Table 4. Characteristics and diagnosis/therapy/cost for 35 patients referred during population survey 1.
Sex Age Main symptoms and findings Diagnosis Therapy/hospital Cost USD F 3 Coughing, 10,9 kg <3 percentile Malnutrition,
URI Nutritionist advice 15
M 3 Oedema. Hb 10,7. Thick drop+. Splenomegaly Malaria Quinine, iron, vit A 16 F 30 Coughing, weight loss, pulmonary rales, acid-
fast bacilli ++++ in expectorate, bilateral x-ray changes lung. HIV negative
Tuberculosis Hospitalised. Anti-Tb 99
M 64 Coughing, oedema. Tb neg Heart failure Diuretic. Hospitalised soon after.
12 F 32 Coughing, fever. Treated for Tb 1 year ago,
expectorate negative, bilateral x-ray changes lung, HIV positive
Aids Bactrim 21
M 1 Weight loss, 7,7 kg = < 3 percentile, arm circumference 14 cm, lung rales
Malnutrition, URI
Salbutamol, vitamins.
Nutritionist advice
10 M 14 Dyspnoe, palpitations. Accentuated heart
sounds. Enlarged heart on x-ray SR 40.
Improved symptoms/x-ray on follow-up
Sequaele rheumatic fever
Pc, furosemid, captopril
23
F 7 Coughing, weight loss, fever. Temp 38,3, Lung rales, tachypnoe 40/min, Hb 9,3. Leukocytes 41000, 90% neutrophils. X-ray shadow one lung. Cured on follow-up.
Pneumonia Pc, quinine 21
M 35 Weight loss, 42 kg. Treated for Tb for 8 months until 6 months ago, still expectorate positive then, could not afford further therapy. Now unilateral fibrotic x-ray changes lung, expectorate negative, HIV negative
Lung fibrosis, post-
tuberculous
Ibuprophen, vit. B,
advice to stop smoking 19
M 24 Weight loss, 37 kg. Treated for Tb the last two months. Now unilateral massive x-ray shadow one lung, expectorate negative, HIV positive, did not return after he was told this result.
Aids
F 1 Weight loss, but 10,9kg > 50-percentile. Thick drop +
Malaria Quinine, multivitamin syrup
12 M 42 Weight loss, coughing. Treated for Tb for 2
months until 9 months ago. X-ray thorax 1 month ago negative, got Bactrim. Now expectorate negative. Leukocytes 11000 with 45% lymphocytes. HIV-test ordered, but he did not come back
Inconclusive.
May have Aids 19
M 35 Weight loss, coughing. Went to another doctor
and was lost to follow-up Inconclusive.
May have Tb M 3 Not gained weight last two years, 9,5 kg < 3
percentile, arm circumference 13 cm. Mother dead when child 8 months old, grandmother says he eats well. Leukocytes 11000, 66%
neutrophils. Got gentamycine 5 days ago
Malnutrition Hospitalisation offered, but refused.
Multivitamins, Vit A, chloroquine, vermox, continue gentamycine.
Nutritionist advice
13
1
M 10 Congenital pes equino-varus with secondary contracture of knees and hips. Used arms as
“crutches” for locomotion. Had quit school after two years, before that a cousin carried him to school every day.
Leg deformity Father was offered 70 USD if they showed up with a locally made three wheel bicycle, estimated to cost 140 USD, but they never came.
5
M 70 Weight loss, couching, 30 kg, lung rales, x-ray shadows both lungs. SR 27mm/h. Expectorate negative.
Broncho-
pneumonia Hospitalised. Pc initially, then tetracycline. Vit B
33
M 6 Osteomyelitis in left tibia, three open wounds 2-5 cm/diam, bone visible. On antiTb drugs last 2 months. SR 92mm/h . Culture showed
Proteus, resistant to most relevant drugs. X-ray generalised inflammation, including epiphyses
Osteomyelitis tibia
Hospitalised.
Ceftriaxon (after resistance pattern).
Amputation below knee offered but refused, wound healed after several months.
175
M 60 Coughing, weight loss. Rales right lung.
Expectorate negative. X-ray massive shadow right lung.
Tb? Referred to Tb-
responsible doctor at the hospital
F 2 Weight loss, 5,9 kg < 3 percentile, arm
circumference 11,5 cm. Mother left when child 15 months old. Tachypnoe 50/min, neutrophilia 65%. X-ray small perihilar shadows bilaterally.
