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Patterns of Prescribing Practices in Makueni County Referral Hospital, Kenya
Get PDFBackground: Prescribing is said to be irrational if it does not conform to good standards of treatment. Irrational prescribing leads to increased cost of drug therapy, increased risk for adverse drug reactions and emergence of drug resistance. Objective: The study objective was to determine the quality and patterns of prescribing in Makueni County Referral Hospital, Kenya, using World Health Organization prescribing indicators. Methodology: The design was a descriptive retrospective cross-sectional study. Data was abstracted from 824 patient encounters selected through quasi-random sampling. Data was collected from the sampled prescriptions using a pre-tested data collection form, entered into and analyzed using Stata version 10.0 software. Results: The mean number of drugs per patient encounter was 2.7. Only 45.5% of the total drugs were prescribed using generic names. Antibiotics and injections were prescribed in 74% and 13.2% of the prescriptions surveyed respectively. Discussion: On average, inpatients received a higher number of drugs per encounter compared to outpatients, probably because they usually have more severe disease than outpatients which may require management with more drugs. Conclusion: The results showed a trend towards irrational prescribing, particularly polypharmacy, underuse of generic names and over-prescription of antibiotics. Relevant educational, managerial and regulatory interventions are recommended to remedy the problems. Keywords: Irrational prescribing, prescribing indicators, polypharmac
Determinants of Adherence to Anticonvulsants Therapy among Outpatient Epileptic Children in a Kenyan Referral Hospital
No full textBackground: Epilepsy is a chronic disease requiring prolonged adherence to treatment. Adherence to anticonvulsants by epileptic children is important as studies have shown that about two-thirds of epileptic children can be completely freed from seizure if they persistently adhere to treatment for a period of 2-5 years. Conversely, non-adherence to anticonvulsants may lead to increased frequencies of status epilepticus and sudden unexplained death from epilepsy. There is scant literature on factors impacting on the adherence to anticonvulsants among children. Objectives: To determine rate of adherence and parents/caregivers’ factors influencing adherence to anticonvulsants among outpatient epileptic children attending neurology clinic. Methods: Cross-sectional study design was carried out at Kenyatta National Hospital from May to July 2014. Systematic sampling was used to recruit a sample of 176 parents/guardians of children with epilepsy. Predesigned questionnaires and Morisky tool for assessing medication adherence were used to capture participant’s socio-demographics and factors impacting on adherence to antiepileptics. Data were analysed using STATA software version 10. Discrete variables were summarized with frequencies and percentages while continuous variables were summarized using measures of central tendency and dispersion. Results: The rates of adherence, when classified in terms of high, medium and low, were 36.9 %, 39.8 % and 23.3 %, respectively. Adherence rate was associated with parents/guardian marital status (Adjusted OR= 5.72, 95% CI= (1.50, 21.78), p=0.01) and education level (Adjusted OR=5.16, 95% CI= (1.88, 14.02), p< 0.01). Unavailability and inaccessibility of drugs were also shown to influence adherence. Conclusion: Adherence to antiepileptic medication was poor. This was partly due to parents/guardian’s related factors. Health care workers should explore ways and means of minimising these factors to improve on adherence. Key words: Adherence, anticonvulsants, epilepsy, children
Knowledge of Correct Use among Hormonal Contraceptive Users in a Kenyan Referral Hospital
