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Biomedical subjects

W B Matuja

Publications and source records attributed to W B Matuja.

At least 19 recordsLinked to original sources
PubMed2001

Risk factors for epilepsy in a rural area in Tanzania. A community-based case-control study.

BACKGROUND AND METHODS: The high prevalence of epilepsy detected in rural Tanzania by Dr. Jilek-Aall since 1960, was verified by the World Health Organization (WHO) survey on neurological and seizure disorders. Neurologists and psychiatrists further interviewed both patients and controls using standard methods. The presence of possible risk factors was complemented by corroborative evidence through interviewing close relatives and scrutinizing medical records. Seizures were classified based on clinical symptoms and the use of EEG. RESULTS: A family history of epilepsy in first-degree relatives was found in 46.6% of patients, but in only 19.6% of controls. The odds ratio for family history with epilepsy was 3.52 (95% confidence interval, CI 2.4-5.74, p < 0.001). A past history of febrile convulsion was found in 44% of patients in comparison to 23% of the control group which was significant (odds ratio 2.4, 95% CI 1.5-3.8; p < 0.001). A history of intrapartum complications was found in 12.1% of patients and 1.8% of controls (odds ratio 7.3, 95% CI 2.5-25.2; p < 0.002). Head injury was not a significant risk factor for epilepsy in this rural community. CONCLUSION: The results indicated a strongly independent association between four factors and the risk of developing epilepsy. It would seem more likely that previous brain insults/diseases play a significant major role in the cause of epilepsy in the Mahenge area. However, a genetic predisposition to low threshold for convulsions cannot be excluded.

Adolescent↗
PubMed2001

Incidence and characteristics of Myasthenia gravis in Dar Es Salaam, Tanzania.

OBJECTIVE: To ascertain the annual incidence and characterise the clinical features of Myasthenia gravis in Dar es Salaam, Tanzania during a ten-year period from 1st January 1988 to 31 December 1998. DESIGN: Prospective cumulative registration at a major urban hospital of all patients with newly diagnosed Myasthenia gravis who were resident in Dar es salaam. SETTING: Muhimbili Medical Centre Teaching Hospital, Dar es Salaam, Tanzania. SUBJECTS: Forty seven patients, twenty males, twenty seven females satisfied the criteria for the diagnosis of Myasthenia gravis (MG). RESULTS: The annual incidence of MG of both sexes was 3 per 1,000,000 population of all age groups (95% CI 2.0 to 3.6). The incidence per 1,000,000 population was lowest in those aged below ten years 2.2 (95% CI 1.4 to 3.4) which was statistically significant. The incidence per 1,000,000 per year was higher in females but this was not statistically significant. The clinical presentation of MG in Tanzania was localised disease accounting for 47% ocular type and 53% was mild to moderately severe generalised type MG. Twenty per cent of patients with generalised MG presented with bulbar features. Single fibre electromyography was the most sensitive test. CONCLUSION: Myasthenia gravis is fairly rare in Tanzania as is in other sub-Saharan countries and presents in similar way to European in terms of age, sex, and clinical features. Ocular Myasthenia gravis was more prevalent in Tanzania than in Europe.

Adolescent↗
PubMed1997

Evaluation of risk factors for Alzheimer's disease in elderly east Africans.

A number of biological risk factors have been implicated for Alzheimer's disease (AD). The investigation of prevalence rates of AD in crosscultural populations has much potential in validating these factors. We previously assessed brain amyloid beta (A beta) protein deposition and other lesions associated with AD as possible markers for preclinical AD in elderly nondemented East Africans. In further analysis, we demonstrate that 17-19% of elderly East African subjects without clinical neurological disease exhibited neocortical A beta deposits and minimal neurofibrillary changes at necropsy that was qualitatively and quantitatively similar to that in an age-matched elderly control sample from Cleveland, OH. A beta deposits varied from numerous diffuse to highly localized neuritic plaques and were predominantly reactive for the longer A beta 42 species. In parallel studies, we evaluated another recently implicated factor in AD, the apolipoprotein E genotype. We found relatively high frequencies of the apolipoprotein E-epsilon 4 allele in elderly nondemented East Africans. The frequencies were comparable to those in other African populations but higher than in subjects from developed countries. Our limited study suggests that elderly East Africans acquire cerebral lesions found in AD subjects but the apolipoprotein E-epsilon 4 allele may not be a highly specific factor for the disease among East Africans.