Broncho- pneumonia.
Malnutrition
Amoxicillin, Vit A,
Nutritionist advice.
Hospitalisation recommended, but stepmother needed to go home to her other children.
25
F 5 Weight loss, periodic fever, weight not noted.
SR 65, neutrophilia 70%. BCG vaccinated.
Rales on both lungs. Tuberculin test negative.
Broncho- pneumonia
Pc. Multivitamins, Vermox. To be revaccinated BCG.
15
M 22 Fever, coughing, weight loss. 47 kg, temp 38,8 and next day 38,1. Lung rales. Expectorate ++
+. Malaria + in thick drop. X-ray massive shadow half of left lung. HIV positive.
Aids, Tb Hospitalised. Anti-Tb 153
M 16 Weight loss, coughing, 37 kg. Anti-Tb treatment for three months one year ago, and for five months until one month ago,
expectorate positive at the end of both treatments. Now expect +. X-ray shadows scattered in both lungs. HIV negative
Tb Hospitalised. Anti-Tb 162
M 6 Weight loss, protruding abdomen. Palpable masses in abdomen, opacities on ultrasound.
SR 68. Malaria ++ in thick drop. X-ray thorax negative, urography inconclusive.
Lymphoma?
Malaria Hospitalised.
Cyclophosphamid i.v..
Prednisolone, Largactil.
Quinine
Died after 4 weeks
124
F 5 Fever at night one week, temp 37.5. 13.6 kg, between 3 and 50 percentile. Thick drop negative.
Malaria? Fansidar, multivitamin,
Vermox 13
2
F 3 Inflammation right knee and left ankle last 3 days. Sickle cell anaemia diagnosed one year ago. Hb 8,5 g/dl.
Sickle cell anaemia with joint symptoms
Acetylsalicylic acid, vermox, folic acid
7
M 2 Weight loss, diarrhoea, 8,6 kg < 3-percentile, arm circumference 12 cm, temp 36,8-38,2.
Rhinitis
Malnutrition Bactrim, chloroquine, Vermox, Vit A, Multivitamins.
Nutritionist advice
9
F 3 Weight loss, diarrhoea, 9,5 kg < 3-percentile, arm circumference 13 cm.
Malnutrition Chloroquine, Vermox, Vit A, Multivitamins.
Nutritionist advice
13
F 2 Weight loss, diarrhoea, 6,8 kg < 3-percentile, arm circumference 11 cm
Malnutrition Bactrim, Vermox, Vit A, Multivitamins.
Nutritionist advice
17
F 13 Weight loss, periodic fever. Albuminuria from early childhood. Now protein ++ in urine. SR 50. Malaria + in thick drop. Serum-creatinine normal. Kidneys normal on ultrasound.
Nephropathy.
Malaria
Bactrim 25
M 1 Weight loss, 4,5 kg, <3-percentile, arm
circumference 8,6 cm. Dehydrated, axillary and inguinal glands. Mother died one month ago.
HIV positive
HIV/Aids Hospitalised.
Hydration, vitamins, enriched milk
30
M 17 Completely deaf after fever disease for 1 week 6 months previously. Had quit secondary school after that.
Deafness, secondary to infectious disease
Referral to nearest ENT-doctor 200 km away
50
M 6 Weight loss, 13,6 kg. Tinea capitis. Malaria +
in blood smear. Malnutrition.
Malaria. Tinea Quinine, Vit A, multivitamins,
Vermox, griseofulvin, nutritionist advice, vaccinations
15
M 3 Weight loss, 10,9 kg <3-percentile, arm circumference 13 cm. Malaria + in thick drop.
Malnutrition.
Malaria.
Quinine, Vit A, multivitamins, Vermox, nutritionist advice, vaccinations
13
F 8 History of generalised epileptic fits from 3 months of age, psychomotor retardation.
Epilepsy Gardenal, Vermox 12 M 4 Coughing, weight loss, fever last two weeks.
12,7 kg < 3-percentile. Temp 38,3, next day 38,5. Rales right lung, light splenomegaly.
Pneumonia Amoxicillin,
paracetamol, Vermox 14
1 12 referred patients had more ”innocent” diseases like upper respiratory infection (URI) and are not shown.
4 patients did not consult after referral
3
