OBJECTIVE To verify the accuracy of direct Vitek testing for blood cultures with Gram-negative bacilli. DESIGN Validation study. SETTING Aga Khan University Hospital Nairobi. SUBJECTS Twenty two positive blood cultures. MAIN OUTCOME MEASURES Correct bacteria identification and errors for susceptibility testing. RESULTS Of the 22 samples analysed 19 (86%) were correctly identified by direct Vitek testing and three (14%) were unidentified. Of the three, one had mixed growth and the other two had pure growth on sub-cultures. Of the 19 cultures with antimicrobial susceptibility testing by direct Vitek, three had discrepancies for some antibiotics when compared with the conventional Vitek method. These discrepancies were minor errors that would not have had any clinical impact. CONCLUSION These data suggest that direct Vitek would provide acceptable identification and antimicrobial susceptibility testing results for Gram-negative bacilli. Compared to the standard method, the direct Vitek method would reduce turnaround time by at least twelve to twenty four hours.
{"title":"SUITABILITY OF VITEK 2 SYSTEM IN IDENTIFICATION AND SUSCEPTIBILITY TESTING OF GRAM NEGATIVE BACTEREMIAS BY DIRECT INOCULATION.","authors":"D. Maina, E. Kagotho","doi":"10.4314/EAMJ.V91I4","DOIUrl":"https://doi.org/10.4314/EAMJ.V91I4","url":null,"abstract":"OBJECTIVE\u0000To verify the accuracy of direct Vitek testing for blood cultures with Gram-negative bacilli.\u0000\u0000\u0000DESIGN\u0000Validation study.\u0000\u0000\u0000SETTING\u0000Aga Khan University Hospital Nairobi.\u0000\u0000\u0000SUBJECTS\u0000Twenty two positive blood cultures.\u0000\u0000\u0000MAIN OUTCOME MEASURES\u0000Correct bacteria identification and errors for susceptibility testing.\u0000\u0000\u0000RESULTS\u0000Of the 22 samples analysed 19 (86%) were correctly identified by direct Vitek testing and three (14%) were unidentified. Of the three, one had mixed growth and the other two had pure growth on sub-cultures. Of the 19 cultures with antimicrobial susceptibility testing by direct Vitek, three had discrepancies for some antibiotics when compared with the conventional Vitek method. These discrepancies were minor errors that would not have had any clinical impact.\u0000\u0000\u0000CONCLUSION\u0000These data suggest that direct Vitek would provide acceptable identification and antimicrobial susceptibility testing results for Gram-negative bacilli. Compared to the standard method, the direct Vitek method would reduce turnaround time by at least twelve to twenty four hours.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/EAMJ.V91I4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70521325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Uwamungu, A. Nyamache, F. Masaisa, SK Njoki, F. Abdalah, K. Saibu, O. Ndahiriwe, D. Agwata
Background : Acute upper respiratory infection is the most common childhood illness and presents with cough, coryza and fever. Available evidence suggests that cough medicines may be no more effective than honey-based cough remedies. Objective : To compare effectiveness of honey, salbutamol and placebo in the treatment of cough in children with acute onset cough. Design : Randomised control trial Setting : Aga Khan University Hospital Paediatric Casualty Subjects : Children between ages one to twelve years presenting with a common cold between December 2010 and February 2012 were enrolled. Outcome measures : Frequency, severity and extent to which cough bothered and disturbed child and parental sleep were assessed at baseline and over the subsequent five days through telephone interview using a validated scoring tool. Results : One hundred and forty five children were enrolled in the study (45- placebo, 57 –honey, 43 –salbutamol). Of the 145 children 51% were male. Honey significantly reduced the total mean symptom score by day three (p< 0.001). Total mean difference in scores between day zero to five demonstrated a significant difference of honey’s efficacy over placebo (p< 0.002) however no difference was noted when compared to salbutamol (p<0.478). Significant differences in both total as well as each individual symptom score was detected with honey consistently scoring the best whilst placebo and salbutamol scored the worst. In paired comparisons honey was superior to placebo but not salbutamol, whilst salbutamol was not superior to placebo. Conclusion : Honey was most effective in symptomatic relief of symptoms associated with the common cold whilst salbutamol or placebo offered no benefit.
