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CHARACTERISTICS OF PATIENTS WITH DIABETIC FOOT IN MOMBASA, KENYA
No full textoai:ojs.journals.uonbi.ac.ke:article/354Objective: To study the causes of perceived high mortality in patients with diabetic foot in Mombasa,Kenya.Design: A five-year retrospective study.Setting: The Mombasa Hospital Private Clinics, from January 2001 to December 2005. An urbanset up.Subjects: Ninety five patients with diabetic foot disease out of 830 in-hospital patientsadmitted with diabetes mellitus, aged between 40 and 90 years, treated mainly at The MombasaHospital.Intervention: Patients were managed conservatively and operatively. The operations were incisionand drainage, debridement and amputation.Measurement: Radiological (Doppler studies), ECG, and laboratory evaluations.Results: The majority of the males were between 50-70 years (76%) while the majority of the femaleswere between 60-80 years (69%), with the mean age for males of 58 years and 65 years for the females.Overall mortality was 13%. Post-amputation mortality was 28%. The mortality was found to beassociated with high co-morbidity, mainly uncontrolled diabetes mellitus (100%), Sepsis (75%),ischaemic heart disease (42%), uncontrolled hypertension (25%) and renal insufficiency (25%). Themeasurable characteristics included high blood sugars, raised WBC count, high creatinine, highserum lipids, abnormal ECG and abnormal arterial Doppler scans.Conclusion: The mortality associated with diabetic foot ulcer disease may be predicted bymeasurable characteristics. These parameters point to conditions that are themselves complicationsof diabetes mellitus and whose management will reduce mortality. The management of diabeticfoot is therefore, multidisciplinary. Amputation appears to carry an added risk and should not berushed until the patient is fully resuscitated
RISK FACTORS FOR SEVERE POST PARTUM HAEMORRHAGE IN MULAGO HOSPITAL, KAMPALA, UGANDA
No full textObjective: To determine the risk factors for severe postpartum haemorrhage.Design: A case control study.Setting: Mulago hospital labour wards, Kampala, Uganda.Subjects: One hundred and six mothers with severe postpartum haemorrhage were recruited between 15th November 2001 and 30th November 2002 and were compared with 500 women who had normal delivery.Results: The predictors for postpartum haemorrhage were co-existing hypertension (O.R 9.3, 95%CI: 1.7-51.7), chronic anaemia (OR 17.3,95% CI: 9.5-31.7), low socio economic background (OR 5.3,95% CI:3.0,9.2), past history of postpartum haemorrhage(OR 3.6,95% CI:1.1-11.8), previous delivery by Caesarean section(OR 7.5,95% CI:3.5-14.3), long birth interval of more than sixty months (OR 5.2,95% CI:2.1- 13.0), prolonged third stage (OR 49.1,95% CI:8.8-342.8)and non use of oxytocics (OR 4.3%, 95%CI:1.2-15.3).Conclusion: Severe postpartum haemorrhage is common in our environment and is associated with a high maternal morbidity and mortality. The determinants of postpartum haemorrhage are useful in identifying mothers at risk and together with the services of a skilled birth attendant at delivery will prevent postpartum haemorrhage and reduce the maternal morbidity and mortality associated with this condition. In our study, the following risk factors were identified: pre-existing hypertension, chronicanaemia, low socio-economic background, history of postpartum haemorrhage, previous delivery by Caesarean section, long birth interval of more than sixty months, prolonged third stage and non use of oxytocics were found to be significant
USE OF A MODIFIED ALVORADO SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS
No full textABSTRACTBackground: The negative appendicectomy rates have remained high. The integration ofclinical scores into the diagnostic process in acute appendicitis has had the purposes ofimproving decision making and reducing the negative rates in this common condition. Theperformance of these score systems have however, not been uniform.Objective: To assess the usefulness of a modified Alvorado score (1986) to predict groups ofpatients with suspected appendicitis for definite surgery, observation or discharge fromhospital.Design: Prospective study.Setting: Kenyatta National Hospital (KNH), a central referral and teaching hospital inNairobi, Kenya.Patients: One hundred and eighty nine patients with suspected acute appendicitis werestudied over a period of twelve months.Methods: Five symptoms and four signs were assigned numerical values and the patientsscored out of a total of 10 points. A score of >7 predicted mandatory operation, 5-6observation and score 1-4 predicted those not considered for surgery. The decision to operatewas the prerogative of the surgeon or surgical resident based on overall clinical suspicion andnot the diagnostic score.Results: The proportion of patients with scores >7 was 40.7%. The mean score was 6.02. Themean ages and the gender ratios were similar across score groups. The negative appendicectomyrate was 17.6% for group 1-4, 16.5% for 5-6 and 19.7% for > 7. These were similar to theoverall negative rate of 18% based on clinical suspicion. The overall sensitivity and sensitivityfor the scoring system was 80.3% and 16.8% respectively.Conclusion: High scores were found to perform poorly in predicting diagnosis of acuteappendicitis preoperatively and in the reduction of negative appendicectomies. The integrationof a scoring system does not offer advantage over degree of clinical suspicion
