Department of Surgical Sciences

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    Assessment of neural tube deffects in two Northern Namibia hospitals: Incidence, seasonal variation, risk factors and prevention strategies for folate sensitive defects
    (University of Namibia, 2021) Amaambo, Filemon
    Neural tube defects (NTDs) represent severe congenital abnormalities of the nervous system and are among significant abnormalities associated with a high mortality and morbidity rates. Studies reported that the incidence of NTDs varies worldwide, with the highest found in low-income countries. Most high-income countries have managed to document and the reduce incidence of NTDs through primary prevention strategies. However, inadequate documentation on NTDs is frequent in low and upper-middle income countries including Namibia. This study focused on assessing the incidence, seasonal variation, risk factors, and comparing the postpartum red blood cell folate in cases and controls in Onandjokwe and Oshakati hospitals in the Northern regions of Namibia over 12 months. The aims of the study were to identify evidence that NTDs constitute both a clinical and a societal problem. And, to propose locally adapted prevention strategies for folate –sensitive NTDs. The study objectives were to assess the incidence of NTDs, determine an association between the conception of NTD babies and seasonal variation (rainfall), identify related risk factors, and to compare postpartum maternal red blood cell folate in NTD cases and controls. The study utilised a quantitative approach with a cross-sectional design to assess the incidence of NTDs and descriptive-statistical analysis to evaluate associated risk factors. A case-control design was used to compare postpartum maternal red blood cell folate between mothers of cases and controls. The study population was mothers who gave birth in the two hospitals during the period of 12 months. Non-random consecutive sampling was used to select participants - mothers with and without NTD babies - to minimise bias when studying rare conditions. Participants were informed, counselled and requested to sign consent forms. Questionnaires were administered face to face to participants and blood samples were drawn to determine postpartum red blood cell folate. Data was analysed using Epi-info software. The findings of the study were: a) the combined hospital neural tube defects incidence was 11 per 10000 births; b) there was a seasonal variation in the birth and conception of babies with NTDs, which could be associated with the seasonal rainfall pattern; c) the risk factors possibly related to NTDs were unemployment, low level of education, diet lacking fruits and vegetables, and low maternal red blood cell folate. Other risk factors, such as age, diabetes, HIV, obesity, smoking, alcohol, drugs, exposure to radiation, hyperthermia, family history, marriage, consanguinity, were not shown to play a significant role in NTD incidence. The study found hydranencephaly to be more common than spina bifida. The study proposed recommendations, future research areas and preventive interventional strategies for NTDs in the Northern regions. The study further underscored health education about NTDs, consumption of fruits and vegetables, folate supplementations + Vit B12 and food fortification for all childbearing women in a sustainable way.
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    A comparison of intrathecal morphine or fentanyl on the duration of postoperative analgesia at Namibian teaching hospitals in Windhoek
    (University of Namibia, 2022) Murakwani, Mandiudza Maria
    Background: Pain management is a cornerstone in the management of femoral fractures. Poorly controlled perioperative pain is associated with detrimental short-term and long-term effects. Addition of intrathecal opioids has been shown to produce a dense block and enhance analgesic effect. The objective of the study was to compare the duration of postoperative analgesia of intrathecal morphine or fentanyl for femur fracture surgery at Namibian Teaching Hospitals in Windhoek. Methodology: This was a prospective randomised double blinded control study which was done in February – July 2021; in which 60 patients above 18 years scheduled for femur fracture surgeries received standard spinal anaesthesia with 0.5% heavy bupivacaine 12.5 mg plus 100 mcg morphine (ITM group) or 25 mcg fentanyl (ITF group). Data was collected using a form designed for the study and analysed with the statistical package for social sciences (SPSS for windows 26.0, SPSS Inc., Chicago, IL, USA). Results: Participants in the ITM group had a significantly longer time to first request for analgesic (14.5 ±8.03 hours) versus the ITF group (7.07 ± 3.07 hours), p =0.0001 and reduced total opioid consumption in 24 hours. The postoperative pain scores (verbal numerical rating scale) at rest and with movement were significantly lower in 2nd, 4th and 6th hour in the ITM group compared to the ITF group (p <0.05). No significant difference was observed between the two groups in terms of pruritus, nausea and vomiting. Respiratory depression was not observed in any participant in the two groups. Patient satisfaction with analgesia was superior in the ITM group (p =0.0001). No significant association was confirmed between type of femur fracture and the total opioid consumption in 24 hours. Conclusion: Use of intrathecal morphine significantly increased the duration of postoperative analgesia and reduced the total opioid consumption.
