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Murless-Collins S, Kawaza K, Salim N, Molyneux EM, Chiume M, Aluvaala J, Macharia WM, Ezeaka VC, Odedere O, Shamba D, Tillya R, Penzias RE, Ezenwa BN, Ohuma EO, Cross JH, Lawn JE. Blood culture versus antibiotic use for neonatal inpatients in 61 hospitals implementing with the NEST360 Alliance in Kenya, Malawi, Nigeria, and Tanzania: a cross-sectional study. BMC Pediatr 2023; 23:568. [PMID: 37968606 PMCID: PMC10652421 DOI: 10.1186/s12887-023-04343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/02/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Thirty million small and sick newborns worldwide require inpatient care each year. Many receive antibiotics for clinically diagnosed infections without blood cultures, the current 'gold standard' for neonatal infection detection. Low neonatal blood culture use hampers appropriate antibiotic use, fuelling antimicrobial resistance (AMR) which threatens newborn survival. This study analysed the gap between blood culture use and antibiotic prescribing in hospitals implementing with Newborn Essential Solutions and Technologies (NEST360) in Kenya, Malawi, Nigeria, and Tanzania. METHODS Inpatient data from every newborn admission record (July 2019-August 2022) were included to describe hospital-level blood culture use and antibiotic prescription. Health Facility Assessment data informed performance categorisation of hospitals into four tiers: (Tier 1) no laboratory, (Tier 2) laboratory but no microbiology, (Tier 3) neonatal blood culture use < 50% of newborns receiving antibiotics, and (Tier 4) neonatal blood culture use > 50%. RESULTS A total of 144,146 newborn records from 61 hospitals were analysed. Mean hospital antibiotic prescription was 70% (range = 25-100%), with 6% mean blood culture use (range = 0-56%). Of the 10,575 blood cultures performed, only 24% (95%CI 23-25) had results, with 10% (10-11) positivity. Overall, 40% (24/61) of hospitals performed no blood cultures for newborns. No hospitals were categorised as Tier 1 because all had laboratories. Of Tier 2 hospitals, 87% (20/23) were District hospitals. Most hospitals could do blood cultures (38/61), yet the majority were categorised as Tier 3 (36/61). Only two hospitals performed > 50% blood cultures for newborns on antibiotics (Tier 4). CONCLUSIONS The two Tier 4 hospitals, with higher use of blood cultures for newborns, underline potential for higher blood culture coverage in other similar hospitals. Understanding why these hospitals are positive outliers requires more research into local barriers and enablers to performing blood cultures. Tier 3 facilities are missing opportunities for infection detection, and quality improvement strategies in neonatal units could increase coverage rapidly. Tier 2 facilities could close coverage gaps, but further laboratory strengthening is required. Closing this culture gap is doable and a priority for advancing locally-driven antibiotic stewardship programmes, preventing AMR, and reducing infection-related newborn deaths.
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Affiliation(s)
- Sarah Murless-Collins
- Maternal, Adolescent, Reproductive, & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Kondwani Kawaza
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Elizabeth M Molyneux
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Msandeni Chiume
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Jalemba Aluvaala
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | | | | | - Opeyemi Odedere
- Rice360 Institute for Global Health Technologies, Rice University, Texas, USA
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Robert Tillya
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Rebecca E Penzias
- Maternal, Adolescent, Reproductive, & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Eric O Ohuma
- Maternal, Adolescent, Reproductive, & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - James H Cross
- Maternal, Adolescent, Reproductive, & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive, & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Petricca K, Kambugu J, Githang'a J, Macharia WM, Njuguna F, McLigeyo A, Nyangasi M, Orem J, Kanyamuhunga A, Laiti R, Katabalo D, Schroeder K, Rogo K, Maguire B, Wambui L, Nkurunziza JN, Wong B, Neposlan J, Kilawe L, Gupta S, Denburg AE. Access to essential cancer medicines for children: a comparative mixed-methods analysis of availability, price, and health-system determinants in east Africa. Lancet Oncol 2023; 24:563-576. [PMID: 37023781 DOI: 10.1016/s1470-2045(23)00072-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Access to essential childhood cancer medicines is a core determinant of childhood cancer outcomes. Available evidence, although scarce, suggests that access to these medicines is highly variable across countries, particularly in low-income and middle-income countries, where the burden of childhood cancer is greatest. To support evidence-informed national and regional policies for improved childhood cancer outcomes, we aimed to analyse access to essential childhood cancer medicines in four east African countries-Kenya, Rwanda, Tanzania, and Uganda-by determining the availability and price of these medicines and the health system determinants of access. METHODS In this comparative analysis, we used prospective mixed-method analyses to track and analyse the availability and price of essential childhood cancer medicines, investigate contextual determinants of access to childhood cancer medicines within and across included countries, and assess the potential effects of medicine stockouts on treatment. Eight tertiary care hospitals were included, seven were public sites (Kenyatta National Hospital [KNH; Nairobi, Kenya], Jaramogi Oginga Odinga Referral and Teaching Hospital [JOORTH; Kisumu, Kenya], Moi University Teaching and Referral Hospital [MTRH; Eldoret, Kenya], Bugando Medical Centre [BMC; Mwanza, Tanzania], Muhimbili National Hospital [MNH; Dar es Salaam, Tanzania], Butaro Cancer Centre of Excellence [BCCE; Butaro Sector, Rwanda], and Uganda Cancer Institute [UCI; Kampala, Uganda]) and one was a private site (Aga Khan University Hospital [AKU; Nairobi, Kenya]). We catalogued prices and stockouts for 37 essential drugs from each of the eight study siteson the basis of 52 weeks of prospective data that was collected across sites from May 1, 2020, to Jan 31, 2022. We analysed determinants of medicine access using thematic analysis of academic literature, policy documents, and semi-structured interviews from a purposive sample of health system stakeholders. FINDINGS Recurrent stockouts of a wide range of cytotoxic and supportive care medicines were observed across sites, with highest mean unavailability in Kenya (JOORTH; 48·5%), Rwanda (BCCE; 39·0%), and Tanzania (BMC; 32·2%). Drugs that had frequent stockouts across at least four sites included methotrexate, bleomycin, etoposide, ifosfamide, oral morphine, and allopurinol. Average median price ratio of medicines at each site was within WHO's internationally accepted threshold for efficient procurement (median price ratio ≤1·5). The effect of stockouts on treatment was noted across most sites, with the greatest potential for treatment interruptions in patients with Hodgkin lymphoma, retinoblastoma, and acute lymphocytic leukaemia. Policy prioritisation of childhood cancers, health financing and coverage, medicine procurement and supply chain management, and health system infrastructure emerged as four prominent determinants of access when the stratified purposive sample of key informants (n=64) across all four countries (Kenya n=19, Rwanda n=15, Tanzania n=13, and Uganda n=17) was interviewed. INTERPRETATION Access to childhood cancer medicines across east Africa is marked by gaps in availability that have implications for effective treatment delivery for a range of childhood cancers. Our findings provide detailed evidence of barriers to access to childhood cancer medicine at multiple points in the pharmaceutical value chain. These data could inform national and regional policy makers to optimise cancer medicine availability and affordability as part of efforts to improve childhood cancer outcomes specific regions and internationally. FUNDING American Childhood Cancer Organization, Childhood Cancer International, and the Friends of Cancer Patients Ameera Fund.
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Mburu AN, Laving A, Macharia WM, Sande J. Prevalence of non-alcoholic fatty liver disease in overweight and obese children seeking ambulatory healthcare in Nairobi, Kenya. BMJ Open Gastroenterol 2023; 10:bmjgast-2022-001044. [PMID: 36796875 PMCID: PMC9936283 DOI: 10.1136/bmjgast-2022-001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND While linked to obesity and associated with an increased cardiovascular morbidity, non-alcoholic fatty liver disease (NAFLD) is an often-asymptomatic cause of chronic liver disease in children. Early detection provides opportunity for interventions to curb progression. Childhood obesity is on the rise in low/middle-income countries, but cause-specific mortality data associated with liver disease are scanty. Establishing the prevalence of NAFLD in overweight and obese Kenyan children would guide in public health policies aimed at early screening and intervention. OBJECTIVES To investigate prevalence of NAFLD in overweight and obese children aged 6-18 years using liver ultrasonography. METHODOLOGY This was a cross-sectional survey. After obtaining informed consent, a questionnaire was administered, and blood pressure (BP) measured. Liver ultrasonography was performed to assess fatty changes. Categorical variables were analysed using frequency and percentages. χ2 test and multiple logistic regression model were used to determine relationship between exposure and outcome variables. RESULTS Prevalence of NAFLD was 26.2% (27/103, 95% CI=18.0% to 35.8%). There was no association between sex and NAFLD (OR1.13, p=0.82; 95% CI=0.4 to 3.2). Obese children were four times more likely to have NAFLD compared with overweight children (OR=4.52, p=0.02; 95% CI=1.4 to 19.0). About 40.8% (n=41) had elevated BP, but there was no association with NAFLD (OR=2.06; p=0.27; 95% CI=0.6 to 7.6). Older children (13-18 years) were more likely to have NAFLD (OR 4.42; p=0.03; 95% CI=1.2 to 17.9). CONCLUSION Prevalence of NAFLD was high in overweight and obese school children in Nairobi. Further studies are needed to identify modifiable risk factors to arrest progression and prevent sequelae.
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Affiliation(s)
- Anne Njeri Mburu
- Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Ahmed Laving
- Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya,Paediatrics and Child Health, University of Nairobi College of Health Sciences, Nairobi, Kenya
| | - William M Macharia
- Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Joyce Sande
- Radiology and Imaging Diagnostics, Aga Khan University Hospital, Nairobi, Kenya
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Coleman J, Ginsburg AS, Macharia WM, Ochieng R, Chomba D, Zhou G, Dunsmuir D, Karlen W, Ansermino JM. Assessment of neonatal respiratory rate variability. J Clin Monit Comput 2022; 36:1869-1879. [PMID: 35332406 PMCID: PMC9637627 DOI: 10.1007/s10877-022-00840-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/02/2022] [Indexed: 11/30/2022]
Abstract
Accurate measurement of respiratory rate (RR) in neonates is challenging due to high neonatal RR variability (RRV). There is growing evidence that RRV measurement could inform and guide neonatal care. We sought to quantify neonatal RRV during a clinical study in which we compared multiparameter continuous physiological monitoring (MCPM) devices. Measurements of capnography-recorded exhaled carbon dioxide across 60-s epochs were collected from neonates admitted to the neonatal unit at Aga Khan University-Nairobi hospital. Breaths were manually counted from capnograms and using an automated signal detection algorithm which also calculated mean and median RR for each epoch. Outcome measures were between- and within-neonate RRV, between- and within-epoch RRV, and 95% limits of agreement, bias, and root-mean-square deviation. Twenty-seven neonates were included, with 130 epochs analysed. Mean manual breath count (MBC) was 48 breaths per minute. Median RRV ranged from 11.5% (interquartile range (IQR) 6.8-18.9%) to 28.1% (IQR 23.5-36.7%). Bias and limits of agreement for MBC vs algorithm-derived breath count, MBC vs algorithm-derived median breath rate, MBC vs algorithm-derived mean breath rate were - 0.5 (- 2.7, 1.66), - 3.16 (- 12.12, 5.8), and - 3.99 (- 11.3, 3.32), respectively. The marked RRV highlights the challenge of performing accurate RR measurements in neonates. More research is required to optimize the use of RRV to improve care. When evaluating MCPM devices, accuracy thresholds should be less stringent in newborns due to increased RRV. Lastly, median RR, which discounts the impact of extreme outliers, may be more reflective of the underlying physiological control of breathing.
