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PNEUMOCYTIS CARINII PNEUMONIA IN HIV/AIDS PATIENTS AT AN URBAN DISTRICT HOSPITAL IN KENYA
No full textABSTRACTBackground: Pneumocytis carinii pneumonia has generally been regarded to be anuncommon opportunistic infection in HIV infected individuals in sub-Saharan Africa.The reason for this has not been clear but postulates included a lack of suitablepathogenic types in the African environment, diagnostic difficulties and the morecommonly held belief that African HIV infected individuals were dying early fromcommon non-opportunistic pathogens before severe degrees of immunosuppressionoccured. Recently a trend has emerged at the Mbagathi district hospital whereby anincreasing number of HIV infected patients are empirically treated for Pneumocytiscarinii pneumonia (PCP) based on clinical and radiological features.Objective: To determine the prevalence of PCP and clinical outcomes of HIV infectedpatients presenting at the Mbagathi District Hospital, Nairobi with the presumptivediagnosis of PCP.Setting: Mbagathi District Hospital, a 169-bed public hospital in Nairobi, Kenya.Methods: Patients presenting with a sub-acute onset of cough and dyspnoea were eligiblefor the study if they were found to have bilateral pulmonary shadows and had negativesputum smears for AFBS. Consenting patients who had no contraindication to fiberopticbronchoscopy had a clinical evaluation which was followed with a fiberoptic bronchoscopyprocedure where bronchoalveolar lavage fluid (BALF) was obtained. BALF wasexamined for cysts of P. carinii using toluidine blue stain and immunofluorescentantibody test (IFAT). BALF was also processed for fungi, bacteria and mycobacteriausing routine procedures. Standard treatment with high dose cotrimoxazole was offeredto all patients who were then followed up until discharge from hospital or deathwhichever came first.Results: Between June 1999 and August 2000 a total of 63 patients were referred forbronchoscopy. Of these four declined to undergo the fiberoptic bronchoscopy procedure,four died before the procedure could be done, one was judged too sick to undergo theprocedure and three had been on cotrimoxazole for longer than five days. Thus 51patients underwent bronchoscopy. Pneumocytis carinii stain was positive in 19 (37.2%)while death occured in 16 (31.4%) of the 51 patients. There were more deaths in thosewithout PCP but this difference was not statistically significant (odds ratio 0.68 (95%CI 0.35-1.32; P=0.2).Conclusion: PCP was found to be common in HIV infected patients presenting withclinical and radiological features of the disease. The mortality rate for patients witha presumptive diagnosis of PCP is high. This study suggests that cotrimoxazolepreventive therapy may be a useful intervention in symptomatic HIV infected patientsin Kenya for the prevention of PCP and may avert deaths from this disease
RAPID ASSESSMENT OF PARTOGRAPH UTILISATION IN SELECTED MATERNITY UNITS IN KENYA
No full textBackground: Prolonged labour causes maternal and perinatal morbidity and mortality.Its sequela include obstructed labour, uterine rupture, maternal exhaustion, postpartumhaemorrhage, puerperal sepsis, obstetric fistula, stillbirths, birth asphyxia and neonatal sepsis. These complications can be reduced by using the partograph to assess the progress of labour. The Ministry of Health, Kenya has adopted this tool for labour management in the country and the standardised partograph is recommended for use in all delivery units.Objective: To determine the utilisation of the partograph in the management of labour in selected health facilities in Kenya.Design: A descriptive cross sectional study.Setting: Nine health facilities -ranging from a tertiary hospital to health centre, including public private and faith based facilities in four provinces in Kenya.Results: All facilities apart from Pumwani Maternity Hospital and one health centre were using the partograph. The correct use was low, the knowledge on the use of the tool was average and there was minimal formal training being provided. Staff shortage was listed as the most common cause of not using the tool. Contractions were recorded30-80%, foetal heart rate 53-90% and cervical dilatation 70-97%. Documentation of state of the liquor, moulding and descent as well as maternal parameters such as pulse,and blood pressure and urinalysis were minimally recorded. Supplies for monitoring labour such as fetoscopes and blood pressure machines were in short supply and sometimes not functional. Overall, the poor usage was contributed to staff shortages, lack of knowledge especially on interpretation of findings, negative attitudes, conflictbetween providers as to their roles in filling the partograph, and senior staff themselves not acting as role models with regards to the use, advocacy and implementation ofthe partograph.Conclusion: The partograph was available in most units. However, accurate recording ofparameters to monitor the foetus, the mother and progress of labour as recommendedwas mostly not done. Shortage of staff, lack of knowledge, lack of team work, lack ofsupplies and negative attitude among healthcare providers were some of the obstaclesnoted to hamper partograph use
DETERMINANTS OF CHILD MORTALITY IN A RURAL UCiANDAN COMMUNITY