Africa, Eastern↗
PubMed1997

Apolipoprotein E polymorphism in elderly east Africans.

Current advances have shown the apolipoprotein E (APOE)-epsilon 4 allele to be highly associated with late-onset familial and sporadic Alzheimer's disease (AD) in Western populations. The association of APOE allele frequencies and dementia remain unknown in populations from developing countries. We recently initiated a project to examine APOE frequencies in non-demented and demented elderly East Africans. Blood DNA collected from two hospital-based populations showed that the APOE allele frequencies in a group of non-demented 67 Tanzanians over the age of 65 years were found to be 14% for epsilon 2, 61% for epsilon 3 and 25% for epsilon 4. By comparison, the frequency of APOE-epsilon 4 in an age-matched demented group was also 25%. Assessment of APOE genotypes in the group of elderly Kenyan subjects from Nairobi also revealed high frequencies of the epsilon 4 allele with no clear difference in frequency between demented and non-demented subjects. Our preliminary observations suggest that elderly East Africans with no apparent clinical AD possess relatively high APOE-epsilon 4 allele frequencies compared to normal ageing subjects from Western countries including African-Americans. These results appear similar to those reported in a recent study in Nigerian Africans where a lack of correlation between APOE-epsilon 4 allele frequency and Alzheimer type of dementia was noted, and imply that APOE-epsilon 4 allele may not necessarily be a risk factor in some populations of Africa.

Aged↗
PubMed1996

Cerebral amyloid beta protein deposits and other Alzheimer lesions in non-demented elderly east Africans.

There is little knowledge of the existence of Alzheimer disease (AD) or Alzheimer type of dementia in indigenous populations of developing countries. In an effort to evaluate this, we assessed the deposition of amyloid beta (A beta) protein and other lesions associated with AD in brains of elderly East Africans. Brain tissues were examined from 32 subjects, aged 45 to 83 years with no apparent neurological disease, who came to autopsy at two medical Institutions in Nairobi and Dar es Salaam. An age-matched sample from subjects who had died from similar causes in Cleveland was assessed in parallel. Of the 20 samples from Nairobi, 3 (15%) brains exhibited neocortical A beta deposits that varied from numerous diffuse to highly localized compact or neuritic plaques, many of which were also thioflavin S positive. Two of the cases had profound A beta deposition in the prefrontal and temporal cortices and one of these also exhibited moderate to severe cerebral amyloid angiopathy. Similarly, 2 of the 12 samples from Dar es Salaam exhibited diffuse and compact A beta deposits that were also predominantly reactive for the longer A beta 42 species compared to A beta 40. We also noted that A beta plaques were variably immunoreactive for amyloid associated proteins, apolipoprotein E, serum amyloid P and complement C3. Tau protein reactive neurofibrillary tangles (NFT) were also evident in the hippocampus of 4 subjects. By comparison, 4 (20%) of the 20 samples from randomly selected autopsies performed in Cleveland showed A beta deposits within diffuse and compact parenchymal plaques and the vasculature. These observations suggest A beta deposition and some NFT in brains of non-demented East Africans are qualitatively and quantitatively similar to that in age-matched elderly controls from Cleveland. While our small scale study does not document similar prevalence rates of preclinical AD, it suggests that elderly East Africans are unlikely to escape AD as it is known in developed countries.

Aged↗
PubMed1995

Headache in a nonclinical population in Dar es Salaam, Tanzania. A community-based study.

