RP-Department of Medical Physiology

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    Effectiveness of Short Message Service Support on Adherence to Chemotherapy Treatment among Patients Attending Cancer Treatment Facilities in Kenya
    (Scientific Research Publishing, 2024-03) Mchidi, Nebert Kiguhe; Oyore, John P.; Ogweno, Gordon
    Introduction: Cancer is a chronic debilitating disease that unnerves patients, communities, and nations. At some point in cancer patient’s disease experience, chemotherapy is used, and the patient is expected to adhere to treatment to improve survival and quality of life. Methods: This multisite Cluster Randomized Trial (CRT) evaluated the effectiveness of mobile phone Short Message Service (SMS) support on the adherence to treatment schedules among adult cancer patients in Kenya. Data was collected using questionnaires. Ethical approvals were obtained from relevant Ethical Review Boards (ERBs). Results: The mean adherence was 83%. There was a significant difference between treatment arms in relation to the adherence. The intervention arm had a higher mean adherence difference, M = 3.913, 95% CI 2.632 - 5.193, t (402) = 6.006, p ≤ 0.001), with Cohen’s d = 0.60. Although not significant, (χ 2 dd = 0.151, df = 1, p = 2.064), more women were perfect adheres than males. Perfect adherers were satisfied with SMS support (χ 2 dd = 7.620, df = 1, p = 0.06), were in the intervention arm (χ 2 dd = 22.942, df = 1, p ≤ 0.001), and had trust in the care provider (χ 2 dd = 10.591 p ≤ 0.001). SMS support was not significant in the multivariate analysis but had an estimated effect size of 0.958 (z = 1.424, p = 0.154, CI = 0.242 - 3.781), indicating that mean adherence was slightly better in the presence of the intervention. Conclusions: SMS-support intervention has demonstrated superiority in influencing adherence. Further, health system-related factors have a significant influence on the adherence to chemotherapy treatment. Interventions to re-design health systems that are responsive to unmet care needs of cancer patients must be explored.
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    Factors Effecting Quality Of Life for Family Caregivers of Cancer Patients in Kenya
    (2022) Mwangi, Samuel N; Onsongo, Lister; Ogutu, James O
    : Characteristics, including age, educational level, economics, and geographical setting during care provision significantly affect quality of life (QoL) among cancer patient caregivers in high-income countries. Investigation in middle/low income countries is limited. Objective: To explore the factors associated with QoL among family caregivers (FCG’s) of cancer patients in Kenya. Methodology: This was a correlational study conducted at the largest teaching and referral hospital in Kenya. The study enrolled 164 family caregivers of cancer patients. The QoL (Family Version) was used to measure Quality of Life. Data collection was done using interviewer-administered questionnaires. A student t-test and Pearson chi-square were used to determine the association between personal, social, and disease characteristics and family caregiver quality of life. Results: The average mean score of family caregiver QoL was 55.8 (SD±10.12) percent, which is lower than in other countries. Conclusion: There was a significant association between family caregiver quality of life (QoL) and level of education, relationship to the patient, caregivers’ ability to carry out normal activities, and caregiver knowledge of the stage of cancer.
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    Determinants of Sexual Function among Survivors of Gynaecological Cancers in a Tertiary Hospital: A Cross-Sectional Study
    (ecancer Global Foundation, 2022) Obora, Maximillar; Onsongo, Lister; Ogutu, James O
    Background: Gynaecological cancer impacts approximately three million women globally. The problem is much more intense in resource-limited countries. Sexual health is a critical aspect of gynaecological cancer treatment and an important component of quality of life (QoL). Aims: This study aimed to assess the determinants of sexual function among survivors of gynaecological cancer. Method: This was a cross-sectional study. The simple random sampling technique was used to recruit survivors of gynaecological cancers aged 18 years and above on follow-up in a tertiary hospital in Kenya. Tools: The study used the socio-demographic survey, Body Image Scale, Multidimensional Perceived Social Support Scale and Female Sexual Function Index. Results: Cervical cancer was the most common gynaecological malignancy among respondents (51%). The