{"title":"Obstetric fistulae in South Sudan: A paradigm shift in repairs is required","authors":"Dr Koma Akim","doi":"10.4314/ssmj.v15i2.1","DOIUrl":"https://doi.org/10.4314/ssmj.v15i2.1","url":null,"abstract":"No abstract","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42748206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What do teachers do? A framework for improving teaching in healthcare education","authors":"R. Bregazzi","doi":"10.4314/ssmj.v15i2.10","DOIUrl":"https://doi.org/10.4314/ssmj.v15i2.10","url":null,"abstract":"No abstract","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47589590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Justin Kon Akech Yaay, Achirin Akech Athian, Deng Dominic Tem Akoon, Agdar Anthony Fabiano, Them Buoi Ariath, Arkangelo Ayiga Mona
{"title":"Risk factors for vesicovaginal and rectovaginal fistulae in women treated at Juba Teaching Hospital in 2020-2021: A retrospective study","authors":"Justin Kon Akech Yaay, Achirin Akech Athian, Deng Dominic Tem Akoon, Agdar Anthony Fabiano, Them Buoi Ariath, Arkangelo Ayiga Mona","doi":"10.4314/ssmj.v15i2.4","DOIUrl":"https://doi.org/10.4314/ssmj.v15i2.4","url":null,"abstract":"Introduction: Vesicovaginal fistulae (VVF) and rectovaginal fistulae (RVF) are major public health concerns especially in sub-Saharan Africa. Our hypothesis was that prolonged obstructed labour, teenage marriages, inadequate emergency obstetric care and poverty are responsible for a high prevalence of VVF and RVF in South Sudan.Objective: The objective of the study is to determine the risk factors for vesicovaginal and rectovaginal fistulae in women treated at Juba Teaching Hospital in South Sudan.Method: Data were obtained from the files of all the 40 women who were operated on for VVF and RVF in Juba Teaching Hospital (JTH) during the 2020 and 2021 fistula campaigns; three women were interviewed.Results: Thirty-six women had VVF, two had RVF and two had both. The main cause was obstructed labour. Spontaneous vaginal delivery accounted for 22 cases, Caesarean Section for 13 while five had a forceps delivery. Four women were aged under 18 years; the age of marriage was below 18 years for 22 women and between 18-25 years for 18 women. Of these 40 women 21 were para 1 & 2,14 were para 3 to 5 and five were para 6 and above; 17 had delivered at home and 23 in hospital; 18 had been attended by midwives / doctor and 22 by Traditional Birth Attendants (TBAs) in the villages; 22 were in labour for more than three days. Thirty-two deliveries had resulted in stillbirths. Most women had not been to school, and all were classified as ‘poor’. Almost all (38) had not attended an ante-natal clinic (ANC) duringthe pregnancy in which they developed fistula. Ten women were operated on more than three times, 10 twice and 20 once. Nine women were divorced after developing fistula and 13 were abandoned. The psychosocial consequences included childlessness, stigmatization, depression, divorce, and abandonment.Conclusion: The main risk factor for developing obstetric fistula was prolonged obstructed labour. Secondary risk factors were delivering at home, lack of obstetric care facilities, deliveries attended by unskilled health workers and TBAs, poor ANC attendance during pregnancy, cultural factors that encourage early marriage, low socioeconomic status, and lack of education.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46977418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Obstetric fistulae: a review","authors":"A. Browning","doi":"10.4314/ssmj.v15i2.5","DOIUrl":"https://doi.org/10.4314/ssmj.v15i2.5","url":null,"abstract":"Obstetric fistula is one of the most feared complications of labour, leaving a woman with a life of ostracism and shame due to her complete incontinence. Many women see this as a curse for something they did and many end up trying to take their life. Obstetric fistula patients present with a complicated array of physical and psychological needs which should all be addressed by the medical team caring for her. In the majority of cases, obstetric fistula is curable as long as the doctor is trained in and skilled in the right surgical techniques. However, the most important message is that obstetric fistula is preventable. Ensuring that all women receive proper, affordable and timely medical care in labour will ensure that women will not need to fear such dreadful sequalae of trying to have a baby.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70658009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cochlear implantation and outcomes in a resource–limited setting: experience from Tanzania","authors":"A. Kahinga, Z. Abraham, Shaban Mawala, E. Liyombo","doi":"10.4314/ssmj.v15i2.3","DOIUrl":"https://doi.org/10.4314/ssmj.v15i2.3","url":null,"abstract":"Introduction: Cochlear Implant is a small medical electronic device that is surgically inserted partially in the cochlear (inner ear) to restore some hearing in patients with severe to profound hearing loss. Cochlear implantation is considered a rehabilitative measure of choice that positively impacts on the quality of life of patients.Objective: The objective was to describe the clinico-demographic characteristics of cochlear implantees and the outcomes of the intervention among the implantees at Muhimbili National Hospital (MNH) in Tanzania.Method: This was a hospital based cross-sectional study which involved a total of 39 patients who underwent cochlear implantation from July 2017 to May 2021 at MNH. Clinico-demographic characteristics and outcomes of the intervention among the implantees were collected using structured questionnaires and data were analysed using Statistical Package for Social Sciences Version 20. Results were then presented in frequency tables and figures.Results: This study recruited 39 patients with bilateral hearing loss with their ages ranging from 2 to 55 years. Their mean age was 4.7 years and median of 3 years. More than half, 24(61.5%) of implantees aged 2-3 years. Males predominated with male to female ratio of 1.2:1. Majority 37(94.9%) had pre lingual hearing loss and 36 (92.3 %) had bilateral profound sensorineural hearing loss. Ototoxicity was the commonest cause of hearing loss among the implantees contributing 16(41%) followed by birth asphyxia, 8(20.5%). A total of 37(94.9%) of these patients were implanted with a single cochlear device due to the high cost associated with this type of intervention.Conclusion: Cochlear implantation in limited resource settings is possible and cost effective if there is enough support from the government and other charitable organisations. The availability of rehabilitative services remains key for better outcome after cochlear implantation.