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MILLENNIUM DEVELOPMENT GOAL 5: A REVIEW OF MATERNAL MORTALITY AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjectives: To review if there is a change in the maternal mortality rate at the Kenyatta National Hospital since the inception of the Millennium Development Goal strategy in 1990, compared to earlier reviews.Design: A retrospective descriptive study.Setting: Kenyatta National Hospital.Subjects: Maternal deaths attributed directly to obstetric causes.Main outcome measures: Determination of maternal mortality rates of all patients admitted to the Kenyatta National Hospital Maternity and died after admission up till six weeks of admission. Also determine any avoidable causes of the same.Results: During the period under review, there were 27,455 deliveries and 253 maternal deaths giving a maternal mortality ratio of 921.5 per 100,000 live births. Direct obstetric causes accounted for 71% of all maternal deaths with sepsis, haemorrhage, andhypertension being the leading causes. Respiratory tract infections associated with HIV/AIDS infection was the prominent indirect cause. 67.5% of deaths occurred in women aged between 25 and 35 years and 78.7% were Para 2 or less. Evidently there was poor antenatal clinic attendance with only 28.6% having had any attendance at all.Conclusion: Antenatal clinic attendance needs to be re-emphasised if an impact is to be realised in curbing maternal mortality; moreover there is need for early referrals and encouraging mothers to deliver under skilled care
Burkitt’s lymphoma in Uganda: the role of immunohistochemistry in diagnosis
No full textBackground: Haematoxylin and eosin staining has remained the standard diagnostic method for Burkitt’s lymphoma. Ancillary tests including immunohistochemistry, not widely available in developing countries, are important tools in verifying the diagnosis of lymphomas with equivocalmorphological findings.Objective: To evaluate the reliability of haematoxylin and eosin staining in the diagnosis of Burkitt’s lymphoma using immunohistochemistry as the gold standard.Design: Cross sectional study.Setting: Department of Pathology laboratory, Makerere University Medical School, Uganda.Subjects: One hundred and thirty eight formalin fixed paraffin embedded biopsies of Burkitt’s lymphoma diagnosed from January 2001 to December 2005.Results: Of the 138 tumours, 88.4% were extra-nodal: jaw 36.2%, ovary 21%, gastrointestinal tract 12.3% other abdominal 11.6%. Males (55.8%) predominated. The sensitivity and specificity of haematoxylin and eosin were 93.2% and 50% respectively. The positive and negative predictivevalues were 91.7% and 55.6%.Conclusion: Histology using haematoxylin and eosin staining is sensitive in the diagnosis of Burkitt’s lymphoma but not very specific. Immunohistochemical staining with CD20, Ki-67 and bcl-2 is necessary for difficult cases
BACTERIOLOGICAL QUALITIES OF INDOOR AND OUT-DOOR DRINKING WATER IN KIBERA SUB-LOCATION OF NAIROBI, KENYA
No full textObjectives: To compare the bacteriological quality of out-house (tank or standpipe) water andin-house drinking water (storage containers) and determine the risk factors influencing it.Design: A cross-sectional study.Setting: The study was carried out in Kibera slums located 7 km southwest from the NairobiCity centre.Subjects: Water samples from twenty outside tanks/standpipes and sixty from in-housewater storage containers.Main outcome measures: Pour plate method was used to enumerate total bacterial counts inwater, while the multiple tube technique was used to determine faecal coliform (FC) andfaecal streptococci (FS) numbers. A questionnaire and environmental observation were usedto determine the risk factors influencing bacteriological quality of water.Results: The mean total bacterial counts (TBC) for out-house water was 46.6 per 100 ml whilethat for in-house water was 818.2 per 100 ml. Faecal coliforms were isolated from 7 (35%)standpipes and 57 (95%) in-house storage containers. The mean faecal coliform count was93 and 103.4 per 100 ml for out-house and in-house water, respectively. The counts weresignificantly higher in the latter. Faecal streptococci were isolated from 2 (10%) standpipesand 37 (61.7%) in-house storage containers. The mean faecal streptococci counts were 35 and65 per 100 ml for out-house and in-house water sources, respectively. Escherichia coli wasisolated in 2 (10%) of out-house water and 30 (50%) of in-house. Of these, four wereenteropathogenic, serotype 011 from one out-house water source and serotypes 011, 011,0112ac from in-house water sources.Conclusions: Bacteriological contamination of water at the source with a further deteriorationbetween the collection points and homes was observed. A defective water delivery system andinadequate environmental sanitation were a potential source of contamination for out-housewater. Scoops were a major source of contamination for stored water