mean total score of the Female Sexual Function Index was significantly low at 10.0 (cut off = 26.5). The majority (85%) of respondents had sexual dysfunction. The most commonly affected sexual domain was lubrication at a mean value of 0.91 (SD = 1.58). Age (aOR = 0.05, 95% CI: 0.003–0.16, p = 0.005), cancer stage 3 (aOR = 9.81, 95% CI: 1.34–20.56, p = 0.035) and social support (aOR = 1.29, 95% CI: 1.05–1.59, p = 0.015) were independent predictors of sexual dysfunction. Conclusion: The prevalence of sexual dysfunction among gynaecological cancer survivors remains significantly high. Having cervical cancer was the most significant predictor of sexual dysfunction in this study population. Recommendation: There is a need for further studies to improve the sexual life and hence the QoL among survivors of gynaecological malignancies
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    The Ethical and Validity Conundrum in Epilepsy Research in LMIC Settings
    (Frontiers, 2023) Samia, Pauline; Shah, Adeel; Patel, Archana; Olielo, Philip; Mudave, Lionel; Gwer, Samson
    In the last few decades, research in epilepsy has significantly improved understanding of risk factors and etiologies associated with epilepsy, promoting greater access to interventions and medications that have improved health-related outcomes for patients. However, these advances and benefits are not being felt evenly on a global scale due to significant inequalities in access to and utilization of research resources and expertise in Low-and Middle-Income Countries (LMICs). To promote effective research output, and advance evidence-based practices; the context, disease burden, and challenges that hinder good research need to be re-defined and addressed. This is key in facilitating implementation of coherent priorities and strategies in epilepsy research in LMICs; and in facilitating the conduct of scientifically and ethically valid research. This paper explores the capacity, ecosystem, and ethical issues that are at play and that need to be addressed to support better evidence generation and utilization in epilepsy care in LMICs.
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    Risk Factors for Seizure Recurrence after Initial Withdrawal of Anti-Seizure Medications in Children with Epilepsy at Aga Khan University Hospital, Nairobi, Kenya.
    (Elsevier Inc, 2023) Odero, Nicholas; Oyieke, Katherine; Gwer, Samson; Samia, Pauline
    We sought to determine risk factors associated with seizure recurrence following initial withdrawal of anti-seizure medications (ASM) among children with epilepsy. Methods: This was a retrospective observational study of children aged between 2 and 18 years with a diagnosis of epilepsy who underwent withdrawal of anti-seizure medication following remission of seizures. All eligible medical records between January 2011 and December 2019 were included. Demographic, clinical, imaging and electroencephalography data of all eligible patients were analyzed against seizure remission within 24 months after withdrawal of ASM, using appropriate parametric and non-parametric tests. Results: A total of 49 records of children who underwent withdrawal of ASM out of a total of 613 patients on follow up during the same period were included. The median age at ASM withdrawal was 70 months (IQR 52–112 months) and 14 (28.6%) were female. Thirteen patients (26.5%) had seizure recurrence within 24 months following withdrawal of ASM. Focal onset seizure type was associated with significant risk of seizure recurrence (OR 13.7; 95% CI 0.97, 193.54; P value = 0.011). Age at epilepsy diagnosis, abnormal EEG at initiation of treatment and at the time of de-escalation, abnormal MRI findings, first or second degree relative with epilepsy, history of developmental delay, seizure burden, use of 2 or more ASMs and duration of seizure-freedom before de-escalation of ASM were not associated with increased risk of relapse. Conclusion: Focal onset seizure type is associated with increased with risk of seizure recurrence in this cohort
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    International League against Epilepsy Classification And Definition of Epilepsy Syndromes with Onset in Childhood: Position Paper by the ILAE Task Force on Nosology and Definitions
    (Wiley online library, 2022-03) Gwer, Sam; Spechio, Nicola; Wirrell2, Elaine C.; Scheffer, Ingrid E.; Nabbout, Rima; Moshé, Solomon L.; Tinuper, Paolo; Auvin, Stéphane; Perucca, Emilio; Cross, Helen J; Samuel, Wiebe; Pressler, S. W.; Yozawitz, Elissa; Samia, Pauline; Wilmshurst, Jo M.; Hirsch, Edouard; Guerreiro, Marilisa; Zuberi, Sameer M.