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Affiliation(s)
- Jesse Coleman
- Evaluation of Technologies for Neonates in Africa (ETNA), Nairobi, Kenya. .,Centre for International Child Health, 305 - 4088 Cambie Street, Vancouver, BC, V5Z 2X8, Canada.
| | | | | | | | - Dorothy Chomba
- Department of Pediatrics, Aga Khan University, Nairobi, Kenya
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, USA
| | - Dustin Dunsmuir
- Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Walter Karlen
- Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - J Mark Ansermino
- Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
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Ginsburg AS, Coleman J, Waiyego M, Murila F, Macharia WM, Ochieng R. A survey of barriers and facilitators to caffeine use for apnoea of prematurity in low- and middle-income countries. Paediatr Int Child Health 2022; 42:137-141. [PMID: 37462339 DOI: 10.1080/20469047.2023.2235938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/05/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Despite its associated benefits which include better long-term pulmonary and neurodevelopmental outcome, the use of caffeine for apnoea of prematurity (AoP) has been limited in low- and middle-income countries (LMIC). AIM To better understand current caffeine use, the barriers and facilitators to its use and perceptions and practices in LMIC which have a disproportionately high burden of prematurity. METHODS An anonymous online global survey was conducted, targeting healthcare providers working and training in paediatrics and/or neonatology in LMIC. RESULTS A total of 181 respondents in 16 LMIC were included in the analysis; most were physicians working in publicly-funded urban tertiary hospitals. Most had received training in the use of caffeine for AoP (77%), reported expertise (70%) and confidence (96%) in its use, and had access to caffeine (65%). Caffeine availability was reported to be the greatest barrier (48%) and the greatest facilitator (37%). Other common barriers included cost (31%), access (7%) and policies or guidelines on caffeine use (7%); other common facilitators included policies or guidelines on caffeine use (11%), access (10%), staff/other providers' acceptance of caffeine as an appropriate treatment (9%) and the availability of staff to administer caffeine (8%). Most (79%) noted that access to caffeine was important, 92% agreed that caffeine improves quality of care, and 95% agreed that caffeine improves patient outcome. CONCLUSION Improving availability and access to low-cost caffeine will be key to increasing caffeine use in LMIC. ABBREVIATIONS AoP: Apnoea of Prematurity; LMIC: low- and middle-Income countries; REDCap: Research Electronic Data Capture.
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Affiliation(s)
| | - Jesse Coleman
- Evaluation of Technologies for Neonates in Africa Aga Khan University, Nairobi, Kenya
| | - Mary Waiyego
- Newborn Unit, Kenyatta National Hospital, Nairobi, Kenya
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Ginsburg AS, Nia SZ, Chomba D, Parsimei M, Dunsmuir D, Waiyego M, Coleman J, Ochieng R, Zhou G, Macharia WM, Ansermino JM. Clinical feasibility of an advanced neonatal epidermal multiparameter continuous monitoring technology in a large public maternity hospital in Nairobi, Kenya. Sci Rep 2022; 12:11722. [PMID: 35810244 PMCID: PMC9271033 DOI: 10.1038/s41598-022-16051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/04/2022] [Indexed: 11/09/2022] Open
Abstract
Clinically feasible multiparameter continuous physiological monitoring technologies are needed for use in resource-constrained African healthcare facilities to allow for early detection of critical events and timely intervention for major morbidities in high-risk neonates. We conducted a prospective clinical feasibility study of a novel multiparameter continuous physiological monitoring technology in neonates at Pumwani Maternity Hospital in Nairobi, Kenya. To assess feasibility, we compared the performance of Sibel's Advanced Neonatal Epidermal (ANNE) technology to reference technologies, including Masimo's Rad-97 pulse CO-oximeter with capnography technology for heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) measurements and Spengler's Tempo Easy non-contact infrared thermometer for temperature measurements. We evaluated key performance criteria such as up-time, clinical event detection performance, and the agreement of measurements compared to those from the reference technologies in an uncontrolled, real-world setting. Between September 15 and December 15, 2020, we collected and analyzed 503 h of ANNE data from 109 enrolled neonates. ANNE's up-time was 42 (11%) h more for HR, 77 (25%) h more for RR, and 6 (2%) h less for SpO2 compared to the Rad-97. However, ANNE's ratio of up-time to total attached time was less than Rad-97's for HR (0.79 vs 0.86), RR (0.68 vs. 0.79), and SpO2 (0.69 vs 0.86). ANNE demonstrated adequate performance in identifying high and low HR and RR and high temperature events; however, showed relatively poor performance for low SpO2 events. The normalized spread of limits of agreement were 8.4% for HR and 52.2% for RR and the normalized root-mean-square deviation was 4.4% for SpO2. Temperature agreement showed a spread of limits of agreement of 2.8 °C. The a priori-identified optimal limits were met for HR and temperature but not for RR or SpO2. ANNE was clinically feasible for HR and temperature but not RR and SpO2 as demonstrated by the technology's up-time, clinical event detection performance, and the agreement of measurements compared to those from the reference technologies.
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Affiliation(s)
- Amy Sarah Ginsburg
- Clinical Trials Center, University of Washington, Seattle, Building 29, Suite 250, 6200 NE 74th Street, Seattle, WA, 98115, USA.
| | - Sahar Zandi Nia
- Department of Anesthesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Dorothy Chomba
- Department of Pediatrics, Aga Khan University, Nairobi, Kenya
| | | | - Dustin Dunsmuir
- Department of Anesthesiology, The University of British Columbia, Vancouver, BC, Canada
| | | | - Jesse Coleman
- Evaluation of Technologies for Neonates in Africa, Seattle, USA
| | | | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, USA
| | | | - J Mark Ansermino
- Department of Anesthesiology, The University of British Columbia, Vancouver, BC, Canada
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Wang D, Macharia WM, Ochieng R, Chomba D, Hadida YS, Karasik R, Dunsmuir D, Coleman J, Zhou G, Ginsburg AS, Ansermino JM. Evaluation of a contactless neonatal physiological monitor in Nairobi, Kenya. Arch Dis Child 2022; 107:558-564. [PMID: 34740876 PMCID: PMC9125375 DOI: 10.1136/archdischild-2021-322344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Globally, 2.5 million neonates died in 2018, accounting for 46% of under-5 deaths. Multiparameter continuous physiological monitoring (MCPM) of neonates allows for early detection and treatment of life-threatening health problems. However, neonatal monitoring technology is largely unavailable in low-resource settings. METHODS In four evaluation rounds, we prospectively compared the accuracy of the EarlySense under-mattress device to the Masimo Rad-97 pulse CO-oximeter with capnography reference device for heart rate (HR) and respiratory rate (RR) measurements in neonates in Kenya. EarlySense algorithm optimisations were made between evaluation rounds. In each evaluation round, we compared 200 randomly selected epochs of data using Bland-Altman plots and generated Clarke error grids with zones of 20% to aid in clinical interpretation. RESULTS Between 9 July 2019 and 8 January 2020, we collected 280 hours of MCPM data from 76 enrolled neonates. At the final evaluation round, the EarlySense MCPM device demonstrated a bias of -0.8 beats/minute for HR and 1.6 breaths/minute for RR, and normalised spread between the 95% upper and lower limits of agreement of 6.2% for HR and 27.3% for RR. Agreement between the two MCPM devices met the a priori-defined threshold of 30%. The Clarke error grids showed that all observations for HR and 197/200 for RR were within a 20% difference. CONCLUSION Our research indicates that there is acceptable agreement between the EarlySense and Masimo MCPM devices in the context of large within-subject variability; however, further studies establishing cost-effectiveness and clinical effectiveness are needed before large-scale implementation of the EarlySense MCPM device in neonates. TRIAL REGISTRATION NUMBER NCT03920761.
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Affiliation(s)
- Dee Wang
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Dorothy Chomba
- Department of Pediatrics, Aga Khan University, Nairobi, Kenya
| | | | | | - Dustin Dunsmuir
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesse Coleman
- Centre for International Child Health, Vancouver, British Columbia, Canada
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Amy Sarah Ginsburg
- Clinical Trials Center, University of Washington, Seattle, Washington, USA
| | - J Mark Ansermino
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
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Ginsburg AS, Zandi Nia S, Chomba D, Dunsmuir D, Waiyego M, Coleman J, Ochieng R, Liu S, Zhou G, Ansermino JM, Macharia WM. Clinical feasibility of a contactless multiparameter continuous monitoring technology for neonates in a large public maternity hospital in Nairobi, Kenya. Sci Rep 2022; 12:3097. [PMID: 35197529 PMCID: PMC8866488 DOI: 10.1038/s41598-022-07189-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/09/2022] [Indexed: 11/16/2022] Open
Abstract
Multiparameter continuous physiological monitoring (MCPM) technologies are critical in the clinical management of high-risk neonates; yet, these technologies are frequently unavailable in many African healthcare facilities. We conducted a prospective clinical feasibility study of EarlySense’s novel under-mattress MCPM technology in neonates at Pumwani Maternity Hospital in Nairobi, Kenya. To assess feasibility, we compared the performance of EarlySense’s technology to Masimo’s Rad-97 pulse CO-oximeter with capnography technology for heart rate (HR) and respiratory rate (RR) measurements using up-time, clinical event detection performance, and accuracy. Between September 15 and December 15, 2020, we collected and analyzed 470 hours of EarlySense data from 109 enrolled neonates. EarlySense’s technology’s up-time per neonate was 2.9 (range 0.8, 5.3) hours for HR and 2.1 (range 0.9, 4.0) hours for RR. The difference compared to the reference was a median of 0.6 (range 0.1, 3.1) hours for HR and 0.8 (range 0.1, 2.9) hours for RR. EarlySense’s technology identified high HR and RR events with high sensitivity (HR 81%; RR 83%) and specificity (HR 99%; RR 83%), but was less sensitive for low HR and RR (HR 0%; RR 14%) although maintained specificity (HR 100%; RR 95%). There was a greater number of false negative and false positive RR events than false negative and false positive HR events. The normalized spread of limits of agreement was 9.6% for HR and 28.6% for RR, which met the a priori-identified limit of 30%. EarlySense’s MCPM technology was clinically feasible as demonstrated by high percentage of up-time, strong clinical event detection performance, and agreement of HR and RR measurements compared to the reference technology. Studies in critically ill neonates, assessing barriers and facilitators to adoption, and costing analyses will be key to the technology’s development and potential uptake and scale-up.
