J. Mangeni, Ann Mwangi, S. Mbugua, Vincent K Mukthar
Objectives : To describe the current situation with respect to substance use and related harms among commercial vehicle drivers, and to identify a range of interventions that could be feasibly implemented to minimise harms related to substance use. Study design : Observational and group interviews. Setting : Four different motor parks in Ibadan, Nigeria. Subjects : Data were obtained from a sample of commercial vehicle drivers, community and members of the law enforcement agencies. Results : Widespread use of psychoactive substances was reported. New trend of local alcohol beverage generally called ‘sepe’ tended to have replaced older ones such as palm wine. All substances of abuse were freely available and openly displayed at motor parks except for cocaine and narcotics. There was poor law provision and enforcement of laws prohibiting sale and use around motor parks or while driving. Conclusions : This study shows the feasibility and value of conducting rapid assessments among commercial vehicle drivers in Nigeria. One outcome of this study is the development of a guide on rapid assessment of alcohol and other substance use assessment and a measure of brief intervention among them. Presentation of these findings should contribute to increased awareness and improved response from the government.
{"title":"RAPID SITUATION ASSESSMENTS OF ALCOHOL AND SUBSTANCE USE AMONG COMMERCIAL VEHICLE DRIVERS IN NIGERIA.","authors":"J. Mangeni, Ann Mwangi, S. Mbugua, Vincent K Mukthar","doi":"10.4314/eamj.v89i11","DOIUrl":"https://doi.org/10.4314/eamj.v89i11","url":null,"abstract":"Objectives : To describe the current situation with respect to substance use and related harms among commercial vehicle drivers, and to identify a range of interventions that could be feasibly implemented to minimise harms related to substance use. Study design : Observational and group interviews. Setting : Four different motor parks in Ibadan, Nigeria. Subjects : Data were obtained from a sample of commercial vehicle drivers, community and members of the law enforcement agencies. Results : Widespread use of psychoactive substances was reported. New trend of local alcohol beverage generally called ‘sepe’ tended to have replaced older ones such as palm wine. All substances of abuse were freely available and openly displayed at motor parks except for cocaine and narcotics. There was poor law provision and enforcement of laws prohibiting sale and use around motor parks or while driving. Conclusions : This study shows the feasibility and value of conducting rapid assessments among commercial vehicle drivers in Nigeria. One outcome of this study is the development of a guide on rapid assessment of alcohol and other substance use assessment and a measure of brief intervention among them. Presentation of these findings should contribute to increased awareness and improved response from the government.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/eamj.v89i11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519944","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}
UNLABELLED Background: Acute appendicitisis themost common cause of acute abdomen worldwide with increasing incidence in developing countries. The diagnosis is mainly clinical and wound infection remains the most common post-operative complication. OBJECTIVE To determine the pattern of presentation of acute appendicitis. DESIGN Hospital based retrospective study. SETTING Department of Surgery, University of Port Harcourt Teaching Hospital, Nigeria. SUBJECTS Patients with histologically confirmed acute appendicitis. RESULTS A total of 130 patients who had appendicectomy for acute appendicitis were included in the study. There were 62 males and 68 females (M:F1:1.1). Their ages ranged from 14 to 67 years with a peak age incidence of 21-30 years. The highest incidence was in the month of July while the lowest was in February. All the patients presented with right iliac fossa pain and tenderness. Post-operative complication rate was 10% and wound infection was the most common (7.7%). CONCLUSION The presentation of acute appendicitis in UPTH is similar to that in other parts of the West African sub-region but with a slight female preponderance in our centre. Early diagnosis and prompt surgical intervention is the key to successful management.
