1602 Records out of 22207 Records

Factors influencing nutritional status of school children 5-14 years in Kibera location, Nairobi

Author: Tai, Sarah Cherobon

Awarding University: University of Nairobi, Kenya

Level : MPH

Year: 2009

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Malnutrition/Nutrition/Children and youth/Health risk assessment/Socioeconomic factors/Kieran Location, Nairobi, Kenya ;

Abstract:

Malnutrition is a major public health problem in Kenya. Fifty four percent of the children under five years are malnourished out of which 30.6% are stunted, 4.8% are wasted, and 19.1% are underweight (CBS, MOH and ORe. Macro 2004). In view of the scale of the problem in children under five years, nutritional programmes in Kenya since independence have focused on this age group. However, malnutrition is a significant problem in older children as well,? a fact that is often overlooked by policy makers and program managers (Kapoor et al 1999). This is despite the fact that malnutrition in children under five years does not disappear magically when children cross the 'critical' threshold of five years because there are many factors. influencing their nutritional status. The aim of this study was to establish factors influencing the nutritional status of school children in Kieran Location, Nairobi. This was a descriptive cross sectional study conducted in the four villages of Kieran Location, namely, Makina, Silanga, Kieran, and Lindi. Multi-stage random sampling was used to select the study location. A pre-tested structured questionnaire was used to collect data from 432 randomly selected households. The questionnaire focused on socio-demographic, environmental, and food security factors of the households and the frequency of food intake. In these households, anthropometric measurements of the youngest school child between 5 and 14 years of age were also taken using a Standiometer and Salter weighing scale. The nutritional status of the school children was assessed using anthropometric indicators of body mass index (BMI for age), weight-for-age (wt/age), and height-for-age (ht/age). The data were entered and analyzed by use ofSPSS version 11 and EPI info version 3.4.3 2007 Nutristat packages, and STRATA version 9. A total of 432 children in the age range of5-14 years were assessed. Out of the group studied, 44% were males and 56% were females. The prevalence of stunting among the children was 35%; prevalence of underweight was 26.0%: prevalence of thinnessxv was14.8 %, prevalence of overweight 7.1 %; and obese was 6.3%. Girls were more affected than boys. Younger children who were ages 5-7 years were also more affected. Results of the bivariate analysis showed that many variables were significant but after subjecting the data to logistic regression analysis to eliminate confounding factors, it was found that only the care givers' level of education (p = 0.003) and consumption of less than three meals per day were significant (p = 0.035) factors affecting the nutritional status of the school children who were underweight. Eating less than three meals per day (p = 0.031) was found to prevent overweight in the school children. The main factors found to have a significant effect on the nutritional status of the school children were the alternate care giver's level of education,and food consumption and frequency patterns (particularly the frequency of meals per day). The study recommended that efforts directed towards education of the alternate care giver and frequency of meal intake per day would have a positive impact on the nutritional status of school children in the study area.

Corrected QT interval in patients with epilepsy attending Kenyatta National Hospital and the Kenya Association for the Welfare of People with Epilepsy clinics in Nairobi

Author: Rono, John Kibet

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 2009

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Epilepsy/Mortality/Electrocardiography/ ;

Abstract:

Background: Patients with epilepsy have a mortality rate two to three times that of the general population. Sudden unexpected death in epilepsy (SUDEP) is a major cause in studies of mortality in epilepsy. SUDEP is defined as a non accidental death in a patient with epilepsy with or without evidence of a seizure having occurred and excluding status epilepticus, where autopsy reveals no anatomical or toxicological cause. The effects of seizures and antiepileptic drugs on cardiac conduction are known to cause SUDEP. The duration of the QT interval (prolonged or shortened) has been implicated in its pathogenesis. Objectives To compare the QT interval in patients with epilepsy with non-epileptic age (to the nearest one year) and sex matched controls. Study design Comparative cross-sectional study Methods Standard 12-lead ECGs were recorded from 146 patients with epilepsy (62 not on treatment, 84 on antiepileptic drugs) and 146 age and sex matched controls from Kenyatta National Hospital and the Kenya Association for the Welfare of people with Epilepsy (KAWE) clinics in Nairobi. The mean QTinterval corrected for heart rate (QTc) for the patients with epilepsy and controls were compared. The relationship between mean QTc and seizure frequency, type and number of anti-epileptic drugs was analysed. Results The mean QTc for patients with epilepsy (405.7 ?31ms) was significantly shorter than in the control group (414.9?29.6 ms), p<O.OOOl. Untreated patients with epilepsy had a significantly shorter mean QTc of 405.6?33ms compared to the matched controls (415.4?27.8ms), p=0.0005. Similarly, . patients on anti-epileptic drugs also had a significantly shorter QTc compared to the matched controls (405.9?29.6ms vs. 414.6?31ms, p= 0.0003). However, there was no statistical difference in the mean QTc in both groups of epilepsy patients (on anti-epileptic drugs and not on treatment) (40S.6?33ms vs. 40S.9?29.6ms, p value= 0.91). The mean QTc did not significantly differ between patients in relation to seizure frequency (p=0.2S3) and type (p=0.22S) and number of antiepileptic drugs (p =0.77). Conclusion Patients with epilepsy had a significantly shorter QTc than controls and there was no association between anti-epileptic drugs and QT interval.

Performance of the cockcroft-gault and modification of diet in renal disease equations compared to 24 hour creatinine clearance in Africans with chronic kidney disease at Kenyatta National Hospital

Author: Ndosi, Emmanuel Kisali

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 2009

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Chronic renal failure ; Medical diagnosis ; Diagnostic tests ;

Abstract:

Background The worldwide rise in the number of patients with chronic kidney disease and end-stage renal failure is threatening to reach epidemic proportions over the next decade. The Glomerular Filtration Rate (GFR) is traditionally considered the best overall index of kidney function in health and disease. Early detection of Chronic kidney disease (CKD) requires identification of individuals with reduced GFR.GFR has been estimated by measurement of Serum creatinine and creatinine excretion in a 24-h urine sample and computation of creatinine clearance. More than 25 different formulas have been derived for estimating GFR using plasma creatinine corrected for a combination of factors like gender, body size, race and age. The most widely used GFR prediction equations for adults are those proposed by Cockcroft and Gault and Modification of Diet in Renal disease equations i.e MDRD original study equation and more recently the MDRD abbreviated equation. These three equations have been validated in heterogeneous populations with various stages of CKD where they have demonstrated greater accuracy and consistency in estimating GFR by incorporating other known demographic and clinical variables other than serum creatinine alone. Objectives To determine the performance of the Cockcroft-Gault and Modification Of Diet in Renal Disease equations(MDRDoriginal and MDRDabbreviated) compared to the 24 hour Creatinine Clearance in Africans with chronic kidney disease at Kenyatta National Hospital. Methods A cross-sectional analysis of the measured 24hr creatinine clearance and estimated GFR using MDRDoriginal, MDRDabbreviated and Cockcroft-Gault equations was carried out on 115 native Africans with CKD to assess the performance of these three commonly used formulas.Data collected included demographic variables,history of hypertension,history of diabetes, and serum biochemistry indices.Data was analysed using SPSS version 12.0 Outcome measures included determining the GFR of the study population as calculated by Cockcroft-Gault equation and MDRD equation 7(original equation) and abbreviated MDRD equation(equation 4) GFR estimating equations, comparing them with the 24 hour creatinine clearance. Indicators of the performances of these equations were derived from precision, bias and Results Comparison was made between 24 hour creatinine clearance, Cockcroft Gault and MDRD prediction equations on 115 African adult patients with CKD aged between 18 and 87 years old. Their mean age was 48.1 years. Sixty-four males (55.7%) and 51 female (44.3%) subjects were studied. Thirty-nine (33.9%) were hypertensive patients,6 (5.2%) had diabetes, 36 (31.3%) had diabetes with hypertension and 34 patients (29.6%) were neither hypertensives nor diabetics. MDRD original equation had better correlation with 24 hour creatinine clearance as compared with Cockcroft -Gault and MD RD abbreviated equations. Statistical correlation was r = 0.815 for MDRDoriginal equation, r =0.794 for MDRD4 equations and r = 0.781 for Cockcroft-Gault equation .MDRD abbreviated equation had the least bias compared to MDRD original and Cockcroft-Gault equations. The accuracy was greatest using MDRD original equation with 78.3% of calculated GFR values falling within 30% and 93% being within 50% of the measured 24hr creatinine clearance. Conclusion The 3 GFR estimating equations MDRD original equation, MDRD abbreviated and CockcroftGault formulae had good agreement with the measured 24 hour creatinine clearance in stage 3, 4 and 5 of Chronic Kidney Disease. This means that the values of GFR as measured by creatinine clearance that classifies patients into stage 3, 4 and 5 of CKD will be in agreement with GFR values as calculated using the 3 GFR estimating equations in that they will also classify these same patients into CKD stage 3, 4 and 5.Patients with CKD stages 1 and 2 were not studied.