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Affiliation(s)
- Amy Sarah Ginsburg
- Clinical Trials Center, University of Washington, Building 29, Suite 250, 6200 NE 74th Street, Seattle, WA, 98115, USA.
| | - Sahar Zandi Nia
- Department of Anesthesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Dorothy Chomba
- Department of Pediatrics, Aga Khan University, Nairobi, Kenya
| | - Dustin Dunsmuir
- Department of Anesthesiology, The University of British Columbia, Vancouver, BC, Canada
| | | | - Jesse Coleman
- Evaluation of Technologies for Neonates in Africa, Seattle, WA, USA
| | | | - Sichen Liu
- Department of Anesthesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, USA
| | - J Mark Ansermino
- Department of Anesthesiology, The University of British Columbia, Vancouver, BC, Canada
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Kinshella MLW, Naanyu V, Chomba D, Waiyego M, Rigg J, Coleman J, Hwang B, Ansermino JM, Macharia WM, Ginsburg AS. Qualitative study exploring the feasibility, usability and acceptability of neonatal continuous monitoring technologies at a public tertiary hospital in Nairobi, Kenya. BMJ Open 2022; 12:e053486. [PMID: 35017248 PMCID: PMC8753390 DOI: 10.1136/bmjopen-2021-053486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To assess the feasibility, usability and acceptability of two non-invasive, multiparameter, continuous physiological monitoring (MCPM) technologies for use in neonates within a resource-constrained healthcare setting in sub-Saharan Africa. DESIGN A qualitative study using in-depth interviews and direct observations to describe healthcare professional and caregiver perspectives and experiences with investigational MCPM technologies from EarlySense and Sibel compared with selected reference technologies. SETTING Pumwani Maternity Hospital is a public, high-volume, tertiary hospital in Nairobi, Kenya. PARTICIPANTS In-depth interviews were conducted with five healthcare administrators, 12 healthcare providers and 10 caregivers. Direct observations were made of healthcare providers using the technologies on 12 neonates overall. RESULTS Design factors like non-invasiveness, portability, ease-of-use and ability to measure multiple vital signs concurrently emerged as key themes supporting the usability and acceptability of the investigational technologies. However, respondents also reported feasibility challenges to implementation, including overcrowding in the neonatal unit, lack of reliable access to electricity and computers, and concerns about cost and maintenance needs. To improve acceptability, respondents highlighted the need for adequate staffing to appropriately engage caregivers and dispel misconceptions about the technologies. CONCLUSION Study participants were positive about the usefulness of the investigational technologies to strengthen clinical care quality and identification of at-risk neonates for better access to timely interventions. These technologies have the potential to improve equity of access to appropriate healthcare services and neonatal outcomes in sub-Saharan African healthcare facilities. However, health system strengthening is also critical to support sustainable uptake of technologies into routine care. TRIAL REGISTRATION NUMBER NCT03920761.
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Affiliation(s)
- Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynecology, British Columbia Children's and Women's Hospital and The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for International Child Health, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Violet Naanyu
- School of Arts and Sciences, Moi University, Eldoret, Uasin Gishu County, Kenya
| | - Dorothy Chomba
- Department of Pediatrics, The Aga Khan University - Kenya, Nairobi, Kenya
| | - Mary Waiyego
- Department of Pediatrics, Pumwani Maternity Hospital, Nairobi, Kenya
| | - Jessica Rigg
- Centre for International Child Health, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Anesthesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesse Coleman
- Evaluation of Technologies for Neonates in Africa, Seattle, Washington, USA
| | - Bella Hwang
- Centre for International Child Health, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - J Mark Ansermino
- Centre for International Child Health, BC Children's Hospital, Vancouver, British Columbia, Canada
- Department of Anesthesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - William M Macharia
- Department of Pediatrics, The Aga Khan University - Kenya, Nairobi, Kenya
| | - Amy Sarah Ginsburg
- Clinical Trial Center, University of Washington, Seattle, Washington, USA
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10
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Abstract
Background Respiratory rate is difficult to measure, especially in neonates who have an irregular breathing pattern. The World Health Organisation recommends a one-minute count, but there is limited data to support this length of observation. We sought to evaluate agreement between the respiratory rate (RR) derived from capnography in neonates, over 15 s, 30 s, 120 s and 300 s, against the recommended 60 s. Methods Neonates at two hospitals in Nairobi were recruited and had capnograph waveforms recorded using the Masimo Rad 97. A single high quality 5 min epoch was randomly chosen from each subject. For each selected epoch, the mean RR was calculated using a breath-detection algorithm applied to the waveform. The RR in the first 60 s was compared to the mean RR measured over the first 15 s, 30 s, 120 s, full 300 s, and last 60 s. We calculated bias and limits of agreement for each comparison and used Bland-Altman plots for visual comparisons. Results A total of 306 capnographs were analysed from individual subjects. The subjects had a median gestation age of 39 weeks with slightly more females (52.3%) than males (47.7%). The majority of the population were term neonates (70.1%) with 39 (12.8%) having a primary respiratory pathology. There was poor agreement between all the comparisons based on the limits of agreement [confidence interval], ranging between 11.9 [− 6.79 to 6.23] breaths per minute in the one versus 2 min comparison, and 34.7 [− 17.59 to 20.53] breaths per minute in the first versus last minute comparison. Worsening agreement was observed in plots with higher RRs. Conclusions Neonates have high variability of RR, even over a short period of time. A slight degradation in the agreement is noted over periods shorter than 1 min. However, this is smaller than observations done 3 min apart in the same subject. Longer periods of observation also reduce agreement. For device developers, precise synchronization is needed when comparing devices to reduce the impact of RR variation. For clinicians, where possible, continuous or repeated monitoring of neonates would be preferable to one time RR measurements.
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Affiliation(s)
| | - J Mark Ansermino
- The University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada
| | | | - Dustin T Dunsmuir
- The University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada
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Ginsburg AS, Kinshella MLW, Naanyu V, Rigg J, Chomba D, Coleman J, Hwang B, Ochieng R, Ansermino JM, Macharia WM. Multiparameter Continuous Physiological Monitoring Technologies in Neonates Among Health Care Providers and Caregivers at a Private Tertiary Hospital in Nairobi, Kenya: Feasibility, Usability, and Acceptability Study. J Med Internet Res 2021; 23:e29755. [PMID: 34709194 PMCID: PMC8587184 DOI: 10.2196/29755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/01/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Continuous physiological monitoring technologies are important for strengthening hospital care for neonates, particularly in resource-constrained settings, and understanding user perspectives is critical for informing medical technology design, development, and optimization. Objective This study aims to assess the feasibility, usability, and acceptability of 2 noninvasive, multiparameter, continuous physiological monitoring technologies for use in neonates in an African health care setting. Methods We assessed 2 investigational technologies from EarlySense and Sibel, compared with the reference Masimo Rad-97 technology through in-depth interviews and direct observations. A purposive sample of health care administrators, health care providers, and caregivers at Aga Khan University Hospital, a tertiary, private hospital in Nairobi, Kenya, were included. Data were analyzed using a thematic approach in NVivo 12 software. Results Between July and August 2020, we interviewed 12 health care providers, 5 health care administrators, and 10 caregivers and observed the monitoring of 12 neonates. Staffing and maintenance of training in neonatal units are important feasibility considerations, and simple training requirements support the feasibility of the investigational technologies. Key usability characteristics included ease of use, wireless features, and reduced number of attachments connecting the neonate to the monitoring technology, which health care providers considered to increase the efficiency of care. The main factors supporting acceptability included caregiver-highlighted perceptions of neonate comfort and health care respondent technology familiarity. Concerns about the side effects of wireless connections, electromagnetic fields, and mistrust of unfamiliar technologies have emerged as possible acceptability barriers to investigational technologies. Conclusions Overall, respondents considered the investigational technologies feasible, usable, and acceptable for the care of neonates at this health care facility. Our findings highlight the potential of different multiparameter continuous physiological monitoring technologies for use in different neonatal care settings. Simple and user-friendly technologies may help to bridge gaps in current care where there are many neonates; however, challenges in maintaining training and ensuring feasibility within resource-constrained health care settings warrant further research. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-035184
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Affiliation(s)
- Amy Sarah Ginsburg
- UW Clinical Trial Center, University of Washington, Seattle, WA, United States
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynecology, British Columbia Children's and Women's Hospital and The University of British Columbia, Vancouver, BC, Canada.,Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | - Violet Naanyu
- School of Arts and Sciences, Moi University, Eldoret, Kenya
| | - Jessica Rigg
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Dorothy Chomba
- Department of Pediatrics, Aga Khan University, Nairobi, Kenya
| | - Jesse Coleman
- Evaluation of Technologies for Neonates in Africa, Nairobi, Kenya
| | - Bella Hwang
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | | | - J Mark Ansermino
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, The University of British Columbia, Vancouver, BC, Canada
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12
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Coleman J, Ginsburg AS, Macharia WM, Ochieng R, Zhou G, Dunsmuir D, Karlen W, Ansermino JM. Identification of thresholds for accuracy comparisons of heart rate and respiratory rate in neonates. Gates Open Res 2021; 5:93. [PMID: 34901754 PMCID: PMC8630397 DOI: 10.12688/gatesopenres.13237.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Heart rate (HR) and respiratory rate (RR) can be challenging to measure accurately and reliably in neonates. The introduction of innovative, non-invasive measurement technologies suitable for resource-constrained settings is limited by the lack of appropriate clinical thresholds for accuracy comparison studies. Methods: We collected measurements of photoplethysmography-recorded HR and capnography-recorded exhaled carbon dioxide across multiple 60-second epochs (observations) in enrolled neonates admitted to the neonatal care unit at Aga Khan University Hospital in Nairobi, Kenya. Trained study nurses manually recorded HR, and the study team manually counted individual breaths from capnograms. For comparison, HR and RR also were measured using an automated signal detection algorithm. Clinical measurements were analyzed for repeatability. Results: A total of 297 epochs across 35 neonates were recorded. Manual HR showed a bias of -2.4 (-1.8%) and a spread between the 95% limits of agreement (LOA) of 40.3 (29.6%) compared to the algorithm-derived median HR. Manual RR showed a bias of -3.2 (-6.6%) and a spread between the 95% LOA of 17.9 (37.3%) compared to the algorithm-derived median RR, and a bias of -0.5 (1.1%) and a spread between the 95% LOA of 4.4 (9.1%) compared to the algorithm-derived RR count. Manual HR and RR showed repeatability of 0.6 (interquartile range (IQR) 0.5-0.7), and 0.7 (IQR 0.5-0.8), respectively. Conclusions: Appropriate clinical thresholds should be selected a priori when performing accuracy comparisons for HR and RR. Automated measurement technologies typically use a smoothing or averaging filter, which significantly impacts accuracy. A wider spread between the LOA, as much as 30%, should be considered to account for the observed physiological nuances and within- and between-neonate variability and different averaging methods. Wider adoption of thresholds by data standards organizations and technology developers and manufacturers will increase the robustness of clinical comparison studies.