    The 2017 International League Against Epilepsy classification has defined a three-tier system with epilepsy syndrome identification at the third level. Although a syndrome cannot be determined in all children with epilepsy, identification of a specific syndrome provides guidance on management and prognosis. In this paper, we describe the childhood onset epilepsy syndromes, most of which have both mandatory seizure type(s) and interictal electroencephalographic (EEG) features. Based on the 2017 Classification of Seizures and Epilepsies, some syndrome names have been updated using terms directly describing the seizure semiology. Epilepsy syndromes beginning in childhood have been divided into three categories: (1) self-limited focal epilepsies, comprising four syndromes: self-limited epilepsy with centrotemporal spikes, self-limited epilepsy with autonomic seizures, childhood occipital visual epilepsy, and photosensitive occipital lobe epilepsy; (2) generalized epilepsies, comprising three syndromes: childhood absence epilepsy, epilepsy with myoclonic absence, and epilepsy with eyelid myoclonia; and (3) developmental and/or epileptic encephalopathies, comprising five syndromes: epilepsy with myoclonic–atonic seizures, Lennox–Gastaut syndrome, developmental and/or epileptic encephalopathy with spike-and- wave activation in sleep, hemiconvulsion–hemiplegia– epilepsy syndrome, and febrile infection-related epilepsy syndrome. We define each, highlighting the mandatory seizure(s), EEG features, phenotypic variations, and findings from key investigations
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    Quality Perspective of Healthcare Provision in Selected Public Health Facilities after Devolution in Garissa County.
    (International Academic Journals, 2021) Buro, Rahima Yussuf; Yitambe, Andrea; Rucha, Kenneth
    Devolution is delegation of power, governance and resources from centralized government to local/subnational level jurisdictions. The Kenyan constitution allows two levels of government i.e. the national and county levels with each level having its mandate. Provision of standard and sustainable health services to the Kenyan citizens is one of the fundamental roles of devolution as stated in the Kenyan Constitution. This study examined the quality of healthcare services delivered before and after devolution in selected public health facilities in Garissa County as perceived by the healthcare users. The study employed cross-sectional descriptive research design to explore the rating of performance of the health care system after the devolution. Two key domains employed were accountability and good governance; and supply of essential drugs. The sample size was 379 respondents representing clients attending outpatient services. Data was analyzed using SPSS software version 22. Qualitative data was analyzed using thematic content analysis. Descriptive statistics was analyzed using frequencies and percentages and inferential statistics was analyzed using Chi-square and Fisher’s exact test to test for associations between variables. P<0.05 was considered significant. The study revealed that majority of the respondents were female (51.3%), had no formal education (47.6%), and were unemployed (57.6%). The mean age of the respondents was 33.49 years. The average time taken to reach the nearest health facility was 2.1 hours and average waiting time before service was 2.6 hours. The study found out that majority of the respondents 53.4% were able to get the essential drugs during the last facility visit. The study established that the challenges facing hospital managers in implementing devolution were poor infrastructure, unskilled staff, stockouts of essential medical supplies, delay in resource allocation and lack of equipment. The study concludes that healthcare services have declined substantially with the introduction of devolution of healthcare services.
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    Baseline Blood Count Levels Increase Odds Of Cytopenia among CML Patients in Kenya: A Case Control Study
    (Research square, 2021) McLigeyo, Angela; Rajab, Jamila; Oyiro, Peter; Ezzi, Mohammed; Bett, Yatich; Ong'ondi, Matilda; Odhiambo, Andrew; Mwanzi, Sitna; Othieno - Abinya, Nicholas
    Imatinib is the gold standard for the treatment of all phases of Philadelphia positive Chronic Myeloid Leukemia (CML). During treatment, patients may develop cytopenia. We aimed to study the baseline characteristics and factors associated with cytopenia at a Nairobi Hospital. Methods This was a retrospective case-control study of patients aged ≥ 18 years on follow-up at the Glivec International Patient Access Program (GIPAP) clinic from 2007–2015. The cases consisted of CML patients on imatinib who developed cytopenia. The controls were CML patients on imatinib who did not develop cytopenia. Baseline socio – demographic, clinical, hematologic, and molecular data were retrieved from patients’ les. Chi square or shers’ exact tests were used to analyze for differences between cytopenia and no cytopenia. Binary logistic regressions were employed to identify relationships. Univariate and multivariate analyses were done to identify independent predictors of cytopenia. Odds ratios (OR) were presented including the 95% condence intervals and respective p values. Results A total of 201 patients were studied. Males were 52%, 42% were aged 36–50 years, 70% had symptoms for > 12 months before diagnosis, 78.6% had B symptoms at baseline, 80% had a moderate splenomegaly at baseline, 40% and 37.4% developed cytopenia within 3 months and 3–6 months respectively after imatinib initiation. Baseline neutrophilia, neutropenia, anaemia, thrombocytosis, thrombocytopenia was found in 68%, 11%, 11%, 23.5% and 11% respectively. Baseline hemoglobin, neutrophil and platelet level were signicantly different between the cytopenia and the no cytopenia group. On univariable analysis, baseline anemia with hb < 7.9g/dL (p = 0.002), neutropenia (p = 0.001), neutrophilia > 100,000/mm3 (p = 0.002) and thrombocytopenia (p = 0.001) increased the odds of developing cytopenia. On multivariable analysis, baseline anaemia (p value < 0.002), neutropenia (p value < 0.001), thrombocytopenia (p value, < 0.001) and thrombocytosis (p value, 0.033) increased the odds of developing cytopenia. Conclusion Odds of cytopenia were higher in presence of baseline cytopenia and thrombocytosis. Clinicians should have a high index of suspicion for these patients.
