Medical Journal of Zambia

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Possible encephalitis following B.C.G vaccination
(Medical Journal of Zambia, 1967-04) Savage, F. M. A.
Four cases of an encephalitis-like illness 3 week after BCG vaccination are described, and alternative explanations of the occurrence are discussed. As none of these explanations account for all the features of the illnesses, it is felt that it is worth recording the observation.
Multiple pregnancy in Zambia
(Medical Journal of Zambia, 1967-04) Lucas, C.; Hassim, Abu M.
An analysis of 151 twin pregnancies and 4 triplets delivered during 1966 is presented. The incidence of twin pregnancy is 1 in 37 and triplets 1 in 1,414. The maternal mortality in this series was nil. The perinatal mortality is 23.5%. Prematurity is the most important single cause of foetal wastage. The etiological factors associated with multiple pregnancy are briefly discussed. The evidence at present indicates that heredity, climatic conditions, age and parity are important factors. The importance of antenatal care and its relation to foetal wastage is emphasized.
Haemosiderosis osteoporosis and scurvy
(Medical Journal of Zambia, 1967-04) Lowenthal, M. N., creator; Siddorn, J. A., creator; Fine, J., creator; Patel, R. P., creator
A case of haemosiderosis, osteoporosis, vertebral collapse and scurvy occurring in a Zambian African male is described in detail.
Possible chloroquine resistant malaria in Zambia
(Medical Journal of Zambia, 1967-04) Himpoo, B.; MacCallum, J. B.
In the fight against malaria the synthetic anti-malarials were greeted with great hopes. However,since their introduction there has been the disturbing evolution of strains of malaria resistant to them. In1947 resistance was reported to proguanil in Malaya and the Far East. In 1954 pyrimethamine resistance was reported in Kenya and afterwards in West Africa, South America and the Far East (Jones 1954, Lasch and N'Guyen 1965, W.H.O. Tech. Ser. 266). The devaluation of these potent prophylactic drugs was to be regretted, but far more alarming was the emergence of resistance to chloroquin. This was first reported in 1961 when, in Columbia, strains of Plasmodium falciparum were discovered to be resistant to therapeutic doses of chloroquin. Later it was reported in the Far East and more recently in West and Central Africa (Harinas uta et al. 1965). The size of the problem can be gauged from the report (Montgomery and Eyles) in 1962 of 10 % evidence of resistance in Commonwealth troops in Malaya, and in 1963 Contactos et al. confirmed that 4 out of 5 Asian strains suspected of resistance were definitely resistant to chloroquin in normally curative doses. In Central Africa the first report of malarial resistance to chloroquin came in 1966 from Malawi(Stevenson 1966) and we would like to report on a further three cases that we feel may well come under this category. These cases were all observed in the latter half of 1966 at the General Hospital in Broken Hill, Zambia.
Cushing's Syndrome in a Zambian Youth
(Medical Journal of Zambia., 1967-10) Kihn, R.B.; Davidson, J.C.
A case of Cushing's Syndrome treated by adrenalectomy is described. CUSHING'S syndrome is an uncommon disorder in the European and has seldom been reported in the African. This case is reported as no record of the condition in Zambian has been found. The case history is of a male African patient of 15 years who was referred to hospital by the Late Mr. L. Nixon health inspector in the Gwembe Valley as a case of pituitary tumour. For a year he had suffered from backache, morning occipital headache, generalised pruritus and increasing obesity. He had had an ulcer on his left foot for five months. On examination, he was Obese, marked buffalo hump, short stature-height 53 ins: moon face, drooping right eye lid (old injury); (Fig. I). (Hg. 2.) Purple striae on the hips, thighs and abdominal wall; ulcer dorsum on left foot. C.V.S. Apex beat displaced to the left.; Aortic second sound exaggerated; B.P.190/120: Fundi-grade 2 hypertensive retinopathy.
Kwashiorkor: Some Reflections
(Medical Journal of Zambia., 1967-10) Collins, J.
The subject of malnutrition in Zambia is one receiving an increasing amount of attention and publicity. Work is being undertaken to assess the incidence and severity of this condition as well as its causation and to plan the best approach to its elimination. This has led to reflection of ideas on this subject and my experience in dealing with malnutrition over the last 22 years and is the excuse for this paper. Malnutrition in this country exists essentially in two main forms. One is found most frequently in the very young and is largely due to protein deficiency and the other is found in all age groups and is caused by multiple food deficiencies. It is with the former, known as Kwashiorkor, that I have been most concerned and it is some aspects of this serious condition that are the subject of these reflections.
A Diet Survey in Kalene Hill Area
(Medical Journal of Zambia., 1969-01) MCGlashan, N. D.