QUALITY OF GLYCAEMIC CONTROL IN AMBULATORY DIABETICS AT THE OUT-PATIENT CLINIC OF KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textABSTRACTBackground: Treatment of diabetes mellitus is based on the evidence that lowering bloodglucose as close to normal range as possible is a primary strategy for reducing or preventingcomplications or early mortality from diabetes. This suggests poorer glycaemic controlwould be associated with excess of diabetes-related morbidity and mortality. This presumptionis suspected to reach high proportions in developing countries where endemic poverty abetspoor glycaemic control. There is no study published on Kenyan patients with diabetesmellitus about their glycaemic control as an audit of diabetes care.Objective: To determine the glycaemic control of ambulatory diabetic patients.Design: Cross-sectional study on each clinic day of a randomly selected sample of both typeI and 2 diabetic patients.Setting: Kenyatta National Hospital.Methods: Over a period of six months, January 1998 to June 1998. During routine diabetescare in the clinic, mid morning random blood sugar and glycated haemoglobin (HbAI c)wereobtained.Results: A total of 305 diabetic patients were included, 52.8% were females and 47.2% weremales. 58.3% were on Oral Hypoglycaemic Agent (OHA) only, 22.3% on insulin only; 9.2%on OHA and insulin and 4.6% on diet only. 39.5% had mean HbAlc £ 8% while 60.5% hadHbAlc ³ 8%. Patients on diet-only therapy had the best mean HbAlc=7.04% while patientson OHA-only had the worst mean HbAlc=9.06%. This difference was significant (p=0.01).The former group, likely, had better endogenous insulin production. The influence of age,gender and duration of diabetes on the level of glycaemic control observed did not attainstatistically significant proportions.Conclusion: The majority of ambulatory diabetic patients attending the out-patient diabeticclinic had poor glycaemic control. The group with the poorest level of glycaemic control wereon OHA-only, while best control was observed amongst patients on diet-only, because ofpossible fair endogenous insulin production. Poor glycaemic control was presumed to be dueto sub-optimal medication and deteriorating diabetes. There is need to empower patientswith knowledge and resources to enhance their individual participation in diabetes self-care.Diabetes care providers and facilities also need capacity building to improve care of patientswith diabetes
SURGICAL MANAGEMENT OF PEPTIC ULCER DISEASE
No full textObjective: To determine the pattern of surgically managed peptic ulcer disease.Design: A retrospective study.Setting: Department of Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya.Subjects: Fifty three patients operated on for peptic ulcer disease.Results: The mean age was 47 years with a male/female ratio of 1.7:1. Duodenal ulcerassociated complications were the commonest with duodenal ulcer/gastric ulcer ratioof 11.5:1. Most patients had chronic peptic ulcer symptoms with inadequate or nomedical treatment. Perforations were the commonest complications (56.6%) followedby gastric outlet obstruction (34.0%). Closure with omental patch was done in 83.3%of perforations while truncal vagotomy and drainage was done in gastric outletobstruction. Hypostatic pneumonia was the commonest post-operative complication.Seventy one point seven per cent of the patients were free of dyspeptic symptoms duringthe brief follow-up period.Conclusion: Most patients with chronic peptic ulcers had had inadequate treatment andperforation was the most common complication. Repair of perforations with omentalpatch, and truncal vagotomy and drainage procedure for gastric outlet obstruction, weresatisfactory surgical methods offered to patients at the Moi Teaching and ReferralHospital
NON-TYPHI SALMONELLA IN CHILDREN WITH SEVERE MALARIA
No full textObjective: To determine the association between Plasmodium falciparum malaria andnon-typhi Salmonella in children.Design: Cross-sectional hospital based study.Setting: Kilifi District Hospital (KDH) between January 1997 and June 2001.Subjects: Children aged between three months to 123 months (mean age 28.28 months)and who had been admitted to the paediatric or High Dependency Research Ward(HDRW) of the KDH.Methods: A total of 19, 118 blood cultures routinely obtained for all admissions and1,820 clinically indicated stools samples were obtained from 9,147 children admittedwith malaria. The specimens were cultured and antibiotic sensitivity done using standardlaboratory procedures with stringent internal and external quality control in place.Results: The total bacterial pathogens isolated from blood and stool were 1,395/19,118(7.3%) and 342/1,820 (19%) respectively. Non-typhi salmonella consisted of 260/1,395(18.6%) of the positive blood cultures and 92/324 (28.4%) of the stool cultures out ofwhich a total of 101 NTS occurred in children with severe malaria. Out of the 9,147malaria cases admitted, 101/9,147 (1.10%) had concomitant NTS infection. NTS withsevere malaria as a proportion of all malaria admissions for the period varied between0.8% and 1.5%. There was a significant association (p-value=0.032) between clinicaloutcome of death and female sex of the patient. The NTS isolates which occurred withsevere malaria showed various levels of antibiotic resistance. They were resistant toampicillin (35%), chloramphenicol (18%), gentamicin (22%), cefuroxime (29%),sulphamethoxazole-trimethoprim (39%), ciprofloxacin (3%), cefotaxime (14%),amoxycillin-clavulanic acid (26%) and tobramycin (18.0%). Multidrug resistance (MDR)was seen in 34 (33.6%) of the isolates.Conclusions: NTS and severe malaria occurring together are a problem in this areaand that a large number of the isolates are MDR. An elaborate case-controlled studyis required to elucidate the chain of events of both NTS and malaria parasite co-existence