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    Dyslipidemia in blood pressure control among adult hypertensive patients in Kiambu County Hospital Kenya
    (The East and Central Africa Medical Journal, 2020) Nderitu, Monica. N.; Wala, Jonathan; Otieno, Otieno O.
    Introduction: Hypertension is one of the most common non-communicable diseases with about 40% global prevalence in adults and 46% in Africa. Dyslipidemia, among other factors may lead to poor blood pressure control in hypertensive patients. Dyslipidemia occurs when someone has abnormal levels of lipids in their blood However, the role of dyslipidemia in predicting hypertension has not received adequate attention. Objectives: This study aims to determine the relationship between dyslipidemia and blood pressure control among hypertensive patients in Kiambu County Hospital Kenya. Methods: This was a cross-sectional analytical study assessing independent association between blood pressure control and dyslipidemia in a cohort of 251 hypertensive patients in a hospital set up. Multiple logistic regression model was applied to determine factors associated with poor blood pressure control. Results: In total, 251 hypertensive patients, mean age 55.7 years, females-majority (80.9%) were considered in the study. The mean systolic blood pressure was 145.1±22.4mmHg and 87.4±13.0mmHg for diastolic blood pressure. Blood pressure was poorly controlled in 56.6% of the patients. High LDL levels was diagnosed in 82.1% of the patients, 23.1% low HDL levels, 31.9% high triglycerides and 59.8% high total cholesterol levels. Patients with poorly controlled hypertension (68.7%) recorded significantly higher mean total cholesterol (221.4 mg/dl) compared to193.4 mg/dl in the wellcontrolled group (mean 193.4 mg/dl), p0.05). Conclusion: Dyslipidemia was recorded in 68% of adult hypertensive patients and was significantly associated with development of of inadequate blood pressure control. Low density lipids ( LDL) was significantly higher in the poorly controlled group where 68.7% of the patients with high level of total cholesterol had poorly controlled blood pressure. Lifestyle modification, routine lipid profile testing among hypertensive patients, early treatment on high lipid level patients, change of lifestyle and use of statin were recommended for dyslipidemia treatment.
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    Streptococcus pneumoniae serotype epidemiology among PCV-10 vaccinated and unvaccinated children at Gertrude’s Children’s Hospital, Nairobi County: a cross-sectional study
    (F1000Research, 2018) Walekhwa, Michael; Muturi, Margaret; Gunturu, Revathi; Kenya, Eucharia; Kabera, Beatrice
    Background: Streptococcus pneumoniae (SPn) serotype replacement and emergence of multidrug resistant SPn has exacerbated the need for continuous regional serotype surveillance. We investigated SPn serotypes circulating among children ≤5 years in Nairobi County. Methods: Streptococcus pneumoniae stocks stored at −70°C in brain heart infusion medium were thawed at room temperature for 30 minutes. In total, 10 μl of the stored SPn cells were suspended in 50 μl PBS and gently vortexed. About 10 μl of the suspended cells were added on to a glass slide and mixed with 10 μl pooled antisera. The glass slide was swirled gently while observing for any reaction. The process was repeated with individual groups under various antisera pools. Those serotypes that did not belong to any pool were typed directly until a positive agglutination reaction was observed. The cells/PBS/serotype-specific antisera mixture on the glass slide were covered with a coverslip and observed under a phase contrast microscope at ×100 objective lens with oil emulsion. Results: Out of the 206 subjects sampled, 20.39% (n=42) were found to be carriers of SPn. About 52% (n=22) of the SPn carriers had received the recommended dose of PCV-10, while 48% (n=20) of the carriers had not. Almost all (n=41; 19.90% of subjects) isolates contained non-vaccine type SPn serotypes, while n=1 of the serotypes (in 0.49% of subjects) were untypeable. Serotypes 28F, 6A, 11A, 3 and 7C were prevalent in both vaccinated and unvaccinated children, whereas serotypes 23A, 17F, 35F, 48, 13 and 35B, and 23B, 20, 19B, 21, untypeable, 15B and 39 were found among unvaccinated and vaccinated groups, respectively. Conclusions: All SPn serotypes isolated from the subjects sampled were non PCV-10 vaccine type. Therefore Kenyan children receiving PCV-10 vaccine are not protected.