This survey of local diet was undertaken into two chiefdoms near Kalene Hill hospital during September, 1968. The inquiry was' undertaken` as a corollary to, and at the same time as, clinical studies of nutritional, state in the same areas. Special emphasis was `given to blood sugar testing in view ' of in earlier geographical suggestions that a high incidence of diabetes mellitus The area lies in the protrusion of Mwinilunga district into a bulge north-westwards between Angola and the Congo (Kiushasa) Republic. The soils are ferrallitic sandy textured sediments which have been strongly leached and have very low inherent fertility. Drainage, although locally north and west, forms the headwaters of the south and east flowing Zambezi. Watertemperatures ncar this continental water parting are cold, which accounts for the absence of bilharziasis locally. The rainy season is longer here in the extreme north-west than in the rest of Zambia, extending usually from mid-October to late April. In this period 60 inches (150cms.) of rain is received, mostly in heavy deluges.
Four Cases of Extra Uterine Pregnancy
(Medical Journal of Zambia., 1969-01) Nightingale, E. A.
On 16.2.67 an African women from 140 miles away was admitted with severe abdominal pain. She appeared to be at term There was some fluid in the abdomen and the foetus appeared to be lying in the abdomen transversely. She was given a blood transfusion and lml of spinal nupercaine injected. After 5 minutes the respiration became laboured but she responded to ephedrine, adrenaline and oxygen. At operation the amniotic sac and placenta were adherent to the abdominal wall, omentum, spleen and uterus. The foetus was extracted but the haemorrhage was severe. A subtotal .hysterectomy was preformed as most of the placenta remaining was adherent to the uterus. The placental site was covered with oxycel gauze and the abdomen closed, but the patient collapsed and died. The infant weighed 7 1bs. 8ozs. It is obvious that any attempts to remove the placenta should be avoided.
Plasmatic vasculosls resulting from dysoria : a modern confirmation of Aschoff's holistic view on vascular diseases
(Medical Journal of Zambia, 1970-01) Lendrum, A. C.
In his writings, Aschoff (1924) mentions "the invading stream of plasma" and this he suspected must normally be traversing arterial walls outwards from the lumen, basing his concept in part at least on the observation that in atheroma a fatty materia,I accumulated against the inner face of the internal elastic lamina.This seemed to him to be validated by the fatty accumulation at the same site in the hyperlipaemic experimental animals of Anitschkow. But fat is not an ideal marker; fat might be formed locally by breakdown of ischaemic tissues. It is sad that Aschoff had no staining method for fibrin able to provide at the same time a satisfactory delineation of the tissues of the site. This probably explains the strange fact that he scarcely mentioned fibrin in his discussion.
Symphysiotony for mild cephalopelvic disproportion
(Medical Journal of Zambia., 1970-01) Mottiar, Y.; Sarla, G.
The operation of symphysiotomy was first performed by Claude-De La Corvee in 1655 on a recently dead patient (Munro Kerr and Chassar Moir 1956). Signault (quoted by Greig 1964) performed the first modern operation in 1777 on a patient who had a true conjugate of 6.5cms., and who had had 4 previous stillbirths. He obtained a live healthy baby but the mother unfortunately suffered from a urinary fistula for the rest of her life. For the next hundred and fifty years the operation enjoyed several brief periods of popularity in Europe, but because it was performed on patients with gross pelvic contraction the inevitable urinary complications of damage to the bladder, urethra and vestibule followed.The incidence of haemorrhage and sepsis was also very high, and the operation never gained general acceptance. In 1931 Zarate (1955) revived the operation with his technique of subcutaneous, partial or intracapsular symphysiotomy. Subsequently, Spain (1949) and Barry (1950, 1952) further popularized the operation in Ireland with their open technique. Barry (1950) declared that symphysiotomy offers a cure for disproportion, not a treatment.. Crichton and Seedat (1963) exhaustively evaluated the operation as a method of managing cases of mild cephalo-pelvic disproportion and reported on 1,200 cases with excellent results.
Cerebrovascular diseases in Africans
(Medical Journal of Zambia, 1970-01) Levy, F. L.
It is the belief of many doctors working in Africa that circulatory disorders in the atherosclerotic sense are not as common as in Europe. I have that same opinion for several reasons. In the first place we rarely see arteriosclerosis at post mortem examination and when we do so at our neuropathology sessions everyone crowds around to see the specimen. It is our impression however that when a vessel is affected by arteriosclerosis, and it is the basilar artery whose branches seem primarily involved, the involvement is of a very severe kind.Secondly I have never once explored the carotid bifurcation of an African patient for stroke and yet it is not an uncommon operation in Europe. This is not because our physicians are unaware of the condition of localized atherosclerosis, the majority of younger patients suffering an apparent cerebral thrombosis are subjected to arteriography, but none to date have required a cleaning out of the carotid bifurcation or of other accessible portions of the carotico-vertebral system. Finally, ruptured cerebral aneurysm and sub-arachnoid haemorrhage are less commonly seen than the size of the population would lead one to expect. It is of course therefore only an impression but I believe that age for age the arteriosclerotic rate is lower in Africans than it is in Europeans.