{"title":"APPENDICITIS IN UNIVERSITY OF PORT HARCOURT TEACHING HOSPITAL, NIGERIA.","authors":"A. Dodiyi-manuel, O. Koroye","doi":"10.4314/EAMJ.V89I10","DOIUrl":"https://doi.org/10.4314/EAMJ.V89I10","url":null,"abstract":"UNLABELLED\u0000Background: Acute appendicitisis themost common cause of acute abdomen worldwide with increasing incidence in developing countries. The diagnosis is mainly clinical and wound infection remains the most common post-operative complication.\u0000\u0000\u0000OBJECTIVE\u0000To determine the pattern of presentation of acute appendicitis.\u0000\u0000\u0000DESIGN\u0000Hospital based retrospective study.\u0000\u0000\u0000SETTING\u0000Department of Surgery, University of Port Harcourt Teaching Hospital, Nigeria.\u0000\u0000\u0000SUBJECTS\u0000Patients with histologically confirmed acute appendicitis.\u0000\u0000\u0000RESULTS\u0000A total of 130 patients who had appendicectomy for acute appendicitis were included in the study. There were 62 males and 68 females (M:F1:1.1). Their ages ranged from 14 to 67 years with a peak age incidence of 21-30 years. The highest incidence was in the month of July while the lowest was in February. All the patients presented with right iliac fossa pain and tenderness. Post-operative complication rate was 10% and wound infection was the most common (7.7%).\u0000\u0000\u0000CONCLUSION\u0000The presentation of acute appendicitis in UPTH is similar to that in other parts of the West African sub-region but with a slight female preponderance in our centre. Early diagnosis and prompt surgical intervention is the key to successful management.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519931","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: Diffuse lung diseases constitute a major cause of morbidity and mortality worldwide. High Resolution Computed Tomography (HRCT) is the recommended imaging technique in the diagnosis, assessment and followup of these diseases. Objectives: To describe the pattern of HRCT findings in patients with suspected interstitial lung disease. Setting: Kenyatta National Hospital (KNH), Nairobi Hospital and MP Shah Hospital; all situated in Nairobi, during the period February to August 2010. Subjects: One hundred and one patients sent for HRCT in the six month study period. Results: A total of 101 patients were recruited with age range 18 to 100 years, with a mean age of 53.6 (SD 19.7) years and a median age of 54 years. The male-female ratio was 1.2: 1. Cough [80.2% (n = 81)] was the most common presenting complaint followed by dyspnoea (53.5%, n=53) and chest pain [24.8% (n = 25)]. Overall, the predominant pattern of involvement on chest HRCT was reticular pattern seen in 56.1 % (n=82) of patients, followed by honey-comb pattern (37.8%, n=82). Conclusion: The study demonstrated marked lung parenchymal destruction in most cases; a poor prognostic indicator which could have been due to delayed referral. HRCT has a high pick up rate of subtle parenchymal lung lesions as well as defining the lesions and their distribution compared to plain chest radiography. This is important in narrowing the differential diagnosis as well as for pre-biopsy planning. The diagnosis of ILD requires a multidisciplinary approach including a detailed clinical history, physical findings, and laboratory investigations, radiological and histological assessment.
{"title":"Pattern of interstitial lung disease detected by high resolution computerised tomography","authors":"C. Onyambu, M. Waigwa","doi":"10.4314/EAMJ.V89I9","DOIUrl":"https://doi.org/10.4314/EAMJ.V89I9","url":null,"abstract":"Background: Diffuse lung diseases constitute a major cause of morbidity and mortality worldwide. High Resolution Computed Tomography (HRCT) is the recommended imaging technique in the diagnosis, assessment and followup of these diseases. Objectives: To describe the pattern of HRCT findings in patients with suspected interstitial lung disease. Setting: Kenyatta National Hospital (KNH), Nairobi Hospital and MP Shah Hospital; all situated in Nairobi, during the period February to August 2010. Subjects: One hundred and one patients sent for HRCT in the six month study period. Results: A total of 101 patients were recruited with age range 18 to 100 years, with a mean age of 53.6 (SD 19.7) years and a median age of 54 years. The male-female ratio was 1.2: 1. Cough [80.2% (n = 81)] was the most common presenting complaint followed by dyspnoea (53.5%, n=53) and chest pain [24.8% (n = 25)]. Overall, the predominant pattern of involvement on chest HRCT was reticular pattern seen in 56.1 % (n=82) of patients, followed by honey-comb pattern (37.8%, n=82). Conclusion: The study demonstrated marked lung parenchymal destruction in most cases; a poor prognostic indicator which could have been due to delayed referral. HRCT has a high pick up rate of subtle parenchymal lung lesions as well as defining the lesions and their distribution compared to plain chest radiography. This is important in narrowing the differential diagnosis as well as for pre-biopsy planning. The diagnosis of ILD requires a multidisciplinary approach including a detailed clinical history, physical findings, and laboratory investigations, radiological and histological assessment.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/EAMJ.V89I9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519951","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}