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48581981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diabetic Ketoacidosis in adults: Part 2. Management","authors":"Ali Azkoul, S. Sim, Victor Lawrence","doi":"10.4314/ssmj.v15i2.7","DOIUrl":"https://doi.org/10.4314/ssmj.v15i2.7","url":null,"abstract":"The priorities for the management of Diabetic Ketoacidosis (DKA) are to assess severity and establish intravenous (i.v.) 0.9% NaCl rehydration with the careful addition of potassium ([K+]). Ideally, a fixed rate insulin infusion should be used initially and addition of 10% glucose infusion when the blood glucose level has fallen to below 14 mmol/l. Regular clinical and laboratory monitoring, particularly of the rate of fall of blood ketones (beta-hydroxybutyrate) and of serum [K+] and glucose is essential to guide fluid and insulin infusion rates. When the criteria for resolution of DKA are met, the patient may be switched to subcutaneous (s.c.) insulin if eating or variable rate insulin infusion if not yet able to eat and drink. Basal insulin should be continued (or started) where possible alongside infused insulin during the treatment of DKA. If fixed rate insulin infusion is not possible, then intermittent s.c. insulin injections may be used instead.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47639061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Back-to-basics: Fever is a syndrome and not just pyrexia","authors":"Lucien Wasingya- Kasereka, J. Kellett","doi":"10.4314/ssmj.v15i1.8","DOIUrl":"https://doi.org/10.4314/ssmj.v15i1.8","url":null,"abstract":"Fever is a common presenting complaint in sub-Saharan Africa. Although it has many causes, the symptoms of fever, with or without an elevated body temperature, should always make the clinician suspect infection. The other presentations associated with fever often help identify its likely cause. However, the features of fever that make it life-threatening continue to bedevil physicians.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47647682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial: The unmet need of pit latrine use by disabled people: a practical solution","authors":"E. Hakim","doi":"10.4314/ssmj.v15i1.1","DOIUrl":"https://doi.org/10.4314/ssmj.v15i1.1","url":null,"abstract":"No Abstract.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44310279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Determinant factors of immediate outcomes of Neonatal Respiratory Distress Syndrome in Gondar, Ethiopia","authors":"Yousif Abdalla Alzubair, Y. Hailu, K. Tamirat","doi":"10.4314/ssmj.v15i1.2","DOIUrl":"https://doi.org/10.4314/ssmj.v15i1.2","url":null,"abstract":"Introduction: Respiratory Distress Syndrome (RDS) is a frequent neonatal emergency worldwide. The prevalence varies with gestational age (GA) being higher among preterm babies. Preterm birth is the world’s primary cause of newborn deaths and RDS is the leading cause of death in premature infants, including in Ethiopia. \u0000Objectives: To identify the determinant factors of the immediate outcomes of RDS in the neonatal intensive care unit (NICU), University of Gondar Specialized and Comprehensive Hospital (UoGSCH). \u0000Method: A hospital-based prospective descriptive analytical cross-sectional study was conducted from February to September 2020. \u0000Results: A total of 162 neonates were enrolled; there were 87 (53.7%) males and 75 (46.3%) females. Of these 106 (65.4%) were discharged with improvement, 4 (2.5%) discharged with complications, and 52 (32.0%) died; 50% of deaths occurred within the first 24 hours of age. The odds of mortality for those admitted below 6 hours of age was 6.14 times higher (AOR=6.14, 95% CI:1.63 23.03) than those admitted aged 6 hours and above. Babies born to primiparous mothers were more than twice as likely to die (AOR=2.49, 95% CI:1.05 5.87) than babies born to multiparous mothers. Neonates who were delivered in other facilities had 3.78 times increased odds of mortality (AOR=3.78, 95% CI: 1.23 11.57). \u0000Conclusion: Age at admission, site of referral, parity and gestational age (GA) had a significant association with neonatal mortality due to RDS.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45376666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"One year’s experience of extra-pulmonary TB in a county/regional hospital in South Sudan","authors":"Gadic Kot Gadic Kot","doi":"10.4314/ssmj.v15i1.3","DOIUrl":"https://doi.org/10.4314/ssmj.v15i1.3","url":null,"abstract":"Introduction: Although Mycobacterium tuberculosis (TB) is becoming rare in the “first” world, it continues to be a killer in South Sudan. The lungs are the most commonly infected organs but extra-pulmonary TB is not uncommon. Objective: To determine the value and limitations of the TB diagnostic aids available at the county/regional hospital.Methods: This paper reports on a series of patients with TB attending a county/regional hospital in one year between 1 September 2020 and 31 August 2021 and alerts clinicians to the more unusual presentations. We also discuss the application of diagnostic techniques that are available in South Sudan or will be available in the near future. Results: In this 12-month period, 162 patients were diagnosed with TB and 40 with EP TB.Conclusion: Good clinical evaluation plus ultrasound and widely available laboratory studies can lead to the diagnosis of TB, resulting in a good clinical outcome rather than an ill, consumptive patient who continues to spread the disease prior to an untimely death.","PeriodicalId":56200,"journal":{"name":"South Sudan Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43666645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}