The aetiology and prognosis of nontraumatic coma in Dar es Salaam.

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University of Dar es Salaam
A study of non-traumatic coma was carried out in Muhimbili Medical wards and intensive care unit over a period of 7 months. A total of 100 patients were studied. Seventy four males and 25 females were seen (male: female sex ration 3.6:1) the causes of come in the 100 patients were a cerebral malaria 37% hepatic failure 19% meningitis 9%, cerebrobrovascular disease 9% poisons and toxins 6%, diabetic coma 4%, miscellaneous causes 8, and in 8% of cases the diagnosis could not be determined. Of the 93 patients fully followed up 66 (71%) survived the first week while only 31 (33.3%) survived to the end of the 4 first month, making a one month mortality of 66.7%. Factors determining prognosi’s were the underlying disease condition, the durations of come, the neurological sign on admission and their subsequent evolution and the development of complication. Age, sex and the presence of convulsions (the latter being commonest in cerebral malaria) did not affect prognosis. Cerebral malaria carried the best prognosis with 25(67.6%) of the patients achieving an independent existence and was responsible for the generally good outcome of the whole series. Clinical sign had a strong predictive value. The chances of regaining independent existence were greater in patient who after 24 hours had orienting or confused verbal responses, opened eyes spontaneously or to noise had orienting eye movements, had normal oculocephalic responses and obeying or localizing motor responses. Conversely, the change of regarding an independent existence fell in patients who after one day lacked the following eye opening, spontareous eye movements, papillary light reflexes, full oculocephalic responses,. Motor responses skeletal muscle tone, deep tendon reflexes and corneal reflexes. It is concluded that most of the causes of coma were potentially treatable even without the use of sophisticated facilities. The supply of a few specific drugs such as neomycin and lactulose for hepatic encephalopalhy or pralidoxime for or organophosphorus in secticide poisoning and improvement of the nursing care facilities are recommended as measures for improving outcome especially if intensive care-cabicals with improved nurse to patient rations are established.
Available in print form, East Africana Collection, Dr. Wilbert Chagula Library, Class mark (THS EAF RB150.C6R9)
Internal medicine, Coma, Nontraumatic, Hepatic encephalopathy
Rwiza, H. T. (1984). The aetiology and prognosis of nontraumatic coma in Dar es Salaam. Master dissertation, University of Dar es Salaam.