{"title":"RANDOMISED DOUBLE BLIND STUDY TO COMPARE EFFECTIVENESS OF HONEY, SALBUTAMOL AND PLACEBO IN TREATMENT OF COUGH IN CHILDREN WITH COMMON COLD.","authors":"S. Uwamungu, A. Nyamache, F. Masaisa, SK Njoki, F. Abdalah, K. Saibu, O. Ndahiriwe, D. Agwata","doi":"10.4314/EAMJ.V91I2","DOIUrl":"https://doi.org/10.4314/EAMJ.V91I2","url":null,"abstract":"Background : Acute upper respiratory infection is the most common childhood illness and presents with cough, coryza and fever. Available evidence suggests that cough medicines may be no more effective than honey-based cough remedies. Objective : To compare effectiveness of honey, salbutamol and placebo in the treatment of cough in children with acute onset cough. Design : Randomised control trial Setting : Aga Khan University Hospital Paediatric Casualty Subjects : Children between ages one to twelve years presenting with a common cold between December 2010 and February 2012 were enrolled. Outcome measures : Frequency, severity and extent to which cough bothered and disturbed child and parental sleep were assessed at baseline and over the subsequent five days through telephone interview using a validated scoring tool. Results : One hundred and forty five children were enrolled in the study (45- placebo, 57 –honey, 43 –salbutamol). Of the 145 children 51% were male. Honey significantly reduced the total mean symptom score by day three (p< 0.001). Total mean difference in scores between day zero to five demonstrated a significant difference of honey’s efficacy over placebo (p< 0.002) however no difference was noted when compared to salbutamol (p<0.478). Significant differences in both total as well as each individual symptom score was detected with honey consistently scoring the best whilst placebo and salbutamol scored the worst. In paired comparisons honey was superior to placebo but not salbutamol, whilst salbutamol was not superior to placebo. Conclusion : Honey was most effective in symptomatic relief of symptoms associated with the common cold whilst salbutamol or placebo offered no benefit.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/EAMJ.V91I2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70521260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Hypertension is a growing concern in developing and developed countries. Most of the diagnosed cases are caused by dietary lifestyle. OBJECTIVE To assess the prevalence of overweight and obesity among adult hypertensive in a selected tertiary health care in Nigeria. DESIGN A cross sectional study. SETTING Lagos State University Teaching Hospital Ikeja, Lagos and University College Hospital, Ibadan Nigeria. SUBJECTS A total of 120 patients (40.8% males and 59.2% females), volunteered to participate in the study after informed consent. Patients were recruited by convenience sampling method. OUTCOME MEASURES Weight, height, waist and hip circumference, Body Mass Index (BMI) and Waist-Hip Ratio (WHR). RESULTS The results showed that high percentage (62.5%) of the respondents had no family history of hypertension while 57.5% had hypertension less than one year ago. Patients' lifestyle revealed that 15.0% were taking alcohol, 85% had history of smoking tobacco while 53.8% of the respondents engaged in regular physical exercise. The BMI showed that grade 2 obesity was higher (41.0%) among females compared with males (21%). The WHR assessment also confirmed incidence of obesity among females compared to males as the WHR was 1.82 ± 0.45 and 2.00 ± 0.00 for male and female respectively. CONCLUSION Nutrition screening of hypertension is necessary for early intervention against hypertension and obesity.
{"title":"ASSESSMENT OF NUTRITIONAL STATUS OF A GROUP OF HYPERTENSIVE PATIENTS ATTENDING TERTIARY HEALTHCARE FACILITIES IN NIGERIA.","authors":"S. Deji, I. Olayiwola, G. Fadupin","doi":"10.4314/EAMJ.V91I3","DOIUrl":"https://doi.org/10.4314/EAMJ.V91I3","url":null,"abstract":"BACKGROUND Hypertension is a growing concern in developing and developed countries. Most of the diagnosed cases are caused by dietary lifestyle. OBJECTIVE To assess the prevalence of overweight and obesity among adult hypertensive in a selected tertiary health care in Nigeria. DESIGN A cross sectional study. SETTING Lagos State University Teaching Hospital Ikeja, Lagos and University College Hospital, Ibadan Nigeria. SUBJECTS A total of 120 patients (40.8% males and 59.2% females), volunteered to participate in the study after informed consent. Patients were recruited by convenience sampling method. OUTCOME MEASURES Weight, height, waist and hip circumference, Body Mass Index (BMI) and Waist-Hip Ratio (WHR). RESULTS The results showed that high percentage (62.5%) of the respondents had no family history of hypertension while 57.5% had hypertension less than one year ago. Patients' lifestyle revealed that 15.0% were taking alcohol, 85% had history of smoking tobacco while 53.8% of the respondents engaged in regular physical exercise. The BMI showed that grade 2 obesity was higher (41.0%) among females compared with males (21%). The WHR assessment also confirmed incidence of obesity among females compared to males as the WHR was 1.82 ± 0.45 and 2.00 ± 0.00 for male and female respectively. CONCLUSION Nutrition screening of hypertension is necessary for early intervention against hypertension and obesity.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70521301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. M. Mutinda, F. E. Onyango, E. Maleche-Obimbo, Rashmi Kumar, D. Wamalwa, Fred Were, B. Osano, P. Mburugu
Background : Clinical Practice Guidelines for childhood illnesses including pneumonia in Kenya are contained in the Ministry of Health Basic Paediatric Protocols. In the presence of a cough and/ or difficulty in breathing and increased respiratory rate for age, pneumonia is diagnosed. In addition to these the presence of lower chest wall indrawing denotes severe pneumonia; The presence of cyanosis, inability to drink/ breastfeed, grunting, level of consciousness using the AVPU scale less than A in addition to the aforementioned is classified as very severe pneumonia. Recommended management is intravascular Crystalline penicillin, gentamycin and oxygen for severe pneumonia, intravascular crystalline penicillin for severe pneumonia and oral amoxyl or cotrimaxole for pneumonia. These guidelines have been disseminated through the Emergency Triage And Treatment Plus (ETAT +) courses held since 2007. Implementation of guidelines into care has been shown to reduce case fatality from pneumonia