Browsing by Author "Otieno, George Ochieng"

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Association analysis of the FTO gene with obesity in children of Caucasian and African ancestry reveals a common tagging SNP
    (Public Library of Science, 2008-03) Grant, S.F.; Li, M.; Bradfield, J.P.; Kim, C.E.; Annaiah, K.; Santa, E.; Glessner, J.T.; Casalunovo, T.; Frackelton, E.C.; Otieno, George Ochieng; Shaner, J.L.; Smith, R.M.; Imielinski, M.; Eckert, A. W.; Chiavacci, R. M.; Berkowitz, R.I.; Hakonarson, H.
    Recently an association was demonstrated between the single nucleotide polymorphism (SNP), rs9939609, within the FTO locus and obesity as a consequence of a genome wide association (GWA) study of type 2 diabetes in adults. We examined the effects of two perfect surrogates for this SNP plus 11 other SNPs at this locus with respect to our childhood obesity cohort, consisting of both Caucasians and African Americans (AA). Utilizing data from our ongoing GWA study in our cohort of 418 Caucasian obese children (BMI$95th percentile), 2,270 Caucasian controls (BMI,95th percentile), 578 AA obese children and 1,424 AA controls, we investigated the association of the previously reported variation at the FTO locus with the childhood form of this disease in both ethnicities. The minor allele frequencies (MAF) of rs8050136 and rs3751812 (perfect surrogates for rs9939609 i.e. both r2 = 1) in the Caucasian cases were 0.448 and 0.443 respectively while they were 0.391 and 0.386 in Caucasian controls respectively, yielding for both an odds ratio (OR) of 1.27 (95% CI 1.08–1.47; P = 0.0022). Furthermore, the MAFs of rs8050136 and rs3751812 in the AA cases were 0.449 and 0.115 respectively while they were 0.436 and 0.090 in AA controls respectively, yielding an OR of 1.05 (95% CI 0.91–1.21; P = 0.49) and of 1.31 (95% CI 1.050–1.643; P = 0.017) respectively. Investigating all 13 SNPs present on the Illumina HumanHap550 BeadChip in this region of linkage disequilibrium, rs3751812 was the only SNP conferring significant risk in AA. We have therefore replicated and refined the association in an AA cohort and distilled a tag-SNP, rs3751812, which captures the ancestral origin of the actual mutation. As such, variants in the FTO gene confer a similar magnitude of risk of obesity to children as to their adult counterparts and appear to have a global impact.
  • Thumbnail Image
    Item
    Determinants of Self Directed Referral amongst Patients Seeking Health Services at Kenyatta National Hospital, Nairobi, Kenya
    (2014-02-24) Mahinda, Faith Wambui; Otieno, George Ochieng; Karama, Mohamed
    Kenyatta National Hospital (KNH) is found at the apex of the referral system of health care. Ideally, patients seen at KNH are supposed to have sought care from lower levels of health care in the referral system first before seeking health services at KNH. Referral can assume two forms: Self and Non-self. Self referral refers to the scenario where a patient bypasses lower health care levels and visits KNH as his first point of entry while non self-referral refers to the referral done by a health care practitioner from a lower level of health care where the patient is sent to KNH with a referral note. The main objective of this study was to identify determinants (individual and institutional) of self directed referral of patients seeking health services at KNH. 404 respondents participated in the study; sample size was determined using the 10% Gay principle (Mugenda and Mugenda). The researcher conducted a cross sectional, descriptive study using both qualitative and quantitative data collection methods to examine patterns of patient self-referral at KNH according to social-economic status, education level and their perception of quality of care offered in lower levels of healthcare as well as the level of awareness of referral procedures. Descriptive and inferential statistics were analyzed using Statistical Package for Social Sciences (SPSS) while Chi square test and Logistic Regression was used to derive relationships that may exist between the dependent and independent variables; results were significant at a p value <0.05 . The findings of the study indicate that only 27.7% of patients seeking health services at the hospital self refer to KNH. Amongst the patients who self refer to KNH, ailments related to surgical complications (28.6%) were found to be the most common health problems. No statistically significant association was found between individual factors and self directed referral. Institutional factors that were found to influence patients‘ decision to have KNH as their hospital of choice were: location of the hospital, availability of medicines, quality of care, clear kept surroundings and affordable deposits. The health problems that cause patients to seek health services from KNH call for high level diagnostic health care which is often unavailable in lower levels of healthcare. It may be useful to introduce reversed referral within the Kenyan health care system where consultant doctors from KNH visit lower level health facilities and see patients on site. This would go a long way in reducing the number of patients who travel from far in search of quality health service at KNH and at the same time help to decongest the hospital.
  • Thumbnail Image
    Item
    Enterohaemorrhagic Eschericida Coli Infections andAntibiotic Susceptibility Patterns among Children Attending Out-Patient Clinic at Embu Provincial General Hospital-Kenya.
    (2013-10-17) Wachirah, Ndungu David; Otieno, George Ochieng; Afullo, A.