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    Metabolic syndrome and its components among university students in Kenya
    (BioMed Central, 2017) Mbugua, Samuel Mungai; Kimani, Samuel Thuo; Munyoki, Gilbert
    Background: Metabolic syndrome refers to a cluster of interrelated disorders which occur together causing an increase in the risk of developing cardiovascular disease and diabetes. The university population is an understudied group despite the increase in the frequency of related disorders and metabolic risk factors e.g. obesity and diabetes, majorly due to the assumption that they are in their most active phase of life therefore healthy. This study looked at metabolic syndrome, the sedentary lifestyles and dietary habits present among university students attending Mount Kenya University, main campus. Methods: Stratified sampling was used to select participants. Self-administered questionnaires were issued to participants after a signed consent had been obtained following which clinical assessments and biochemical measures were performed. They included blood pressure, fasting blood glucose, triglycerides, high density lipoprotein-cholesterol, anthropometric measurements; height, weight, BMI and waist circumference. Pearson’s chisquare tests and non-parametric independent t-test were used to analyze the prevalence of metabolic syndrome criteria per gender, the number of metabolic syndrome criteria per BMI and prevalence of metabolic syndrome criteria per BMI category. Results: The study established that 1.9% of the participants met the criteria for diagnosis of metabolic syndrome according to HJSS criteria. Among the elements, there was statistical difference in gender BMI and waist circumference. 11.8% of subjects had two metabolic syndrome components while 3.1% had three components while none of the subjects had all six components. Elevated triglycerides was the most prevalent defining component for metabolic syndrome. There is a statistically significant relationship between sedentary lifestyle and dietary habits as risk factors to metabolic syndrome. Conclusion: Young adults in university have begun developing metabolic syndrome and the risk of developing the syndrome continues to increase with the components being reported in early age. Educational initiatives to encourage healthy eating should be conducted within school premises in order to reinforce the message on healthy diets and physical exercise. Pre-admission screening to identify at risk students should be conducted. Targeted interventions development through a mandatory extra co-curricular program should be enforced to positively engage those at risk.
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    Key bottlenecks to the provision of safe obstetric anaesthesia in low- income countries; a cross-sectional survey of 64 hospitals in Uganda
    (BioMed Central, 2017) Epiu, Isabella; Wabule, Agnes; Kambugu, Andrew; Mayanja-Kizza, Harriet; Tindimwebwa, Jossy Verel Bahe; Dubowitz, Gerald
    Background: Despite recent advances in surgery and anaesthesia which significantly improve safety, many health facilities in low-and middle-income countries (LMICs) remain chronically under-resourced with inability to cope effectively with serious obstetric complications (Knight et al., PLoS One 8:e63846, 2013). As a result many of these countries still have unacceptably high maternal and neonatal mortality rates. Recent data at the national referral hospitals in East Africa reported that none of the national referral hospitals met the World Federation of Societies of Anesthesiologists (WFSA) international standards required to provide safe obstetric anaesthesia (Epiu I: Challenges of Anesthesia in Low-and Middle-Income Countries. WFSA; 2014 http://wfsa.newsweaver.com/Newsletter/p8c8ta4ri7a1 wsacct9y3u?a=2&p=47730565&t=27996496). In spite of this evidence, factors contributing to maternal mortality related to anaesthesia in LMICs and the magnitude of these issues have not been comprehensively studied. We therefore set out to assess regional referral, district, private for profit and private not-for profit hospitals in Uganda. Methods: We conducted a cross-sectional survey at 64 government and private hospitals in Uganda using pre-set questionnaires to the anaesthetists and hospital directors. Access to the minimum requirements for safe obstetric anaesthesia according to WFSA guidelines were also checked using a checklist for operating and recovery rooms. Results: Response rate was 100% following personal interviews of anaesthetists, and hospital directors. Only 3 of the 64 (5%) of the hospitals had all requirements available to meet the WFSA International guidelines for safe anaesthesia. Additionally, 54/64 (84%) did not have a trained physician anaesthetist and 5/64 (8%) had no trained providers for anaesthesia at all. Frequent shortages of drugs were reported for regional/neuroaxial anaesthesia, and other essential drugs were often lacking such as antacids and antihypertensives. We noted that many of the anaesthesia machines present were obsolete models without functional safety alarms and/or mechanical ventilators. Continuous ECG was only available in 3/64 (5%) of hospitals. Conclusion: We conclude that there is a significant lack of essential equipment for the delivery of safe anaesthesia across this region. This is compounded by the shortage of trained providers and inadequate supervision. It is therefore essential to strengthen anaesthesia services by addressing these specific deficiencies. This will include improved training of associate clinicians, training more physician anaesthetists and providing the basic equipment required to provide safe and effective care. These services are key components of comprehensive emergency obstetric care and anaesthetists are crucial in managing critically ill mothers and ensuring good surgical outcomes.