UTILISATION OF ANTENATAL AND MATERNITY SERVICES BY MOTHERS SEEKING CHILD WELFARE SERVICES IN MBEERE DISTRICT, EASTERN PROVINCE, KENYA
No full textBackground: Utilisation of antenatal and maternity services is an important maternal healthindicator. Increasing the proportion of mothers who are cared for in health facilities duringpregnancy, childbirth and puerperium reduces the health risks to mothers and theirchildren.Objective: To determine the utilisation of antenatal and maternity services by mothers ofMbeere District bringing their children to the child welfare clinic.Design: Cross-sectional, descriptive study.Setting: Four rural health centres in Mbeere district.Subjects: Two hundred mothers bringing their children aged one year and below to the childwelfare clinic between September and December 2000.Results: The proportion of mothers who utilised health facilities for antenatal and maternityservices was 97.5% and 52%, respectively. Utilisation of health facilities for maternityservices was significantly influenced by number of children and distance to health facility inthat, as number of children increased, utilisation of maternity services reduced (c2=8.99;p=0.027; df=1). Mothers living less than 5km to a health facility utilised the services betterthan those living 5 km and beyond (c2=7.57; p=0.0059; df=1). Among the reasons given bythe mothers (individual respondents and through Focus Group Discussions) regardingdissatisfaction with the services offered included shortage of drugs and essential supplies,lack of commitment by staff, poor quality of food and lack of cleanliness in the healthfacilities.Conclusion: Coverage for antenatal services was high among mothers during their lastpregnancy. However, only about half of the mothers interviewed utilised health facilities formaternity services (labour and delivery). The major constraints experienced by the mothersas they sought for the services (as reported by individual respondents and through FocusGroup Discussions) included lack of transport, lack of money for transport and hospital feeand delay in admission to health facility once mothers report in labour. Lack of satisfactionwith quality of care given could be the major demotivating factor in the use of health facilitiesfor maternity services
NOSOCOMIAL INFECTIONS IN DEVELOPING COUNTRIES: COST EFFECTIVE CONTROL AND PREVENTION
No full textObjectives: To review the efficient and cost-effective preventive, control and surveillancemeasures that could be employed against nosocomial infections in developing countries.Data sources: Literature search on compact disk-read only memory (CD-ROM), Medlineand Internet, using the key words: nosocomial infection, prevention and control, useof antibiotics and use of computers. Some articles were manually reviewed.Study selection: Relevant studies or articles on nosocomial infections in developing anddeveloped countries were included in the review.Data extraction: From individual studies or articles.Data synthesis: Information on nosocomial infections from developing and developedcountries with some emphasis on Kenya is synchronized under the headings; introduction,historical background of nosocomial infections. Current situation of nosocomial infectionsand predisposing factors, nosocomial infections and antimicrobial resistance, consequencesof nosocomial infections, hospital infection control programme and use of computersin nosocomial infection surveillance, and the cost benefit of infection prevention andcontrol programme.Conclusion: Nosocomial infections may be contained more effectively by having aninfection prevention and control programme. Computer-assisted epidemiologicalsurveillance appears to be the most important aspect of monitoring infection controlprogrammes, and to identify changes in risk factors that can increase the infection rate.Even minimally, effective infection control programmes are cost-effective. For the waragainst nosocomial infections to be won, the whole exercise should be handled as a globalproject with significant inputs from developing countries
CHILDHOOD ACHALASIA IN ZARIA, NIGERIA
No full textObjectives: Tostudy the presentation, management and outcomeofachalasia of theoesophagusin children.Design: A retrospective case study.Setting: Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.Subjects: Seven children managed for achalasia of the oesophagus in a period of 19 years.Results: There were six boys and one girl. The median age at presentation was ten years(range three months to fifteen years). The median duration of symptoms before presentationwas 20 months (range: 2 - 24 months), Three children were treated on several occasions forpneumonia before the diagnosis was made. Dysphagia, vomiting and regurgitation were themain presenting symptoms. Diagnosis was by barium oesophagogram. Six had modifiedHeller's myotomy via celiotomy anda Thal fundoplicationin a threemonth old. TransthoracicHeller's myotomy was done in the seventh child. There was complete resolution of symptomsin six children. One patient had post-operative retrosternal pain, which was controlled byoral nifedipine.Conclusion: Achalasia of the oesophagus should be excluded in children with recurrent chestinfection. Modified Heller's myotomy without antireflux procedure via the abdominal routeis effective in relieving symptoms of achalasia in children