Asymptomatic bacteriuria of pregnancy in Zambia
(Medical Journal of Zambia, 1974) Jenkinson, D.
A survey of 500 Zambian antenatal patients revealed a 3.8% incidence of asymptomatic bacteriuria. Interest in asymptomatic bacteriuria has increased since large groups of individuals were studied by Kass (1956). Subsequent studies by the same authors (Kass,1960a,1960b) appeared to show an increased incidence of acute pyelonephritis and pre-maturity when this condition was associated with pregnancy. Further studies in many parts of the world have confirmed that this condition is present in approximately 4% of all pregnant women. The condition is not confined to pregnancy. It is believed that there is a variable 4% of all women who demonstrate asymptomatic bacteriuria and that pregnancy is a state in which the condition may become symptomatic and recognised.
Out~ Patient care gradients for a rural Zambian Hospital
(Medical Journal of Zambia, 1974) Vicary, F. Robin, Creator
Maurice King (Medical Care in Developing Countries, 1966), has shown that Out-Patient Care Gradients, i.e., the relationship between distance travelled by patients to attend clinic, is exponential for hospitals in developing countries. The purpose of this survey was to discover whether this was true in a country in which development was progressing rapidly. Almost all surveys done previously have been some years ago in areas where communications were poor and modern luxuries such as buses were unheard of. As such, they bear little relevance to our understanding of community needs in present day Africa, where modern technology is changing all but the most remote areas.
Biliary lipids and the paucity of cholesterol gallstone disease in Zambia
(Medical Journal of Zambia, 1974) Lewis, K.O.
The concept that cholesterol gallstone formation is the result of precipitation of cholesterol from super-saturated bile has been confirmed by the demonstration that gallstone-containing bladder bile had a concentration of cholesterol at or near the limit of its solubility (Admirant and Small,1968). Apparently closing a prolonged debate as to whether the primary defect was in the hepatic cell or in the gallbladder, the demonstration that hepatic bile from gallstone patients is saturated or supersaturated with cholesterol has led to the widely held view that cholesterol gallstone disease results from a derangement of liver metabolism(Vlahcevic et al, 1970) Some workers consider that this derangement of metabolism is due to an external factor such as diet. The evidence implicates the Western type of diet comprising largely of refined foods and in particular sucrose. Cholesterol gallstone disease has become increasingly common among the Japanese, for example, since their introduction of a Western way of life.
The methanol,ethanol and fusel oil contents of some Zambian alcoholic drinks
(Medical Journal of Zambia, 1974) Conor, R.; Okafor, B.; Nwegbu, M.
There is considerable evidence that certain Zambian home-produced beers and spirits contain toxic contaminants. Apart from known additives such as methylated spirits and plant juices, high levels of iron, copper and zinc have been recorded (Reilly and MCGlashan 1969; Reilly 1973 a and b). These metals normally result from the use of galvanized iron containers during fermentation. The toxic effect of high iron levels in beer has been noted by Lowenthal et al (1967). A potent carcinogen of the nitrosamine group has also been detected in certain Zambian drinks (MCGlashan, Walters and MCLean 1968). As a further step in such investigations of locally produced drinks, we looked at levels of methanol and fusel oils, as well as ethanol, in both commencially available and home-produced samples of traditional Zambian beers and spirits. Methanol, or wood spirit, is a common contaminant of alcoholic drinks. It is a highly toxic substance and can, depending on the quantity consumed, lead to blindness, insanity and even death. Methanol is not produced by yeasts fermentation but results from the break-down of` pectin in plant material by the enzyme pectinase. Fusel oil is the collective name given to a mixture of such higher alcohols as isoamyl, active amyl and isobutyl alcohol. It is produced by the action of enzymes on amino acids present in the fermentation medium. The oils are highly toxic and have been shown to cause cancer in experimental Animals (Gibel, Wildner and Lohs 1968, Purchase 1969). They also account for the aroma and taste of drinks and are responsible for the severe headache and thirst associated with a hangover.