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    Early management of traumatic brain injury in a Tertiary hospital in Central Kenya: A clinical audit
    (Medknow Publications, 2016) Mwita, Clifford Chacha; Muthoka, Johnstone; Maina, Stephen; Mulingwa, Phillip; Gwer, Samson
    Background: Traumatic brain injury (TBI) is a major cause of death and disability worldwide and is mostly attributed to road traffic accidents in resource‑poor areas. However, access to neurosurgical care is poor in these settings and patients in need of neurosurgical procedures are often managed by general practitioners or surgeons. Materials and Methods: A retrospective clinical audit of the initial management of patients with TBI in Thika Level 5 Hospital (TL5H), a Tertiary Hospital in Central Kenya. Seventeen audit criteria divided into five clinical domains were identified and patient case notes reviewed for compliance with each criterion. Data were analyzed separately for those below 13 years owing to differences in response to brain trauma in those below this age. Results: Overall, there was poor compliance with audit criteria in both groups. Among those below 13 years of age, only 3 out of 17 criteria achieved compliance and 4 out of 17 criteria achieved compliance for those above 13 years of age. Assessment for the need for a cervical radiograph (7.1% and 8.8% compliance) and administration of oxygen (21.4% and 20.6% compliance) had the worst performance in both groups. Conclusion: Poor compliance to audit criteria indicates the low quality of care for patients with TBI in TL5H. Quality improvement strategies with follow‑up audits are needed to improve care. There is a need to develop and enforce evidence‑based protocols and guidelines for use in the management of patients with TBI in sub‑Saharan Africa
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    Acne vulgaris in general population of rural western Kenya: cross-sectional community survey
    (International Society of Dermatology, 2015) Kiprono, Samson K.; Wamburu, Grace
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    Crypotococcal meningitis in a none-HIV infected five month old infant with rickets: Case report
    (Kenyatta University, 2015-08) Okwara, F. N.; Makewa, S.; Karo, E.
    Crypotococcal is an invasive fungal disease, now endemic in the tropics. It is largely transmitted through inhalation, but can be transmitted locally through skin and eyes. Mostly, it causes disease in immune compromised individuals, especially older children and adults, where it causes disseminated disease. Baby JG aged 5 months presented with a prodrome of respiratory symptoms. His anterior fontanel was wide and bulging, and had poor muscle tone. A week later, he developed convulsions, and a depressed sensorium. Haemogram showed a leucocytosis. Bone metabolism showed serum low phosphate and high alkaline phosphatase. Cerebrospinal fluid biochemistry was unremarkable, but microscopy was positive for Indian ink stain and crypotococcal antigen. HIV PCR test was negative. Clinical improvement was observed on institution of anti meningitic therapy, and intravenous fluconazole, vitamin D3 and calcium supplementation, but another spike was noted on day 7 of therapy. The findings of crypotococcal meningitis in HIV seronegative infant is very rare. Immune reconstitution syndrome may occur during treatment. High index of suspicion for cryptococcosis is needed in high risk children with sub-acute presentations of meningitis, and a relatively normal CSF cell counts and biochemistry. Routine fungal screening of CSF for all suspected children is justified.
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    Antimicrobial resistance patterns among E. coli isolates from children presenting with diarrhoea at a cosmopolitan hospital in Kenya
    (Kenyatta University, 2015-08) Kangethe, S. K.; Kiiru, J.; Kabiru, Ephantus W.; Kariuki, S.
    Diarrhoea is a serious infection that kills at least 2 million children globally. Children under the age of 5 years are particularly predisposed to diarrhoea especially if the surrounding environment is contaminated or polluted with human sewerage. Due to frequent episodes of diarrhoea, children may unjustifiably be subjected to antibiotics and this could in turn lead to emergence of multi drug resistant strains. In this study, we isolated and determined antimicrobial susceptibility profiles of 384 E. coli isolates from rural and urban children with chronic and acute diarrhoea.
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    Abnormal Intra-aural Pressure Waves Associated with Death in African Children with acute Nontraumatic Coma.
