ISSN 2309 - 4605 Volume 10. Number 2. May 2017 www.southsudanmedicaljournal.com SSMJSouth Sudan Medical Journal Implementing the Sustainable Development Goals in South Sudan • Maternal near-miss in Chad • Trust in medical professionals • How to read liver function tests • RTAs in Juba Vol 10. No 2. May 2017 25 South Sudan Medical Journal CONTENTS EDITORIAL South Sudan Medical Journal ISSN 2309 - 4605 Sustainable Development Goals SSMJ implementation in the context of South Volume 10. No. 2. www.southsudanmedicaljournal.com Sudan Lul Riek ................................ 27 A Publication of the South Sudan Doctors’ Association EDITOR-IN-CHIEF ORIGINAL RESEARCH Dr Edward Eremugo Luka South Sudan Doctors’ Association Maternal Near-miss in N’Djamena Mother and Child Hospital, Chad Gabkika Bray Ministerial Complex Madoue, Saleh Abdelsalam, Doumbia Juba, South Sudan Madjouma Badara Aliou, Adoum Of, Sabre [email protected] Twitter: @eremugo Emile, Ehdjolbo Pallai, Askemdet Obelix . 28 ASSOCIATE EDITORS What causes patents to trust medical Dr Wani Gindala Mena professionals? Insights from mothers in Juba Department of Ophthalmology Rachel Ayrton with Christne Mori Lado and Juba Teaching Hospital, Edward Eremugo Luka ....................... 33 PO Box 88, Juba South Sudan Causes of road trafc accidents in Juba [email protected] Akway M. Cham, Anthony Lasuba, Riing Y. Chan, Angelo L. Jockmet, Asmaa S. Korokon, Dr Eluzai Abe Hakim Malong A. Aguer, John L. Otwari ......... 37 Department of Adult Medicine & Rehabilitation St Mary’s Hospital, Newport, MAIN ARTICLE Isle of Wight PO30 5TG, UK [email protected] How to interpret liver functon tests Christna Levick ................................ 40 EDITORIAL BOARD Dr James Ayrton SHORT ITEMS [email protected] Dr Charles Bakhiet Case Report: From traditional birth [email protected] attendants to hospital: a maternal Professor James Gita Hakim near-miss Ogunlaja OA, Fehintola [email protected] AO, Ogunlaja IP, Idowu A, Abiola OO, Dr Ayat C. Jervase Bojuwoye MO ................................ 31 [email protected] Quiz on liver function tests ............. 43 Dr David Tibbutt [email protected] Funding for South Sudanese ............ 44 Prof. John Adwok [email protected] Hello and goodbye ......................... 45 Dr. Charles Ochero Cornelio Langoya [email protected] The Small Baby Series .................... 45 EDITORIAL ADVISOR Ann Burgess Care groups in emergencies in Unity [email protected] State ............................................. 46 DESIGN AND LAYOUT BACK COVER South Sudan Medical Dr Edward Eremugo Luka Journal Call for submissions ............ 48 The South Sudan Medical Journal is a quarterly publication intended for Healthcare Professionals, both those working in the South Sudan and those Front cover photo: Smoke inhalaton in the house from in other parts of the world seeking information on health in South Sudan. biomass fuel may cause respiratory disease in adults and The Journal is published in mid-February, May, August and November. children (fle photo credit: Richard A Lewis) South Sudan Medical Journal 26 Vol 10. No 2. May 2017 EDITORIAL Sustainable Development Goals implementation in the context of South Sudan On 25 September 2015, world leaders adopted the 2030 Agenda for Sustainable Development, which includes a set of 17 Sustainable Development Goals (SDGs), 169 targets and at least 300 indicators to end poverty, fght inequality and injustice, ensure peace and stability, and tackle climate change and environmental degradation by 2030 as well as putting in place a robust global partnership in support of the realization of the goals. The overreaching goal of the SDGs is poverty eradication that focuses on fve Ps - people, planet, prosperity, peace, and partnership. SDGs place a strong focus on equity, expressed most frequently as “no one will be left behind.” Furthermore, the SDGs success will not be achieved simply by reaching numerical averages. Rather true success of the SDGs will be realized by improving the lives of the most disadvantaged and hardest to reach populations. The SDGs agenda recognizes that each country has primary responsibility for its own economic and social development. The SDGs are about development and not just about developing countries. The SDGs were developed through extensive consultation with all levels of society to constitute a comprehensive development plan. With the SDGs, a country like South Sudan has the opportunity to act upon its vision for the future. Building on lessons learned in implementing the Millennium Development With the SDGS, a Goals (MDGs) from 2000-2015, South Sudan is well positioned to engage in the domestication of the SDGs. The Ministry of Finance and Economic country like South Planning