Objectives: To evaluate the sonographic abdominal findings in children with suspected upper gastrointestinal disease, establish indications for sonography and describe the gastrointestinal disease patterns that can be evaluated by ultrasound. Design: Descriptive prospective study. Setting: Kenyatta National Hospital and Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi. Subjects: Fifty-six children who presented with vomiting and suspected upper gastrointestinal disease. Age range was from six days to 12 years with mean age of one year five months. Seventy seven percent were two years and below. Results: Of the 56 children, six were normal on sonography; 18 (32.1%) had intussusception, 16 (28.6%) gastroesophageal reflux, seven (12.5%) pyloric stenosis, four appendicitis, three jejunal/ileal atresia and two enteric duplication cysts. All the children with pyloric stenosis were male. The male: female ratio for intussusception and GER was 1.5:1 and 1.6:1 respectively. The most common clinical presentation in children found to have intussusception was palpable abdominal mass, and few of them presented with bloodstained stool. More than two thirds of the children with gastro-oesophageal reflux presented with complications of recurrent pneumonia and failure to thrive. The sonographic findings correlated with fluoroscopy for GER except in two children where sonography was found to be more sensitive. The sonographic findings correlated with surgical outcome for pyloric stenosis, intussusception, jejunal/ ileal atresia and enteric duplication cysts. Conclusion : Trans-abdominal sonography has a definite role in investigating the child suspected to have upper gastrointestinal disease and should be considered as the initial imaging modality, instead of fluoroscopy, thereby avoiding or limiting the use of ionising radiation. Findings in this study confirm that ultrasound is an accurate, reliable and rapid screening method to evaluate the causes of upper gastrointestinal disease in children.
{"title":"EVALUATING CHAMBERLAIN'S, McGREGOR'S, AND McRAE'S SKULL-BASE LINES USING MULTI DETECTOR COMPUTERISED TOMOGRAPHY.","authors":"G. Mwango, S. Salim, M. Wambugu, A. Aywak","doi":"10.4314/EAMJ.V89I8","DOIUrl":"https://doi.org/10.4314/EAMJ.V89I8","url":null,"abstract":"Objectives: To evaluate the sonographic abdominal findings in children with suspected upper gastrointestinal disease, establish indications for sonography and describe the gastrointestinal disease patterns that can be evaluated by ultrasound. Design: Descriptive prospective study. Setting: Kenyatta National Hospital and Department of Diagnostic Imaging and Radiation Medicine, University of Nairobi. Subjects: Fifty-six children who presented with vomiting and suspected upper gastrointestinal disease. Age range was from six days to 12 years with mean age of one year five months. Seventy seven percent were two years and below. Results: Of the 56 children, six were normal on sonography; 18 (32.1%) had intussusception, 16 (28.6%) gastroesophageal reflux, seven (12.5%) pyloric stenosis, four appendicitis, three jejunal/ileal atresia and two enteric duplication cysts. All the children with pyloric stenosis were male. The male: female ratio for intussusception and GER was 1.5:1 and 1.6:1 respectively. The most common clinical presentation in children found to have intussusception was palpable abdominal mass, and few of them presented with bloodstained stool. More than two thirds of the children with gastro-oesophageal reflux presented with complications of recurrent pneumonia and failure to thrive. The sonographic findings correlated with fluoroscopy for GER except in two children where sonography was found to be more sensitive. The sonographic findings correlated with surgical outcome for pyloric stenosis, intussusception, jejunal/ ileal atresia and enteric duplication cysts. Conclusion : Trans-abdominal sonography has a definite role in investigating the child suspected to have upper gastrointestinal disease and should be considered as the initial imaging modality, instead of fluoroscopy, thereby avoiding or limiting the use of ionising radiation. Findings in this study confirm that ultrasound is an accurate, reliable and rapid screening method to evaluate the causes of upper gastrointestinal disease in children.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/EAMJ.V89I8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519909","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}
J L Finkelstein, K P Manji, C Duggan, E Hertzmark, S Mehta, G I Msamanga, D Spiegelman, W W Fawzi
Objective: To examine the predictors of tuberculosis infection in HIV-exposed children.
Design: A longitudinal cohort study nested within a randomised controlled trial.
Setting: Antenatal clinics in Dar-es-Salaam, Tanzania.
Subjects: Children born to 875 HIV-infected women in Tanzania.