Headache is a common symptom that constitutes a major health problem to all countries in the world with a variable prevalence from about 20.2% in the African population to about 80% in populations of the civilized world. Community-based studies in African populations are still scanty, and the impact on health facility utilization and sickness absence from work is unknown. After a simple random selection, 1540 urban workers and students of higher education completed a standardized self-administered questionnaire on headache. A total of 815 (52%), (620 (51%) men, 195 (60%) women) admitted to having suffered a headache requiring medication or medical consultation in the last year. Of these, 366 (23.7%) had recurrent headache not attributable to systemic disease. Of the total with recurrent headache, there was a significant preponderance of women over men with sex prevalence of 28.9% and 22.4%, respectively (X2 P = 0.0001). Combined vascular-muscular-type of headache exceeded all types of headache, accounting for 35.8% of cases, followed by migraine accounting for 30.8% of cases. Organic disease was rare, accounting for 8.5% of cases, and psychogenic causes of headache were even rarer at less than 1.2% of cases. Within 2 months of onset of recurrent headaches, over 32% of sufferers had utilized the health facility at their place of work or study. A significant number of cases (175) had an average of 11.3 lost work days per year in comparison to a control group of 154 persons with an average of 5.7 lost work days per year for reasons other than headache (X2 P = 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Absenteeism↗
PubMed1994

The elderly patients as seen at Muhimbili Medical Centre, Tanzania.

Ageing is fast developing in Tanzania like in most developing countries against a background of many unsolved infrastructural problems. Persons aged 60 years and over constituted only about one percent of the total population in 1961 to 4% of 23.2 million people in 1988. Ageing is a process associated with chronic and disabling diseases. A two year hospital based study at the teaching hospital revealed five major diseases, similar to those in the western world, except for infectious diseases which accounted for a sixth of the total diagnoses. Socio-medical interview of 100 elderly patients uncovered that widowhood among females was ten times more than among males. A large proportion of elderly patients especially women had less than 4 years of education. Most elderly patients lived in extended family structures. Over 40% females and 32% males suffered from a multiplicity of chronic diseases. Physical disabilities increased rapidly with advancing age in both sexes. Capacity for self-care was worse in females than in males. The nature of diseases and disabilities in the elderly in Tanzania are difficult to ignore, particularly in the light of expected rapid progression of an ageing population. The need for systematic planning to meet the needs of the elderly is highlighted in the discussion.

Age Distribution↗
PubMed1994

Electroencephalographic findings in epileptic patients in Tanzania.

Electroencephalogram (EEG) of 524 Tanzanian epileptic patients seen between 1985 and 1988 were reviewed after a description and classification of seizures. Over two thirds were young patients between the age of five and thirty. The majority (86%) had abnormal records. Of these, 89% of abnormal records had focal abnormality and 11% had centrencephalic abnormality. Grand mal seizures did not imply centrencephalic abnormality, only 13% had such abnormality. Absence seizures are rare and over one third of these had temporal focal abnormality. Partial seizures were associated highly with focal abnormality. However, complex partial seizures did not imply temporal focal abnormality. Implications of EEG findings to correlation with epileptic seizures is discussed.

Adolescent↗
PubMed1994

Knowledge, attitude and practice (KAP) towards epilepsy in secondary school students in Tanzania.

Persons with epilepsy are shunned and discriminated against in education, employment, and marriage in Africa, because epilepsy is seen as a highly contagious and shameful disease in the eyes of the public. These observations come from many studies carried out in Africa including recent ones in Nigeria and Liberia. The KAP towards epilepsy among school children in Tanzania has not been studied and this information is essential before a health education programme on epilepsy can be designed for incorporation into the school curriculum. Therefore a study was carried out on 426 secondary school children in Mahenge to find out their KAP towards epilepsy. Forty six pc (193 of 420, students attributed epilepsy to heredity, brain injury, brain infection and witchcraft in that order. About 60 pc (186 of 331) considered epilepsy to be contagious through physical contact, saliva, and breath. Hospital treatment was considered by 62.7 pc (248 of 395) students and 80 pc (346 of 422) considered epilepsy to be controllable. Over 90 pc (385 of 414) of the students believed an epileptic person to be mentally subnormal and considered this a major reason for not sending an epileptic child to school. Their belief in the contagiousness of epilepsy was a major reason for discriminating against an epileptic child or person playing with other children; going to school; sharing the same plate or bed and as a marriage partner and this was significantly more so in the lower than upper classes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Electroencephalographic findings in Tanzanian epileptic patients.