should lead the process, with strong support from the UN and SuDan haS the other developmental partners. opportunity to act The Government of South Sudan should commission an initial gap analysis upon itS viSion for the to answer the following question: which targets and indicators from the future. SDGs are already being monitored, given that most MDG targets are also embedded in the SDGs? The outcome of this analysis would help the Government prepare a plan to domesticate and prioritize the new elements in the SDGs, and to estimate the cost. The overall objective in the analysis is to assess which SDGs indicators are already refected in the National Development Framework and more specifcally to: • Identify which SDGs targets and indicators are already refected within the national development documents namely Vision 2040, South Sudan Development Plan and Sector Strategic Plans - and which are not, • Analyse where possible adjustments needed to national documents to respond to the SDGs’ targets and indicators, • Conduct key consultations to further explore the challenges, gaps, and opportunities to domesticate and implement the SDG agenda. Dr. Lul Riek, MD, MPH Public Health Specialist and Former Director General for International Health, Ministry of Health, South Sudan Email: [email protected] Vol 10. No 2. May 2017 27 South Sudan Medical Journal ORIGINAL RESEARCH Maternal near-miss in N’Djamena Mother and Child Hospital, Chad Gabkika Bray Madouea, Saleh Abdelsalama, Doumbia Madjouma Badara Alioua, Adoum Ofa, Sabre Emilea, Ehdjolbo Pallaia, Askemdet Obelixb a N’Djamena Mother and Child Hospital, Chad b University Hospital Le Bon Samaritn, N’Djamena, Chad Correspondence: Gabkika Bray Madoue [email protected] BACKGROUND: Maternal near-miss describes a woman who almost died but survived a complicaton that occurred during pregnancy, childbirth or within the 42 days following pregnancy terminaton. The prevalence of maternal near-miss is variable around the world. In Chad no previous survey has been performed on maternal near-miss. OBJECTIVE: To describe the characteristcs of patents afected by maternal near-miss in N’Djamena mother and child hospital. RESULTS: During the 6-month period (January 1st to June 30th 2016) of data collecton there were 4,857 live births. The 100 most severe cases of near-miss (2.06 % of all deliveries) were selected. The majority of these patents (96%) were ≤ 35 years old. Seventy six per cent had had 0-3 prenatal consultatons. A high proporton of women had been referred (84%). Main morbidites were: haemorrhage (62%) and hypertensive complicaton (24%) followed by aborton (6%). CONCLUSION: Maternal near-miss is ofen recorded in our hospital. Haemorrhage and hypertension are the main pathologies registered. Key words: Near-miss, N’Djamena mother and child hospital Chad. Introducton following pregnancy termination [8]. The prevalence of Reduction of maternal morbidity is one of the United maternal near-miss is variable around the world. Data Nations Millennium Development Goals [1]. The from a systematic review of 46 countries demonstrate that number of maternal deaths refects the socioeconomic the prevalence varies from 0.04 to14.98 %, with higher level and the quality of medical assistance, and is inversely rates in lower income regions in Africa and Asia [9]. related to the degree of human development. Maternal In Chad no previous survey has been performed on mortality is unequally distributed among developed and maternal near-miss cases. Information on maternal near- developing countries, and developing countries account miss cases is scarce. Thus, the aim of the current study for 99% of all known maternal deaths in the world [1,2]. is to describe the characteristics of maternal near-miss Maternal mortality in Chad is still high and was patients. estimated at 860/100,000 live births in the year 2015[3]. Patents and Methods The main causes of maternal deaths were: haemorrhage, hypertension/eclampsia abortion, complications of This was a retrospective and descriptive survey of labour, sepsis and infectious disease [4,5]. Studies on six months from January 1st, 2016 to June 30th, 2016 the physiopathology of pregnancy, child-birth and the performed at the maternity of N’Djamena Mother and postpartum period have revealed a wide spectrum of Child hospital. N’Djamena Mother and Child hospital is clinical conditions in women, ranging from a healthy a level III hospital located in N’Djamena city, which is pregnancy to the other extreme of maternal death. surrounded by 4 district hospitals and many health centers. Severe maternal morbidity forms part of this range of These health facilities often refer patients to N’Djamena clinical conditions and begins with the occurrence of a