    Diarrheaisthe second leading cause of death in under-fives in the world. EHEC 0157:H7 is an important etiologicagent of diarrhea with public health significance since exposure to low doses can lead to an infectionand could cause an epidemic. EHEC 0157:H7 induces HUS, the leading cause of acute renal failurein childrenbelow five years. The global prevalence of EHEC 0157:H7 is about 2% while most isolatesof this bacterium exhibit multi-drug resistance to most antibiotics in use. To clarify the role of 0157:H7as an important etiologic agent of acute gastroenteritis in children below five years in Kenya, a descriptivecross-sectional study was conducted to establish the prevalence and antibiotic susceptibility patternsassociatedwith EHEC 0157 :H7 isolates from human sources. Diarrhea accounted for 7% of all illnessescausingout-patient morbidity and mortality in children below five years in the study area during the study period. Stool samples were obtained from 302 consenting children below five years in Embu Districtwho were systematically selected between November 2009 and June 2010 and characterized as EHEC0151:H7 using Cowan method as well as sero-typing. Confirmation was through analytical profile indexingas well as CerTest. Antibiotic susceptibility testing of the isolates was through Kirby Bauer disc diffusionmethod. 201 (66.7%) samples out of 302, had E. coli, 84 (27.8%) cases had parasites while 17 (5.63%)cases did not have any growth. Out of 201stool samples with E. coli, 32 (10.6%) isolates were foundto be positive for EHEC 0157:H7 on Sorbitol MacConkey agar, 2 (0.66 %) cases were confirmed to be positivefor EHEC 0157:H7 by CerTest method, while 12 (4%) cases were confirmed positive EHEC 0157:H7by slide agglutination. Based on sere-typing test results, the area under study was found to be havinga prevalenceof about 4% which is above' the global prevalence. 58% of the 12 confirmed cases of E. coli were found to be resistant to Trimethoprim/sulfamethoxazole, 50% were resistant to Ampicillin while 33% of EHEC 0157:H7 isolates were resistant to Chloramphenicol, Tetracycline and cotrimoxazole. All EHEC 0157:H7 isolates were susceptible to Streptomycin, Kanamicin and Gentamicin. Z-test statistic was used to test for significance while a two-tailed chi-square test (X2) was used to test for associations between various demographic factors. The isolation of EHEC 0157:H7 in stool samples from children confirms the circulation of this bacterium in the immediate environment whilethe detection of multidrug resistance is a course for concern. The research findings shall be used to inform policy on; the need for improvement on provision of clean, safe drinking water and general hygienefor the general public, the importance of making laboratory confirmations a routine undertaking in hospitals to ascertain the actual causes of diarrhea particularly in under-fives and state mandating of cases reporting. Introduction of faster presumptive diagnostic tools such as Rapid-Antigen testing is highlyrecommended.
  • Thumbnail Image
    Item
    A Novel Susceptibility Locus for Type 1 Diabetes on Chr12q13 Identified by a Genome-Wide Association Study
    (American Diabetes Association, 2008-04) Hakonarson, H.; Qu, H.; Bradfield, J. P.; Marchand, L.; Kim, C. E.; Glessner, J. T.; Grabs, R.; Casalunovo, T.; Taback, S. P.; Frackelton, E. C.; Eckert, A. W.; Annaiah, K.; Lawson, M. L.; Otieno, George Ochieng; Santa, E.; Shaner, J. L.; Smith, R. M.; Onyiah, C. C.; Skraban, R.; Chiavacci, R. M.; Robinson, L. J.; Stanley, C. A.; Kirsch, S. E.; Devoto, M.; Monos, D. S.; Grant, S. F. A.; Polychronakos, C.
    OBJECTIVE—In stage 1 of our genome-wide association (GWA) study for type 1 diabetes, one locus at 16p13 was detected (P = 1.03 × 10−10) and confirmed in two additional cohorts. Here we describe the results of testing, in these additional cohorts, 23 loci that were next in rank of statistical significance. RESEARCH DESIGN AND METHODS—Two independent cohorts were studied. The Type 1 Diabetes Genetics Consortium replication cohort consisted of 549 families with at least one child diagnosed with diabetes (946 total affected) and DNA from both parents. The Canadian replication cohort consisted of 364 nuclear family trios with one type 1 diabetes–affected offspring and two parents (1,092 individuals). RESULTS—One locus at 12q13, with the highest statistical significance among the 23, was confirmed. It involves type 1 diabetes association with the minor allele of rs1701704 (P = 9.13 × 10−10, OR 1.25 [95% CI 1.12–1.40]). CONCLUSIONS—We have discovered a type 1 diabetes locus at 12q13 that is replicated in an independent cohort of type 1 diabetic patients and confers a type 1 diabetes risk comparable with that of the 16p13 locus we recently reported. These two loci are identical to two loci identified by the whole-genome association study of the Wellcome Trust Case-Control Consortium, a parallel independent discovery that adds further support to the validity of the GWA approach
  • Thumbnail Image
    Item
    Sophistication of information technology in healthcare: a comparison among a sample of hospitals in Japan
    (Electronic Journal of Health Informatics, 2007) Otieno, George Ochieng; Toyama, Hinako; Asonuma, Motohiro; Koide, Daisuke; Naitoh, Keiko
    This study examines the level of clinical sophistication of information technology (IT) in a sample of hospitals in Japan and benchmarks the extent of clinical sophistication in Japan with the findings from similar surveys conducted at different points in time in the State of Iowa in the US and two provinces in Canada. Data for the study were collected using a validated instrument assessing three dimensions of IT sophistication: functional, technological and integration levels. Clinical areas that were assessed include patient management, patient care activities and clinical support activities. The results show that the majority of processes and activities that have been computer-ised in Japan are the basic patient management processes, such as admission, registrations and order entry systems. Telemedicine, expert systems and voice recognition systems for notes tran-scriptions were only available in less than 5% of the sample hospitals. Overall, there were no differences between the small hospitals and large hospitals in terms of functional and integration sophistication. However, large hospitals had higher technological sophistications than small hospitals. Functional sophistication was higher in Japan than Canada and the US. Technological sophistication in Japan was somewhat better than that of Canada but lower than that of the US. The results demonstrated that there exists substantial room for expanding clinical IT systems in the hospitals in Japan. Keywords: Hospital information systems, information technology, computerised medical records, system integration, medical informatics, medical technology