Opio Christopher Kenneth, Kazibwe Francis, Ocama Ponsiano, Rejani Lalitha, Belousova Elena Nikolaevna, Ajal Paul
Makerere University, College of Health Sciences, P.O.Box 7072, Kampala, Uganda.
Bishop Stuart University, Public Health Department, P.O.Box 9, Mbarara, Uganda.
Pan Afr Med J. 2016 Aug 3;24:296. doi: 10.11604/pamj.2016.24.296.9755. eCollection 2016.
Severe chronic hepatic schistosomiasis is a common cause of episodes upper gastrointestinal bleeding (UGIB) in sub-Saharan Africa (SSA). However, there is paucity of data on clinical epidemiology of episodes of UGIB from rural Africa despite on going public health interventions to control and eliminate schistosomiasis.
Through a cross sectional study we profiled lifetime episodes of upper gastrointestinal bleeding and associated factors at a rural primary health facility in sub-Saharan Africa were schistosomiasis is endemic. The main outcome was number of lifetime episodes of UGIB analyzed as count data.
From 107 enrolled participants, 323 lifetime episodes of UGIB were reported. Fifty-seven percent experienced ≥ 2 lifetime episodes of UGIB. Ninety-four percent had severe chronic hepatic schistosomiasis and 80% esophageal varices. Alcohol use and viral hepatitis was infrequent. Eighty-eight percent were previously treated with praziquantel and 70% had a history of blood transfusion. No patient had ever had an endoscopy or treatment for prevention of recurrent variceal bleeding. Multivariable analysis identified a cluster of eight clinical factor variables (age ≥ 40, female sex, history of blood transfusion, abdominal collaterals, esophageal varices, pattern x periportal fibrosis, anemia, and thrombocytopenia) significantly associated (P-value < 0.05) with increased probability of experiencing two or more lifetime episodes of UGIB in our study.
Upper gastrointestinal bleeding is a common health problem in this part of rural SSA where schistosomiasis is endemic. The clinical profile described is unique and is important for improved case management, and for future research.
严重慢性肝血吸虫病是撒哈拉以南非洲（SSA）上消化道出血（UGIB）发作的常见原因。然而，尽管正在进行控制和消除血吸虫病的公共卫生干预措施，但关于非洲农村地区UGIB发作的临床流行病学数据却很少。
通过一项横断面研究，我们在撒哈拉以南非洲一个血吸虫病流行的农村初级卫生机构中，对UGIB的终生发作情况及相关因素进行了分析。主要结局是将UGIB终生发作次数作为计数资料进行分析。
在107名登记参与者中，共报告了323次UGIB终生发作。57%的人经历过≥2次UGIB终生发作。94%的人患有严重慢性肝血吸虫病，80%的人有食管静脉曲张。饮酒和病毒性肝炎并不常见。88%的人曾接受过吡喹酮治疗，70%的人有输血史。没有患者接受过内镜检查或预防静脉曲张再出血的治疗。多变量分析确定了一组八个临床因素变量（年龄≥40岁、女性、输血史、腹部侧支循环、食管静脉曲张、门静脉周围纤维化类型、贫血和血小板减少症），在我们的研究中，这些变量与经历两次或更多次UGIB终生发作的概率增加显著相关（P值<0.05）。
在上消化道出血是撒哈拉以南非洲农村这一血吸虫病流行地区的常见健康问题。所描述的临床特征是独特的，对改善病例管理和未来研究很重要。
