against medical advice 48 hours later upon refusing surgical intervention. Conclusion: The diagnosis and management of BEEC is a challenge in sub-Sahara Africa. Radiologists doing prenatal ultrasounds should check routinely to exclude foetal anomalies.

Type IIB Ileosigmoid knotting: a case report

Ileosigmoid knotting is a rare cause of acute intestinal obstruction. It is more common in Africans and Asians than in white populations and it is more prevalent in males than in females with a ratio of 14:1. It is classified into four types (I, II, III and IV) with further extra two subtypes of A and B where type A is the most common presentation. Preoperative diagnosis is a challenge to the frontline doctors in the accidents and emergency departments; especially with limited diagnostic tools. Ultrasonography may be misleading in most of the cases due to the similarity of the disease with other causes of acute abdomen, especially acute appendicitis. Clinical presentation of an unprecedented intestinal obstruction with constant upper to mid-abdominal quadrant pain associated with mild to moderate abdominal distension contrary to the severe abdominal distension in sigmoid volvulus are the hallmarks that can help the surgical team to reach an accurate and early diagnosis preoperatively to avoid the devastating ischemia and gangrene in case of delay. Emergency laparotomy with possible resection and primary anastomosis in type I or resection and exteriorization with ileostomy or colostomy in the other types is recommended.

Summaries