No full textObjective: To estimate the rate of and risk factors associated wit1 I child mortality in ruraleastern Uganda.Design: A community based cross-sectional study using the preccbding birth technique - arobust method of obtaining information of survival of the previo~ s child.Setting: A rural district in Eastern Uganda.Participants: In total, 2888 multigravidae were interviewed in Aplil and May 1999.Main outcome measure: Number of deaths among children born alive.Results: The undertwo child mortality rate was 108 per 1000 live >irths. The annual childmortality was 82 per 1000 child-years of risk. Child mortality Ivas associated with lowparental education, being born to adolescent mothers or motllers aged 35 or more.Unconditional logistic regression showed that children born to uneducated parents had adoubled risk of not celebrating their second birthday. It was three times more likely for achild to die in the neonatal period than in the first year of life. Child I nortality risk decreasedby 4% and 6% for every year of education attained by mothers al~d fathers, respectively.Parity, residence and marital status were not associated with excesc risk of child mortality.Seasonal mortality followed the El Nino rainfall pattern. Finally, t lere were geographicaldifferences in child mortality although this was not statistically sigr iificant.Conclusion: Monitoring trends in child mortality at district level can be done using thepreceding birth technique in antenatal settings. Maternal education, an important predictorof child survival should be included in routine data collection at cli lics
DIPHTHERIA SEROPREVALENCE IN CHILDREN LIVING IN THE EASTERN TURKEY
No full textABSTRACTObjectives: To determine the seroprevalence of diphtheria in 767 children aged 0-6 yearsand to identify the relationship between diphtheria seroprevalence and several sociodemographiccharacteristics of the study subjects in the Erzurum, Erzincan and Karscities situated in Eastern Turkey.Design: A cross sectional study.Setting: The subjects were recruited from three cities (Erzurum, Erzincan, Kars). Thesampling method of 30 clusters recommended for field studies was used for a predeterminednumber of selecting subjects in the rural and urban areas in each city.Subjects: Of the 767 children included in this study, 423 were from Erzurum, 187 fromKars and 157 from Erzincan. Diphtheria serology was used to examine the blood samplesby ELISA method.Results: Positive diphtheria seroprevalence was detected in 77.9% of 767 subjects inEastern Turkey. Seroprevalence was 74.5% in children younger than one year of age,increased to 84% at the age of 3-4 years, and reduced to 80% at the age of 4-5 yearsand 69.8% at the age of 5-6 years. The seroprevalence rates were similar in sex andnumber of siblings. Seroprevalence of diphtheria increased with educational level ofparents in the rural area.Conclusion: Positive seroprevalence against diphtheria in eastern Turkey is disturbinglylow
PATIENTS KNOWLEDGE OF HYPERTENSION AND ITS CONTROL IN EASTERN SUDAN
No full textABSTRACTObjective: To describe the knowledge of hypertensive patients, in Kassala, eastern Sudan, aboutthe disease, in relation to its control.Design: Cross-sectional study.Setting: Kassala Teaching Hospital, Kassala, Eastern Sudan.Subjects: Patients with hypertension attending referred outpatient medical clinic.Main outcome measures: Blood pressure, control status and hypertension knowledge score.Results: Two hundred and forty two patients were involved in this study, of whom 68 (73.6%) werefemales and were of middle age. The majority were of low education. One fifth (19.4%) was foundto have controlled blood pressure. About two-thirds of patients showed a high score of knowledgeabout the aetiology and complications of hypertension. Half of the patients knew about treatmentof hypertension. Patients have a very low score regarding knowledge of symptoms of hypertension(38.8%).Conclusion: This study showed good patients’ knowledge about hypertension, but such knowledgedid not seem to have a significant beneficial effect on blood pressure control. Health education iswarranted by health care providers and other factors leading to poor control should be identifiedand managed
HOME-BASED HIV COUNSELLING AND TESTING IN WESTERN KENYA
No full textBackground: The World Health Organisation (WHO) estimates that only 12% of men and 10% of women in sub-Saharan Africa have been tested for HIV and know their test results. Home-based counselling and testing (HBCT) offers a novel approach to complement facility-based provider initiated testing and counselling (PITC) and voluntary counselling and testing (VCT) and could greatly increase HIV prevention opportunities. However, there is almost no evidence that large-scale, door-to-doortesting is even feasible in settings with both limited resources and significant stigma around HIV and AIDS.Objective: To describe our experience with the feasibility and acceptance of home-based HIV counselling and testing (HBCT) in two large, rural, administrative divisions of western Kenya.Design: The USAID-AMPATH Partnership conducted population-based, house-to-house HIV counselling and testing in western Kenya between June 2007 and June 2009. All individuals aged ≥13 years and all eligible children were offered HBCT. Children were eligible if they were above 13 years of age, and their mother was either HIVpositive or had unknown HIV serostatus, or if their mother was deceased or whose vital status was unknown.Setting: Kosirai and Turbo Divisions, Rift Valley Province, Kenya.Results: There were 47,066 households approached in 294 villages: 97% of households allowed