Electroencephalogram (EEG) of 524 Tanzanian epileptic patients seen between 1985 and 1987 were reviewed. Over two thirds were young patients between the ages of five and thirty. Four hundred and fifty (86%) had abnormal records. Eighty nine per cent of abnormal records had focal abnormality and 11% had centrencephalic abnormality. Grand mal seizures did not imply centrencephalic abnormality, only 13% had such abnormality. Petit mal seizures are rare, over one third of these had temporal focal abnormality. Partial seizures were associated highly with focal abnormality. However, complex partial seizures did not imply temporal focal abnormality. Implications of EEG findings to correlation with epileptic seizures is discussed.

Adolescent↗
PubMed1991

Headache: pattern and features as experienced in a neurology clinic in Tanzania.

Patients with recurrent headaches accounted for 319 (20.6%) of all new referrals to the neurology clinic over a two-year period. Of these, 47 (34%) had migraine, 38 (27%) psychogenic disorders (non-migrainous) and 18 (13%) post traumatic headache. Others included 16 (11%) vascular-muscular contraction, 11 (8%) muscular contraction and 9 (7%) were miscellaneous. Recurrent headache was found commonly in young patients of both sexes. However, migraine was more common in females. Common migraine was about 4 times as frequent as classical migraine. Headache due to psychogenic disorders was part of a symptom complex of anxiety states in 17% and 8% neurotic depression. Over two thirds of patients experienced severe headaches. This was common in the younger age group. Whereas a half of the patients experienced warning symptoms, over two thirds had precipitating factors. About a third of patients with migraine and psychogenic disorders associated witchcraft with their headaches while a half of those with psychogenic disorders expressed fear of having a brain tumour.

Adolescent↗
PubMed1991

Raised intracranial pressure of obscure cause: prospective clinical review on African Tanzanian patients.

This paper reports a clinical review of 13 patients with raised intracranial pressure of obscure cause seen over a six-year period. Patients were young in the 8 to 40 years age range. Female patients accounted for 54 pc. About half of the females had menstrual abnormalities. 15 pc were obese while the rest were normal or underweight. A previous long history of headache was present in patients with focal neurological signs. The main presenting symptoms were headache and reduction in visual acuity. Main signs were papilloedema and reduced visual Acuity. After a short term follow-up period of one to six years, (mean three years), the general outcome was good with recurrence in one patient. Headache and visual symptoms recovered early after treatment. Focal long tract signs recovered rather slowly. Twelve patients are at present free of symptoms. One died from mesenteric vessel thrombosis and was presumed to have pregnancy related sagittal sinus thrombophlebitis.

Adolescent↗
PubMed1990

Psychological disturbance in African Tanzanian epileptics.

138 (60%) of 230 African patients with epilepsy consecutively referred to the neurology clinic, Muhimbili Medical Centre, Dar es Salaam, had a psychological disturbance warranting intervention. 81% of them had only minor disturbance, dominated by neurotic disorders. 19% had a major disturbance dominated by a schizophrenic form of psychosis. Other major disturbances were hysterical reactions, agarophobia and severe depression. Organic brain disease was significantly associated with psychological disturbance. Over 80% of patients with major disturbance had epilepsy and brain-lesion and 77% of patients with minor disturbance had evidence of an organic brain lesion. Organic brain lesion and psychological disturbance was overwhelmingly associated with social disadvantage. Although the social attitude to epilepsy is still negative in Africa, psychological disturbance and social disadvantage in the African Tanzanian epileptic seem to be more strongly related to an organic brain lesion than to be a result of the individual reaction to social prejudices.

Adolescent↗
PubMed1990

Epilepsy following non-missile head injury among African people in Dar es Salaam: a retrospective clinical analysis study.