by 36%. Objectives : To evaluate the level of adherence and factors affecting adherence to the National guidelines on management of pneumonia in children aged two to fifty nine months at Garissa provincial General Hospital, Kenya. Design: Retrospective hospital based cross sectional study. Setting: Paediatric Department of Garissa Provincial General Hospital (PGH) in Kenya. Subjects : Hospital medical records of children aged two to fifty nine months diagnosed with pneumonia between January and June 2012 were reviewed. Data abstracted from the records included demographic information, recorded clinical signs and symptoms, disease classification and treatment. Results : Records of 91 children were reviewed. Their median age was 12 months (IQR 6 – 18 months). There were more boys than girls with a male to female ratio of 1.25:1. Forty-eight of the participants (52.8%) had severe pneumonia. Guideline adherence was assessed at three levels; assessment of clinical signs and symptoms reflected by their recording, correct disease severity classification and correct treatment prescribed. There were a minimum of two and a maximum of six clinical sign and symptoms recorded. The average level of adherence was 42.9% (SD ±17.3).Documented correct classification of disease severity was 56.6% and recommended treatment of pneumonia was 27.7%. The presence of a co-morbidity and severe disease was associated with better adherence to the assessment tasks (p = 0.033 and p = 0.021 respectively). Disease severity was associated with better adherence to the disease classification task (p = <0.001) and treatment task (p = 0.02). Conclusion : Adherence to guidelines was low at all assessed levels. Overall, disease severity was associated with better guideline adherence. Presence of co-morbidities improved disease assessment.
{"title":"Adherence to Pneumonia Guidelines for Children 2 – 59 Months at Garrisa Provincial General Hospital","authors":"C. M. Mutinda, F. E. Onyango, E. Maleche-Obimbo, Rashmi Kumar, D. Wamalwa, Fred Were, B. Osano, P. Mburugu","doi":"10.4314/EAMJ.V91I1","DOIUrl":"https://doi.org/10.4314/EAMJ.V91I1","url":null,"abstract":"Background : Clinical Practice Guidelines for childhood illnesses including pneumonia in Kenya are contained in the Ministry of Health Basic Paediatric Protocols. In the presence of a cough and/ or difficulty in breathing and increased respiratory rate for age, pneumonia is diagnosed. In addition to these the presence of lower chest wall indrawing denotes severe pneumonia; The presence of cyanosis, inability to drink/ breastfeed, grunting, level of consciousness using the AVPU scale less than A in addition to the aforementioned is classified as very severe pneumonia. Recommended management is intravascular Crystalline penicillin, gentamycin and oxygen for severe pneumonia, intravascular crystalline penicillin for severe pneumonia and oral amoxyl or cotrimaxole for pneumonia. These guidelines have been disseminated through the Emergency Triage And Treatment Plus (ETAT +) courses held since 2007. Implementation of guidelines into care has been shown to reduce case fatality from pneumonia by 36%. Objectives : To evaluate the level of adherence and factors affecting adherence to the National guidelines on management of pneumonia in children aged two to fifty nine months at Garissa provincial General Hospital, Kenya. Design: Retrospective hospital based cross sectional study. Setting: Paediatric Department of Garissa Provincial General Hospital (PGH) in Kenya. Subjects : Hospital medical records of children aged two to fifty nine months diagnosed with pneumonia between January and June 2012 were reviewed. Data abstracted from the records included demographic information, recorded clinical signs and symptoms, disease classification and treatment. Results : Records of 91 children were reviewed. Their median age was 12 months (IQR 6 – 18 months). There were more boys than girls with a male to female ratio of 1.25:1. Forty-eight of the participants (52.8%) had severe pneumonia. Guideline adherence was assessed at three levels; assessment of clinical signs and symptoms reflected by their recording, correct disease severity classification and correct treatment prescribed. There were a minimum of two and a maximum of six clinical sign and symptoms recorded. The average level of adherence was 42.9% (SD ±17.3).Documented correct classification of disease severity was 56.6% and recommended treatment of pneumonia was 27.7%. The presence of a co-morbidity and severe disease was associated with better adherence to the assessment tasks (p = 0.033 and p = 0.021 respectively). Disease severity was associated with better adherence to the disease classification task (p = <0.001) and treatment task (p = 0.02). Conclusion : Adherence to guidelines was low at all assessed levels. Overall, disease severity was associated with better guideline adherence. Presence of co-morbidities improved disease assessment.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Fever is one of the most common complaints presented to the Paediatric Emergency Unit (PEU). It is a sign that there is an underlying pathologic process, the most common being infection. Many childhood illnesses are accompanied by fever, many of which are treated at home prior to presentation to hospital. Most febrile episodes are benign. Caregivers are the primary contacts to children with fever. Adequate caregivers' knowledge and proper management of fever at home leads to better management of febrile illnesses and reduces complications. OBJECTIVE To determine the caregivers' knowledge and practices regarding fever in children. DESIGN A cross-sectional study. SETTING Peadiatric Emergency Unit at Kenyatta National Hospital (KNH) SUBJECTS: Two hundred and fifty caregivers of children under 12 years presenting with fever in August to October 2011 to the PEU. RESULTS Three quarters of the caregivers' defined fever correctly. Their knowledge on the normal body was at 47.6%. Infection was cited as the leading cause of fever (95.2%). Brain damage (77.6%) and dehydration (65.6%) were viewed as the most common complication. Fever was treated at home by 97.2% of caregivers, most of them used medication. CONCLUSIONS Fever was defined correctly by 75.2% of the study participants and a majority of them used touch to detect fever. Fever was managed at home with medications. Public Health Education should be implemented in order to enlighten caregivers on fever and advocate for the use of a clinical thermometer to monitor fever at home.