    (Nature Publishing Group, 2015) Gwer, S.; Kazungu, M.; Chengo, E.; Ohuma, E. O.; Idro, R.; Birch, T.; Marchbanks, R.; Kirkham, F. J.; Newton, C. R.
    BACKGROUND: We explored the relationship between tympanic membrane displacement (TMD) measurements, a tool to monitor intracranial pressure noninvasively, and clinical features and death in children with acute coma in Kilifi, Kenya. METHODS: Between November 2007 and September 2009, we made serial TMD measurements and clinical observations on children with acute coma (Blantyre coma score (BCS) ≤ 2) on the pediatric high dependency unit of Kilifi District Hospital, and on well children presenting to the hospital's outpatient department for routine follow-up. We examined middle ear function using tympanometry and measured cardiac pulse (CPA) and respiratory pulse pressure amplitudes (RPA) using the TMD analyzer. RESULTS: We recruited 75 children (32 (43%) females; median age 3.3 (IQR: 2.0, 4.3) years). Twenty-one (28%) children died. Higher TMD measurements predicted death. Adjusting for diagnosis, every 50 nl rise in both semirecumbent and recumbent CPA was associated with increased odds of death associated with intracranial herniation (OR: 1.61, 95% confidence interval (CI): 1.07, 2.41; P = 0.02 and OR: 1.35, 95% CI: 1.10, 1.66; P ≤ 0.01 respectively). CONCLUSION: Raised TMD pulse pressure measurements are associated with death and may be useful in detecting and monitoring risk of intracranial herniation and intracranial pressure in childhood coma.
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    Neonatal seizures in a rural Kenyan District Hospital: aetiology, incidence and outcome of hospitalization
    (BioMed Central, 2010-03) Gwer, S.; Mwaniki, M.; Mturi, N.; Bauni, E.; Newton, C. R.; Berkley, J.; Idro, R.
    Background: Acute seizures are common among children admitted to hospitals in resource poor countries. However, there is little data on the burden, causes and outcome of neonatal seizures in sub-Saharan Africa. We determined the minimum incidence, aetiology and immediate outcome of seizures among neonates admitted to a rural district hospital in Kenya. Methods: From 1st January 2003 to 31st December 2007, we assessed for seizures all neonates (age 0-28 days) admitted to the Kilifi District Hospital, who were resident in a defined, regularly enumerated study area. The population denominator, the number of live births in the community on 1 July 2005 (the study midpoint) was modelled from the census data. Results: Seizures were reported in 142/1572 (9.0%) of neonatal admissions. The incidence was 39.5 [95% confidence interval (CI) 26.4-56.7] per 1000 live-births and incidence increased with birth weight. The main diagnoses in neonates with seizures were sepsis in 85 (60%), neonatal encephalopathy in 30 (21%) and meningitis in 21 (15%), but only neonatal encephalopathy and bacterial meningitis were independently associated with seizures. Neonates with seizures had a longer hospitalization [median period 7 days - interquartile range (IQR) 4 to10] -compared to 5 days [IQR 3 to 8] for those without seizures, P = 0.02). Overall, there was no difference in inpatient case fatality between neonates with and without seizures but, when this outcome was stratified by birth weight, it was significantly higher in neonates >or= 2.5 kg compared to low birth weight neonates [odds ratio 1.59 (95%CI 1.02 to 2.46), P = 0.037]. Up to 13% of the surviving newborn with seizures had neurological abnormalities at discharge. Conclusion: There is a high incidence of neonatal seizures in this area of Kenya and the most important causes are neonatal encephalopathy and meningitis. The high incidence of neonatal seizures may be a reflection of the quality of the perinatal and postnatal care available to the neonates.
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    Iron deficiency and acute seizures: results from children living in rural Kenya and a meta-analysis.
    (Public Library of Science, 2010-11) Gwer, S.; Idro, R.; Williams, T. N.; Otieno, T.; Uyoga, S.; Fegan, G.; Kager, P. A.; Maitland, K.; Kirkham, F.; Neville, B. G.; Newton, C. R.
