Late-onset Visual Loss in Osteopetrosis.

Late-onset visual loss is a complication of nerve entrapment and increased intracranial pressure. We hereby describe the first case in Eastern Africa. A 23 year-old lady presented with sudden blindness, headaches and body weakness. She had previously had treatment for multiple unexplained fractures. Findings of optic nerve entrapment explained this blindness. This case highlights the need to have a high index of suspicion in cases of unexplained fractures with late-onset blindness.

From HIV Abandonment to Adoption: Case study of New Life Home for abandoned babies, Kenya.

OBJECTIVE: The number of orphaned and vulnerable children (OVC) worldwide has increased as a result of the Human Immunodeficiency Virus (HIV) pandemic. New Life Home (NLH) specialises in the care of infants who have been orphaned or abandoned, often because of their exposure to HIV and places them for adoption. This paper documents the lessons learnt from the Home's first 8.5 years of existence. METHODS: This retrospective study analyses the pattern of the 490 infants admitted at NLH. The characteristics of the infants' stay are analysed: bio-data, weight, HIV exposure, referring organisation/agent and outcome. This study ceased to follow infants after adoption, death, transferral to other homes, or reunion with own family. The infants came via health facilities (58%), local authorities (15%), good Samaritans (2%), and other children's homes (25%). RESULTS: At the end of the study period, 425 (92%) of babies were still alive. Of those who died, 80% were less than 6 months old (p<0.003) and 45% were HIV positive. A child mortality rate of 77.6/1000 was demonstrated with the key associated factors being HIV exposure (p <0001), and weight at admission (p=0.002). The mortality rate for the HIV exposed was 71/1000 at 6 months, 94.7/1000 at 12 months and 100.6/1000 at 18 months, while for those not exposed to the virus it was 43.3/1000 at 6 months and 46.7/1000 at 12 months. The major cause of death in the HIV exposed was pneumonia (56%) and septicaemia (22%). The majority of infants, 323 (67%) were adopted, some were reabsorbed into their biological families 31(6.3%) and a minority 7(1.4%) transferred to other children's homes which cater for older children. CONCLUSION: NLH demonstrates a possible model of care for OVC as majority of vulnerable child can have the opportunity to be adopted and thereby a 'second lease' of life. This strategy is worth studying and duplicating in the mitigation of the OVC dilemma in HIV high prevalence countries in sub-Saharan Africa.