{"title":"CAREGIVERS' KNOWLEDGE AND HOME MANAGEMENT OF FEVER IN CHILDREN.","authors":"P. Koech, F. Onyango, C. Jowi","doi":"10.4314/EAMJ.V91I5","DOIUrl":"https://doi.org/10.4314/EAMJ.V91I5","url":null,"abstract":"BACKGROUND Fever is one of the most common complaints presented to the Paediatric Emergency Unit (PEU). It is a sign that there is an underlying pathologic process, the most common being infection. Many childhood illnesses are accompanied by fever, many of which are treated at home prior to presentation to hospital. Most febrile episodes are benign. Caregivers are the primary contacts to children with fever. Adequate caregivers' knowledge and proper management of fever at home leads to better management of febrile illnesses and reduces complications. OBJECTIVE To determine the caregivers' knowledge and practices regarding fever in children. DESIGN A cross-sectional study. SETTING Peadiatric Emergency Unit at Kenyatta National Hospital (KNH) SUBJECTS: Two hundred and fifty caregivers of children under 12 years presenting with fever in August to October 2011 to the PEU. RESULTS Three quarters of the caregivers' defined fever correctly. Their knowledge on the normal body was at 47.6%. Infection was cited as the leading cause of fever (95.2%). Brain damage (77.6%) and dehydration (65.6%) were viewed as the most common complication. Fever was treated at home by 97.2% of caregivers, most of them used medication. CONCLUSIONS Fever was defined correctly by 75.2% of the study participants and a majority of them used touch to detect fever. Fever was managed at home with medications. Public Health Education should be implemented in order to enlighten caregivers on fever and advocate for the use of a clinical thermometer to monitor fever at home.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70521419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Robert Shihuzire Magomere, R. Kosgei, M. Kamene, E. Masini, D. Gathara, Nicholas Kirui, John Omondi, E. Omesa
Background: Tuberculosis is a common cause of morbidity and mortality in children. Children are less likely to acquire resistance during the treatment of tuberculosis (TB). Most of the drug resistant TB infection in children is transmitted from adults. Objective: To determine the characteristics and treatment outcomes among children below 15 years managed for drug resistant TB in Kenya, 2010 – 2016. Design: Retrospective descriptive study. Setting: All health facilities managing drug resistant TB in Kenya Subjects: Children below 15 years treated for drug resistant TB between 2010 and 2016. Results: Sixty three children were notified with DR TB between 2010 and 2016. The median (IQR) age was11 (10‐13) years with a female to male ratio of 1:1. With 32 (52%) and 31 (51%) with smear and culture positive laboratory results respectively. Primary drug resistance was present in 25 (40%) of the children All the sputum and culture converted negative at month three of treatment. HIV testing uptake was 100% with a positivity rate of 26 (41%) and 100% anti‐retroviral therapy uptake. The treatment success rate for the cases was 31(91%) with a mortality rate of 2(5%) and lost‐to‐follow up 1 (3%). Conclusion: Drug‐resistant tuberculosis can be successfully treated and therapy well tolerated among children. There is need for contact tracing and screening for all at risk including paediatric population.