Factors associated with late presentation to Kenyatta National Hospital for acute severe illness in children aged 2-59 months

Author: Gitau, James M

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 2008

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Babies ; Children and youth ; Health care ; Health services utilization ; Infant mortality ;

Abstract:

Background: Delay in seeking appropriate hea1thcare for ill children is an important cause of morbidity and mortality especially for those aged below five years. Many factors contribute to these delays. Understanding these factors in any particular setting is helpful to enable the concerned health worker( s) address the caretaker concerns insofar as this leads to late care seeking for illness with its subsequent implications. Objective: To determine the factors associated with late bealthcare seeking behaviour among severely ill children aged 2-59 months presenting to Kenyatta National hospital. Design: A hospital-based case control study. Setting: The Paediatric filter clinic and the paediatric medical wards at the Kenyatta National Hospital (KNH). Subjects: Children aged 2- 59 months who were brought to the hospital with acute severe illness and their caretakers. A total of 316 caretakers and their ill children were enrolled into the study between November 2007 and February 2008. Results: Of the 316 caretakers interviewed, 301 (95%) were mothers, the rest were other relatives. Among their ill children, 177 (56%) were boys, the rest were girls. The median age for the controls was 10 months, and 7 months for the cases. Symptoms of cough and diarrhoea were likely to be associated with presentation later than 3 days with OR of 2.09 (CI 1.23-3.56) and 1.57(CI 1.01-2.73) respectively. Herbal Medicine was used by 5% of the study population and was associated with marked likelihood of late presentation [OR 41.7(Cl 4.70-369.1)]' On outcome, there was enhanced chance of death in the cases compared to the controls [OR 4.69 (Cl 1.62-14.6)]. The median length of hospital stay was longer for the cases (7 days vs 5 days) p=0.05. Conclusion: Caretakers bringing their acute severely ill children later than 3 days since illness onset to KNH are more likely to have explored other healthcare options first compared to similarly ill children brought within 3 days. These severe presenta1ions include severe dehydration, severe respiratory distress among others. Cases had more adverse outcomes in terms of mortality and length of morbidity as reflected by the longer periods of hospitalization. Recommendation: Education of mothers and health caregivers at the peripheral health facilities on the aspects of community !MCl will promote timely referral for ill children.

Survival among retinoblastoma patients at Kenyatta National Hospital : a retrospective audit

Author: Gichigo, Nyawira

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 2008

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Eyes and eyesight ; Cancer ; Retinoblastoma ; Surgery ; Clinical outcomes ;

Abstract:

Aim The purpose of this study was to estimate the survival of patients with retinoblastoma admitted at Kenya's national referral hospital, The Kenyatta National Hospital. The information obtained will provide a good audit into the management of retinoblastoma in our country. Methods The study was a retrospective audit and was carried out at the Kenyatta National Hospital. All records of patients admitted with retinoblastoma in the period January 2000 to December 2004 were retrieved using ICD9 coding system. The files were coded 69.2 for retinoblastoma. Demographic data,clinical presentation, intraoperative finding and histology report were recorded in a provided questionnaire. Patient or their next of kin were contacted in order to find out the outcome ofthe disease. The data was stored in a computer for analysis and analysis carried out using the Statistical Package for Social Scientists (SPSS) version 12. Results The cumulative 3-year survival rate was found to be 26.6%. The mean survival time for the 3- year survivors was 68 months (SD 16.6) and the Kaplan-Meier survival probability at 36-months follows up ?s 0.2. The factors that significantly influenced good outcome were; age at presentation of <12 months, early disease at presentation (leucocoria only) 4.l3( 1.48-11.68) p<O.OOI, intraocular disease on histology (compared with extraocular disease) 8.5(2.23-34.49) p<O.OOI and total delay to management of:::;5 months 3.5(1.31-9.68) p=0.005. Proptosis and tumor recurrences were associated with 100% mortality. Multivariate analysis found early disease at presentation (leucocoria only) and intraocular disease on histology to significantly affect good outcome. Accuracy in correlating intraoperative findings with histopathological report was found to be 69.9%. Only 48% ofthe histologies were reported within two week ofthe surgical intervention. Conclusions The survival rate of patients treated for retinoblastoma was found to be very low compared to findings in studies done in the developed countries and developing countries outside Africa. The main reasons were the late presentation and presentation with recurrent disease. The factors associated with poor outcome were presentation with advanced or metastatic disease, extraocular disease on histology and total delay to management of more than five months. The accuracy in correlating the intraoperative findings with histopathological findings was moderate.

Prevalence of post traumatic stress disorder among sexually abused children and adolescents at the GOAL Kenya program Nairobi, Kenya

Author: Gwada, Margaret Anyango

Awarding University: University of Nairobi, Kenya

Level : MSc

Year: 2008

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Post traumatic stress disorder ; Sex crimes ; Children and youth ; GOAL Kenya ;

Abstract:

Background: The impact of sexual abuse on the physical health of children and adults is well recognized and discussed, but the psychological consequences have only recently become a topic of research. While other traumatic experiences of childhood are well studied, general psychological effects particularly the prevalence of post traumatic stress disorder among sexually abused children in Kenya requires investigation. Study objectives.' This study sought to establish the prevalence of post traumatic stress disorder among sexually abused children attended to at the GOAL Kenya Programme and also determine the sexual abuse patterns and risk factors while describing their social demographic profiles. Design a/the study This was a cross sectional descriptive study. Setting: GOAL Kenya Children's Program in Nairobi - A rescue centre for abused and neglected children. Subjects: Children and adolescents between the ages of 8 -- 17 years rescued from sexual abuse and were receiving psychological and medical support at the centre. Sampling and methods: A total of 122 based on the predetermined total number of sexually abused children at the GOAL Rescue Centre were purposefully sampled for the study. Research instruments. Three research instruments were used: A socio demographic profile designed by the researcher, the Sexual Abuse Profile by Conte & Berliner (1984) and the Children Impact of Traumatic Events Scale Revised by Wolfe et al (1991). Results: All the -128 children studied presented with post traumatic stress disorder. 33 children had moderate PTSD, 87 children had severe PTSD. Adolescent females (65%) were more vulnerable than their male counterparts (0%). The occurrence of PTSD symptoms between the 2 age groups was not statistically significant. Majority ?01' the children were abused by people they know 24.2% being people with parental responsibility. The occurrence of PTSD symptoms was related with child's relationship with perpetrator with statistical significance in intrusive thoughts p = 0.000 and self blame and guilt p 0.002. First borns (50%) were found to be more vulnerable to abuse than children in other birth orders. Sexual abuse mainly took the form of penetration (82%). The occurrence of PTSD symptoms was not related to the null hypothesis p = 0.384 therefore the Alternative Hypothesis that sexually abused children and adolescents develop PTSD is therefore accepted. Conclusion: This dissertation studied Post-traumatic Stress Disorder: - one of the different types of posttraumatic responses in order to help alleviate the long term negative impacts of the abuse. The study concluded that sexually abused children are at a high risk of developing post traumatic stress disorder.