No full textBackground: Contraception is the intentional use of temporary, long-term or permanent methods to prevent pregnancy. The consistent and correct use of contraceptives ensures that unintended pregnancies and pregnancy-related health risks are prevented. Objectives: To assess the prevalence, types and level of knowledge on the correct use of hormonal contraceptives among women of reproductive age at Kenyatta National Hospital. Methodology: A cross-sectional study was carried out targeting 400 women in their reproductive age at Kenyatta National Hospital, Nairobi, Kenya. Data was collected using an interviewer administered questionnaire and analyzed using SPSS version 20 into descriptive and inferential statistics. Results: The prevalence of contraceptive use was 42.8%. Contraceptive use was associated with number of children [OR 1.7 (1.3-2.1)] p<0.001. 56.1% of contraceptive users were on hormonal contraceptives. Injectable contraceptives were the most preferred followed by implants and pills. The choice of contraceptive methods was associated with age [OR 2.003 (1.330-3.017)] p=0.001 and level of education [OR 1.697 (1.135-2.539)] p=0.010. The level of knowledge on the correct use of hormonal contraceptive use was limited and was associated with the level of education [OR 1.389 (1.144-2.051)] p=0.000. Conclusion: Contraceptive use is low compared to knowledge of contraceptives. Injectable contraceptives are the most preferred hormonal contraceptives. The level of knowledge on the correct use of hormonal contraceptive is low. Key words: contraceptive use, hormonal contraceptives, knowledge, correct us
Anti-inflammatory and Antinociceptive Effects of the Methanol Extract of Indigofera arrecta Hochst-Holl. in Rodents
No full textBackground: Indigofera arrecta (Hoscht-Holl) is used traditionally in Nigeria for treating conditions associated with pain and inflammation. Based on the traditional use of the plant for the management of pain and inflammation, the present study was designed to evaluate scientifically the anti-inflammatory and analgesic activities of whole plant parts of Indigofera arrecta so as to generate data that could support such traditional applications. To the best of our knowledge, no similar studies on Indigofera arrecta have been undertaken previously. Objectives: To experimentally demonstrate the anti-inflammatory and analgesic effects of the whole plant parts of Indigofera arrecta. Methodology: The extract of I. arrecta was screened for the presence of phytochemicals. The methanol extract of the plant was tested orally for acute toxicity effect (median lethal dose; LD50) at doses between 10 mg/kg and 5000 mg/kg. Similarly, the extract at 100, 400 and 1000 mg/kg was evaluated in vivo for anti-inflammatory and analgesic properties in rodent models. Results: Carbohydrates, cardiac glycosides, flavonoids, glycosides, saponins, steroids and triterpenes and tannins were detected in the extract. The extract is relatively safe when administered orally to rats with a median lethal dose (LD50) of ≥ 5000 mg/kg. The plant exhibited significant (p< 0.05) in vivo anti-inflammatory and analgesic effects at all the tested doses. However, at 100 mg/kg, the extract did not produce significant effect against thermal-induced pain. Discussion: Phytochemical study showed the presence of flavonoids, glycosides, tannins, steroids and triterpenes in the extracts of Indigofera arrecta. One or more of these constituents either singly or in combination may be responsible for the pharmacological action of the plant. Flavonoids and phenolic compounds have been reported to have multiple biological effects such as antioxidant, analgesic, anti-inflammatory actions, inhibition of platelet aggregation, inhibition of mast cell histamine release and inhibitory actions on arachidonic acid metabolism as demonstrated by in vitro and in vivo tests. Flavonoids have been documented to have anti-inflammatory and analgesic effects. The analgesic and anti-inflammatory effects of steroids and tannins have also been reported. Key words: Indigofera arrecta, Methanol extract, Antinociceptive, Analgesic, Median lethal dos
Knowledge of Correct Use among Hormonal Contraceptive Users in a Kenyan Referral Hospital - Supporting Information
No full textBackground: Contraception is the intentional use of temporary, long-term or permanent methods to prevent pregnancy. The consistent and correct use of contraceptives ensures that unintended pregnancies and pregnancy-related health risks are prevented. Objectives: To assess the prevalence, types and level of knowledge on the correct use of hormonal contraceptives among women of reproductive age at Kenyatta National Hospital. Methodology: A cross-sectional study was carried out targeting 400 women in their reproductive age at Kenyatta National Hospital, Nairobi, Kenya. Data was collected using an interviewer administered questionnaire and analyzed using SPSS version 20 into descriptive and inferential statistics. Results: The prevalence of contraceptive use was 42.8%. Contraceptive use was associated with number of children [OR 1.7 (1.3-2.1)] p<0.001. 