SSMJ February 2013


Editorial: The SSMJ Website, Blog and Facebook Group

The South Sudan Medical Journal (SSMJ) blog has been running for over a year, and during this time its readership has increased massively. With over 500 views a month we are able to promote the work of the SSMJ and provide health news from South Sudan.

News, Reports and Policy

Training the Trainers Course on Postgraduate Medical Education

A three-day Training the Trainers Course (19th-21st November 2012) was organised in conjunction with the Ministry of Health (RoSS) and Dr Oromo, Consultant Pathologist in Juba and the Wessex Consortium as a starter towards the Basic Medical Training Programme. Tim Walsh led the team with Dr Rich Bregazzi, an Educationalist and Dr David Attwood, a Medical Registrar. There were 18 participants, who were Consultants in various specialties at Juba Teaching Hospital (see Figure 1).

Resources Feb 2013

These are listed under: • General issues. • Child health and Nutrition. • HIV and other infections.

SSMJ Vol 6_1 Extras

Clinical Guidance

The baby has not come: obstructed labour

This article is about how to recognize obstructed labour and deal with it in a way that preserves the life and health of mother and child. It is for midwives and others who work in maternity care and is based on our experiences in Yei, South Sudan. Obstructed labour means that the baby is too big to pass through the birth canal. It can be associated with prolonged labour. Prolonged labour can sometimes be treated, resulting in a normal delivery but a woman in true obstructed labour should be delivered by Caesarean section.

Tuberculosis 2: Pathophysiology and microbiology of pulmonary tuberculosis

Pathophysiology Inhalation of Mycobacterium tuberculosis leads to one of four possible outcomes: • Immediate clearance of the organism • Latent infection • The onset of active disease (primary disease) • Active disease many years later (reactivation disease). Among individuals with latent infection, and no underlying medical problems, reactivation disease occurs in 5 to 10 percent of cases [1]. The risk of reactivation is markedly increased in patients with HIV [2]. These outcomes are determined by the interplay of factors attributable to both the organism and the host.

Poisoning with organophosphates

In a recent article in this journal [1] I discussed the question of poisoning in South Sudan in an attempt to generate information about the size of the problem. As I pointed out from my experience in Uganda I was concerned about the occurrence of, and mortality from, poisoning with organophosphates. Seventy-one cases of poisoning from organophosphates were reported from forty hospitals and health centres over a six months’ period with a 27% mortality. No other agent was associated with a death in this series (Table 1).

Quiz - Feb 2013

Spot diagnosis and Quiz

Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine

World Health Organization and Global Malaria Programme During the last few years, WHO has observed a slowing of efforts to scale-up intermittent preventive treatment of pregnant women (IPTp) for malaria with Sulfadoxine-Pyrimethamine (SP) in a number of countries in Africa. While there are several reasons for this, confusion among health workers about SP administration for IPTp may also be playing a role. For this reason, WHO is clarifying its recommendations, and urging national health authorities to disseminate these recommendations widely and ensure their correct application.

Suspected clinical-radiological discord

17-year male student presented with vague constitutional symptoms and jaundice. His clinical chest findings initially suggested a discord with radiological findings. It turned out that the patient had a rare congenital disorder in addition to a seemingly common condition that brought him to the hospital. The purpose of this case presentation is to share some challenges of a clinical-radiological discord in a teaching hospital in Zimbabwe. It shows a flow of teamwork from House Officers to the Consultants as well as radiological back up.

Checklists 2013

Below are two more of the nine checklists from the Maternal, Newborn, and Child Survival (MNCS) Initiative, which was developed and is being implemented countrywide by Massachusetts General Hospital and the Ministry of Health. These two checklists illustrate the basic steps that community-based providers can use to diagnose and manage the danger signs of labour, and heavy bleeding. For more information, please contact: Dr Thomas Burke, [email protected].


Hypertension in Juba, South Sudan

South Sudan is thought to be undergoing an epidemiological transition with an increasing burden of non-communicable diseases such as hypertension. No current data exist on the prevalence of these diseases. Blood pressure readings of 5660 blood donors during 2010-12 at Juba Teaching Hospital were analysed. Prevalence of hypertension was 19.3%, positively associated with older age and being male. This has implications for public health policy, indicating a need for prevention, screening and treatment to prevent complications of hypertension.

Case Reports

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