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Affiliation(s)
- Jesse Coleman
- Evaluation of Technologies for Neonates in Africa (ETNA), Aga Khan University Hospital, Nairobi, Kenya
| | | | | | - Roseline Ochieng
- Department of Paediatrics, Aga Khan University Hospital, Nairobi, Kenya
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Dustin Dunsmuir
- Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Walter Karlen
- Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zürich, Zürich, 8092, Switzerland
| | - J. Mark Ansermino
- Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
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13
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Coleman J, Ginsburg AS, Macharia WM, Ochieng R, Zhou G, Dunsmuir D, Karlen W, Ansermino JM. Identification of thresholds for accuracy comparisons of heart rate and respiratory rate in neonates. Gates Open Res 2021; 5:93. [PMID: 34901754 PMCID: PMC8630397 DOI: 10.12688/gatesopenres.13237.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 04/05/2024] Open
Abstract
Background: Heart rate (HR) and respiratory rate (RR) can be challenging to measure accurately and reliably in neonates. The introduction of innovative, non-invasive measurement technologies suitable for resource-constrained settings is limited by the lack of appropriate clinical thresholds for accuracy comparison studies. Methods: We collected measurements of photoplethysmography-recorded HR and capnography-recorded exhaled carbon dioxide across multiple 60-second epochs (observations) in enrolled neonates admitted to the neonatal care unit at Aga Khan University Hospital in Nairobi, Kenya. Trained study nurses manually recorded HR, and the study team manually counted individual breaths from capnograms. For comparison, HR and RR also were measured using an automated signal detection algorithm. Clinical measurements were analyzed for repeatability. Results: A total of 297 epochs across 35 neonates were recorded. Manual HR showed a bias of -2.4 (-1.8%) and a spread between the 95% limits of agreement (LOA) of 40.3 (29.6%) compared to the algorithm-derived median HR. Manual RR showed a bias of -3.2 (-6.6%) and a spread between the 95% LOA of 17.9 (37.3%) compared to the algorithm-derived median RR, and a bias of -0.5 (1.1%) and a spread between the 95% LOA of 4.4 (9.1%) compared to the algorithm-derived RR count. Manual HR and RR showed repeatability of 0.6 (interquartile range (IQR) 0.5-0.7), and 0.7 (IQR 0.5-0.8), respectively. Conclusions: Appropriate clinical thresholds should be selected a priori when performing accuracy comparisons for HR and RR. Automated measurement technologies typically use median values rather than counts, which significantly impacts accuracy. A wider spread between the LOA, as much as 30%, should be considered to account for the observed physiological nuances and within- and between-neonate variability and different averaging methods. Wider adoption of thresholds by data standards organizations and technology developers and manufacturers will increase the robustness of clinical comparison studies.
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Affiliation(s)
- Jesse Coleman
- Evaluation of Technologies for Neonates in Africa (ETNA), Aga Khan University Hospital, Nairobi, Kenya
| | | | | | - Roseline Ochieng
- Department of Paediatrics, Aga Khan University Hospital, Nairobi, Kenya
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Dustin Dunsmuir
- Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Walter Karlen
- Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zürich, Zürich, 8092, Switzerland
| | - J. Mark Ansermino
- Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
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14
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Migowa AN, Macharia WM, Samia P, Tole J, Keter AK. Effect of a voice recognition system on pediatric outpatient medication errors at a tertiary healthcare facility in Kenya. Ther Adv Drug Saf 2018; 9:499-508. [PMID: 30181858 DOI: 10.1177/2042098618781520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/10/2018] [Indexed: 12/15/2022] Open
Abstract
Background Medication-related errors account for one out of every 131 outpatient deaths, and one out of 854 inpatient deaths. The risk is threefold greater in the pediatric population. In sub-Saharan Africa, research on medication-related errors has been obscured by other health priorities and poor recognition of harm attributable to such errors.Our primary objective was to assess the effect of introduction of a voice recognition system (VRS) on the prevalence of medication errors. The secondary objective was to describe characteristics of observed medication errors and determine acceptability of VRS by clinical service providers. Methods This was a before-after intervention study carried out in a Pediatric Accident and Emergency Department of a private not-for-profit tertiary referral hospital in Kenya. Results A total of 1196 handwritten prescription records were examined in the pre-VRS phase and 501 in the VRS phase. In the pre-VRS phase, 74.3% of the prescriptions (889 of 1196) had identifiable errors compared with 65.7% in the VRS phase (329 of 501).More than half (58%) of participating clinical service providers expressed preference for VRS prescriptions compared with handwritten prescriptions. Conclusions VRS reduces medication prescription errors with the greatest effect noted in reduction of incorrect medication dosages. More studies are needed to explore whether more training, user experience and software enhancement would minimize medication errors further. VRS technology is acceptable to physicians and pharmacists at a tertiary care hospital in Kenya.
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Affiliation(s)
- Angela N Migowa
- Department of Pediatrics and Child Health, Aga Khan University, 3rd Parklands Avenue, PO Box 30270, Nairobi County 00100, Kenya
| | | | - Pauline Samia
- Department of Pediatrics and Child Health, Aga Khan University, Kenya
| | - John Tole
- Department of Pediatrics and Child Health, Aga Khan University, Kenya
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15
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Nyongesa C, Xu X, Hall JJ, Macharia WM, Yego F, Hall B. Factors influencing choice of skilled birth attendance at ANC: evidence from the Kenya demographic health survey. BMC Pregnancy Childbirth 2018; 18:88. [PMID: 29631549 PMCID: PMC5891962 DOI: 10.1186/s12884-018-1727-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 03/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Kenya, skilled attendance at delivery is well below the international target of 90% and the maternal mortality ratio is high at 362 (CI 254-471) per 100,000 live births despite various interventions. The preventative role of skilled attendance at delivery makes it a benchmark indicator for safe motherhood. METHODS Maternal health data from the Service Provision Assessment Survey, a subset of the 2010 Kenya Demographic Health Survey was analyzed. Logistic regression models were employed using likelihood ratio test to explore association between choice of skilled attendance and predictor variables. RESULTS Overall, 94.8% of women are likely to seek skilled attendance at delivery. Cost, education level, number of antenatal visits and sex of provider were strongly associated with client's intention to deliver with a skilled birth attendant at delivery. Women who reported having enough money set aside for delivery were 4.34 (p < 0.002, 95% CI: 1.73; 10.87) times more likely to seek skilled attendance. Those with primary education and above were 6.6 times more likely to seek skilled attendance than those with no formal education (p < 0.001, 95% CI: 3.66; 11.95). Women with four or more antenatal visits were 5.95 (p < 0.018, 95% CI: 1.35; 26.18) times more likely to seek skilled attendance. Compared to men, female providers impacted more on the client's plan (OR = 2.02 (p < 0.014, 95% CI: 1.35; 3.53). CONCLUSION Interventions aimed at improving skilled attendance at delivery should include promotion of formal education of women and financial preparation for delivery. Whenever circumstances permit, women should be allowed to choose gender of preferred professional attendant at delivery.
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Affiliation(s)
- Caroline Nyongesa
- Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, School of Medicine and Public Health, the University of Newcastle, New Lambton Heights, NSW, 2305, Australia. .,Malteser International, P.O. Box 66587, Nairobi, 00800, Kenya.
| | - Xiaoyue Xu
- Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, School of Medicine and Public Health, the University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - John J Hall
- Centre for Clinical Epidemiology and Biostatistics, Hunter Medical Research Institute, School of Medicine and Public Health, the University of Newcastle, New Lambton Heights, NSW, 2305, Australia
| | - William M Macharia
- Aga Khan University Hospital, 3rd Parklands Avenue, P.O Box 30270, Nairobi, 00100, Kenya
| | - Faith Yego
- Department of Health Policy and Management, Moi University, Nandi Road, Eldoret, 30100, Kenya
| | - Brigid Hall
- Faculty of Medicine, UNSW Medicine, Wallace Wurth Building, The University of New South Wales, Sydney, 2052, Australia
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Sean Quadros DR, Kamenwa R, Akech S, M Macharia W. Hospital-acquired malnutrition in children at a tertiary care hospital. South African Journal of Clinical Nutrition 2017. [DOI: 10.1080/16070658.2017.1322825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Del-Rossi Sean Quadros
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Rose Kamenwa
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Samuel Akech
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - William M Macharia
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
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17
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Hiatt RA, Engmann NJ, Ahmed M, Amarsi Y, Macharia WM, Macfarlane SB, Ngugi AK, Rabbani F, Walraven G, Armstrong RW. Population Health Science: A Core Element of Health Science Education in Sub-Saharan Africa. Acad Med 2017; 92:462-467. [PMID: 27508343 PMCID: PMC5367502 DOI: 10.1097/acm.0000000000001320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Sub-Saharan Africa suffers an inordinate burden of disease and does not have the numbers of suitably trained health care workers to address this challenge. New concepts in health sciences education are needed to offer alternatives to current training approaches.A perspective of integrated training in population health for undergraduate medical and nursing education is advanced, rather than continuing to take separate approaches for clinical and public health education. Population health science educates students in the social and environmental origins of disease, thus complementing disease-specific training and providing opportunities for learners to take the perspective of the community as a critical part of their education.Many of the recent initiatives in health science education in sub-Saharan Africa are reviewed, and two case studies of innovative change in undergraduate medical education are presented that begin to incorporate such population health thinking. The focus is on East Africa, one of the most rapidly growing economies in sub-Saharan Africa where opportunities for change in health science education are opening. The authors conclude that a focus on population health is a timely and effective way for enhancing training of health care professionals to reduce the burden of disease in sub-Saharan Africa.