entry. Of the 138,026 individuals captured, 101,167 individuals were eligible for testing: 89% of adults and 58% of children consented to HIV testing. The prevalence of HIV in these communities was 3.0%: 2.7% in adults and 3.7% among children. Prevalencewas highest in the 36-45 year age group and was almost always higher among women and girls. All persons testing HIV-positive were referred to Academic Model Providing Access to Healthcare (AMPATH) for further assessment and care; all consenting persons were counselled on HIV risk-lowering behaviours.Conclusion: Home-based HIV counselling and testing was feasible among this rural population in western Kenya, with a majority of the population accepting to get tested.These data suggest that scaling-up of HBCT is possible and may enable large numbers of individuals to know their HIV serostatus in sub-Saharan Africa. More research is needed to describe the cost-effectiveness and clinical impact of this approach
EMOTIONAL AND BEHAVIOURAL DISORDERS IN HIV SEROPOSITIVE ADOLESCENTS IN URBAN UGANDA
No full textObjective: To investigate the emotional and behavioral problems of HIV sero-positive adolescents. Design: A cross-sectional descriptive study Setting: A specialised HIV/ AIDS Health Care Centre, the Mildmay Centre, In Kampala, Uganda. Subjects: A sample of 82 HIV sero-positive adolescents was consecutively enrolled for the study. Results: Over half (55.6%) of the subjects were female. They were mostly (88.9%) under the age of 15 years, orphans (97.6%) and stayed with non-parental relatives (68.3%). Almost two thirds (60.9%) of them were in the HIV/ AIDS clinical disease stage III or IV and were not on ARVs drugs. Forty two (51.2%) of the subjects had signifi cant psychological distress (SRQ-25 scores > 6) and 14 (17.1 %) had attempted suicide within the last 12 months. Their specifi c psychiatric disorders, made using ICD-10 criteria, were: Anxiety 45.6%, depression 40.8%, somatisation 18.0%, seizures 8.4%, mania 1.2% and HIV-associated progressive encephalopathy 4.8%. Conclusion: HIV/AIDS infection in adolescence was associated with considerable psychological problems and the presence of major psychiatric disorders. With the current increasing availability of effective antiretroviral therapy, many of these children are surviving into adolescence, thus calling for the development of adolescent friendly HIV medical and psychological support and treatment services in developing countries such as Uganda
AUTOLOGOUS TRANSFUSION IN SURGICAL PATIENTS AT KE: YYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjective: To identify autotransfusion strategies and their basis in elective surgery patients.Design: A cross sectional prospective study.Setting: General surgery and orthopaedic wards, Kenyatta National Hospital, Nairobi.Subjects: Adult patients of both sexes planned for elective sure ery.Main outcome measure: For every patient, the following were enql ired about and documented:age in years, sex, ethnicity, religion, occupation and education: 11 standard. Blood values ofhaemoglobin, platelet counts, total and diierential white cell cc bunts, urea, electrolytes andliver function tests were assayed. Others were the number of UI lits of blood donated beforethe operation, the type of surgery performed, time taken from diagnosis to performing theoperation and whether the blood was transfused preoperativel! , intraoperatively and postoperatively.Results: A total of sixty three cases constituting five per cent of a U surgical patients admittedduring the period of study were evaluated. Of these 53 (84%) were males and ten (16%)females. The age range was 15 to 65 years with a peak at 45-49 years. There were moreChristians (90%) than Muslims (10%). In all, 32 (51.6%) had primary school education, 23(36.5 %) secondary school education, seven (11.3%) no formal ec lucation and one (1.6%) hadattained college level. Employment pattern showed 50% were c ivil servants, 30% were selfemployed and 20% were unemployed. The duration of disease ranged from 1-24 weeks withtwo peaks at two weeks and six weeks. Orthopaedic cases constituted 78.7% and generalsurgery 21.3%. Preoperative haemoglobin ranged from 13.5-1 4.2 gtdl. Transfusions weregiven intraoperatively to 41 (66.1 %) and to 12 (33.9%) postoperatively. Mean duration ofhospitalisation was 13 days (range 5 to 21 days). 98.4% deposited only one unit while 1.6%deposited four units of blood. Only one patient required additional transfusion fromhomologous donors.Conclusion: The strategies and basis for autotransfusion have I teen demonstrated among amajority of adult patients requiring orthopaedic procedures. Mi ljor determinants are shownto be baseline blood count profdes and time to operation
FRACTURES OF THE MANDlELE IN CHILDREN
No full textObjective: To determine thc pattern of occurrence of mandibular fractures in a paediatricpopulation.Design: A retrospective study.Setting: University College Hospital, lbadan, Nigeria.Subjects: Seventy two pacdiatric patients seen and managed between 1989 and 1998.Results: Road traffic accidents were the most common (52.8%) cause d mandibularfractures. The majority of the patients (57.0%) were within theage group (12 - 16years).Thebody of themandible was involved in 43.4% of thefractures. Eyelet wires with intermaxillaryfixation was used in 41.7 % of the cases.Conclusion: Thcre is a need to cnforce le~slation aimed at preventing road traffic accidentsto reduce maxillafacial injuries among children