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PRESENTATION AND HEALTH CARE SEEKING BEAAVIOUR OF PATIENTS WITH CERVICAL CANCER SEEN AT MU1 TEACHING AND REFERRAL HOSPITAL, ELDORET, KENYA
No full textObjective: TO determine the clinicopathological characteristics and health care seekingbehaviour of cervical cancer patients seen at Moi Teaching and Referral Hospital (MTRH).Design: Prospective cross-sectional study.Sefting: Gynaecology Unit, Moi Teaching and Referral Hospital {MTRH). Eldoret, Kenya.Subjects: Forty two consecutive cervical cancer patients seen at MT'RH gynaecology unitbetween May 1998 and Novrmber 1999.Results: I'he mean age of the patients was 49.4 years (YS%CI 45.4 to 53.3 years) range 24 to80 years. All had been married and 42.9% had been in polygamous unions. Slightly morethan seventy six per cent had had five or more confirmed pregnancies Contraceptive everusewas 22%. The mean duration of clinical symptoms on presentation at MTRH was 8.2months (95% '01 6.5 to 9.8 months) range I to24 months. Female relatives and husbands werethe firstto be told about the symptoms by 90.3% oft he patients and husbands alone by 48.8 %of the patients. More than ninety per cent of patients sought health for the first time at afacility manned by trained health worker, with 39% visiting a dispensary ur health centrefirst, More than 95 % of patknb had tumour stage 2 and above. Histopathulogically, 80.9%of the tumours were squamous cell carcinoma, 11.9 % were adenocarcinoma while the restwere anaplastic.Conclusion: Patients with cervical cancer present late for treatment at MTRH. They aremost likely to have discussed their illness with their female relatives and husbands and tuhave first visited peripheral facilities manned by trained healthcare workers. Interventionsto improve health care seeking behaviour among cervical cancer patients need to includeeducation of husbands in addition to increasing awareness of the disease among privatemedical practitioners and health workers at dispensary and health centre level
MAJOR OBSTETRIC INTERVENTIONS AMONG EIQCAMPED REFUGEES AND THE LOCAL POPULATION IN TURKANA DISTRICT, KENYA
No full textBackground: Maternal mortality in developing countries remains high due to lack ofappropriate emergency obstetric care. Major obstetric intervention (MOI) rate can be usedas an indicator of unmet obstetric needs and quality of care.Objectives: Identify indications for major obstetric interventions, determine M01 rates andassess extent of unmet obstetric need for women in Turkana district, Kenya.Design: Descriptive bi-directional study.Setting: Turkana district: Kakuma Refugee Camp, Kakuma Catholic Mission and Lodwar -District Hospitals.Subjects: Four thousand two hundred and eighty encamped refugee women and 7,630women from the host population delivering in Turk ma district between January 1995 andSeptember 1999.Data Sources: Maternity registers, inpatient case notes and theatre registers.Main outcome measures: Maternal mortality, perinatal mortality, major obstetricinterventions, unmet obstetric need and length of st ty.Results: The subjects from the two study populations were similar with respect to age, parityand indications for surgical intervention. Caesarea~t section was the only major obstetricintervention. Overall, caesarean section rate was sig iificantly higher among refugees thanin the host population (3.1 % versus 2.1 % , p<O.Ol; CI 1.4-2.1). Maternal indications were themain reasons for CIS in both populations, with the ds rate being higher for refugees than forlocal women (2.5% versus 1.7%). At least 0.8% of parturient women from the hostpopulation had unmet obstetric needs: this translata to 61 pregnant women who may havedied or experienced birth-related complications over the study period. The mean length ofhospital stay was much less for refugee women than fc r the host population (8.1 days versus11.3 days).Conclusion: Encamped refugee women in Kakuma lave better obstetric care than thosefrom the host population, and the level of unmet obst 3tric needs in the district is high. Thisimbalance could be reduced through resource sharing and integration of refugee health careservices with that for the host population
RISK OF CONJUNCTIVAL CONTAMINATION FROM BLOOD SPLASHES DURING SURGERY AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjectives: To determine the utilisation rate of design specific eye protection by surgeons and to assess the risk of conjunctival contamination with blood splashes during surgery.Design: Cross sectional, observational study.Setting: The theatre suite of Kenyatta National Hospital, NairobiSubjects: Surgeons from all specialties operating in the theatre suite.Results: The minority of surgeons, 5.2% utilised protective eye goggles compared to 3.5% of assistants. Prescription eye spectacles were the most common form of eye protection at 41.9 and 20.9% respectively for surgeons and their assistants. The contamination rate for provided protective eye wear was 53.1% with the average number of droplets being 2.48 per procedure for the principal surgeon. The duration of surgery and the use of power tools influenced the contamination rate.Conclusions: The utilisation rate of design specific protective eye wear is low and with a significant risk of conjunctival contamination, changes in attitudes and practices are needed to increase utilisation