INCIDENCE AND CHARACTERISTICS OF MYASTHENIA GRA VIS IN DAR ES SALAAM, TANZANIA
No full textObjective: To ascertain the annual incidence and characterise the clinical features ofMyasthenia gravis in Dar es Salaam, Tanzania during a ten-year period from 1st January1988 to 31 December 1998.Design: Prospective cumulative registration at a major urban hospital of all patients withnewly diagnosed Myasthenia gravis who were resident in Dar es salaam.Setting: Muhimbili Medical Centre Teaching Hospital, Dar es Salaam, Tanzania.Subjects: Forty seven patients, twenty males, twenty seven females satisfied the criteria forthe diagnosis of Myasthenia gravis (MG).Results: The annual incidence of MG of both sexes was 3 per 1,000,000 population of all agegroups (95 % CI 2.0 to 3.6). The incidence per 1,000,000 population was lowest in those agedbelow ten yean: 2.2 (95% CI 1.4 to3.4) which was statistically significant. The incidence per1,000,000 per year was higher in females but this was not statistically significant. The clinicalpresentation of MG in Tanzania was localised disease accounting for 47% ocular type and53% was mild to moderately severe generalised type MG. Twenty per cent of patients withgeneralised MG presented with bulbar features. Single fibre electromyography was the mostsensitive test.Conclusion: Myastherliagravis is fairly rare in Tanzania as is in other sub-Saharan countriesand presents in similar way to European in terms of age, sex, and clinical features. OcularMyasthenia gravis was more prevalent in Tanzania than in Europe
MEASLES TRENDS AND VACCINE EFFECTIVENESS IN NAIROBI, KENYA
No full textABSTRACTObjectives: To determine morbidity and mortality from measles and to estimate measlesvaccine effectiveness among children hospitalised with measles in two hospitals in Nairobi.Design: A review of hospital records (index cards).Setting: Kenyatta National Hospital and Mbagathi District Hospitals covering the years1996-2000.Method: A review of index cards for measles morbility and mortality was undertaken in thetwo hospitals. Measles data at the Kenya Expanded Programme on Immunisation coveringboth hospitals was analysed for vaccine effectiveness.Results: The incidence of measles was unusually high in 1998 between July and November(monthly range 130-305), reflecting on the occurrence of an outbreak at that time. There wasno definite monthly incidence trend of measles in 1996, 1997, 1999 and 2000. The median ageof cases was 13 months (range 0-420 months) for Kenyatta hospital and 18 months (range 1-336 months) for Mbagathi Hospital. Significantly, 29.8% of all cases were aged below ninemonths when routine immunisation for measles had not begun. The median number of daysspent in hospital were five days (range 0-87 days) for Kenyatta and four days (range 1-13days) for Mbagathi. The overall case fatality rate was 5.6% and was similar for both malesand females. The overall measles vaccine effectiveness among measles cases admitted toKenyatta and Mbagathi Hospitals was 84.1%.Conclusion: The case admissions in Kenyatta and Mbagathi Hospitals suggest measles wasprevalent in Nairobi over the latter half decade of the 1990’s. Apart from 1998 when therewas an outbreak, the seasonality of measles was dampened. The 1998 outbreak suggests abuild up of susceptible children the majority of whom were born in the last quarter of 1996.The high mortality may have had to do with the majority of cases presenting late whensymptoms were already complicated and severe
TIMING OF BREAST MILK HIV-1 TRANSMISSION: A META-ANALYSIS
No full textObjective: To define the frequency and timing of breast milk transmission of HIV-1.Design: Meta-analysis of data abstracted from published literature.Subjects: Participants in prospective cohort studies of MTCT of HIV-1. Cohorts wereseparated on the basis of breast feeding duration.Interventions: None.Main outcome measures: HIV-1 transmission rates.Results: Two thousand three hundred and seventy five HIV-1 infected women and theirinfants, 499 of whom breast fed, the estimated risk of breast milk HIV- 1 transmission was16% (95% CI: 9, 22%). Among breastfeeding infants, forty seven per cent of HIV- 1infections were attributable to breast feeding. Breast milk transmission risk was 21 % (95%CI: 10,33%) in cohorts with meadmedian duration of breast feeding 23 months and 13%(95 % CI: 4,21%) in cohorts with median duration of breast feeding <2 months. In a separateanalysis of 702 infants with prolonged duration of breast feeding, the risk of late postnataltransmission (infection occurring later than three to six months of age) was four per cent(95% CI 2,5%).Conclusions: This analysis suggests that breast milk transmission of HIV-1 is substantial andcontinues throughout the postnatal period. Early cessation of breast feeding at six monthswould avert some but not most infant HIV- 1 infections due to breast feeding. While recentlypublished studies showing some effectiveness of antiretrovirals early during the breastfeeding period are encouraging, prevention of breast milk HIV-1 transmission needs toremain a high research priority