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    Evaluation of the effect of 2.5 IU vs 5 IU oxytocin on uterine tone during elective caesarean section at Windhoek hospital complex: A double-blind randomized controlled clinical study
    (University of Namibia, 2022) Nembale, Fredrika Nembale
    Introduction: Oxytocin is routinely administered during caesarean delivery to initiate and maintain uterine tone (UT) after delivery of the baby. It reduces blood loss thus preventing postpartum haemorrhage (PPH). However higher doses of oxytocin are associated with unwanted side effects namely; cardiovascular effects, headache as well as nausea and vomiting. However, the optimal dose of oxytocin at caesarean delivery remains ambiguous among various official bodies. This study compared the effect of two doses of oxytocin 2.5 IU vs 5 IU on uterine tone, haemodynamic changes, blood loss and side effects. Methodology: A double-blinded, randomized controlled clinical study was conducted at Windhoek Teaching Hospitals Complex. Eighty (80) parturients undergoing elective caesarean section under spinal anaesthesia received an intravenous bolus of either 2.5 IU (n=40) or 5 IU (n=40) of oxytocin after delivery followed by an infusion of 5 IU/hr. Uterine tone, haemodynamic changes, side effects and blood loss were compared between the two groups. The two groups were statistically compared using a two-sided, independent samples t-test with a P-value set at 0.05 (5%) critical level of significance using the per-protocol analysis. Results: The two groups were comparable in terms of demographic characteristics. Parturients in both study groups had adequate uterine tone at 3 minutes with a median (SD) score of 3.28(0.51) for the 2.5 IU group and 3.20(0.56) for the 5 IU group. A rapid increase in heart rate (HR) was seen in the 5 IU group with a mean increase of 17(17) and 12(16) beats/min at 1 min and 2 min with a p-value of 0.000 and 0.005 respectively. Higher incidence of nausea, headache and chest pain (40%, 25%, 15%) were noted in the ii 5 IU group compared to (15%, 2.5%, 0%) in the 2.5 group. Blood loss did not differ among the two groups. Conclusion: 2.5 IU of oxytocin bolus was compared and non-inferior to 5 IU oxytocin bolus in initiating and maintaining adequate uterine tone and it was associated with fewer haemodynamic changes and other adverse effects.
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    Prophylactic phenylephrine bolus versus infusion for prevention of maternal hypotension during spinal anaesthesia for caesarean section at Windhoek-based teaching hospitals, Namibia
    (University of Namibia, 2022) Shaanika, Ebba Panduleni
    Background: Maternal hypotension is a common complication of spinal anaesthesia during caesarean delivery. Injection of vasopressors with non-pharmacological measures have been investigated for prevention of martenal hypotension as well as the foeto-maternal effects of treatment. Aim: The primary aim of the study was to compare prophylactic 50 mcg phenylephrine bolus (PB) with a fixed continuous 25 mcg/min phenylephrine infusion (PI). The secondary aim was to assess the side effects and neonatal outcomes of the two treatments. Settings and design: A prospective, randomised, controlled double-blinded study was conducted in the maternity theatres of Windhoek Central Hospital and Katutura Intermediate Hospital. Methods and Materials: Ninety-two eligible parturients, ASA I and II, scheduled for elective caesarean section under spinal anaesthesia were recruited and randomised into two groups. PB group received a prophylactic 50 mcg phenylephrine (PE) bolus immediately after spinal anaesthesia whereas PI group received prophylactic 25 mcg/min PE infusion. Maternal blood pressure, heart rate and side effects were recorded every minute for the first 20 minutes while neonatal outcome was assessed with Apgar score at the 1st and 5th minute. Statistical Analysis: Categorical variables were presented in numbers and percentages. Normally distributed continuous variables were presented as mean standard deviation (±SD) and compared using t-test. Non normally distributed continuous variables were compared with Mann-Whitney test. A p-value of p< 0.05 was considered significant. Results: Parturients in the PI group had a significantly lower incidence of hypotension than PB group (32% vs 71% p = 0.0001). Nausea and vomiting was lower in PI group than PB group (13% vs 31% p = 0.033). Reflex bradycardia was comparable between groups (p= 0.489). No parturient in the PB group had reactive hypertension whereas 11% of participants in PI group did (p=0.024). Participants in the PI group received about 36% more phenylephrine than the PB group (p=0. 0277). Apgar scores between the two groups showed good neonatal outcomes. Conclusion: There was better control of blood pressure in the PI group than PB group. Both groups had similar incidence of reflex bradycardia as well as good neonatal outcomes. Intraoperative nausea and vomiting (IONV) was higher in the PB group than PI group, whereas no reactive hypertension experienced in PB group.
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    A survey on end of life care practices in intensive care units of three government teaching hospitals in Namibia
    (University of Namibia, 2022) Shivolo, Loini Talishi
    Background: End of life (EOL) care may be described as care provided for patients in the final hours or days of their life. More broadly it’s defined as care for all patients with a terminal illness that is deemed progressive and incurable. It implies a focus on pain and symptom management which is distinct from the aggressive pursuit of investigation and therapies focused on cure. End of life care in the ICU however involves a substantial degree of emotional and psychological stress both for health care providers as well as the family members. Significance of the study: The study aimed to evaluate the current practices of EOL care in a lifesaving department like the intensive care unit. It also intended to evaluate the knowledge of EOL care practices among ICU health professions and to identify gaps that would require improvement. Methodology: This was a mixed study that used the sequential explanatory design. It had a quantitative study phase 1 and a qualitative study phase 2. The quantitative method looked at the experience of health care workers on EOL care as the dependent variable with relation to age, training background, gender, and years of employment and facility of employment. The qualitative method approach was used to assess the knowledge and attitudes of family members and health care providers on EOL care. This methodology was achieved through cross-sectional surveys and a series of questionnaire-based interviews. Findings: About 59.7% of the respondents had never heard the term EOL care. In addition, less than half of them reported that the decision to offer EOL care to patients rested with the attending physicians. Furthermore, 50% of the study participants believed that family members do not take part in the decision to offer their patients EOL care. Conclusion: EOL is an essential part of patient management. Not only for the patient but also focuses on family members and health care workers as it has an effect on their emotional, mental health, as well as physical health. Recommendations: Improve communication between health care workers and family members and continuous medical education to be offered to health care workers on EOL care.