{"title":"Treatment outcomes for drug resistant tuberculosis among children below 15 years in Kenya, 2010‐2016","authors":"Robert Shihuzire Magomere, R. Kosgei, M. Kamene, E. Masini, D. Gathara, Nicholas Kirui, John Omondi, E. Omesa","doi":"10.4314/EAMJ.V94I10","DOIUrl":"https://doi.org/10.4314/EAMJ.V94I10","url":null,"abstract":"Background: Tuberculosis is a common cause of morbidity and mortality in children. Children are less likely to acquire resistance during the treatment of tuberculosis (TB). Most of the drug resistant TB infection in children is transmitted from adults. Objective: To determine the characteristics and treatment outcomes among children below 15 years managed for drug resistant TB in Kenya, 2010 – 2016. Design: Retrospective descriptive study. Setting: All health facilities managing drug resistant TB in Kenya Subjects: Children below 15 years treated for drug resistant TB between 2010 and 2016. Results: Sixty three children were notified with DR TB between 2010 and 2016. The median (IQR) age was11 (10‐13) years with a female to male ratio of 1:1. With 32 (52%) and 31 (51%) with smear and culture positive laboratory results respectively. Primary drug resistance was present in 25 (40%) of the children All the sputum and culture converted negative at month three of treatment. HIV testing uptake was 100% with a positivity rate of 26 (41%) and 100% anti‐retroviral therapy uptake. The treatment success rate for the cases was 31(91%) with a mortality rate of 2(5%) and lost‐to‐follow up 1 (3%). Conclusion: Drug‐resistant tuberculosis can be successfully treated and therapy well tolerated among children. There is need for contact tracing and screening for all at risk including paediatric population.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70522633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE To identify the factors that are associated with uptake of skilled delivery services during child delivery among women of reproductive age in Garissa town. DESIGN Cross sectional study. SETTING Garissa town. SUBJECT Three hundred and thirty four women aged 15-49 years who had had at least one delivery in their lifetime were asked about the type of delivery services they had during their last child delivery. RESULTS The study found that 47% of the last deliveries women were attended by skilled persons and the rest of the deliveries were provided by TBAs. The predictors of skilled delivery uptake in this study were found to be; having knowledge on skilled delivery service providers (AOR = 17.2; 95% CI: 1.05-281.12; p = 0.046), child deliveries numbering one to three (AOR = 116.95; 95% CI: 26.68-512.64; p = 0.001) and four to six (AOR = 16.75; 95% CI: 4.44-62.87; p = 0.001), presence of previous delivery complication (AOR = 11.71; 95% CI: 3.96-34.60; p = 0.001), disapproval of TBA services (AOR = 27.19; 95% CI: 6.67-110.76; p = 0.001), lack of preference for gender of skilled delivery service provider (AOR = 6.51; 95% CI: 1.08-39.37; p = 0.041), and positive view on service related factors such as time to nearest facility (AOR = 3.91; 95% CI: 1.24-12.34; p = 0.020), hygiene (AOR = 5.03; 95% CI: 1.49-17.05; p = 0.009) and operation time of health facility (AOR = 4.67; 95% CI: 1.59-13.76; p = 0.005). CONCLUSSION The findings show that cultural and maternal factors as well as quality of services at facility level play major role in determining uptake of skilled services among women in Garissa as compared to social demographic and economic factors.
{"title":"FACTORS ASSOCIATED WITH UPTAKE OF SKILLED ATTENDANTS' SERVICES DURING CHILD DELIVERY IN GARISSA TOWN, KENYA.","authors":"R. A. Abikar, M. Karama, Z. Ng'ang'a","doi":"10.4314/EAMJ.V90I11","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I11","url":null,"abstract":"OBJECTIVE\u0000To identify the factors that are associated with uptake of skilled delivery services during child delivery among women of reproductive age in Garissa town.\u0000\u0000\u0000DESIGN\u0000Cross sectional study.\u0000\u0000\u0000SETTING\u0000Garissa town.\u0000\u0000\u0000SUBJECT\u0000Three hundred and thirty four women aged 15-49 years who had had at least one delivery in their lifetime were asked about the type of delivery services they had during their last child delivery.\u0000\u0000\u0000RESULTS\u0000The study found that 47% of the last deliveries women were attended by skilled persons and the rest of the deliveries were provided by TBAs. The predictors of skilled delivery uptake in this study were found to be; having knowledge on skilled delivery service providers (AOR = 17.2; 95% CI: 1.05-281.12; p = 0.046), child deliveries numbering one to three (AOR = 116.95; 95% CI: 26.68-512.64; p = 0.001) and four to six (AOR = 16.75; 95% CI: 4.44-62.87; p = 0.001), presence of previous delivery complication (AOR = 11.71; 95% CI: 3.96-34.60; p = 0.001), disapproval of TBA services (AOR = 27.19; 95% CI: 6.67-110.76; p = 0.001), lack of preference for gender of skilled delivery service provider (AOR = 6.51; 95% CI: 1.08-39.37; p = 0.041), and positive view on service related factors such as time to nearest facility (AOR = 3.91; 95% CI: 1.24-12.34; p = 0.020), hygiene (AOR = 5.03; 95% CI: 1.49-17.05; p = 0.009) and operation time of health facility (AOR = 4.67; 95% CI: 1.59-13.76; p = 0.005).\u0000\u0000\u0000CONCLUSSION\u0000The findings show that cultural and maternal factors as well as quality of services at facility level play major role in determining uptake of skilled services among women in Garissa as compared to social demographic and economic factors.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Olu, O. Babaniyi, P. Songolo, B. Matapo, E. Chizema, M. Kapina-Kany’anga, E. Musenga, O. Walker
OBJECTIVE To review the cholera epidemiology in Zambia from 2000 to 2010 in order to highlight the key lessons learned. Based on our findings, we make recommendations for improving cholera prevention and control in country. DESIGN Ten years descriptive cholera data was extracted from the national IDSR database and analysed. SETTING The study was conducted in Zambia using national epidemiology data which were disaggregated by Province. SUBJECTS None. RESULTS Starting from 2003, there has been a progressive increase in yearly incidence of cholera in the country. In 2010, 6794 cases (500% increase compared to 2003) and 115 deaths (CFR 1.6%) of the disease were reported with Lusaka Province accounting for 85% of the total cases. Outbreaks start between epidemiological weeks 40 to 45 of the year and ends between weeks 20 to 25 of the following year (which corresponds to the Zambian rainy season). Outbreaks are largely confined to the peri-urban areas of Lusaka, Luapula, Southern and Copperbelt Provinces. CONCLUSION In the last 10-20 years, the epidemiology of cholera in Zambia has changed; Laboratory confirmation of Vibrio cholerae in the country on a yearly basis in the last ten years suggests that the country is now endemic for cholera hence the need to review current cholera prevention and control strategies.