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Affiliation(s)
- Robert A. Hiatt
- R.A. Hiatt is professor and chair, Department of Epidemiology and Biostatistics, University of California, San Francisco, and director of population sciences and associate director, Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Natalie J. Engmann
- N.J. Engmann is a doctoral student, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Mushtaq Ahmed
- M. Ahmed is professor and associate dean of medical education, Aga Khan University, Faculty of Health Sciences–East Africa, Dar es Salaam, Tanzania
| | - Yasmin Amarsi
- Y. Amarsi is professor and dean, School of Nursing and Midwifery, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - William M. Macharia
- W.M. Macharia is professor and chair, Department of Paediatrics and Child Health, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - Sarah B. Macfarlane
- S.B. Macfarlane is professor, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, and visiting professor, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - Anthony K. Ngugi
- A.K. Ngugi is assistant professor, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
| | - Fauziah Rabbani
- F. Rabbani is professor and chair, Department of Community Health Sciences, Aga Khan University–Karachi, Pakistan
| | - Gijs Walraven
- G. Walraven is honorary professor, Department of Community Health Sciences, Aga Khan University–Karachi, Pakistan, and director for health, Aga Khan Development Network, Geneva, Switzerland
| | - Robert W. Armstrong
- R.W. Armstrong is professor and dean of the medical college, Aga Khan University, Faculty of Health Sciences–East Africa, Nairobi, Kenya
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18
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Wamithi S, Ochieng R, Njenga F, Akech S, Macharia WM. Cross-sectional survey on prevalence of attention deficit hyperactivity disorder symptoms at a tertiary care health facility in Nairobi. Child Adolesc Psychiatry Ment Health 2015; 9:1. [PMID: 25657818 PMCID: PMC4318353 DOI: 10.1186/s13034-015-0033-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder is the most common childhood neurobehavioral disorder with well documented adverse consequences in adolescence and adulthood, yet 60-80% of cases go undiagnosed. Routine screening is not practiced in most pediatric outpatient services and little information exists on factors associated with the condition in developing countries. METHODS This was a questionnaire based cross-sectional survey whose primary objective was to determine prevalence of attention deficit hyperactivity disorder (ADHD) symptoms in children aged 6-12 years attending a tertiary care hospital Accidents and Emergency unit. Secondary objectives were to: (i) ascertain if physical injury and poor academic performance were associated with ADHD, (ii) compare diagnostic utility of parent-filled Vanderbilt Assessment Scale (VAS) against Statistical Manual of Mental Disorders-IV (DSM-IV) as the gold reference and (iii) establish if there exists an association between ADHD symptoms cluster and co-morbid conditions. RESULTS Prevalence of cluster of symptoms consistent with ADHD was 6.3% (95% CI; 3.72-10.33) in 240 children studied. Those affected were more likely to repeat classes than the asymptomatic (OR 20.2; 95% CI 4.02-100.43). Additionally, 67% of the symptomatic had previously experienced burns and 37% post-traumatic open wounds. The odds of having an injury in the symptomatic was 2.9 (95% CI; 1.01-8.42) compared to the asymptomatic. Using DSM-IV as reference, VAS had a sensitivity of 66.7% (95%; CI 39.03-87.12) and specificity of 99.0% (95% CI; 96.1-99.2). Positive predictive value was 83.0% (95% CI; 50.4-97.3) and negative predictive value 98.0% (CI 95.1-99.1). Oppositional defiant disorder symptoms, anxiety, depression and conduct problems were not significantly associated with ADHD cluster of symptoms. CONCLUSION The study found a relatively high prevalence of symptoms associated with ADHD. Symptomatic children experienced poor school performance. These findings support introduction of a policy on routine screening for ADHD in pediatric outpatient service. Positive history of injury and poor academic performance should trigger further evaluation for ADHD. Vanderbilt assessment scale is easier to administer than DSM-IV but has low sensitivity and high specificity that make it inappropriate for screening. It however provides a suitable alternative confirmatory test to determine who among clinically symptomatic patients requires referral to a psychiatrist.
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Affiliation(s)
- Susan Wamithi
- Department of Paediatrics and Child Health, Aga Khan University Hospital, P.O BOX 30270-00100, Nairobi, Kenya
| | - Roseline Ochieng
- Department of Paediatrics and Child Health, Aga Khan University Hospital, P.O BOX 30270-00100, Nairobi, Kenya
| | | | - Samuel Akech
- Department of Paediatrics and Child Health, Aga Khan University Hospital, P.O BOX 30270-00100, Nairobi, Kenya
| | - William M Macharia
- Department of Paediatrics and Child Health, Aga Khan University Hospital, P.O BOX 30270-00100, Nairobi, Kenya
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19
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Kabera B, Riyat M, Macharia WM, Pamnani R. ACUTE LEUKEMIAS IMMUNOPHENOTYPES AT AGAKHAN UNIVERSITY HOSPITAL, NAIROBI. East Afr Med J 2013; 90:45-51. [PMID: 26866101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim was to determine relative frequencies of acute leukemia immunophenotypes using commonly expressed markers and to describe the clinicopathological characteristics. Design: This was a prospective cross-sectional study. SETTING The study was based at Aga khan clinical laboratory department. SUBJECTS One hundred and thirty two (132) consecutive blood and bone marrow specimens from patients suspected to have acute leukemia were analysed for cytomorphological characteristics and immunophenotyping. The clinical-pathological characteristics were also recorded. Immunological category was assigned using the EGIL criteria. RESULTS There were 88 AML and 42 ALL patients analysed for immunophenotypes. Only tw cases of biphenotypic leukemia were found. The commonest overall AML morphological sub-type was AML-M2, 26 (29.5%). Majority of ALL cases were B-cell immunological sub-type (96.6%). Early pre-B phenotype constituted 62.07% and Common B-cell ALL 37.93%. There were only 4 cases of T-cell ALL. Majority of patients presented with anaemia with a median hemoglobin of 7.5g/dl (range 2-15g/dl). The median platelet count was 55 (range 4-462 x 10(9)/L). CONCLUSION Immunophenotyping of acute leukemia is beneficial in accurate diagnosis of patients with these malignancies in this setup. T-cell ALL, AML-M6 and M7 are less frequent than what has been reported in most studies in Africa.
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MESH Headings
- Adolescent
- Adult
- Aged
- Blood Cell Count/methods
- Bone Marrow Examination/methods
- Bone Marrow Examination/statistics & numerical data
- Child
- Flow Cytometry/methods
- Hemoglobins/analysis
- Humans
- Immunophenotyping/methods
- Immunophenotyping/statistics & numerical data
- Kenya/epidemiology
- Leukemia, Biphenotypic, Acute/blood
- Leukemia, Biphenotypic, Acute/diagnosis
- Leukemia, Biphenotypic, Acute/epidemiology
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/epidemiology
- Male
- Middle Aged
- Reproducibility of Results
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Affiliation(s)
- B Kabera
- Aga Khan University Hospital, Nairobi, Kenya.
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20
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Kumar R, Musoke R, Macharia WM, Revathi G. Validation of c-reactive protein in the early diagnosis of neonatal sepsis in a tertiary care hospital in Kenya. ACTA ACUST UNITED AC 2013; 87:255-61. [PMID: 23057268 DOI: 10.4314/eamj.v87i6.63084] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate utility of C-reactive protein (CRP) in the early diagnosis of neonatal sepsis in a tertiary care Newborn Unit in Kenya. DESIGN Cross-sectional study. SETTING Newborn Unit, Kenyatta National Hospital. SUBJECTS All neonates admitted to Newborn Unit, Kenyatta National Hospital during the study period with suspected sepsis based on specified clinical criteria. RESULTS Of the 310 infants, there were 83 episodes of proven sepsis and 94 episodes of probable sepsis. Using the standard CRP cut-off value of 5 mg/dl, a sensitivity of 95.2% in proven sepsis and 98.9% for probable septic episodes were noted. In proven sepsis, a specificity of 85.3%, positive predictive value of 80.6%, and a negative predictive value of 96.5% were noted. In probable sepsis, a specificity of 83.3%, positive predictive value of 80.9% and a negative predictive value of 99.1% were noted. The overall accuracy in proven sepsis was 96.5%, and in probable sepsis was noted to be 99.1%. Sub-analysis showed a lower positive predictive value (61.5%) for early onset sepsis compared to 93% for late onset sepsis. Repeat CRP tests were done in 33 babies. Twenty two of the 29 with proven/probable infection had a ten-fold increase in CRP levels, but levels were noted to be low or reducing in seven (24.1%) babies showing signs of improvement clinically. Using a receiver operator characteristic curve, the optimal cut-off point for CRP was found to be 5 mg/dl. CONCLUSIONS Serum CRP is an accurate indicator of neonatal sepsis, with high sensitivity, specificity and predictive values, at the standard cut-off of 5. CRP is a better screening test for late-onset than early-onset neonatal sepsis. The standard recommended CRP cut -off point of 5 is appropriate for local use.
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Affiliation(s)
- R Kumar
- Gertrude's Children's Hospital, P.O. Box 42325 - 00100, Nairobi, Kenya
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Wilson RM, Michel P, Olsen S, Gibberd RW, Vincent C, El-Assady R, Rasslan O, Qsous S, Macharia WM, Sahel A, Whittaker S, Abdo-Ali M, Letaief M, Ahmed NA, Abdellatif A, Larizgoitia I. Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital. BMJ 2012; 344:e832. [PMID: 22416061 DOI: 10.1136/bmj.e832] [Citation(s) in RCA: 180] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the frequency and nature of adverse events to patients in selected hospitals in developing or transitional economies. DESIGN Retrospective medical record review of hospital admissions during 2005 in eight countries. SETTING Ministries of Health of Egypt, Jordan, Kenya, Morocco, Tunisia, Sudan, South Africa and Yemen; the World Health Organisation (WHO) Eastern Mediterranean and African Regions (EMRO and AFRO), and WHO Patient Safety. PARTICIPANTS Convenience sample of 26 hospitals from which 15,548 patient records were randomly sampled. MAIN OUTCOME MEASURES Two stage screening. Initial screening based on 18 explicit criteria. Records that screened positive were then reviewed by a senior physician for determination of adverse event, its preventability, and the resulting disability. RESULTS Of the 15,548 records reviewed, 8.2% showed at least one adverse event, with a range of 2.5% to 18.4% per country. Of these events, 83% were judged to be preventable, while about 30% were associated with death of the patient. About 34% adverse events were from therapeutic errors in relatively non-complex clinical situations. Inadequate training and supervision of clinical staff or the failure to follow policies or protocols contributed to most events. CONCLUSIONS Unsafe patient care represents a serious and considerable danger to patients in the hospitals that were studied, and hence should be a high priority public health problem. Many other developing and transitional economies will probably share similar rates of harm and similar contributory factors. The convenience sampling of hospitals might limit the interpretation of results, but the identified adverse event rates show an estimate that should stimulate and facilitate the urgent institution of appropriate remedial action and also to trigger more research. Prevention of these adverse events will be complex and involves improving basic clinical processes and does not simply depend on the provision of more resources.
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Affiliation(s)
- R M Wilson
- New York City Health and Hospital Corporation, 125 Worth Street, New York, NY 10013, USA.