Results: A total of 82 children developed tuberculosis during the follow-up period. In multivariate analyses, HIV infection was associated with a six-fold increase in risk of tuberculosis. Breastfeeding duration, child mid-upper arm circumference, and maternal CD4 T-cell counts were inversely related to risk of tuberculosis. In HIV-infected children, greater number of people eating at the same household meal and child CD8 T-cell counts were associated with increased risk of tuberculosis; higher maternal lymphocyte counts, increased duration of breastfeeding, and lower vitamin E levels were associated with reduced risk of tuberculosis. In HIV-uninfected children, breastfeeding duration and increased child mid-upper arm circumference were associated with reduced risk of tuberculosis.
Conclusion: Breastfeeding duration, HIV status, maternal and child nutritional and immunological status were important predictors of child tuberculosis. Appropriate infant feeding and nutritional interventions could represent important adjuncts to prevent tuberculosis in children born to HIV-infected women in sub-Saharan Africa.
目的研究暴露于艾滋病病毒的儿童感染结核病的预测因素：环境：坦桑尼亚达累斯萨拉姆的产前检查诊所：地点：坦桑尼亚达累斯萨拉姆的产前诊所：结果：共有 82 名儿童患上了结核病：结果：共有 82 名儿童在随访期间患上结核病。在多变量分析中，艾滋病病毒感染与结核病风险增加六倍有关。母乳喂养时间、儿童中上臂周长和母体 CD4 T 细胞计数与结核病风险成反比。在感染艾滋病毒的儿童中，在同一家庭就餐的人数越多、儿童的 CD8 T 细胞计数越高，患结核病的风险就越高；而母体淋巴细胞计数越高、母乳喂养时间越长、维生素 E 水平越低，患结核病的风险就越低。在未感染艾滋病毒的儿童中，母乳喂养时间的长短和儿童中上臂围的增加与结核病风险的降低有关：结论：母乳喂养时间、艾滋病病毒感染状况、母婴营养和免疫状况是预测儿童结核病的重要因素。在撒哈拉以南非洲地区，适当的婴儿喂养和营养干预措施是预防感染艾滋病毒妇女所生儿童患结核病的重要辅助手段。
{"title":"PREDICTORS OF INCIDENT TUBERCULOSIS IN HIV-EXPOSED CHILDREN IN TANZANIA.","authors":"J L Finkelstein, K P Manji, C Duggan, E Hertzmark, S Mehta, G I Msamanga, D Spiegelman, W W Fawzi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To examine the predictors of tuberculosis infection in HIV-exposed children.</p><p><strong>Design: </strong>A longitudinal cohort study nested within a randomised controlled trial.</p><p><strong>Setting: </strong>Antenatal clinics in Dar-es-Salaam, Tanzania.</p><p><strong>Subjects: </strong>Children born to 875 HIV-infected women in Tanzania.</p><p><strong>Results: </strong>A total of 82 children developed tuberculosis during the follow-up period. In multivariate analyses, HIV infection was associated with a six-fold increase in risk of tuberculosis. Breastfeeding duration, child mid-upper arm circumference, and maternal CD4 T-cell counts were inversely related to risk of tuberculosis. In HIV-infected children, greater number of people eating at the same household meal and child CD8 T-cell counts were associated with increased risk of tuberculosis; higher maternal lymphocyte counts, increased duration of breastfeeding, and lower vitamin E levels were associated with reduced risk of tuberculosis. In HIV-uninfected children, breastfeeding duration and increased child mid-upper arm circumference were associated with reduced risk of tuberculosis.</p><p><strong>Conclusion: </strong>Breastfeeding duration, HIV status, maternal and child nutritional and immunological status were important predictors of child tuberculosis. Appropriate infant feeding and nutritional interventions could represent important adjuncts to prevent tuberculosis in children born to HIV-infected women in sub-Saharan Africa.</p>","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10864092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139729312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND For more than 25 years, efforts have been geared towards curtailing the practice of female genital mutilation (FGM) in countries like Nigeria. This study was designed to see if all these efforts have made any impact in reducing the prevalence of FGM appreciably in the south-West of Nigeria. OBJECTIVE To determine the prevalence of female genital mutilation and profiling the trends of FGM affected patients. DESIGN A prospective study based on direct observation of the external genitalia by health-care workers . SUBJECTS Five hundred and sixty five females less than 15 years of age. SETTING The children emergency and gynaecological wards of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from 1st of January to December 31s 2007. RESULTS Forty one point nine percent of the patients examined had female genital mutilation, 93.2% of these had the procedure before attaining the age of one year. Type 2 FGM predominated (58.22%). The procedure was performed predominantly (64.6%) by traditional birth attendants. The decision to have the procedure done was influenced in 78% of cases by mothers and grandmothers. In 35.4% of cases, there were immediate and short term complications. Demands of tradition predominated (59.1%) as the most important reason for the practice of female genital mutilation. CONCLUSION The practice of FGM appears to be still highly prevalent and resistant to change probably due to deep rooted socio-cultural factors. Strategies such as public education campaigns highlighting its negative impact on health and disregard for human rights should be evolved.