56.1% of contraceptive users were on hormonal contraceptives. Injectable contraceptives were the most preferred followed by implants and pills. The choice of contraceptive methods was associated with age [OR 2.003 (1.330-3.017)] p=0.001 and level of education [OR 1.697 (1.135-2.539)] p=0.010. The level of knowledge on the correct use of hormonal contraceptive use was limited and was associated with the level of education [OR 1.389 (1.144-2.051)] p=0.000. Conclusion: Contraceptive use is low compared to knowledge of contraceptives. Injectable contraceptives are the most preferred hormonal contraceptives. The level of knowledge on the correct use of hormonal contraceptive is low. Key words: contraceptive use, hormonal contraceptives, knowledge, correct us
Patterns and Risk Factors for Alanine Aminotransferase Elevation among HIV Patients on Nevirapine Regimens - Supplementary Information
No full textBackground: Elevated levels of serum transaminases are often detected in HIV patients. This has often been attributed to hepatic effects of antiretroviral drugs. Objective: To determine the pattern and risk factors for alanine aminotransferase elevation in HIV patients positive on nevirapine based regimens. Methodology: We conducted a retrospective cohort study of HIV infected patients on nevirapine containing regimens who attended the Kenyatta National Hospital comprehensive care clinic between May and August 2014. We sampled participants by convenient sampling method. Generalized linear regression was performed to establish patterns and predictors for hepatotoxicity (grade 1-4) which were the primary outcomes of interest. Predictor variables that were included in the analysis include; demographic information, baseline ALT and CD4 levels, ART regimens, co-morbidities and treatment duration. Results: Risk factors for ALT elevation differed by gender. Predictor variables that were significantly associated with ALT elevation in both sexes included; elevated baseline ALT level [β=10.14 (95%CI 7.34- 12.96); P<0.001], [β=13.52 (95%CI 9.36 –17.68); P < 0.001] and renal disease [β=5.44 (95%CI 2.62 – 8.25); P <0.001], [β=11.52 (95%CI 3.46 – 19.60); P = 0.005] in females and males respectively. Ethnicity had a protective effect in both sexes; [β-6.61(95%CI-9.28, -3.93); P< 0.001] in males and [β-1.20 (95% CI-2.39, -0.01); P= 0.048] in females. Among the different ethnic groups, Nilotes and Cushites had lower ALT levels compared to Bantus. Other factors that were significant included; smoking (P=0.001), concurrent illnesses (P=0.045), previous adverse drug reactions (P=0.040) in females and a longer duration of anti-retroviral therapy [β 1.81(95%CI 0.89 – 2.73); P < 0.001] in males. Poor adherence had a protective effect [β -1.62(95%CI -3.20, -0.04); P=0.045] among females, whereas initiation on AZT+3TC+NVP had a significant protective effect [β-7.80 (95%CI -13.96, -1.63); P=0.013] in males. Conclusion: Creatinine and transaminase testing should be done routinely to deal with delayed hepatotoxicity in patients with abnormal ALT baseline levels. Key words: Alanine aminotransferase, hepatotoxicity, nevirapine
Traditional therapeutic uses and phytochemical screening of some selected indigenous medicinal plants from Northwest Ethiopia
Get PDFBackground: Medicinal plants including Achyranthes aspera, Brucea antidysentrica and Croton macrostachyus in the Zegie and Lake Tana area are among the main herbal agents traditionally used to treat various illnesses. However, scientific investigations including their phytochemical screening have not been conducted. Objective: To survey the use of these selected medicinal plants by traditional healers and/or herbal medicine users in the Zegie and Lake Tana areas, and conduct phytochemical screening of such commonly used herbal agents. Methodology: Detailed interviews about the therapeutic uses of Achyranthes aspera, Brucea antidysentrica and Croton macrostachyus were conducted among the traditional healers and users in the study area. The plants were collected and separately extracted using water and ethanol and the crude extracts screened for phytochemical components by using standard procedures. Results: The interview results from the traditional healers and users in the study area on the selected medicinal plants pointed to the therapeutic usage of these herbal agents for a variety of disease conditions, including infectious and non-communicable diseases. Plant extracts from Achyranthes aspera and Brucea antidysentrica showed the presence of flavonoids, carbohydrates and vitamin C but the absence of saponins and proteins (peptides). Croton macrostachyus was found to have most of the screened phytochemical constituents (including saponins, flavonoids, carbohydrates, free amino acids and vitamin C) except proteins. Discussion: The herbal agents were found to have a variety of therapeutic uses for various illnesses in the area. The presence of the above mentioned phytoconstituents detected may be responsible for the therapeutic activities of these herbal agents. Key words: Traditional medicines, phytochemicals, Achyranthes aspera, Brucea antidysentrica, Croton macrostachyu