INTENTION-TO-TREAT ANALYSIS IN THE CHRONIC SUPPURATIVE OTITIS MEDIA TRIALS
No full textABSTRACTObjectives: To determine the extent of application of the intention to treat principlein the chronic suppurative otitis media (CSOM) randomised controlled trials.Design: Data were extracted from 28 CSOM randomised controlled trials.Main outcome measures: Conceptual and methodological approaches of dealing withprotocol deviations with respect to withdrawal, missing response and non-compliance.Results: Of the 28 CSOM trials included in this study, only one (4%) trial mentionedintention-to-treat (ITT) analysis. However, 10(36%) other trials which did not mentionITT, had no protocol deviations and thus carried out an ITT analysis by default. Itis highly likely that a biased treatment effect existed in the trial that mentioned ITTsince the authors undertook a complete case analysis disregarding the 22% protocoldeviators. There were no attempts in any of the trials to impute for missing responsesand carrying out a sensitivity analysis. For trials with a big percentage of protocoldeviations, the validity of their results are brought to question.Conclusions: In practice, not all those entered into a randomised-controlled trial willcomplete the trial. Thus intention-to-treat analysis is an important aspect of randomisedcontrolled trials of health care interventions which tries to bridge this gap. It is importantfor authors to explicitly state the protocol deviations, the methods used to handle themand the potential effect with reference to bias and study outcome
PATTERN AND CLINICAL CHARACTERISTICS OF FIREARM INJURIES
No full textObjective: To determine the pattern and characteristics of patients admitted with firearm injuries (FAls) and establish the morbidity and mortality associated with these injuries.Design: Retrospective cross-sectional study.Setting: Kenyatta National Hospital (KNH), January 2004 to December 2005.Subjects: All patients admitted with physically evident firearm injury.Results: There were a total of 717 patients recorded with FAIs constituting 0.6% of the total number of patients seen in the casualty. Of these, 421 (58.7%) were admitted and treated as in- patients. A firearm was used in 6.7% of the 6300 assault cases recorded in 2004 and in 9.7% of the 3079 cases recorded in 2005. The increase from 6.7% in 2004 to 9.7% in 2005 was statistically significant (p<0.05). There were 370 (87.9%) males and 49(11.6%) females giving a male to female ratio of 7.5:1. The mean age was 29.7 + l0.9 years with a range of 3 to 66 years. At least 262 (62.2%) of the 421 admitted FAI casualties were treated under general anaesthesia (GA). The average duration of operation per patient was 2 + 1.5 hours.Conclusion: FAls are on the increase and affect all age groups but is largely a disease of a young male adult in the 3rd and 4th decade of life. Mortality is higher with increasing age while female victims are fewer but on average six years younger than males. The lower extremities are the commonest target among the survivors. However, abdominal wounds tend to be the most lethal, accounting for greater mortality
ANTIMICROBIAL RESISTANCE OF BACTERIAL ORGANISMS ISOLATED FROM RATS
No full textObjective: To determine if antimicrobial resistance occurs in v:~rious bacterial speciesisolated from rats.Method: Two hundred and fifteen rats were trapped from areas in and around Nairobi,Kenya. They were sacrificed and their intestinal, liver and sple:n specimens obtained.Various bacterial species were isolated from these specimens. The s ~ecies were analysed forantimicrobial susceptibility to 12 commonly used antimicrobials using the disc diffusiontechnique.Results: The bacterial species isolated included pathogenic and pot~:ntially pathogenic onessuch as Escherichia coli 137,Salrnonellatyphirnuriurn 1, Klebsiellapnt urnoniae 2, Enterobactercloacae 4, Enterobacter sakazakii 2, Citrobacter freundii 3, Mt,rganella rnorganii (2),Pseudornonas aeruginosa 2 and Burkhoddria cepacia 6. Depend ng on the species, theresistance to the various antimicrobials were: 0-100% for cef~~taxime, nalidixic acid,cefuroxime, tetracycline, chloramphenicol, co-amoxyclav, sulfan~ethoxazole, ampicillin,trimethoprim and cephradine, 0-66.6% for gentamicin and 0-25% for apramycin.Conclusion: 'The results showed that, rats from the study area harlloured bacterial specieswith antimicrobial resistance. These micro-organisms may form an important reservoir forantibiotic resistance which could pose a public health hazard. Cor trol of rat populations,better management of sewer systems and waste dumping sites are rt commended in order toreduce occurrence of these drug resistance reservoirs