{"title":"FEMALE GENITAL MUTILATION: ARE WE WINNING?","authors":"O. Makinde, J. Elusiyan, A. B. Adeyemi, O. Taiwo","doi":"10.4314/EAMJ.V89I6","DOIUrl":"https://doi.org/10.4314/EAMJ.V89I6","url":null,"abstract":"BACKGROUND\u0000For more than 25 years, efforts have been geared towards curtailing the practice of female genital mutilation (FGM) in countries like Nigeria. This study was designed to see if all these efforts have made any impact in reducing the prevalence of FGM appreciably in the south-West of Nigeria.\u0000\u0000\u0000OBJECTIVE\u0000To determine the prevalence of female genital mutilation and profiling the trends of FGM affected patients.\u0000\u0000\u0000DESIGN\u0000A prospective study based on direct observation of the external genitalia by health-care workers .\u0000\u0000\u0000SUBJECTS\u0000Five hundred and sixty five females less than 15 years of age.\u0000\u0000\u0000SETTING\u0000The children emergency and gynaecological wards of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria from 1st of January to December 31s 2007.\u0000\u0000\u0000RESULTS\u0000Forty one point nine percent of the patients examined had female genital mutilation, 93.2% of these had the procedure before attaining the age of one year. Type 2 FGM predominated (58.22%). The procedure was performed predominantly (64.6%) by traditional birth attendants. The decision to have the procedure done was influenced in 78% of cases by mothers and grandmothers. In 35.4% of cases, there were immediate and short term complications. Demands of tradition predominated (59.1%) as the most important reason for the practice of female genital mutilation.\u0000\u0000\u0000CONCLUSION\u0000The practice of FGM appears to be still highly prevalent and resistant to change probably due to deep rooted socio-cultural factors. Strategies such as public education campaigns highlighting its negative impact on health and disregard for human rights should be evolved.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519756","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 In developing countries,most of these patients with urinary tract infections (UTI) are normally treated empirically and urine culture is usual ordered for as a last resort in patients refractory to antibiotic treatment. OBJECTIVE To explore the possibility of designing empiric antibiotic therapy for symptomatic UTI in patients at Aga Khan University Hospital by looking at the trends of UTI, common pathogens isolated and their antibiotic susceptibility pattern. DESIGN A retrospective clinical-laboratory study. SETTING Aga Kahn University Hospital- Nairobi. SUBJECTS Allpositive urine cultures between January and December 2008 were included in the study. RESULTS A total of 409 urine specimens were retrieved and analysed and 100 cases had negative cultures. Three hundred and nine cases had positive cultures. Sixty eight point seven percent were females while 31.3% were males with a mean age of 31 years. One hundred and thirty five out of 409 patients (33%) had classical signs and symptoms. In 143 (35%) cases E. coli was isolated. The other cultures were organisms other than E. coli. There was a higher resistance to clotrimazole in E. coli (71%) as compared to non-E. coli organisms (23%. There was a higher resistance rate to Nalidixic acid in non-E. Coli organisms (35%) and higher resistance rate to Augmentin in E. Coli 43 versus 18% (c/f non-E.Coli. Forty patients in the study had predisposing factors for UTI. CONCLUSIONS It is sometimes warranted to start the patient on empiric antibiotic treatmentbefore culture results are available. Nitrofurantoin, Cefuroxime, Ciprofloxacin have good sensitively rates and are therefore drugs of first choice for the treatment of uncomplicated urinary tract infection provided that the contraindications and specific precautions are noted.
