Evaluation of bacterial meningitis surveillance data of the northern region, Ghana, 2010-2015

Fournier’s gangrene: a retrospective review of management outcomes and seasonal variations of clinical presentation

Background

To review retrospectively the outcomes of management of Fournier’s gangrene (FG) and to assess for possible seasonal variations in clinical presentations of FG to a referral hospital in a tropical African country.

Methods

The medical records of patients who presented with FG from February 2012 to December 2019 were reviewed. Of interest were age of patient, vital signs at presentation, site of gangrene, duration of hospital admission, and management interventions deployed. Analysis was with SPSS® version 21.

Results

Twenty-three of 28 medical records could be analyzed. Median Fournier’s Gangrene Severity Index (FGSI) was 5 (IQR:3–10), the median Uludag-FGSI (UFGSI) was 7 (IQR:4–14). In 82.6%, the scrotum was the site of onset; in 8.7%, the lesion had spread beyond the pelvis. Diabetes mellitus (30.4%), HIV infection (13.0%) and nephropathy (17.4%) were identified co-morbidities. There were 2.4 ± 1.0 debridement sessions and 1.5 ± 1.3 transfused units of blood per patient. In 60.9%, the wound edges were undermined and apposed; in 17.4%, split skin grafting or fascio-cutaneous flap cover was deployed. In 17.4%, satisfactory wound closure needed more than 1 theater session. Mean duration of hospital admission was 51.4 ± 19.4 days. No mortality was recorded.

Majority (91.2%) presented in hot, dry months of October through March with peak in December. No case presented in the wet months of May through September.

Conclusion

Meager resources notwithstanding, FG management outcomes are generally satisfactory. Furthermore, FG is observed to present mostly in the hot, dry months of the year in the 8 years under review.

A twin disaster: Addressing the COVID-19 pandemic and a cerebrospinal meningitis outbreak simultaneously in a low-resource country

Managing a deadly pandemic in low- and middle-income countries (LMIC) is challenging. The task becomes tougher when there is an outbreak of an equally deadly disease. This is the present situation of Ghana, a low-resource country, that is confronted with the coronavirus disease 2019 (COVID-19) pandemic and cerebrospinal meningitis (CSM) outbreak. Apart from the resource constraint at both governmental and individual levels, such a situation affects the overall wellbeing of ordinary citizens as well as healthcare professionals, particularly those in high-risk areas. Perhaps, more than ever, we have to ensure equitable distribution of scarce healthcare resources in our effort to manage this ‘twin disaster’ of COVID-19 and CSM. We evaluated Ghana’s situation (outbreak response) and recommended measures to help us navigate this conundrum of a public health crisis.

Bacterial meningitis in Sudanese children; critical evaluation of the clinical decision using clinical prediction rules

BACKGROUND

Sudan falls in the meningitis belt where most global cases of bacterial meningitis are reported. Highly accurate decision support tools have been developed by international specialized societies to guide the diagnosis and limit unnecessary hospital admissions and prolonged antibiotic use that have been frequently reported from countries around the world. The goals of this study are to critically evaluate the clinical decision of bacterial meningitis in children in Sudan using clinical prediction rules and to identify the current bacterial aetiology.

METHODS

This cross-sectional hospital-based study was conducted in October to July of 2010 in a major referral pediatric hospital in Khartoum, Sudan. Febrile children age 1 day to 15 years who were provisionally diagnosed as having meningitis on admission were included (n = 503). Cerebrospinal fluid (CSF) specimens were obtained from all patients while clinical and demographic data were available for only 404. Conventional laboratory investigations were performed. The clinical decision was evaluated by the International Classification of Diseases-Clinical Modification code 320.9 and the Bacterial Meningitis Score. Ethical clearance and permissions were obtained.

RESULTS

Out of 503 provisionally diagnosed bacterial meningitis patients, the final clinical confirmation was assigned to 55.9%. When codes were applied; 5.7% (23/404) with CSF pleocytosis were re-classified as High Risk for bacterial meningitis and 1.5% (6/404) with confirmed bacterial aetiology as Proven Bacterial Meningitis. Neisseria meningitidis was identified in 0.7% (3/404) and Streptococcus pneumoniae in another 0.7%. Typical laboratory findings (i.e. CSF pleocytosis and/or low glucose and high protein concentrations, Gram positive or Gram negative diplococcic, positive bacterial culture) were seen in 5 (83%). Clinically, patients showed fever, seizures, chills, headache, vomiting, stiff neck and bulging fontanelle. All confirmed cases were less than 5 years old and were admitted in summer. All patients were prescribed with antibiotics; they were all recovered and discharged.

CONCLUSIONS

Bacterial meningitis is over-diagnosed in hospitals in Khartoum therefore clinical prediction rules must be adopted and applied to guide the clinical decision. The sole bacterial aetiology in this selected group of Sudanese children remain N. meningitidis and S. pneumoniae, but with significant decrease in prevalence. Some cases showed atypical clinical and laboratory findings.

Analysis of air quality in Dire Dawa, Ethiopia

Ambient air quality was monitored and analyzed to develop air quality index and its implications for livability and climate change in Dire Dawa, Ethiopia. Using survey research design, 16 georeferenced locations, representing different land uses, were randomly selected and assessed for sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon dioxide (CO₂), carbon monoxide (CO),volatile organic compounds (VOCs), and meteorological parameters (temperature and relative humidity). The study found mean concentrations across all land uses for SO₂ of 0.37 ± 0.08 ppm, NO₂ of 0.13 ± 0.17 ppm, CO₂ of 465.65 ± 28.63 ppm, CO of 3.35 ± 2.04 ppm, and VOCs of 1850.67 ± 402 ppm. An air quality index indicated that ambient air quality for SO₂ was very poor, NO₂ ranged from moderate to very poor, whereas CO rating was moderate. Significant positive correlations existed between temperature and NO₂, CO₂, and CO and between humidity and VOCs. Significant relationships were also recorded between CO₂ and NO₂ and between CO and CO₂. Poor urban planning, inadequate pollution control measure, and weak capacity to monitor air quality have implications for energy usage, air quality, and local meteorological parameters, with subsequent feedback into global climate change. Implementation of programs to monitor and control emissions in order to reduce air pollution will provide health, economic, and environmental benefits to the city.

IMPLICATIONS

The need to develop and implement emission control programs to reduce air pollution in Dire Dawa City is urgent. This will provide enormous economic, health, and environmental benefits. It is expected that economic effects of air quality improvement will offset the expenditures for pollution control. Also, strategies that focus on air quality and climate change present a unique opportunity to engage different stakeholders in providing inclusive and sustainable development agenda for Dire Dawa.