Over a period of 2 years, 26 subjects with epilepsy following non-missile head injury were referred to the neurology clinic at Muhimbili Medical Centre, Dar es Salaam. The mean age was 28.5 yr. Twenty of these subjects were males. Sixteen (62%) were victims of road traffic accidents, six (23%) had direct blows of the head and four (15%) had fallen from heights. The first late seizure occurred 2 weeks after injury in all subjects. Fifty-eight per cent had the first late seizure between the third and seventh month after injury. Only 8% had the first seizure after 1 year of injury. Posttraumatic amnesia of over 24 h was the commonest recorded complication and occurred in 58% of subjects. Other complications were: depressed fracture (31%), acute intracranial haematoma (27%) and early seizures (12%). Twenty per cent of subjects had no complications. The role of the head injury complications as a factor in increasing the risk of late epilepsy as well as individual susceptibility to seizures is discussed.

Accidents, Traffic↗
PubMed1989

Aetiological factors in Tanzanian epileptics.

The study deals with 428 patients with epilepsy who were referred to the neurology clinic, Muhimbili Medical Centre, Dar es Salaam; and analysed for aetiological factors. Of these, 146(34%) had identifiable causes which were acquired in 95%. Sixty seven (46%) of patients with identifiable causative factors were children below the age of fifteen and 35(24%) adults were above the age of thirty. The cause of epilepsy in 71% of children was childhood febrile convulsions and CNS infections while in 74% adults, it was due to head injury, tumours and vascular disease. Twice as many patients with partial epilepsy had identifiable aetiological factors than those with generalised epilepsy. Childhood febrile convulsion was commonly associated with partial epilepsy with complex symptoms while birth injury and CNS infections were associated with generalised epilepsy. Vascular causes and tumours were associated with partial epilepsy. The significance of identifiable aetiological factors and their association to various types of epilepsy is discussed. This study is a preliminary report of a major study which commenced in January, 1983 dealing with classification, clinical presentation, social factors and management of epileptic patients referred to this Clinic.

Adolescent↗
PubMed1987

Causes and early prognosis of non-traumatic coma in Tanzania. Muhimbili Medical Centre experience.

150 patients admitted in medical coma at Muhimbili Medical Centre were studied prospectively to determine the causes and early prognosis. 89 (60%) patients had potentially treatable causes (60 cerebral malaria, 16 meningitis, 7 diabetic ketoacidosis and 6 drug over dosage). Other causes were 20 (13%) with cerebrovascular diseases, 30 (20%) hepatic failure and 11 (8%) were of miscellaneous and obscure causes. The cause of coma was an important indicator of prognosis. Good recovery was achieved in 42 (70%) with cerebral malaria, 4 (57%) diabetic ketoacidosis, 4 (25%) meningitis and 1 (16%) drug overdosage. Other indicators were the Glasgow Coma Score on admission and subsequent scores, early neurological signs and complications that arose. The Glasgow Coma Scale was found useful and easy to perform. Further studies are needed to confirm its usefulness in developing countries.

Adolescent↗
PubMedDate not supplied

Prevalence and incidence of epilepsy in Ulanga, a rural Tanzanian district: a community-based study.

A random cluster sample survey of approximately 18,000 people in 11 villages was performed in Ulanga, a Tanzanian district with a population of approximately 139,000 people. Well-instructed fourth-year medical students and neurologic and psychiatry nurses identified persons with epilepsy using a screening questionnaire and sent them to a neurologist for detailed evaluation. Identified were 207 subjects (88 male, 119 female) with epilepsy; of these, 185 (89.4%) (80 male, 105 female) had active epilepsy. The prevalence of active epilepsy was 10.2 in 1,000. Prevalence among villages varied, ranging from 5.1 to 37.1 in 1,000 (age-adjusted 5.8-37.0). In a 10-year period (1979-1988) 122 subjects living in the 11 villages developed epilepsy, with an annual incidence of 73.3 in 100,000. Generalized tonic-clonic seizures (GTCS) accounted for 58% and partial seizures accounted for 31.9%, whereas in 10.1% seizures were unclassifiable. Of the partial seizures, secondarily generalized seizures were the most common. Possible etiologic or associated factors were identifiable in only 25.3% of cases. Febrile convulsions were associated in 13.4 of cases. Other associated factors included unspecified encephalitis (4.7%), cerebral malaria (1.9%), birth injury (1.4%), and other (3%). In 38% of the cases, there was a positive family history of epilepsy.

Adolescent↗