Opportunities and barriers to effective operation and maintenance of public toilets in informal settlements: perspectives from toilet operators in Kampala

Although classified by the Joint Monitoring Programme (JMP) as unimproved sanitation facilities, public toilets still play a critical role in eliminating open defecation in informal settlements. We explored perspectives of toilet operators on opportunities and barriers to operation and maintenance (O&M) of public toilets in informal settlements. A cross-sectional study design was used. Up to 20 in-depth interviews were used to obtain data on the experiences of public toilet operators. Thematic content analysis was used.

Ressults show that opportunities for improving O&M include; operation of public toilets is a source of livelihood; operators are knowledgeable on occupational risks, and the community is involvedin sanitation activities. Barriers to effective O&M include; high operation costs, failure to break even and a lack of investments in occupational health Therefore, there is need to recognise the significance of public toilets as a viable alternative to open defecation in areas where ownership of private sanitation facilities is difficult. Failure to observe the health and safety of toilet operators may further compromise O&M.     

Atrial fibrillation, ischaemic heart disease, and the risk of death in patients with heart failure.

AIMS: Atrial fibrillation (AF) is a risk factor for death in patients with a myocardial infarction, but highly variable results are reported in patients with heart failure. We studied the prognostic impact of AF in heart failure patients with and without ischaemic heart disease. METHODS AND RESULTS: During a period of 2 years, 3587 patients admitted to hospital because of heart failure were included in this study. All patients were examined by echocardiography and the presence of AF was recorded. Follow-up was available for 8 years. Twenty four percent of those discharged alive from hospital had AF. After 4 and 8 years of follow-up, mortality was higher in patients with AF than in patients without, 56 vs. 52% and 77 vs. 73%, respectively. Cox multivariable regression analysis showed a small but significant importance of AF for long-term mortality [hazard ratio (HR) 1.12, 95% confidence limits (CI), 1.02-1.23, P=0.018]. There was a significant interaction between the importance of AF and the presence of ischaemic heart disease (P=0.034). In patients with AF at the time of discharge and ischaemic heart disease, HR was 1.25 (95% CI: 1.09-1.42) and P<0.001; in patients with AF at discharge and without ischaemic heart disease, HR was 1.01 (95% CI: 0.88-1.16) and P=0.88. CONCLUSION: AF is associated with increased risk of death only in patients with ischaemic heart disease. This finding may explain the variable results of studies of the prognosis associated with AF in heart failure.     

Post-stroke depression among stroke survivors attending two hospitals in Kampala Uganda

Background

The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere.

Methods

In a cross-sectional study, we assessed adult participants with confirmed first stroke with a standardized questionnaire. The Patient Health Questionnaire-9 was used to assess for depression among non-aphasic patients while the Aphasic Depression Rating Scale was administered to aphasic patients. Univariable and multivariable analyses performed to describe associations with PSD.

Results

Forty three females (58.9%) and 30 males (41.1%) who had a stroke participated. Fifty eight (79.5%) had ischemic strokes and 12 participants (16.4%) were aphasic. The prevalence of PSD among the study participants was 31.5%. PSD was higher among patients assessed within 6 months after the onset of stroke. PSD was strongly associated with the total Barthel index of activities of daily living (BIADL) score; p=0.001. There was no significant association between demographic characteristics and PSD.

Conclusion

There is a high prevalence of unrecognized post-stroke depression. Post-stroke depression was strongly associated with the patient''s inability to undertake activities of daily life. There is urgent need for integration of screening for and management of post-stroke depression among stroke survivors.     

Electromyography Before and After Treatment of TMJ Dysfunction

The patient described in this article suffered from pain in the right side of her face for five years before she saw the authors. Earlier treatment with medication and neurosurgery had not been successful. The authors used electromyography to examine the disturbed muscle function and to investigate a possible cause for the pain in the muscles of mastication. The silent periods of the patient's muscles were measured before and after treatment, since it is known from the literature that the EMG silent periods may be elongated in patients with TMJ dysfunction or occlusal irregularities. The coordination of both heads of this patient's lateral pterygoid muscles were bilaterally investigated before and after treatment. Treatment consisted of splint therapy and selective grinding. Oral rehabilitation was also undertaken, beginning three months after the disappearance of the patient's symptoms.     

Severe complex regional pain syndrome type II after radial artery harvesting

The radial artery is increasingly used as a coronary bypass graft. We report on a patient who developed a severe complex regional pain syndrome type II--also called causalgia--after radial artery harvesting. After an odyssey of diagnostic and presumed therapeutic procedures, she underwent surgical revision of the left forearm. Intraoperatively, a titanium clip in close neighborhood to the superficial radial nerve affecting the perineurium was found and removed, and more distally, a small neurinoma (3 by 4 mm) was resected. Despite presumed successful operation, symptoms did not improve. The patient presumably remains unable to use her left arm and hand.     

Bronchogenic cyst —cause of refractory wheezing in infancy

A 11/2-year-old male child with past history of recurrent wheezing presented with a severe and refractory episode following a peanut aspiration. A bronchoscopy was done and the peanut removed. However, as the wheezing persisted a detailed evaluation was done which revealed a bronchogenic cyst. Surgical excision of the cyst was done and the child improved symptomatically. Congenital lesions need to be ruled out in infants and children with persistent and refractory wheezing