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Kitonyi GW, Macharia WM, Mwanda OW, Pamnani R. Clinico-pathologic characteristics and treatment outcomes in children with neuroblastoma at the Kenyatta National Hospital, Nairobi. ACTA ACUST UNITED AC 2011; 86:S39-46. [PMID: 21591508 DOI: 10.4314/eamj.v86i12.62899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine clinical-pathologic characteristics, treatment modalities and treatment outcomes of children diagnosed with neuroblastoma. DESIGN Cross-sectional descriptive study based on secondary data from patient records. SETTING Records department of Kenyatta National Hospital (KNH), a tertiary teaching and referral hospital based in Nairobi. SUBJECTS Children aged 15 years and below, admitted with the diagnosis of neuroblastoma, between January 1997 and December 2005. MAIN OUTCOME MEASURES Presenting clinical features, diagnostic modalities including laboratory and imaging data, treatment modalities, response to treatment and patient survival. RESULTS Twenty six patients were eligible for the study; 13 males and 13 females giving a M:F ratio of 1:1. The age range was 5 days to 12 years, with a median age of five years. Abdominal swelling (53.8%), inability to walk due to bone pains, (50%), and cranial or periorbital swelling, (38.5%) were the commonest presenting features. Diagnosis of neuroblastoma was based on tissue biopsy in 50% (95% CI 40.6-79.8%) of the patients, and on fine needle aspiration cytology of mass or bone marrow in the rest. Bone marrow involvement was present in 16, (75%). Anaemia, was common with 72.7% patients having a haemoglobin (HB) <8 g/dl at presentation. Immunohistochemistry and cytological grading were done in two, (8%), patients. Urinary vanilly 1 mandelic acid (VMA), screening was positive in 50% (95% CI 29.9%-70.1%). The most frequently involved organs were abdomen (88.9%), and skeleton, (84.6%). Majority of patients, (92.3%), presented with advanced stage IV disease. Three patients died before commencement of treatment. All treated patients (100%), received cytotoxic therapy. Only two patients (8.6%) had surgery as part of treatment while one, (4.3%) was treated with radiotherapy. The initial treatment regimen was similar for all the patients. Although most patients had a complete initial response to treatment, early relapse, treatment failure, death or loss to follow up of patients with progressive disease were common. Overall survival (OS) at one year and two years were 19.2% (95% CI 6.6-39.4%) and 7.7% (95% CI 0.9%-25.1%) respectively. Only one patient was alive, (also free of disease), five years after diagnosis. CONCLUSION Although other clinical-pathologic findings of the patients were similar to those reported elsewhere, virtually all study patients presented with advanced stage IV disease, which would be associated with poor prognosis irrespective of quality of care. Priority must therefore be on ensuring early diagnosis and referral of patients with neuroblastoma before any other interventions can be expected to positively impact on outcome. The limited role of surgery and radiotherapy observed over the study period may be attributed to late presentation of the patients. Pathologic evaluation of important information could have been availed at minimal extra cost. To be at par with current internationally accepted treatment approaches that have been associated with improved survival, there is need to base choice of regimens for individual patients on clinical and readily accessible pathologic markers.
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Affiliation(s)
- G W Kitonyi
- Haematology and Blood Transfusion Unit, Department of Human Pathology, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
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Macharia WM. Outcome and haemato-toxicity of two chemotherapy regimens for childhood non-Hodgkin's lymphoma in a Kenyan hospital. East Afr Med J 2009; 86:S34-S38. [PMID: 21591507 DOI: 10.4314/eamj.v86i12.62896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Effectiveness and toxicity of childhood cancer treatments have never been evaluated in Kenya since introduction of structured care in the early seventies. OBJECTIVE To evaluate effectiveness and toxicity of two treatment protocols for Non-Hodgkin's lymphoma (NHL). DESIGN Historical cohort study using medical records. SETTING Kenyatta National Hospital, a tertiary care and medical teaching hospital. SUBJECTS Children < or =15 years with diagnosis of non-Hodgkin's Lymphoma. MAIN OUTCOME MEASURES Primary outcomes were median survival, event free survival and toxicity. RESULTS Out of 101 records, only 26 (25.7%) met inclusion criteria. Baseline characteristics were similar in the two treatment arms. Median survival was 0.75 months (95% CI = 0.54-0.96) and 1.0 months (95% CI = 0.29-1.71) for short and long arm groups. There was no difference in event free survival and haematological toxicity. CONCLUSION No clear difference in effectiveness and toxicity between the intensive-short and the less aggressive long course chemotherapy regimens was evident. Though lack of difference may be attributed to the small sample size, suboptimal supportive care for intensive treatment would increase risk of toxic deaths. As the short course protocol did not demonstrate obvious deterioration of median and event free survival, a strong case may be made for a randomised clinical trial within a context of improved supportive care.
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Affiliation(s)
- W M Macharia
- Department of Paediatrics and Child Health, Aga Khan University Hospital, P.O. Box 30270, 00100, Nairobi, Kenya
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Admani B, Macharia WM, Were F. Seroprevalence of varicella zoster antibodies among children with malnutrition, malignancies and HIV infection. ACTA ACUST UNITED AC 2009; 85:480-6. [PMID: 19537424 DOI: 10.4314/eamj.v85i10.9669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the seroprevalence of varicella zoster in paediatric patients at a high risk of developing complications. DESIGN A cross-sectional study. SETTING Paediatric general wards at Kenyatta National Hospital. SUBJECTS Children with malignancies, severe malnutrition and were HIV positive. INTERVENTIONS The sample size was calculated at 147 subjects. Venous samples were tested for varicella zoster virus (VZV) antibodies using enzyme immunosorbent assay (ELISA) technique at Kenya Medical Research Institute (KEMRI) laboratories, The data were analysed using the SPSS software and presented in form of tables and graphs. The prevalence of VZV antibodies was determined and 95% confidence interval computed. RESULTS The overall seroprevalence of VZV antibodies in the three groups of children studied was 23.6% (95% CI = 17.4, 29.8). The seroprevalence of VZV antibodies in those with malignancies and severe malnutrition was 24.1 and 25.0% respectively. About 22% of HIV positive children had protective levels of VZV antibodies. Though the seroprevalence increased with age, it was not significantly associated with area of residence, size of residence, family size or income. CONCLUSIONS The low prevalence of protective VZV antibodies among children with severe malnutrition, malignancies and HIV infection children at Kenyatta National Hospital warrants routine immunisation of the high-risk population.
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Affiliation(s)
- B Admani
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
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Macharia WM, Njeru EK, Muli-Musiime F, Nantulya V. Severe road traffic injuries in Kenya, quality of care and access. Afr Health Sci 2009; 9:118-124. [PMID: 19652745 PMCID: PMC2707053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Road traffic injuries (RTI) are on increase in developing countries. Health care facilities are poorly equipped to provide the needed services. OBJECTIVE Determine access and quality of care for RTI casualties in Kenya. DESIGN Cross-sectional survey SETTING 53 large and medium size private, faith-based and public hospitals. PARTICIPANTS In-patient road traffic crash casualties and health personnel in the selected hospitals were interviewed on availability of emergency care and resources. Onsite verification of status was undertaken. RESULTS Out of 310 RTI casualties interviewed, 72.3%, 15.6% and 12.2% were in public, faith-based and private hospitals, respectively. Peak age of the injured was 15-49 years. First aid was availed to 16.0% of casualties. Unknown persons transported 76.5% of the injured. Police and ambulance vehicles transported 6.1% and 1.4%, respectively. 51.9% reached health facilities within 30 minutes of crash and medical care provided to 66.2% within one hour. 40.8% of recipient facilities were adequately prepared for RTI emergencies. CONCLUSIONS Most RTI casualties were young and from poor backgrounds. Training of motorists and general public in first aid should be considered in RTI control initiatives. Availability of basic trauma care medical supplies in public health facilities was highly deficient.
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Affiliation(s)
- W M Macharia
- Nairobi Clinical Epidemiology Unit, University of Nairobi, Nairobi.
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Awasthi S, Agarwal GG, Mishra V, Nag VL, El Sayed HF, da Cunha AJL, Madeiro A, Jain D, Macharia WM, Ndung'u J, Awasthi S, Wakhlu A. Four-country surveillance of intestinal intussusception and diarrhoea in children. J Paediatr Child Health 2009; 45:82-6. [PMID: 19210606 DOI: 10.1111/j.1440-1754.2008.01434.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Establishment of baseline epidemiology of intussusception in developing countries has become a necessity with the possibility of reintroduction of rotavirus vaccine. The current study assessed the seasonal trend in cases admitted with intussusceptions and dehydrating acute watery diarrhoea in children aged 2 months to 10 years. METHODS In a prospective surveillance study, teaching and research hospital sites in India (Lucknow and Nagpur), Brazil (Fortazela), Egypt (Ismailia) and Kenya (Nairobi) established a surveillance where a network of hospitals with surgical facilities catered to a reference population of about 1-2 million for reporting of intussusception. One large hospital per site also recruited admitted cases of acute watery diarrhoea. RESULTS From April 2004 to March 2006, 173 and 2346 cases of intussusception and diarrhoea, respectively, were recruited. Cases of intussusception had no apparent seasonality. Most cases of intussusception (61.3%) (107/173) were in the < or =1 year age group, with males comprising 68.8% (119/173) of all cases. Hospital mortality of intussusception was 4.2% (4/96). Cases of diarrhoea peaked in March, with 56.6% (1328/2346) of admitted cases being males. Majority (83.1%) of cases of diarrhoea had received antibiotics, and the hospital mortality was 0.8% (18/2280). CONCLUSION Intussusception in the four participating countries exhibited no seasonal trend. We found that it is feasible to establish a surveillance network for intussusception in developing countries. Future efforts must define population base before the introduction of rotavirus vaccine and continue for some years thereafter.
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Affiliation(s)
- Shally Awasthi
- Department of Paediatrics, King George Medical University, Lucknow, India.
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Abstract
Angio-oedema may be hereditary or acquired and is characterised by episodes of potentially life threatening localised tissue oedema and swelling resulting from deficiency of compliment pathway C1 esterase inhibitor. Acquired angio-oedema is about ten times less frequent than the hereditary type and has been associated with immune-deficiency disorders, malignancies and exposure to specific medications and food substances. We present a case of seven year old, human immune-deficiency virus positive girl, who developed gross swelling of the tongue and neck while on treatment for pneumococcal meningitis with ceftriaxone. Difficulties in arriving at a definitive diagnosis of angio-oedema in a resource poor country are discussed and alternative diagnostic options proposed.
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Affiliation(s)
- W M Macharia
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
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Swingler GH, Irlam JH, Macharia WM, Tietche F, Meremikwu MM. A systematic review of existing national priorities for child health research in sub-Saharan Africa. Health Res Policy Syst 2005; 3:7. [PMID: 16300672 PMCID: PMC1315320 DOI: 10.1186/1478-4505-3-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 11/21/2005] [Indexed: 11/20/2022] Open
Abstract
Background We systematically reviewed existing national child health research priorities in Sub-Saharan Africa, and the processes used to determine them. Methods Collaborators from a purposive sample of 20 WHO-AFRO Region countries, assisted by key informants from a range of governmental, non-governmental, research and funding organisations and universities, identified and located potentially eligible prioritisation documents. Included documents were those published between 1990 and 2002 from national or nationally accredited institutions describing national health research priorities for child health, alone or as part of a broader report in which children were a clearly identifiable group. Laboratory, clinical, public health and policy research were included. Two reviewers independently assessed eligibility for inclusion and extracted data. Results Eight of 33 potentially eligible reports were included. Five reports focused on limited areas of child health. The remaining three included child-specific categories in reports of general research priorities, with two such child-specific categories limited to reproductive health. In a secondary analysis of Essential National Health Research reports that included children, though not necessarily as an identifiable group, the reporting of priorities varied markedly in format and numbers of priorities listed, despite a standard recommended approach. Comparison and synthesis of reported priorities was not possible. Conclusion Few systematically developed national research priorities for child health exist in sub-Saharan Africa. Children's interests may be distorted in prioritisation processes that combine all age groups. Future development of priorities requires a common reporting framework and specific consideration of childhood priorities.