HISTOLOGY OF SPECIMENS TAKEN BY PROSTATECTOMY AND NEEDLE BIOPSY
No full textABSTRACTObjectives: To determine the histology of the prostate in prostatectomy done for benign prostatichypertrology (BPH), and prostate needle biopsy done for raised prostatic specific antigen (PSA).Design: A retrospective study.Settings: Nairobi Hospital, Kenyatta National Hospital and Upper Hill Medical Centre.Subjects: The records of all the patients who had prostatectomy for BPH or trans-rectal needlebiopsy of the prostate for raised prostatic specific antigen by the author and whose histology wasdetermined at the Nairobi Hospital between May 2004 and December 2006.Results: A total of 108 specimens from 108 patients were sent to the laboratory. The ages of thepatients ranged from 48 years to 83 years with a mean of 71.3 years. Of the 108 specimens submitted82 were benign prostatic hypertrophy and 26 were carcinoma of the prostate. Out of 78 prostatectomyspecimens ten (12.8%) had prostate cancer. In the needle biopsy group 16 out of 30 (53%) had prostatecancer. In total there were 82 (76%) patients with histology of benign prostate enlargement and 26(24%) with histology of prostate cancer.Conclusion: Prostate cancer is a common disease in Kenya and a lot of it is important cancer asit will progress and cause death. In this poor resource setting it is possible to make diagnosis ofprostate cancer even in the absence of transrectal ultrasound (TRUS) to help biopsy the prostate.The higher the prostatic specific antigen in asymptomatic patients the higher the yield of prostatecancer on biopsy of the prostate
HYDROQUINONE NEUROPATHY FOLLOWING USE OF SKIN BLEACHING CREAMS: CASE REPORT
No full textA 30-year old black woman presented with gradual onset of weakness of the legs associatedwith burning sensation in the feet for two months. She had been using two hydroquinone -based skin bleaching creams (MGC by M. G. C. International, MEKAKO by Anglo FabricsI30LTON Ltd) for about four years. Her BP was 80140mm Hg supine with un-recordablediastolic pressure on standing. She had decreased power (Grade 315), loss of deep tendonreflexes and impairment of deep sensation in the lower limbs. A complete blood count,urinalysis, serum electrolytes, serum creatinine and uric acid were all normal. Oral GTT,VDRL and brucella tests were negative. Chest and abdominal radiographs did not show anyabnormalities. A diagnosis of peripheral neuropathy with autonomic neuropathy possiblydue to hydroquinone toxicity was made and she was advised to stop using hydroquinonebased skin bleaching creams. Four months later she was asymptomatic, her BP was 120180mmHg supine and standing, and neurological examination was normal. The case raises thequestion of whether hydroquinone based skin bleaching creams could be a cause ofperipheral neuropathy and underscores the need for research on hydroquinone based skinbleaching creams and neuropathy particularly in black women involved in the sale and/oruse of skin bleaching creams
HERPES ZOSTER MYELITIS: REPORT OF TWO CASES
No full textTwo male patients aged 40 and 45 years with HIV infection and paraplegia are presented.The two had sub-acute onset paraplegia with a sensory level, which developed 10 days afterherpes zoster dermatomal rash. They both had asymmetrically involvement of the lowerlimbs. Investigation including imaging of the spinal cord did not reveal any other cause of theneurological deficit. The two responded very well to treatment with acyclovir. Herpes zostermyelitis is a condition likely to rise with the upsurge of HIV infection and there is a need toidentify the condition early. We also review the literature on the subject
PATTERN OF OCCURRENCE OF HEAD AND NECK CANCER PRESENTING AT KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textBackground: Currently there is a dearth of data on the pattern of occurrence of head and neck cancers in Kenya.Objective: To provide a comprehensive analysis of the pattern of occurrence of head and neck cancers in a Kenyan population.Design: Retrospective hospital-based descriptive study.Setting: Kenyatta National Hospital, Nairobi.Result: A total of 793 cases were recorded consisting of 507 male and 286 female (M: F = 2:1). Most of the lesions arose from the upper aerodigestive pathway. The larynx was the most common site for aerodigestive malignancies. This was followed in order of frequency, by the tongue, the mouth, and the nasopharynx. Outside the aerodigestive pathway the eye was the most commonly affected site followed by the thyroid. Squamous cell carcinoma was the most common malignancy. Sarcomas were typically rare. Gender and age distribution showed an overall male preponderance and a wide age range. However, specific tumour sites and tumour types showed varying patterns ofgender and age distribution.Conclusion: This study confirms the relative prominence of laryngeal, oral and nasopharyngeal cancers in the African population. It is, however, at variance with other African studies regarding the relative frequency of nasal and paranasal cancers
