Post-injection paralysis: The new polio in Uganda
Dec 09, 2007
APPROXIMATELY 5% of the world’s population is infected with malaria. There are approximately 1,000,000 deaths caused by malaria annually with children being the most casualities. In Uganda, 320 people die everyday due to malaria.
By John Ekure
APPROXIMATELY 5% of the world’s population is infected with malaria. There are approximately 1,000,000 deaths caused by malaria annually with children being the most casualities. In Uganda, 320 people die everyday due to malaria.
To stem this death toll, a number of measures have been put in place. In Uganda, one of them is the use of quinine, a bitter powder obtained from the back of the Cinchona tree.
Quinine is well-absorbed after oral or intramuscular administration, peak levels usually reach within 4 hours. It does so more rapidly if the intra-muscular injections are diluted.
However, if not appropriately diluted and correctly administered, quinine can lead to adverse consequences including physical disability.
The following are proven as consequences of intramuscular administration of Quinine.
Gluteal fibrosis
This is a muscle disorder of intramuscular fibrous bands in the gluteal muscle (buttocks).
Gluteal fibrosis results from multiple quinine injections on the buttocks. Patients with this condition walk with difficulty, legs facing outward, cannot sit properly and squat like a frog. Both buttocks usually have injection scars.
If the injections are administered in the thigh muscles, the patient gets quadriceps fibrosis hence cannot bend their knees.
Gluteal fibrosis cases are increasing. By November 2007, over 60 children with gluteal fibrosis have been operated at Kumi Hospital alone.
Post injection paralysis of the sciatic nerve
This is the new ‘polio’ in Uganda, which is avoidable if health workers practised correct nursing.
This condition is caused when a needle hits the sciatic nerve during the process of injection. The patient gets a foot drop that requires expensive treatment, sometimes involving complex surgical procedures to correct.
This year, 314 children with post quinine injection paralysis of the sciatic nerve have been treated at Kumi Hospital out of 1,820 cases attending the paediatric orthopaedic clinic.
The other consequences of poor intramuscular administration of quinine are injection abscesses and extensive necrosis.
Stamping out the disability
The following recommendations may help stamp out this preventable cause of disability.
Responsibility of parents/patients. Parents / patients should not delay to go to hospital when there is a change in the wellbeing of the patient. Avoid self-medication. In this case, other anti-malarials may be used, therefore avoiding quinine injections.
Quinine should be reserved for treatment of complicated malaria, which should also be only handled in centres capable of monitoring its use, that is, health centre IV and above.
Administer quinine orally or intravenously (by drip) only.
Training health workers to properly administer injections.
Sensitisation of the people to accept oral treatment as effective route of administration of drugs.
The costs of managing disabilities from preventable causes such as the one above are unaffordable!
The writer is an orthopaedic surgeon in Kumi Hospital
APPROXIMATELY 5% of the world’s population is infected with malaria. There are approximately 1,000,000 deaths caused by malaria annually with children being the most casualities. In Uganda, 320 people die everyday due to malaria.
To stem this death toll, a number of measures have been put in place. In Uganda, one of them is the use of quinine, a bitter powder obtained from the back of the Cinchona tree.
Quinine is well-absorbed after oral or intramuscular administration, peak levels usually reach within 4 hours. It does so more rapidly if the intra-muscular injections are diluted.
However, if not appropriately diluted and correctly administered, quinine can lead to adverse consequences including physical disability.
The following are proven as consequences of intramuscular administration of Quinine.
Gluteal fibrosis
This is a muscle disorder of intramuscular fibrous bands in the gluteal muscle (buttocks).
Gluteal fibrosis results from multiple quinine injections on the buttocks. Patients with this condition walk with difficulty, legs facing outward, cannot sit properly and squat like a frog. Both buttocks usually have injection scars.
If the injections are administered in the thigh muscles, the patient gets quadriceps fibrosis hence cannot bend their knees.
Gluteal fibrosis cases are increasing. By November 2007, over 60 children with gluteal fibrosis have been operated at Kumi Hospital alone.
Post injection paralysis of the sciatic nerve
This is the new ‘polio’ in Uganda, which is avoidable if health workers practised correct nursing.
This condition is caused when a needle hits the sciatic nerve during the process of injection. The patient gets a foot drop that requires expensive treatment, sometimes involving complex surgical procedures to correct.
This year, 314 children with post quinine injection paralysis of the sciatic nerve have been treated at Kumi Hospital out of 1,820 cases attending the paediatric orthopaedic clinic.
The other consequences of poor intramuscular administration of quinine are injection abscesses and extensive necrosis.
Stamping out the disability
The following recommendations may help stamp out this preventable cause of disability.
Responsibility of parents/patients. Parents / patients should not delay to go to hospital when there is a change in the wellbeing of the patient. Avoid self-medication. In this case, other anti-malarials may be used, therefore avoiding quinine injections.
Quinine should be reserved for treatment of complicated malaria, which should also be only handled in centres capable of monitoring its use, that is, health centre IV and above.
Administer quinine orally or intravenously (by drip) only.
Training health workers to properly administer injections.
Sensitisation of the people to accept oral treatment as effective route of administration of drugs.
The costs of managing disabilities from preventable causes such as the one above are unaffordable!
The writer is an orthopaedic surgeon in Kumi Hospital