The rate of HIV seroconversion during pregnancy as seen in women seeking obstetric services in Kenyatta National Hospital

Author: Ambuchi, Janerose Amoit

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 2008

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: HIV infection ; Pregnancy ; Diagnostic tests ; Women ;

Abstract:

Background: HIV infection is a global pandemic and in Kenya it was declared a national disaster in 1999. To date no cure has been found and preventlon of 'HIV acquisition and transmission remains the mainstay of management. Studies. done have shown that there is increased risk of HIV? acquisition during pregnancy'. However, the incidence of HIV in pregnancy has not been established in our setup. Objective: The aim of this study was to determine the rate of HIV seroconversion during pregnancy and factors associated with the seroconversion. Study site: Kenyatta National Hospital, Nairobi Kenya. Methods: This was a prospective cohort study in which 500 clients seeking antenatal, delivery and postnatal care at KNH were recruited. These women had tested HI' negative at initial testing in early gestation. They were tested again at term using the same kits to determine th,,;e who seroconvened. The women who seroconverted were analyzed and their characteristics described. A questionnaire was used to collect individual data. Dara was analyzed using the SPSS computer program. Results: Of the 500 women. 4(0.8%) seroconverted. They were all below 30 years of age. 3(75?.J) or' the seroconverted were single, had a secondary level of education and were unemployed. All the seroconverted had single sexual partners, and did not use condoms during the entire pregnancy. Conclusions: Pregnant women are at risk of contacting HIV infection, but the rate of seroconversiori is low. Although more of those who seroconverted were single, educated and unemployed the overall number was too small to make statistical conclusions. Recommendations A similar study should be conducted in other parts of the country to establish a national outlook for purposes of formulating policies.

Timing of emergency surgery at the Kenyatta National Hospital

Author: Arunga, Kevin Otieno

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 2008

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Surgical emergencies ; Kenyatta National Hospital, Nairobi, Kenya ;

Abstract:

ABSTRACT NOT AVAILABLE

Clinical characteristics prevalence of autoantibodies in patients with thyrotoxicosis at Kenyatta National Hospital

Author: Bagha, Saleem M A

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 2008

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Thyroid gland ; Hyperthyroidism ; Drug therapy ;

Abstract:

Background: Thyrotoxicosis is an important and common endocrine disorder with high levels of morbidity. Local studies on the prevalence of control and the associated thyroid autoantibodies are lacking. Objective: To determine the clinical characteristics, the autoantibody profile, the modes of management and the prevalence of adequate control of hyperthyroid patients attending Medical and Radiotherapy Out-Patient Clinics at Kenyatta National Hospital. Design: Cross-sectional study. Setting: Kenyatta National Hospital, Nairobi, Kenya. Subjects: Patients attending Medical and Radiotherapy Out-Patient Clinics diagnosed to have hyperthyroidism, who were on treatment. Methods Eighty one patients with hyperthyroidism who were on treatment, were consecutively recruited from the medical outpatient clinic. Detailed history was taken and a physical examination performed on each patient. Blood samples were drawn for profiles of anti- Thyroperoxidase and Thyroglobulin autoantibodies and thyroid function tests which were done by Enzyme Linked Immunosorbant Assay test. The treatment modalities and the other investigations done were documented from the file. Results The mean age of the study participants was 37.8 +/- 12.6 years with a range of 15-67 years. The peak age was 26-35 years. The female to male ratio was 9: 1. The major clinical symptoms of the patients were fatigue and weakness (96.3%), heat intolerance and sweating (93.8%), awareness of the heartbeat (93.8%), hyperactivity and irritability (86%) and weight loss (76.5%). The main signs were goitre (91.4%), tremor (75.3%), warm and moist skin (64.2%), eye involvement (63%), tachycardia (48.1 %), muscle weakness (41.5%) and onycholysis (9.3%). Thyroperoxidase autoantibodies were positive at 41.5% and Thyroglobulin autoantibodies at 38.5% among the patients. Carbimazole was the preferred mode of therapy although biochemical control was achieved in less than 113 of the treated patients with 38% of the patients having been on treatment for over 2 years. Autoantibodies were significantly common among Graves disease patients, as expected. Thyroperoxidase antibodies were positive in 41 % of Graves disease patients as compared to only 2.4% in non-Graves disease patients. Thyroglobulin antibodies were positive in 38.5% of the Graves disease patients as compared to 2.4% in nonGraves patients. Thyroperoxidase autoantibody positivity was significantly associated with lack of biochemical control on treatment. Conclusion There is a high prevalence of poor biochemical control among patients with thyrotoxicosis in the clinic. Only 29% had achieved biochemical control on treatment. Thyroperoxidase autoantibody seropositivity is associated with poor biochemical control.

