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A child’s buttocks shrunken by poorly administered injections |
By Elizabeth Agiro
OVER 45 children in Ayivu County, Arua District, aged between eight and 13 years, have been crippled by poorly administered quinine injections.
All the affected children are said to have received treatment from the same dispensary. Sixteen of the children arrived in Kampala last week to undergo orthopaedic surgery to correct the deformities.
According to Nobert Akantorana, a physiotherapist at Mengo Hospital, the deformity, called gluteal fibrosis, comes as a result of unqualified medical personnel giving injections close to the sciatic nerve, which runs from the pelvis to the toes.
Once damaged, the muscle loses its elasticity and the buttocks shrink, causing the patient to have difficulty in sitting, walking and bending. The extent of impairment varies from one person to another, depending on how much of the muscle is damaged.
One medical personnel from the Comprehensive rehabilitation Service in Uganda for people with disabilities (CORSU), where the 16 children are getting free surgery, said infants are more likely to be affected because they have smaller buttocks.
Also, difficulty in refraining the child and poor techniques, such as angulating the needle, increase the risk of damaging the nerve.
Akantorana first became aware of the problem a year ago when he received 10-year-old Mophart Mwamuku.
Mwamuku was a normal child at birth. He had all his limbs intact and was in good medical condition. But when he turned three, the boy endured frequent bouts of malaria. He was rushed to the nearest dispensary in Adumi, Ayivu County, in Arua District, where he received quinine injections.
Before long, Mwamuku’s skin around the pelvis and buttocks tightened and the buttocks gradually shrunk. He started having difficulty walking, kneeling, bending, squatting and sitting.
When he sat down, he fell on his back. To assume an upright position, Mwamuku had to sit on the edge of the chair and stretch his legs. To squat, he spread his legs even further with his feet facing opposite directions. He walked with an outrageous gait, his feet pointing outwards to form a circle before curving in front of him.
His father thought nothing of it because he believed his son was disabled. It was not until Mwamuku was 10 years old that a family friend convinced him that the boy needed professional medical attention.
Akantorana later discovered that there were dozens of other cases in the boy’s village. They had all been treated for malaria at the local health centre.
Orthopaedic surgeons Antonio Loro and Justin Okello warned in an article published in June 2007 that poorly administered injections or repeated injections in a short period of time, can lead to loss of muscle functioning.
This, they said, causes the establishment of the fibrosis, in which the muscle loses its elasticity. The surgeons attribute the problem to lack of training or unskilled hands.
Drugs like antibiotics and quinine are more likely to cause damage.
“The needle and the reaction of the muscles to the injected drugs can cause multiple mechanical injuries. Muscle function and control are impaired,” the article said. “The child with fibrosis of the thigh muscles may be unable to bend the knee, so that usual actions such as walking, running, squatting and climbing are severely restricted. In the most dramatic cases, the lower limb is transformed in a sort of stick with no motion at all.”
Surgery may help to correct the problem, but full control of the joints and muscles is difficult to regain, they said.
Nobody seems to know the exact extent of the problem in Uganda. Arua is not the only area affected, said a doctor working with CORSU. “We are seeing patients from all parts of the country.”
Mwamuku is among the lucky ones. He arrived in Kampala last year and underwent orthopaedic surgery at Mengo Hospital. He had intense physiotherapy for several weeks.
Today, Mwamuku enjoys the things most people take for granted, like sitting and bending to touch his toes.
His friend, Mophart Madira, one of the 16 children operated on last week, looks forward to returning to school as a normal child. The boy had to endure teasing from classmates over his condition. Whenever he was tired of sitting with his legs folded underneath him, Madira stood for hours on end during classes.
At home, he often pretended he was satisfied during meals so he could go and lie down.
Allowing only qualified staff to administer injections, as well as better supervision of medical staff, are ways to avoid a growing number of crippled children in Uganda.
Avoiding quinine injections is another way. Surgeons Loro and Okello tell people not to ask for injections unless it is absolutely necessary. If need be, inject at different sites on the buttocks, they advise.
Dr. Edward Naddumba, an orthopaedic surgeon at Mulago Hospital, said if quinine is the only choice, then it should be given in intravenous form, slowly and diluted 1 in 10.
Published on: Saturday, 23rd May, 2009
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