Analysis of Blue Chamomile Essential Oil produced by multi-solvent Solvent Extraction Clevenger Distillation Method
Get PDFBlue colored essential oil samples were obtained from chamomile flowers by a Solvent Extraction Clevenger Distillation (SECD) method and by the standard Clevenger distillation of Chamomile flowers. The solvents used were hexane, acetone, dichloromethane (DCM), ethyl acetate and methanol. The solvents were evaluated in terms of the yield of extract, and the quality of extract (determined by Gas Chromatography-Mass Spectrometry). Of all the SECD extracts, the DCM extract gave the highest yield of the essential oil while the hexane extract gave the lowest yield of the blue essential oil
The influence of urban public space pattern on degradation of external envolope of urban blocks : The case of Nairobi Central District
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The Circle of Concerned African Women Theologians and Their Engagement in Public Theology: A Pathway to Development
Get PDFThis article is informed by the work and writings of the Circle of Concerned African Women Theologians and what ordinary African women are doing as agents of social transformation in their churches and communities. It recognized that African women play crucial roles in the development of their communities, church and nations despite their efforts being ignored or un-reflected in mainstream economic systems. African women theologians seek to take women’s experiences and contexts seriously in their theological reflection. Just like elsewhere on the globe, women’s experiences in Africa are shaped by particular conditions of culture, gender, class, ethnicity and race. As Phiri and Sarojini (? 93) observe, “African women theologians seek solidarity with those who suffer marginalization of every kind, trying to understand, analyze and change the systems of domination and abuse of power.” African women theologians consider themselves as “activist theologians” committed to the struggle for gender justice through their involvement in organizations of social development, social welfare, conducting gender sensitization, HIV and AIDS, anti poverty, culture and Bible study workshops as individuals and groups. They aim to raise awareness of gender justice and to transform the patriarchy that is prevalent in both the churches and society. True to feminist ideals, they see themselves as activists and intellectuals. The following quotation from a South African Instituted Church leader women leader attests to the significant roles women play in the development of Church and society. Women are the fountain of life, responsible for human growth through childbirth. They are rooted here; no longer independent but self-instituted…God today calls AIC women, like all other women, to relate the Gospel to the total needs of individuals, to share a ministry that is biblically based, theologically grounded and socially aware… (AIC women) are actually missionaries… (August: year? 255). These words, spoken by the late Dr. Lydia August Archbishop of the St. John Apostolic Faith Mission, in South Africa succinctly depict the salient missionary function of women. It is an affirmation of a holistic ministry that engages every facet of life. This article begins by exploring the context in which African women live, their responses to the various challenges they experience, how African women theologians respond to this context through theological reflection and it will end with proposing a strategy for a public theology informed by a framework that recognizes and utilizes women’s capacities. The key focus of this article is in the contextual theological appraisal of specific aspects of human capability development and how this can offer to the church and the society a framework through which they can engage in their pursuit of gender justice and quality of life for all especially for women and girls who are the most vulnerable and marginalized. What characterizes the African context