Quality of life and willingness to accept cataract surgery

Author: Briesen, Sebastian

Awarding University: University of Nairobi, Kenya

Level : MMed

Year: 2008

Holding Libraries: University of Nairobi Medical Library ;

Subject Terms: Eyes and eyesight ; Cataracts ; Blindness ; Quality of life ; Surgery ; Socioeconomic factors ; Kwale District ;

Abstract:

Background: Cataract is the major cause of blindness worldwide. Programmes like Vision 2020 make a great effort to eliminate avoidable blindness; but still acceptance and uptake of cataract surgical services remain low in developing countries. The barriers and factors that lead to refusal of cataract surgery are of great interest in contemporary applied research activities. There is growing recognition that measurement of a person's ability to perform daily activities which require vision is more meaningful than measurement of his distance visual acuity. Vision-related Quality of Life (VRQoL) Scales are a sensitive and useful tool to determine a patient's impairment in his daily life. So far little is known about the correlation between subjective perception of the visual impairment and the decision making processes towards cataract surgery. Aim: The aim of the study was to determine whether the vision related Quality of Life scores differ among people who accept and those who refuse cataract surgery. Further objectives were to determine the socioeconomic variables influencing QoL scores and the decision to accept cataract surgery. Methods: 144 people with visual impairment due to cataract were interviewed during outreach activities at Kwale District. 33 of them refused and 111 accepted free cataract surgery. The WHO Quality of Life questionnaire WHOIPBD VFQ-20 was used to determine the vision related Quality of Life; the socioeconomic variables were collected using structured questionnaires. Results: There was a strong correlation between Visual Acuity and vision related QoL-scores, as expected. The second variable independently influencing QoL score was Literacy (Education). People with lower educational level had poorer QoL scores. Other sociodemographic factors like gender or marital status did not independently influence QoL scores. People with poor visual acuity were not more likely to accept surgery than people with better vision. The strongest predictor of acceptance was the QoL score. For every point decrease in QoL there was a 1.08 fold higher chance that surgery was accepted. The other factor that influenced acceptance independently was the gender. Males were 4,4 times more likely to accept than females. Conclusion: Visual acuity was not a predictor of someone's decision whether to accept or refuse free cataract surgery. The factors independently influencing acceptance were the QoL Background: Cataract is the major cause of blindness worldwide. Programmes like Vision 2020 make a great effort to eliminate avoidable blindness; but still acceptance and uptake of cataract surgical services remain low in developing countries. The barriers and factors that lead to refusal of cataract surgery are of great interest in contemporary applied research activities. There is growing recognition that measurement of a person's ability to perform daily activities which require vision is more meaningful than measurement of his distance visual acuity. Vision-related Quality of Life (VRQoL) Scales are a sensitive and useful tool to determine a patient's impairment in his daily life. So far little is known about the correlation between subjective perception of the visual impairment and the decision making processes towards cataract surgery. Aim: The aim of the study was to determine whether the vision related Quality of Life scores differ among people who accept and those who refuse cataract surgery. Further objectives were to determine the socioeconomic variables influencing QoL scores and the decision to accept cataract surgery. Methods: 144 people with visual impairment due to cataract were interviewed during outreach activities at Kwale District. 33 of them refused and 111 accepted free cataract surgery. The WHO Quality of Life questionnaire WHOIPBD VFQ-20 was used to determine the vision related Quality of Life; the socioeconomic variables were collected using structured questionnaires. Results: There was a strong correlation