Infant mortality in the Gwembe Valley
(Medical Journal of Zambia, 1974)
The Gwembe Valley lies in the Southern Province of Zambia and has been the subject of intense sociological and anthropological study (Colson 1967,Scudder 1968). The site of this survey was the upper Gwembe Valley, a relatively infertile area with low rainfall. The area lies between 1500 feet and 2000 feet and the main food crop is millet. Malaria is endemic. In January,1973, this hospital began four new Mobile Health Clinics in the Valley. The clinics were held near primary schools at Jamba, Siamwinga, Moonga and Sinadabwe. Previously no medical personnel had visited these areas except for periodic visits to schools by Government vaccination teams. No care at all had been given to Under Fives except at Jamba which had been visited once in 1972 by a team from Lusitu Rural Health Clinic. A few of the children at Jamba thus had Under Fives cards when we first visited.
Prevalence of bilharzia in Zambia
(Medical Journal of Zambia, 1974-01) Fine, J.
There has been a considerable accumulation of data in recent years enabling a more accurate assessment of the extent of bilharzia in Zambia than has been possible hitherto. The data fall into two groups. The first consists of the laboratory records of urine and stool examinations of the patients of some twenty-seven hospitals in the various provinces of the country. These have been collected with great diligence by Mr. Henderson (1969), Principal Health Inspector for the Ministry over a period of three years from 1966-8, and the total number of specimens comprised 309,000 of urine and 195,000 of faeces. The second consists of microscopic examination of urine specimens from normal population groups, comprising some 10,000 samples. Half of these were from school children and the remainder from various other sources - villages, normal pregnancy groups and normal adults from a prison and two factories. Some of the school studies have already been the subject of reports (Fine, Kitwe 1966; Bhagwandeen, Lusaka 1970). The others were communicated to me privately (Bakshi, Ndola schools 1972) or reported to the Ministry of Health (Mundia and Hashmi, Rufunsa School 1972).
Studies on malaria in Lusaka
(Medical Journal of Zambia., 1974-10) Hira, P. R.; Koularas, A.
Species diagnosis of 692 malaria-positive blood films showed a parasite formula of F 94.65, M 7.51 0 1.59, V 0.58. P. vivax which has been rarely seen in Zambia was reported in four cases. Infection with a single species, P. falciparum being the most common, was reported in 95.81%. Mixed infections were recorded in 4.19% with P. falcifarum and P. malariae being most common. The need for accurate species diagnosis for appropriate chemotherapy and the importance of such data for time-limited control and eradication programmes is stressed. Age-analysis of the data showed that children are a vulnerable group with infants harbouring 13.6% of such infections. Though malaria transmission is perennial, the most intense period is between the late rainy season and early dry season with a substantial decline thereafter when the mean minimum night temperatures are lowest.
Serum protein concentrations of healthy Zambians and Europeans resident in Lusaka
(University of Zambia, Medical Library, 1974-10) Snook, C.R.
Substantial differences in plasma protein patterns have been reported for apparently health persons living in the tropics (Holmes et al., 1955, Eziolo 1970, Nantulya and Lindqvist 1973). This seems to be particularly true if values for peoples living in tropical countries are compared with those from temperate regions. There seems to be little doubt that some of these differences are due to prolonged or repeated exposure to a variety of tropical diseases. Recent investigations of serum protein patterns in subjects with experimentally induced malaria (Collins et al., 1971) showed significantly altered patterns in some individuals many months after a single administration of the parasites. (Gilles and McGregor 1962) showed significant alteration towards Western values in serum proteins of Gambian women living in a rural village who received malaria prophylaxis for two years. Untreated women of the same village did not show a similar alteration. Apart from two previous studies which have been carried out on normal protein patterns in Zambians (Ezeilo 1970; Briggs, Wenlock and Briggs 1972), very little information in presently available on normal serum protein patterns in Zambians. In neither of these studies was a comparison made with a European group living under similar circumstances to the Zambians. It was therefore thought that a study comparing results on normal serum proteins in Zambians with those found in Europeans resident in Zambia would be a useful addition to the already available information. A study of the various serum proteins is reported in fifty male and fifty female Zambians.The results are compared with a group of 22 European females and 12 European males. Differences in the albumin levels are expected and are most probably due to diet differences. Similarly the increase in the gamma globulin fraction among Zambians was expected and is most certainly related to prolonged malaria experience.
Morbidity in Bilharzia
(Medical Journal of Zambia, 1975-01) Fine, J.
In a study of bilharzia in a school where 60% of the children were found to be infected with Schistosoma haematobium, a comparison was made between the infected and uninfected children in respect of Hb. percentage, weight, height, systolic and diastolic blood pressure and abnormalities found on clinical examination. Blood urea was determined in the infected children only, and were all found normal. Finally backwardness at school was compared between the two groups. The results of the examinations showed no significant difference between the infected and uninfected children.

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