{"title":"CHOLERA EPIDEMIOLOGY IN ZAMBIA FROM 2000 TO 2010: IMPLICATIONS FOR IMPROVING CHOLERA PREVENTION AND CONTROL STRATEGIES IN THE COUNTRY.","authors":"O. Olu, O. Babaniyi, P. Songolo, B. Matapo, E. Chizema, M. Kapina-Kany’anga, E. Musenga, O. Walker","doi":"10.4314/EAMJ.V90I10","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I10","url":null,"abstract":"OBJECTIVE\u0000To review the cholera epidemiology in Zambia from 2000 to 2010 in order to highlight the key lessons learned. Based on our findings, we make recommendations for improving cholera prevention and control in country.\u0000\u0000\u0000DESIGN\u0000Ten years descriptive cholera data was extracted from the national IDSR database and analysed.\u0000\u0000\u0000SETTING\u0000The study was conducted in Zambia using national epidemiology data which were disaggregated by Province.\u0000\u0000\u0000SUBJECTS\u0000None.\u0000\u0000\u0000RESULTS\u0000Starting from 2003, there has been a progressive increase in yearly incidence of cholera in the country. In 2010, 6794 cases (500% increase compared to 2003) and 115 deaths (CFR 1.6%) of the disease were reported with Lusaka Province accounting for 85% of the total cases. Outbreaks start between epidemiological weeks 40 to 45 of the year and ends between weeks 20 to 25 of the following year (which corresponds to the Zambian rainy season). Outbreaks are largely confined to the peri-urban areas of Lusaka, Luapula, Southern and Copperbelt Provinces.\u0000\u0000\u0000CONCLUSION\u0000In the last 10-20 years, the epidemiology of cholera in Zambia has changed; Laboratory confirmation of Vibrio cholerae in the country on a yearly basis in the last ten years suggests that the country is now endemic for cholera hence the need to review current cholera prevention and control strategies.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Modern dental composite restorations are wholly dependent on the use of Visible Light Curing devices. The characteristics of these devices may influence the quality of composite resin restorations. OBJECTIVE To determine the characteristics of light curing units (LCUs) in dental clinics in Nairobi and their effect on light intensity output, depth of cure (DOC) and surface micro-hardness (SMH) of dental resin composite. DESIGN Laboratory based, cross-sectional analytical study. SETTING Public and private dental clinics in Nairobi, Kenya. SUBJECTS Eighty three LCUs which were in use in private and public dental health facilities in Nairobi, Kenya and resin composite specimens. RESULTS Of the 83 LCUs studied, 43 (51.8%) were Light Emitting Diodes (LEDs) and 39(47.0%) were Quartz-Tungsten-Halogen (QTH) and 1 (1.2%) was Plasma Arc Curing (PAC) light. Mean light intensity for QTH and LED lights was 526.59 mW/cm2 and 493.67 mW/cm2 respectively (p=0.574), while the mean DOC for QTH lights was 1.71 mm and LED was 1.67 mm (p=0.690). Mean Vickers Hardness Number (VHN) for LED was 57.44 and for QTH was 44.14 (p=0.713). Mean light intensity for LCUs < or = 5 years was 596.03 mW/cm2 and 363.17 mW/cm2 for units > 5 years old (p=0.024). The mean DOC for the two age groups was 1.74 mm and 1.57 mm respectively (p=0.073). For SMH, the < or = 5 years and >5 years age groups gave a mean VHN of 58.81 and 51.46 respectively (p=0.1). On maintenance history, the frequency of routine inspection, duration since the last repair/replacement of a part or other maintenance activity and the nature of the last maintenance activity were determined and were not found to have influenced the light intensity, DOC and SMH. CONCLUSION The LCU age has a statistically significant influence on its light intensity (p=0.024) while the type and maintenance history have no significant influence on its light intensity and composite DOC and SMH (p=0.574, p=0.690, p=0.713 respectively).