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Affiliation(s)
- George H Swingler
- School of Child and Adolescent Health, University of Cape Town, South Africa
| | - James H Irlam
- School of Child and Adolescent Health, University of Cape Town, South Africa
- Directorate of Primary Health Care, University of Cape Town, South Africa
| | - William M Macharia
- Department of Paediatrics and Child Health, University of Nairobi, Kenya
| | - Félix Tietche
- Department of Paediatrics, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Cameroon
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Abstract
BACKGROUND Kenya has a soaring rate of road traffic fatalities. Available evidence suggests significant alcohol-relatedness to trauma. We know little about the prevalence of alcohol-related injuries in Nairobi. OBJECTIVE To determine the extent and pattern of alcohol use in subjects admitted following road traffic accident. DESIGN A descriptive hospital based survey. SETTING Kenyatta National Hospital (KNH)- a university affiliated hospital in Nairobi, Kenya. RESULTS The overall incidence of alcohol use was 26.3%. This was higher in males (29.6%) than females (9.1%). Use was 24.4%, 31.0%, 28.6% and 13.6% in the 16-25, 26-35, 36-45 and 46-55 age groups respectively. The mean ages, pre-hospital times and ISS were similar for the AUG and NAUG. The incidence of males, weekend injuries, night collisions, and pedestrian involvement was 94.4%, 69.4%, 41.7%, 77.8% in the AUG and 83.2%, 35.6%, 19.8% and 61.4% in the NAUG respectively. The incidence of head and extremity injuries in AUG was 27.8% and 50% respectively compared to 11.9% and 66.3% in the NAUG. Treatment costs were higher for the NAUG. CONCLUSIONS The results suggest a high incidence and potential alcohol-relatedness to road trauma in Nairobi. The study calls for objective evaluation of the extent, interactions and effects of this modifiable trauma factor.
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Affiliation(s)
- S Hassan
- Department of Human Anatomy, College of Health Sciences. University of Nairobi, P.O. Box 30197. Nairobi, Kenya
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Noorani N, Macharia WM, Oyatsi D, Revathi G. Bacterial isolates in severely malnourished children at Kenyatta National Hospital, Nairobi. East Afr Med J 2005; 82:343-8. [PMID: 16167706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To identify bacterial isolates and determine antibiotic sensitivity pattern in children with severe Protein Energy Malnutrition (PEM) presenting at the Paediatric Filter Clinic (PFC) of Kenyatta National Hospital (KNH). DESIGN Hospital based cross-sectional survey. SETTING Paediatric Filter Clinic of Kenyatta National Hospital (KNH), a tertiary level teaching institution for the University of Nairobi, Kenya. SUBJECTS Children between two and sixty months presenting at the hospital outpatient filter clinic with severe malnutrition. RESULTS Ninety-one children, forty six female and forty five males, were recruited for the study. Of these, sixty had Marasmus, twenty Kwashiorkor and eleven Marasmic-Kwashiorkor. HIV serology was positive in 43% of study subjects. There were 30 bacterial isolates from 26 subjects. Ten bacterial isolates were gram positive and twenty gram negative. Isolation rates did not vary by HIV serological status. Twenty one out of the 30 isolates were from blood culture. About 1/3 of the gram positive isolates were coagulase negative staphylococci, largely resistant to commonly used antibiotics such as Erythromycin, Ampicillin, Cotrimoxazole, Chloramphenicol and even Oxacillin. More than half demonstrated resistance to commonly used oral antibiotics while 80% of all gram positive and negative isolates were sensitive to Ciprofloxacin. Aminoglycosides, Gentamicin and Amikacin, and third generation Cephalosporins, Ceftriaxone and Ceftazidime, were found to be effective against most gram-negative isolates. CONCLUSION Nearly a third (28.9%) of children admitted with severe malnutrition at KNH have concomitant severe bacterial infections; primarily manifesting as bacteraemia. Gram-negative agents are responsible for most severe bacterial infections in children admitted at the KNH, regardless of their HIV serological status. Whenever possible, blood culture should be included in the initial septic screening of severely malnourished children at KNH. In the absence of culture and sensitivity information, ciprofloxacin should be considered among the first line options in the empirical treatment of severe bacterial infections among these children. Clinical trials to further evaluate in-vivo effectiveness of various single or combination antibiotics are recommended.
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Affiliation(s)
- N Noorani
- Kenyatta National Hospital, Nairobi, Kenya
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Abdallah FK, Macharia WM. Clinical presentation and treatment outcome in children with nephroblastoma in Kenya. East Afr Med J 2001; 78:S43-7. [PMID: 11957249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
OBJECTIVE To review the clinical presentation and management of children with nephroplastoma and the factors influencing the outcome at Kenyatta National Referral and Teaching Hospital (KNH). DESIGN This was a retrospective case series study based on secondary data accumulated between 1990 and 1996. SETTING The relevant data were extracted from records of all children aged 12 years and below, admitted for cancer at KNH, Nairobi. RESULTS Out of 803 children with cancer, 71 (8.8%) had histologically proven nephroblastoma. At presentation, 1.5% were in stage I, 13.2% stage II, 36.8% stage III, 41.2% stage IV and 7.4% stage V. Eighty five per cent presented with stage III-V disease. Ninety five per cent had nepherectomy and received chemotherapy. Radiotherapy was given to 50.7% of the patients. Nine patients died before commencement of chemotherapy, two of whom died in the immediate post-operative period. The median duration between admission and surgery was 41 days. Pre-operative chemotherapy was given to 42% of the patients. Approximately 25.5% of the patients received little or no induction chemotherapy due to unavailability of drugs while only 2.8% received the prescribed maintenance treatment with the remainder getting erratic or no treatment. Overall, only 34.7% remained disease free two years from time of diagnosis. CONCLUSION Late presentation, poor availability of cytotoxic drugs and frequent treatment interruptions for various reasons have contributed to the poor outcome of nephroblastoma in Kenya.
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Affiliation(s)
- F K Abdallah
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya
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Murila FV, Macharia WM, Wafula EM. Iron deficiency anaemia in children of a peri-urban health facility. East Afr Med J 1999; 76:520-3. [PMID: 10685324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To ascertain the prevalence of iron deficiency anaemia(IDA) and its risk factors. DESIGN A cross-sectional survey. SETTING A peri-urban health centre in Nairobi, Kenya. SUBJECTS Four hundred and three children, aged six months to six years. INTERVENTION Demographic data were obtained and each child examined for signs of iron deficiency anaemia. Blood was drawn for haemoglobin determination. MAIN OUTCOME MEASURE The diagnosis of iron deficiency anaemia was made using a pre-defined criteria. RESULTS Iron deficiency anaemia had a prevalence of 7.4% (95% CI = 4.8-10.0) and was predominantly mild (93.6%). Age was found to be significantly associated with iron deficiency anaemia with a prevalence of (14.6%) in infants. No association was found between IDA and sex, birthweight, weaning age and weaning diet, sanitation, water source or mother's education. CONCLUSION The prevalence of iron deficiency anaemia in this health facility was relatively low and was predominantly mild.
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Affiliation(s)
- F V Murila
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya
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Macharia WM. Childhood cancers in Kenya. East Afr Med J 1999; 76:1-2. [PMID: 10442138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Munyi ST, Macharia WM, Alwar AJ, Njeru EK. Screening for urinary tract infection in children with cancer. East Afr Med J 1998; 75:264-7. [PMID: 9746994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Neutropaenia and immunosuppression place children on treatment for malignancies at a high risk for infections. We undertook to determine the prevalence of urinary tract infection (UTI) in children on treatment for cancer at the Kenyatta National Teaching and Referral hospital. With the understanding that many laboratories in the rural areas of the country lack appropriate facilities for confirmation of UTI, it was also important to evaluate simple and inexpensive screening methods against a "gold standard" in this cross sectional study. One hundred and eighty six children between the ages of five and 14 years admitted in Kenyatta hospital with leukaemia or lymphoma were enrolled. Besides clinical evaluation, urinalysis and culture and sensitivity were performed on all the subjects. Urine culture was considered the "gold standard" for diagnosis for UTI. The prevalence of UTI was 8.1% (CI = 6.1, 10.1). Only five out of 15 patients were symptomatic. E. coli and klebsiella spp. were responsible for 93.4% of the infections. Presence of pyuria, defined as five or more pus cells per high power field, had a sensitivity of 80.0%, specificity of 97.1% and a positive predictive value of 70.6% while comparative values associated with a positive nitrite test were 60%, 97.7% and 96%. Other clinical and laboratory tests had low sensitivity. UTI is a relatively frequent infection in children on cancer treatment. Screening for pyuria is simple, inexpensive and an accurate method of diagnosing UTI in children on treatment for lymphohaematopoietic malignancies in situations where facilities for urine culture are unavailable.
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Affiliation(s)
- S T Munyi
- Kenyatta National Hospital, Alwar, Nairobi
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Abstract
To identify child feeding behavior and household hygiene practices that are risk factors for prolonged diarrheal illness, a longitudinal community study was conducted over a 14-month period among 920 children aged 3-37 months who lived in an urban slum settlement in Nairobi, Kenya. Morbidity surveillance was done by home visits every third day in the absence of diarrhea and daily during diarrheal illness until termination of the episode. In-home observations were made to characterize maternal hygiene, cooking, and child feeding practices. Overall, 1,496 episodes of diarrhea were detected. The average diarrheal incidence was 3.5 episodes/child-year, and the incidence of diarrhea > 14 days was 3 episodes/100 child-years. Cox regression was used to examine the independent effects of covariates on time to recovery from a diarrheal episode. Adjusted behavioral factors that were observed to influence recovery from diarrhea included: uncovered water containers (rate ratio (RR) = 0.77, 95% confidence interval (CI) 0.64-0.94); giving no fluids (as opposed to oral rehydration solutions (ORS)/sugar salt solutions (SSS)) (RR = 1.42, 95% CI 1.14-1.77); and administration of diluted cow's milk during the first 3 days of an episode (RR = 1.23, 95% CI 1.00-1.52). These associations remained significant after adjusting for diarrheal severity. The authors recommend, among other measures, improvement of water storage and promotion of continued feeding with cereal-milk mix during diarrhea.