CD4T LYMPHOCYTE SUBSETS AND DISEASE MANIFESTATION IN CHILDREN WITH AND WITHOUT HIV BORN TO HIV-1 INFECTED MOTHERS
No full textABSTRACTObjective: To understand the natural history of HIV-1 infection in children in termsof evolution of childhood clinical manifestations versus the immune status, we prospectivelystudied children with and without maternally transmitted HIV-1 infection born tomothers infected with HIV-1 for two years between March 1998 and March 2000.Design: A prospective cohort study.Setting: An institutional children’s home.Subjects: Fifty nine children (26 males and 33 females) with and without maternallytransmitted HIV-1 infection born to mothers infected with HIV-1 and adopted ininstitutional children home.Methods: HIV-1 status of children under nine months was confirmed by polymerasechain reaction(PCR). ELISA for HIV-1 antibody in serum/plasma was used to confirmHIV-infection status for children aged £18 months. Children were visited every threemonths between March and June 2000. At every visit blood was collected for total whitecell count, haemoglobin and CD4+ and CD8+ T cell counts. The institutional doctorroutinely examined children and treated all ailments. Clinical data were recorded.Measures: HIV-DNA, anti-HIV antibodies, total white blood count, total T cell counts,CD4 and CD8 T cell subset counts, frequency of childhood manifestations of infection.Results: The children were aged between 4.5 and 13 years. The baseline haematologicaland immunological profiles (mean, mode) were: HIV-1 sero-converters (WBC 7151,7150;HB 11.6, 12.0; CD4+ 686, 795; CD8+ 2168, 1507) and HIV-1 de-seroconverters (mean,mode) were: (WBC 8386, 7150; HB 11.7, 12.8; CD4+ 735, 795; CD8+ 2168, 1507). Thecommonest causes of illnesses among the HIV-1 children were URTI (85.3%), TB(56.1%),pneumonia (56.2%), tonsillitis (34.1%), parotiditis (28%) and acute otitis media (25%).The distribution of clinical manifestations was similar between the two categories ofchildren, except URTI, whose prevalence was significantly increased among HIV-1infected children (p-value=0.006). Among the HIV-1 infected children, only TB,parotiditis, and acute otitis media (AOM) were significantly associated with decreasedCD4+ T cell count (p<0.05) resulting from HIV infection.Conclusions: HIV infection in children predisposes them to common childhood infectionsthat can be used as markers of immune decline. TB, AOM, URTI may be early indicatorsof suspicion that would enable selective screening for HIV infection in children
EFFECT OF DIAGNOSIS AND TREATMENT OF INOPERABLE CERVICAL CANCER ON QUALITY OF LIFE AMONG WOMEN RECEIVING RADIOTHERAPY AT KENYATTA NATIONAL HOSPITAL
No full textBackground: Cancer of the uterine cervix is the most common female cancer in Kenya. Despitebeing preventable, it is often diagnosed when it is already late. For this reason, only palliativetherapy is provided. Hence, it is expected that their daily routines and that of their caregivers areseverely disrupted.Objectives: To determine the extent to which diagnosis and treatment of inoperable cervicalcarcinoma affects quality of life (QOL).Design: Cross-sectional descriptive study.Setting: Radiotherapy Department at the Kenyatta National Hospital.Subjects: Women undergoing radiotherapy for inoperable cervical cancer.Results: There is high prevalence of profound disruptions in nearly all domains of QOL. In thesocial domain, between 33% and 44% had the perception that family members and friends hadwithdrawn social support. Reduction in various economic facets was reported by 47.4% – 52.6%,with 44.7% reporting a fall in the overall living standards. There were significant changes in thesexual domain, as a result in which 28.3% reported marital discordance. In the personality domain,decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. Onfunctional outcomes (EORTC QLQ-C30), only 32% – 41% reported not being affected in the variousfacets of emotional function. Physical functions were affected in 19% – 79%, role functions in 69%– 75%; symptoms in 49% – 80%; cognitive functions in 46% – 56%; social functions in 63% – 71% andfinancial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruptionin overall physical health and overall QOL.Conclusion: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancerand subsequent therapies. For this reason there is need to establish severe disease and end-of-liferesearch and management services that would ensure better coping with cancer for patients andfor home-based caregivers