{"title":"URINARY TRACT INFECTIONS AT AGA KHAN UNIVERSITY HOSPITAL NAIROBI - A ONE YEAR EXPERIENCE.","authors":"N. Okinda, G. Revathi","doi":"10.4314/EAMJ.V89I5","DOIUrl":"https://doi.org/10.4314/EAMJ.V89I5","url":null,"abstract":"BACKGROUND\u0000In developing countries,most of these patients with urinary tract infections (UTI) are normally treated empirically and urine culture is usual ordered for as a last resort in patients refractory to antibiotic treatment.\u0000\u0000\u0000OBJECTIVE\u0000To explore the possibility of designing empiric antibiotic therapy for symptomatic UTI in patients at Aga Khan University Hospital by looking at the trends of UTI, common pathogens isolated and their antibiotic susceptibility pattern.\u0000\u0000\u0000DESIGN\u0000A retrospective clinical-laboratory study.\u0000\u0000\u0000SETTING\u0000Aga Kahn University Hospital- Nairobi.\u0000\u0000\u0000SUBJECTS\u0000Allpositive urine cultures between January and December 2008 were included in the study.\u0000\u0000\u0000RESULTS\u0000A total of 409 urine specimens were retrieved and analysed and 100 cases had negative cultures. Three hundred and nine cases had positive cultures. Sixty eight point seven percent were females while 31.3% were males with a mean age of 31 years. One hundred and thirty five out of 409 patients (33%) had classical signs and symptoms. In 143 (35%) cases E. coli was isolated. The other cultures were organisms other than E. coli. There was a higher resistance to clotrimazole in E. coli (71%) as compared to non-E. coli organisms (23%. There was a higher resistance rate to Nalidixic acid in non-E. Coli organisms (35%) and higher resistance rate to Augmentin in E. Coli 43 versus 18% (c/f non-E.Coli. Forty patients in the study had predisposing factors for UTI.\u0000\u0000\u0000CONCLUSIONS\u0000It is sometimes warranted to start the patient on empiric antibiotic treatmentbefore culture results are available. Nitrofurantoin, Cefuroxime, Ciprofloxacin have good sensitively rates and are therefore drugs of first choice for the treatment of uncomplicated urinary tract infection provided that the contraindications and specific precautions are noted.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519745","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 assess the adequacy of nutrient intake including proteins, energy, calcium, iron, folate and vitamin C and identify the factors associated with nutrient intake. Design : Cross sectional study. Setting : Healthy facility based. Bungoma District Hospital and Bumula Health centre. Subjects : Teenage pregnant girls attending Antenatal Clinic participated after providing written consent, with girls under 18 years being considered as emancipated minors. A standardised interviewer administered Food Frequency Questionnaire was used to asses the dietary intake. Nutrient calculator was used to determine the nutrient intake of the study participant. Results : The intakes of all selected nutrients were significantly lower than the RDA. Protein intake was significantly associated with Education (OR: 0.537; 95% CI: 0.318 – 0.907), income (OR: 0.049; 95% CI: 0.919 – 0.128) and perceived food shortage (OR: 0.617; 95% CI: 0.389 – 0.890). Energy intake was significantly associated with income (p=0.007, OR: 2.103; 95%CI: 1.225 – 3.608). Iron intake was significantly associated with perceived food shortage (OR: 2.548; 95% CI: 1.632 – 3.980). Hookworm affected calcium intake (OR: 3.074; 95% CI: 1.089 – 8.698) and malaria parasites affected folate intake (OR: 0.355; 95% CI: 0.226 – 0.557). Those with hookworm were 3 times more likely to have inadequate calcium intake as compared to those without. Conclusion : All the nutrients selected were lower than the Required Dietary Allowance. Level of education, income, Hookworm and malaria affected intake of various nutrients.