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Kariuki N, Macharia WM, Aseso HO. Cardiac abnormalities in children with malignancies at Kenyatta National Hospital. East Afr Med J 1997; 74:702-4. [PMID: 9557440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This was a cross-sectional survey in which 80 children with malignancies were studied at the Kenyatta National Hospital to determine cardiac status before and during cancer therapy. An equal number of age and sex matched subjects admitted to the surgical wards for minor procedures was recruited as a comparison group. All the subjects underwent clinical cardiac assessment. Chest radiographs, electrocardiograms (ECG), echocardiograms, haemograms and renal function tests were also performed. Overall, 13 cases (16.3%) had abnormal cardiac findings compared to 7 (8%) in the comparison group (p = 0.429). Sixteen, two and five subjects had abnormal velocity of circumferential fibre shortening, ejection fraction and pericardial effusion respectively. Three out of the five subjects with pericardial effusion were cancer patients who had not undergone treatment. Mitral valve prolapse with regurgitation was diagnosed in one cancer patient. Though not statistically significant, children with malignancies appear to have a higher frequency of acquired cardiac abnormalities than those without cancers. Since a larger proportion of the abnormalities occurred in cancer children before commencement of treatment, the pathology is more likely to have resulted from the malignancies than therapy. There was no evidence to suggest that cancer treatment contributed to cardiac morbidity. We recommend that all oncology patients undergo cardiac evaluation on admission.
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Affiliation(s)
- N Kariuki
- Department of Paediatrics and Child Health, University of Nairobi
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Macharia WM. Is your patient taking treatment as prescribed? East Afr Med J 1997; 74:537-8. [PMID: 9487425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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39
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Macharia WM, Shiroya A, Njeru EK. Knowledge, attitudes and beliefs of primary caretakers towards sickle cell anaemia in children. East Afr Med J 1997; 74:416-9. [PMID: 9491171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The objective of this study was to evaluate knowledge, attitudes and beliefs (KAB) that may influence health seeking behaviour of caretakers of children with sickle cell disease (SCD). A cross-sectional survey was undertaken at Nyanza provincial hospital in Kenya between March and September 1993 to identify socio-demographic and economic factors that may influence health seeking behaviour of primary caretakers of children with SCD. All caretakers accompanying children under the age of 18 years to the Sickle Cell Clinic were eligible. Guardians accompanying children to the clinic were interviewed using pretested questionnaires. An exploratory factor analysis method was used to categorise questionnaire items into domains (knowledge, attitude and belief) and to investigate for association between certain socio-demographic factors and KAB. Seventy five per cent of the 108 respondents interviewed were mothers and 16.7% fathers. Seventy eight percent knew SCD to be hereditary while 55% knew how the disease presents in childhood. Only 42% associated SCD with increased risk of infection. Many felt severe infections are largely preventable and that prevention would reduce their anxiety and illness related costs. In factor analysis, variables loaded almost exclusively on "Attitudes" and "Beliefs" factors. Only family size was found to influence caretaker attitudes (p = 0.0095) and beliefs (p = 0.0034). Education, monthly income, occupation and religion had no significant influence. The majority of caretakers had good knowledge and positive attitudes towards SCD in children. Interventions aimed at management of SCD or prevention of its sequelae would be well accepted. Factor analysis is recommended for statistical analysis of KAB data. The effect of family size on attitudes and behaviour needs further evaluation.
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Affiliation(s)
- W M Macharia
- Department of Paediatrics and Nairobi Clinical Epidemiology Unit, University of Nairobi, Nairobi
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Macharia WM. Bone involvement in childhood acute lymphoblastic leukaemia. East Afr Med J 1996; 73:772. [PMID: 8997874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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41
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Macharia WM. Childhood cancers in a referral hospital in Kenya: a review. East Afr Med J 1996; 73:647-50. [PMID: 8997844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Following the outbreak of human immune deficiency virus (HIV) infection in the early 1980's, there has been an increase in reported cases of Kaposi's sarcoma, among other childhood malignancies, from the East and Central African region. To assess the status of childhood cancers at Kenyatta National Hospital during the AIDS epidemic period and to compare the findings with those obtained before the outbreak, relevant data were extracted from ward admission registers for all children admitted in the paediatric wards and in whom a diagnosis of a malignant disease was confirmed. The data were summarised in tables and bar charts. The hospital based prevalence for malignant diseases was 1.27% (CI = 1.23,1.31). Lymphoma (51.3%), leukaemia (21.3%), nephroblastoma (8.5%) and rhabdomyosarcoma (5.2%) are the most common childhood cancers. Compared with earlier studies, the frequency of acute lymphoblastic leukaemia, Hodgkin's disease and rhabdomyosarcoma appear to have increased. Despite the AIDS epidemic, there has been no obvious increase in number of cases of Kaposi's sarcoma.
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Affiliation(s)
- W M Macharia
- Department of Paediatrics, Unversity of Nairobi, Kenya
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42
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Macharia WM. Comparison of prognostic determinants in childhood acute lymphoblastic leukaemia in negroid and Caucasian populations. East Afr Med J 1996; 73:638-42. [PMID: 8997842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The response of acute lymphoblastic leukaemia (ALL) to treatment remains very low in developing countries. Many factors have been cited to be probable determinants of prognosis. To compare the prognostic determinants of childhood ALL in developed Western countries and developing African countries, a review of published data was carried out. Both an electronic and manual search were undertaken. The manual search was confined to four leading African journals. All articles were subjected to an eligibility criteria. The proportions of six prognostic factors were either extracted from the original publications or calculated from available published data. A pooled proportion was computed and 95% confidence intervals calculated and compared. Eleven articles fulfilled the inclusion criteria. One article with nineteen study subjects was available on black African population. Six articles from developed countries were excluded. The proportions of children below the age of two years or above the age of nine years constituted 26% (CI = 0.24,0.28) and 37% (CI = 0.15,0.59) in developed countries and the Black African population respectively. There was a statistically significant higher population of children with high total WBC count in African children compared to developed countries. Proportions for other factors in developed countries and developing countries respectively were as follows: T-cell immunophenotype (17% and 60%), FAB-L2, L3 (15% and 83%), CNS involvement (5% and 13%) and mediastinal shadows on CXR (8% and 13%). It is concluded that there is a need for basic epidemiologic research on childhood ALL in African countries. The frequency of poor prognostic determinants for ALL in developing African countries is higher than in developed countries.
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Affiliation(s)
- W M Macharia
- Department of Paediatrics, University of Nairobi, Kenya
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Macharia WM. Highlight on childhood lymphomas. East Afr Med J 1996; 73:341-2. [PMID: 8840590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Macharia WM, Anabwani GM, Owili DM. Clinical presentation of atopic dermatitis in Negroid children. Afr J Med Med Sci 1993; 22:41-4. [PMID: 7839928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Clinical findings in 54 consecutive negroid children with atopic dermatitis (AD) are presented. The age range was 0.25 to 10.25 years. Male:Female ratio was 1.2:1. Time of onset range between 1 week and 8 years with onset before the age of 1 year in 81.1%. Facial and flexural involvement were observed in 81.5% and 70.4% of patients respectively. The latter was more common after the age of two years. Keratosis pilaris, repeated skin infections and ichthyosis were observed in 72, 45, and 40 per cent of the children. Allergic conjunctivitis was present in 11.8%. The findings suggest that the clinical presentation of AD in Negroid children is similar to that in white children.
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Affiliation(s)
- W M Macharia
- Department of Paediatrics, University of Nairobi, Kenya
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45
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Affiliation(s)
- B J Stephenson
- Design, Measurement, and Evaluation Program, McMaster University, Hamilton, Ontario, Canada
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46
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Affiliation(s)
- W M Macharia
- Design, Measurement, and Evaluation Program, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Abstract
There is little published literature on the effects of skin contactants during early infancy on eventual development of atopic dermatitis (AD). The purpose of this study was to determine whether or not a relationship exists between the use of skin care products in early infancy and the subsequent development of AD. We studied a group of 54 Kenyan children with AD and 63 age and sex matched controls. Emollients had been used to lubricate the skin during early infancy in a similar proportion of children in both groups (odds ratio = 0.33; 95% CI = 0.14, 0.80). Similarly, no association was found between the use of toilet soaps or laundry detergents in early infancy and development of AD. These findings suggest that baby soaps and vaseline petroleum jelly can safely be used in the skin care of AD susceptible individuals.
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Affiliation(s)
- W M Macharia
- Department of Paediatrics, University of Nairobi, Kenya
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48
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Macharia WM, Mirza NM, Wafula EM, Onyango FE. Childhood asthma at Kenyatta National Hospital, Nairobi. East Afr Med J 1990; 67:837-41. [PMID: 2083517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Between January 1986 and July 1988, 356 children with bronchial asthma below 14 years of age were evaluated at the Kenyatta National Hospital. 21.3% experienced initial asthmatic attacks before the age of six months and 55.1% before 2 years. Only 8% of the study patients were below the age of 2 years at recruitment. The male:female ratio was 1:1. Physical exercise led to precipitation or worsening of attacks in 43.4% while 71.6% of the patients experienced attacks in the evening or at night. 18.5% and 42.9% had personal history of atopic dermatitis and allergic rhinitis respectively. The study shows that a substantial number of patients experience initial asthmatic attacks before the age of 6 months contrary to what has been previously believed.
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Affiliation(s)
- W M Macharia
- Department of Paediatrics, University of Nairobi
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49
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Wafula EM, Onyango FE, Mirza WM, Macharia WM, Wamola I, Ndinya-Achola JO, Agwanda R, Waigwa RN, Musia J. Epidemiology of acute respiratory tract infections among young children in Kenya. Rev Infect Dis 1990; 12 Suppl 8:S1035-8. [PMID: 2270401 DOI: 10.1093/clinids/12.supplement_8.s1035] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The epidemiology of acute respiratory tract infection (ARI) was investigated in a rural community 80 km north of Nairobi, Kenya. This research was conducted prospectively on 250 families with 470 children less than 5 years of age who were contacted every 8 days during the 3-year study. The yearly incidence of respiratory tract infections decreased from 5.2 to 3.4 during the study; less than 5% of these infections involved the lower respiratory tract. The incidence was inversely related to age, and the illnesses were generally mild and brief in length. Fifteen children died during the study period. The precise causes of death are unknown, but respiratory infections possibly played a role in most cases. This study emphasizes the importance of determining the risk factors responsible for unusually severe morbidity and high mortality in children with ARI in developing countries.
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Affiliation(s)
- E M Wafula
- Department of Paediatrics, University of Nairobi, Kenya
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50
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Mirza NM, Macharia WM, Wafula EM, Agwanda R, Onyango FE. Mortality patterns in a rural Kenyan community. East Afr Med J 1990; 67:823-9. [PMID: 2076684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Causes of death of 239 children below the age of 5 years in a rural community were determined using structured questionnaires. It was found that mortality was highest in infancy, accounting for 63% of all deaths with a trend of decreasing mortality with increasing age. The commonest cause of death was ARI (pneumonia and measles) accounting for 49% of the deaths, followed by diarrhoeal illnesses (8.8%). Only half of the deaths (51.5%) occurred at some health facility, though 77% of all children had been taken to a health facility for treatment during the fatal illness.
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Affiliation(s)
- N M Mirza
- Department of Paediatrics, College of Health Sciences, University of Nairobi
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