现代牙科复合修复完全依赖于可见光固化设备的使用。这些装置的特性可能会影响复合树脂修复体的质量。目的了解内罗毕地区牙科诊所光固化单元(lcu)的特点及其对牙用树脂复合材料光强输出、固化深度(DOC)和表面显微硬度(SMH)的影响。设计实验室为基础，横断面分析研究。肯尼亚内罗毕的公立和私立牙科诊所。受试者:在肯尼亚内罗毕的私人和公共牙科保健机构使用的73个lcu和树脂复合材料标本。结果83个lcu中，发光二极管(led) 43个(51.8%)，石英钨卤灯(QTH) 39个(47.0%)，等离子弧固化(PAC)灯1个(1.2%)。QTH灯和LED灯的平均光强分别为526.59 mW/cm2和493.67 mW/cm2 (p=0.574)， QTH灯和LED灯的平均DOC分别为1.71 mm和1.67 mm (p=0.690)。LED的平均维氏硬度值(VHN)为57.44,QTH为44.14 (p=0.713)。lcu <或= 5年的平均光强为596.03 mW/cm2, bbb50年的平均光强为363.17 mW/cm2 (p=0.024)。两个年龄组的平均DOC分别为1.74 mm和1.57 mm (p=0.073)。对于SMH， < or = 5岁和bb0 = 5岁年龄组的VHN平均值分别为58.81和51.46 (p=0.1)。在维修历史方面，确定了例行检查的频率、自上次维修/更换部件或其他维修活动以来的持续时间以及上次维修活动的性质，但没有发现这些因素影响光照强度、DOC和SMH。结论LCU年龄对其光强的影响有统计学意义(p=0.024)，而类型和维护历史对其光强和复合DOC、SMH的影响无统计学意义(p=0.574、p=0.690、p=0.713)。
{"title":"EFFECT OF LIGHT CURING UNIT CHARACTERISTICS ON LIGHT INTENSITY OUTPUT, DEPTH OF CURE AND SURFACE MICRO-HARDNESS OF DENTAL RESIN COMPOSITE.","authors":"B. A. Kassim, B. Kisumbi, W. Lesan, L. Gathece","doi":"10.4314/EAMJ.V90I9","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I9","url":null,"abstract":"BACKGROUND\u0000Modern dental composite restorations are wholly dependent on the use of Visible Light Curing devices. The characteristics of these devices may influence the quality of composite resin restorations.\u0000\u0000\u0000OBJECTIVE\u0000To determine the characteristics of light curing units (LCUs) in dental clinics in Nairobi and their effect on light intensity output, depth of cure (DOC) and surface micro-hardness (SMH) of dental resin composite.\u0000\u0000\u0000DESIGN\u0000Laboratory based, cross-sectional analytical study.\u0000\u0000\u0000SETTING\u0000Public and private dental clinics in Nairobi, Kenya.\u0000\u0000\u0000SUBJECTS\u0000Eighty three LCUs which were in use in private and public dental health facilities in Nairobi, Kenya and resin composite specimens.\u0000\u0000\u0000RESULTS\u0000Of the 83 LCUs studied, 43 (51.8%) were Light Emitting Diodes (LEDs) and 39(47.0%) were Quartz-Tungsten-Halogen (QTH) and 1 (1.2%) was Plasma Arc Curing (PAC) light. Mean light intensity for QTH and LED lights was 526.59 mW/cm2 and 493.67 mW/cm2 respectively (p=0.574), while the mean DOC for QTH lights was 1.71 mm and LED was 1.67 mm (p=0.690). Mean Vickers Hardness Number (VHN) for LED was 57.44 and for QTH was 44.14 (p=0.713). Mean light intensity for LCUs < or = 5 years was 596.03 mW/cm2 and 363.17 mW/cm2 for units > 5 years old (p=0.024). The mean DOC for the two age groups was 1.74 mm and 1.57 mm respectively (p=0.073). For SMH, the < or = 5 years and >5 years age groups gave a mean VHN of 58.81 and 51.46 respectively (p=0.1). On maintenance history, the frequency of routine inspection, duration since the last repair/replacement of a part or other maintenance activity and the nature of the last maintenance activity were determined and were not found to have influenced the light intensity, DOC and SMH.\u0000\u0000\u0000CONCLUSION\u0000The LCU age has a statistically significant influence on its light intensity (p=0.024) while the type and maintenance history have no significant influence on its light intensity and composite DOC and SMH (p=0.574, p=0.690, p=0.713 respectively).","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE To determine the incidence and risk factors for intra-operative hypothermia in paediatric patients undergoing general anaesthesia at the Kenyatta National Hospital. DESIGN A prospective observational study. SETTING The Kenyatta National Hospital main operating theatres and affiliated satellite operating theatres. SUBJECTS A total of 100 paediatric patients (range; three days to 12 years, mean; 4.1 ± 3.3 years) were enrolled in the study. RESULTS Thirty out of 100 patients developed hypothermia defined as a core temperature < 36 °C recorded at least once during provision of general anaesthesia. Ninety percent of those developing hypothermia were male compared to 63% who remained normothermic (p = 0.006). Proportionally, more than twice as many hypothermic patients had a caudal block (43% versus 20%, p = 0.016) and received 121 ml more of fluid (p = 0.002) compared to the normothermic group. The patients who became hypothermic tended to be colder at induction of anaesthesia (36.6 ± 0.5°C versus 37.0 ± 0.5 °C, p = < 0.0001) but there was no significant difference in the waiting time, time of induction, environmental temperatures or theatre temperatures compared to those not developing hypothermia. There was no significant difference in the BMI between the two groups (14.0 ± 2.9 kg/ m2 versus 15.2 ± 3.5 kg/m2, p = 0.101). CONCLUSION The incidence of intra-operative core hypothermia in paediatric patients undergoing general anaesthesia at the Kenyatta National Hospital is 30%. Gender (male), lower body temperature at induction, use of caudal block and the volume of intravenous fluids infused were significant independent predictors of core hypothermia. The most significant predictor was body temperature at the time of induction of general anaesthesia.