{"title":"NUTRIENT INTAKE AMONG PREGNANT TEENAGE GIRLS ATTENDING ANTE-NATAL CLINICS IN TWO HEALTH FACILITIES IN BUNGOMA SOUTH DISTRICT, WESTERN KENYA.","authors":"Shipala Ek, Wafula Sw, Ettyang Ga, Were Eo","doi":"10.4314/EAMJ.V89I3","DOIUrl":"https://doi.org/10.4314/EAMJ.V89I3","url":null,"abstract":"Objective : To assess the adequacy of nutrient intake including proteins, energy, calcium, iron, folate and vitamin C and identify the factors associated with nutrient intake. Design : Cross sectional study. Setting : Healthy facility based. Bungoma District Hospital and Bumula Health centre. Subjects : Teenage pregnant girls attending Antenatal Clinic participated after providing written consent, with girls under 18 years being considered as emancipated minors. A standardised interviewer administered Food Frequency Questionnaire was used to asses the dietary intake. Nutrient calculator was used to determine the nutrient intake of the study participant. Results : The intakes of all selected nutrients were significantly lower than the RDA. Protein intake was significantly associated with Education (OR: 0.537; 95% CI: 0.318 – 0.907), income (OR: 0.049; 95% CI: 0.919 – 0.128) and perceived food shortage (OR: 0.617; 95% CI: 0.389 – 0.890). Energy intake was significantly associated with income (p=0.007, OR: 2.103; 95%CI: 1.225 – 3.608). Iron intake was significantly associated with perceived food shortage (OR: 2.548; 95% CI: 1.632 – 3.980). Hookworm affected calcium intake (OR: 3.074; 95% CI: 1.089 – 8.698) and malaria parasites affected folate intake (OR: 0.355; 95% CI: 0.226 – 0.557). Those with hookworm were 3 times more likely to have inadequate calcium intake as compared to those without. Conclusion : All the nutrients selected were lower than the Required Dietary Allowance. Level of education, income, Hookworm and malaria affected intake of various nutrients.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519694","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 Wounds have provided a challenge to the clinicians for centuries and this scenario persists to the 21st century. Negative pressure wound therapy (NPWT) is one of the latest additions in wound management. It has been widely adopted in developed countries with foam as the default wound dressing although it has some limitations. OBJECTIVE To determine the difference in outcomes between the use of gauze versus foam as wound dressing in NPWT for the management of acute traumatic wounds with soft tissue loss. DESIGN Prospective randomised comparative interventional study. SETTING Kenyatta National Hospital Orthopaedic and Surgical wards. SUBJECTS All patients aged above 12 years with Class III and Class IV acute traumatic wounds. OUTCOME MEASURES The main outcome measure is the time taken to achieve 100% wound granulation. Comparisons were also made on the mean pain scores during dressing change and the percentage change in wound surface area. RESULTS Wounds took an average of 8.4 days in the gauze group and 8.1 days in the foam group (p = 0.698) to achieve full granulation. The percentage change in wound surface area was 5.3 versus 5.5 (P = 0.769) in the gauze and foam groups respectively. The infection rates were comparable between the two groups (28% for gauze and 23.1% for foam, p = 0.697) and there was no significant difference in the median pain scores (gauze = 4.5, foam = 4.8 with p = 0.174). However, outcomes with gauze dressing were influenced significantly by the time to application of NPWT, initial wound surface area and wound infection while with foam dressing outcomes tended to be affected less so by the above factors. CONCLUSION In the use of NPWT for the management of acute traumatic wounds, there is no difference in terms of time to full wound granulation, change in wound surface area, wound infection and pain during dressing change whether gauze or foam is used as the wound dressing material.
{"title":"OUTCOME OF FOAM VERSUS GAUZE DRESSINGS IN NEGATIVE PRESSURE WOUND THERAPY FOR THE MANAGEMENT OF ACUTE TRAUMATIC WOUNDS WITH SOFT TISSUE LOSS AT KENYATTA NATIONAL HOSPITAL.","authors":"JG Ondieki, S. Khainga, F. Owilla, F. Nangole","doi":"10.4314/EAMJ.V89I7","DOIUrl":"https://doi.org/10.4314/EAMJ.V89I7","url":null,"abstract":"BACKGROUND Wounds have provided a challenge to the clinicians for centuries and this scenario persists to the 21st century. Negative pressure wound therapy (NPWT) is one of the latest additions in wound management. It has been widely adopted in developed countries with foam as the default wound dressing although it has some limitations. OBJECTIVE To determine the difference in outcomes between the use of gauze versus foam as wound dressing in NPWT for the management of acute traumatic wounds with soft tissue loss. DESIGN Prospective randomised comparative interventional study. SETTING Kenyatta National Hospital Orthopaedic and Surgical wards. SUBJECTS All patients aged above 12 years with Class III and Class IV acute traumatic wounds. OUTCOME MEASURES The main outcome measure is the time taken to achieve 100% wound granulation. Comparisons were also made on the mean pain scores during dressing change and the percentage change in wound surface area. RESULTS Wounds took an average of 8.4 days in the gauze group and 8.1 days in the foam group (p = 0.698) to achieve full granulation. The percentage change in wound surface area was 5.3 versus 5.5 (P = 0.769) in the gauze and foam groups respectively. The infection rates were comparable between the two groups (28% for gauze and 23.1% for foam, p = 0.697) and there was no significant difference in the median pain scores (gauze = 4.5, foam = 4.8 with p = 0.174). However, outcomes with gauze dressing were influenced significantly by the time to application of NPWT, initial wound surface area and wound infection while with foam dressing outcomes tended to be affected less so by the above factors. CONCLUSION In the use of NPWT for the management of acute traumatic wounds, there is no difference in terms of time to full wound granulation, change in wound surface area, wound infection and pain during dressing change whether gauze or foam is used as the wound dressing material.