    Background: There are conflicting reports on whether iron deficiency changes susceptibility to seizures. We examined the hypothesis that iron deficiency is associated with an increased risk of acute seizures in children in a malaria endemic area. Methods: We recruited 133 children, aged 3-156 months, who presented to a district hospital on the Kenyan coast with acute seizures and frequency-matched these to children of similar ages but without seizures. We defined iron deficiency according to the presence of malarial infection and evidence of inflammation. In patients with malaria, we defined iron deficiency as plasma ferritin<30 µg/ml if plasma C-reactive protein (CRP) was<50 mg/ml or ferritin<273 µg/ml if CRP≥50 mg/ml, and in those without malaria, as ferritin<12 µg/ml if CRP<10 mg/ml or ferritin<30 µg/ml if CRP≥10 mg/ml. In addition, we performed a meta-analysis of case-control studies published in English between January 1966 and December 2009 and available through PUBMED that have examined the relationship between iron deficiency and febrile seizures in children. Results: In our Kenyan case control study, cases and controls were similar, except more cases reported past seizures. Malaria was associated with two-thirds of all seizures. Eighty one (30.5%) children had iron deficiency. Iron deficiency was neither associated with an increased risk of acute seizures (45/133[33.8%] cases were iron deficient compared to 36/133[27.1%] controls, p = 0.230) nor status epilepticus and it did not affect seizure semiology. Similar results were obtained when children with malaria, known to cause acute symptomatic seizures in addition to febrile seizures were excluded. However, in a meta-analysis that combined all eight case-control studies that have examined the association between iron deficiency and acute/febrile seizures to-date, iron deficiency, described in 310/1,018(30.5%) cases and in 230/1,049(21.9%) controls, was associated with a significantly increased risk of seizures, weighted OR 1.79(95%CI 1.03-3.09). Conclusions: Iron deficiency is not associated with an increased risk of all acute seizures in children but of febrile seizures. Further studies should examine mechanisms involved and the implications for public health.
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    Clinical stroke scores for distinguishing stroke subtypes: a systematic review of diagnostic test accuracy
    (2013-04) Gwer, S.; Mwita, C.; Kajia, D.; Newton, C.R.
    Background Stroke is a major cause of morbidity and mortality especially in low and middle income countries. Computerized tomography is used to distinguish between ischemic and hemorrhagic subtypes, but it is expensive and unavailable in some low and middle income countries. Clinical stroke scores are proposed to differentiate between ischemic and hemorrhagic stroke but their reliability is unknown. Objective To synthesize the best available research evidence on the accuracy of clinical scores in distinguishing ischemic and hemorrhagic stroke in patients with acute stroke. Inclusion Criteria Participants Patients admitted to hospital with acute stroke according to the World Health Organization criteria, regardless of age, sex or ethnicity. Intervention This review considered studies that evaluated the Siriraj, Guy’s Hospital, Besson and Greek stroke scores compared to computerized tomography as the reference standard. Outcomes The sensitivity and specificity of the clinical stroke scores compared to computerized tomography results in distinguishing between stroke subtypes. Types of Studies This review considered studies of diagnostic test accuracy in which the index test(s) and reference standard were interpreted independently of one another on the same group of participants. Search Strategy We searched online databases for published and unpublished studies written in English and identified articles using predefined criteria. Methodological Quality Papers selected for retrieval were assessed by four independent reviewers for methodological validity prior to inclusion in the review using the QUality Assessment of Diagnostic Accuracy Studies tool. Data Extraction A modified Joanna Briggs Institute data extraction form was used to collect details from included studies. Data Synthesis A bivariate mixed effects binomial regression model was used to statistically pool data in meta-analysis. A narrative synthesis was undertaken where statistical pooling was not feasible. Results For studies from low and middle income countries, overall sensitivity and specificity for the Siriraj stroke score were 0.69 (95% CI 0.62-0.75) and 0.83 (95% CI 0.75-0.88) for ischemic stroke and 0.65 (95% CI 0.56-0.73) and 0.88 (95% CI 0.83-0.91) for hemorrhagic stroke. For the Guy’s hospital stroke score, overall sensitivity and specificity were 0.70 (95% CI 0.53-0.83) and 0.79 (95% CI 0.68-0.87) for ischemic stroke and 0.54 (95% CI 0.42-0.66) and 0.89 (95% CI 0.83-0.94) for hemorrhagic stroke. For the Greek stroke score, sensitivity and specificity ranged from 0.39 to 0.64 and 0.63 to 0.88 for ischemic stroke and 0.11 to 0.44 and 0.63 to 0.96 for hemorrhagic stroke. Discussion Clinical stroke scores were developed for use in settings where computerized tomography scan is unavailable to differentiate between stroke subtypes but they minimally alter the post-test probability of disease and thus are not sufficiently accurate to replace neuro-imaging in differentiating stroke subtypes. Conclusions Clinical stroke scores are not accurate enough for use in clinical or epidemiological settings. Use of computerized tomography is recommended for differentiating stroke subtypes.