目的确定肯雅塔国家医院接受全身麻醉的儿科患者术中低温的发生率和危险因素。设计:前瞻性观察性研究。肯雅塔国家医院的主要手术室和附属卫星手术室。受试者:共100例儿科患者(范围;平均3天到12年;4.1±3.3岁)入组。结果100例患者中有30例发生低温，定义为在提供全身麻醉期间至少记录一次核心温度< 36°C。发生体温过低的患者中有90%是男性，而保持体温正常的患者中有63% (p = 0.006)。按比例计算，与正常体温组相比，有两倍多的低体温患者出现了尾侧阻滞(43%对20%，p = 0.016)，并且接受了121毫升的液体(p = 0.002)。体温过低的患者在麻醉诱导时更冷(36.6±0.5°C vs 37.0±0.5°C, p = < 0.0001)，但在等待时间、诱导时间、环境温度和手术室温度方面与未发生体温过低的患者无显著差异。两组患者BMI(14.0±2.9 kg/m2 vs 15.2±3.5 kg/m2)差异无统计学意义(p = 0.101)。结论在肯雅塔国家医院接受全身麻醉的儿科患者术中核心低温的发生率为30%。性别(男性)、诱导时较低的体温、尾侧阻滞的使用和静脉输液量是核心低温的重要独立预测因素。最重要的预测因子是全身麻醉诱导时的体温。
{"title":"THE INCIDENCE AND RISK FACTORS FOR INTRA-OPERATIVE HYPOTHERMIA AMONG PAEDIATRIC PATIENTS UNDERGOING GENERAL ANAESTHESIA AT THE KENYATTA NATIONAL HOSPITAL.","authors":"P. M. Kioko, P. Olang, C. Mwangi, T. Chokwe","doi":"10.4314/EAMJ.V90I8","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I8","url":null,"abstract":"OBJECTIVE\u0000To determine the incidence and risk factors for intra-operative hypothermia in paediatric patients undergoing general anaesthesia at the Kenyatta National Hospital.\u0000\u0000\u0000DESIGN\u0000A prospective observational study.\u0000\u0000\u0000SETTING\u0000The Kenyatta National Hospital main operating theatres and affiliated satellite operating theatres.\u0000\u0000\u0000SUBJECTS\u0000A total of 100 paediatric patients (range; three days to 12 years, mean; 4.1 ± 3.3 years) were enrolled in the study.\u0000\u0000\u0000RESULTS\u0000Thirty out of 100 patients developed hypothermia defined as a core temperature < 36 °C recorded at least once during provision of general anaesthesia. Ninety percent of those developing hypothermia were male compared to 63% who remained normothermic (p = 0.006). Proportionally, more than twice as many hypothermic patients had a caudal block (43% versus 20%, p = 0.016) and received 121 ml more of fluid (p = 0.002) compared to the normothermic group. The patients who became hypothermic tended to be colder at induction of anaesthesia (36.6 ± 0.5°C versus 37.0 ± 0.5 °C, p = < 0.0001) but there was no significant difference in the waiting time, time of induction, environmental temperatures or theatre temperatures compared to those not developing hypothermia. There was no significant difference in the BMI between the two groups (14.0 ± 2.9 kg/ m2 versus 15.2 ± 3.5 kg/m2, p = 0.101).\u0000\u0000\u0000CONCLUSION\u0000The incidence of intra-operative core hypothermia in paediatric patients undergoing general anaesthesia at the Kenyatta National Hospital is 30%. Gender (male), lower body temperature at induction, use of caudal block and the volume of intravenous fluids infused were significant independent predictors of core hypothermia. The most significant predictor was body temperature at the time of induction of general anaesthesia.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/EAMJ.V90I8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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