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519796","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 effect of partial Kangaroo Mother Care (KMC) on growth rates and duration of hospital stay of Low Birth Weight (LBW) infants. DESIGN Unblinded, randomised clinical controlled trial. SETTING Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS Over a nine month period, consecutive recruitment of eligible LBW infants weighing 1000 g to 1750 g was done until a sample of 166 infants was reached. INTERVENTION Kangaroo mother care was practised over an eight hour period per day for the intervention group while the controls remained in incubators or cots. Weight, head circumference, and mid upper arm circumference were monitored for all infants till discharge at 1800 g. RESULTS Of the 166 infants recruited 157 were followed up to discharge. Baseline characteristics were similar for the two groups except for mother's age, with the KMC group mothers having a mean age of 26.5 years while the control group mothers had a mean age of 24 years, (p = 0.04). The KMC group had significantly higher growth rates as shown by the higher mean weight gain of 22.5 g/kg/day compared with 16.7g/kg/day for the control group, (p < 0.001); higher mean head circumference gain of 0.91 cm/week compared with 0.54 cm/week for the control group, (p < 0.001) and higher mean mid upper arm circumference gain of 0.76 cm/week compared with 0.48 cm/week for the control group, (p = 0.002). Although overall duration of stay was similar between study arms, when infants were stratified into those above or below 1500 g KMC infants' duration of stay was significantly shorter than those in regular care. Using logistic regression, KMCwas the strongest predictor formeanweight, meanhead circumference and mean MUAC gain while mother's age (older) was the strongest predictor for mean duration of stay with KMC being an independent predictor of duration of stay. CONCLUSION Low birth weight infants in this cohort achieved rates of growth within the recommended intrauterine growth but babies managed using partial KMC grew faster and were thus discharged earlier than those on standard of care. Since partial KMC was beneficial, it should be fully implemented for all eligible infants.
{"title":"IMPACT OF PARTIAL KANGAROO MOTHER CARE ON GROWTH RATES AND DURATION OF HOSPITAL STAY OF LOW BIRTH WEIGHT INFANTS AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI.","authors":"A. Mwendwa, R. Musoke, D. Wamalwa","doi":"10.4314/EAMJ.V89I2","DOIUrl":"https://doi.org/10.4314/EAMJ.V89I2","url":null,"abstract":"OBJECTIVE To determine the effect of partial Kangaroo Mother Care (KMC) on growth rates and duration of hospital stay of Low Birth Weight (LBW) infants. DESIGN Unblinded, randomised clinical controlled trial. SETTING Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS Over a nine month period, consecutive recruitment of eligible LBW infants weighing 1000 g to 1750 g was done until a sample of 166 infants was reached. INTERVENTION Kangaroo mother care was practised over an eight hour period per day for the intervention group while the controls remained in incubators or cots. Weight, head circumference, and mid upper arm circumference were monitored for all infants till discharge at 1800 g. RESULTS Of the 166 infants recruited 157 were followed up to discharge. Baseline characteristics were similar for the two groups except for mother's age, with the KMC group mothers having a mean age of 26.5 years while the control group mothers had a mean age of 24 years, (p = 0.04). The KMC group had significantly higher growth rates as shown by the higher mean weight gain of 22.5 g/kg/day compared with 16.7g/kg/day for the control group, (p < 0.001); higher mean head circumference gain of 0.91 cm/week compared with 0.54 cm/week for the control group, (p < 0.001) and higher mean mid upper arm circumference gain of 0.76 cm/week compared with 0.48 cm/week for the control group, (p = 0.002). Although overall duration of stay was similar between study arms, when infants were stratified into those above or below 1500 g KMC infants' duration of stay was significantly shorter than those in regular care. Using logistic regression, KMCwas the strongest predictor formeanweight, meanhead circumference and mean MUAC gain while mother's age (older) was the strongest predictor for mean duration of stay with KMC being an independent predictor of duration of stay. CONCLUSION Low birth weight infants in this cohort achieved rates of growth within the recommended intrauterine growth but babies managed using partial KMC grew faster and were thus discharged earlier than those on standard of care. Since partial KMC was beneficial, it should be fully implemented for all eligible infants.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70519644","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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