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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015
AFRICA
25
Methods:
As part of a large-scale public–private partnership to
combat RHD in Zambia, a two-day penicillin allergy workshop
was conducted in Lusaka in July 2013. The curriculum was
developed according to evidence-based guidelines from the
World Allergy Organisation, and included interactive didactic
sessions, peer-to-peer learning, and a skills session focused
on anaphylaxis management. Trainees completed a 10-item
multiple-choice questionnaire before and after the course and
were graded on a standardised five-point scale during pre- and
post-training skills sessions. Mean test scores were compared
using paired Wilcoxon signed rank sum testing (SOFA software,
version 1.3.4).
Results:
Twenty-nine health workers (mostly nurses and doctors)
from 20 district clinics and the University Teaching Hospital
participated. Knowledge scores improved from 7.8/10 (SD 1.6)
to 9.8/10 (SD 0.4;
p
<
0.001), and skill scores improved from
2.5/5 (SD 1.4) to 4.8/5 (SD 0.4;
p
<
0.001). In anonymous post-
course evaluations, all participants reported that their clinical
practice would change as a result of the course.
Conclusion:
Significantly improved knowledge and skills were
documented after conduct of a penicillin allergy workshop
in Zambia, and all trainees reported the course to be highly
relevant to their clinical practice. It is recommended that
clinicians, policymakers, and other stakeholders that work in
similar contexts determine whether fear of penicillin allergy
is a contributing cause of failed secondary prevention in their
programs and, if so, to address this concern in order to safe-
guard essential medical care for patients with RHD.
CHARACTERISTICS AND TREATMENT OUTCOMES OF
PATIENTS WITH ANDWITHOUT PULMONARY HYPER-
TENSION WHO UNDERWENT CARDIAC SURGERY AT
MUHIMBILI CARDIAC UNIT FROM 2008 TO 2012
Mutagaywa Reuben
Muhimbili University College of Health and Allied Sciences,
Dar es Salaam, Tanzania
Introduction:
Pulmonary hypertension (PHT) can complicate
rheumatic heart disease (RHD) and congenital heart disease
(CHD). Early intervention is the mainstay to avoid PHT and
its complications. Here we report the outcomes of patients with
and without PHT admitted for cardiac surgery at Muhimbili
National Hospital (MNH).
Methods:
A total of 453 patients were assessed retrospectively
from patients’ files, wards and theatre records. Ethical clearance
was obtained. Data were recorded and filled in on a structured
questionnaire. Analyses were done using mean or median,
counts or percentages, the chi-square test and Kaplan–Meir
survival curve;
p
-value
<
0.05 was considered statistically signifi-
cant.
Results:
A total of 330 patients underwent surgical operations
in which 212 had RHD, 91 had CHD, 14 had both RHD and
CHD, and 13 had other forms of cardiac disease. Among the
operated patients, data on PHT were available in 259 (78.5%),
where 178 (68.7%) had PHT. In the RHD group, PHT was
present in 150 (82.0%) of patients, in whom 31.7% had mild
PHT, 30.6% moderate, and 19.7% severe PHT. In the CHD
group, PHT was present in 18 (32.1%) patients, 14.3% had mild
PHT, 16.1% moderate, and 1.8% severe PHT.
At the end of the patients’ files review from the day of
surgery to the day each patient was last seen, 47 (18.1%) patients
had died, and 80.9% of them had had PHT. In patients who died
from RHD, 26 (66.7%) had died within 90 days (early mortal-
ity) and 88.5 % of these had PHT. All of the deaths in the CHD
group were early mortalities and all had had PHT. Moreover,
patients with PHT stayed longer in ICU postoperatively versus
patients without PHT. Kaplan–Meir analysis demonstrated an
85% one-year survival. When stratified by PHT the one-year
survival was 90% in patients without PHT and 80% in patients
with PHT (log-rank
p
=
0.06).
Conclusion:
The prevalence of PHT in patients undergoing
cardiac surgery at MNH was high, especially in those with
RHD. PHT was associated with early postoperative mortality.
These findings call for intense care during the early postopera-
tive period and further studies are required to look for other
factors causing mortality.
BALLON MITRAL VALVULOPLASTY IN KENYA
Mutai Loice*, Jowi Christine
Department of Paediatric Cardiology, the Mater Hospital; and
University of Nairobi, Kenya;
drloicemutai@yahoo.comIntroduction:
A retrospective study was done to analyse tran-
scatheter treatment of severe mitral valve stenosis (MS) in rheu-
matic heart disease at the Mater Hospital. The patient profile,
outcome and follow up were assessed. The period was over 19
years since the treatment became available, to date.
Methods:
A retrospective study was done at the Mater Hospital.
Data were obtained from 1996 until April 2015 from the cath-
eterisation laboratory procedure book and individual patient
files by the investigator and research assistants. The study
population was rheumatic heart disease patients with severe
mitral stenosis who had balloon mitral valvuloplasty (BMV) at
the hospital.
Results:
There were 272 patients treated in the catheterisation
laboratory for over 19 years to date; 32% were 10 to 15 years
old, 20% were 16 to 20, 14% were 21 to 25, and 32% were 26 to
50 years old. The most commonly used method of BMV was
the multitrack technique. The majority of patients were lost to
follow up after two visits to the clinic. This is usually within the
first year of treatment. Only two had over 10 years of follow up.
Conclusion:
Balloon mitral valvuloplasty is an efficient way
to treat MS patients. It has a short hospital stay of between
three and five days’ duration. Follow up at the hospital is poor.
Without long-term data it is difficult to tell whether BMV is
an effective treatment of patients with severe MS. It should
be possible to set up a data base which is updated each time
patients are seen. Even reviews at private offices could be chan-
nelled on e-mail to update this data base.