Management of Type 2 Diabetes at Vihiga County referral hospital, Kenya: compliance with guidelines and prevalence of complications

Background: In 2013, 382 million people suffered from diabetes globally, with 19.8 million in Africa and a Kenyan prevalence of 4.2%. Poor diabetic related outcomes such as complications, high blood sugar levels have resulted due to inadequate management of the condition. To ensure effective diagnosis, management and monitoring of Type 2 diabetic patients, the healthcare team should adopt and adhere to standard treatment guidelines that are valid and up-to date Objective: To assess the management, monitoring and complications of Type 2 diabetes among adult outpatients at Vihiga County Referral Hospital, Kenya. Methodology: A retrospective cross sectional study design was used to obtain data from 212 patient files selected through a systematic random sampling. Using a pre-designed data collection form, data on patient demographics, blood pressure, blood sugar, weight and complications was collected. Descriptive statistics were used to summarize findings to determine the proportion of adult Type 2 diabetic cases diagnosed, managed and monitored as per the Institute of Clinical Systems Improvement (ICSI) guidelines. Inferential analysis using t-test and chi square test were also carried out to ascertain extent of adherence to the guidelines. Results: Majority of the participants (31.1%) were aged 50 – 59 years (31.1%), and most were female (70.3%). Most, 39.6% had had diabetes for 1 to 5 years. Random blood sugar test was the most used method of diagnosis (58.5%) whilst fasting blood glucose test was performed in 34%. A compliance rate of 72.2% was reported in ensuring metformin was part of first line therapy as recommended. The recommended blood pressure, weight and cholesterol monitoring at initiation of treatment was observed in 96.7, 1.4 and 6.1% of the patients, respectively. Of the 141 patients monitored using fasting blood sugar, 113 (80.1%) had uncontrolled blood sugar levels (median blood sugar = 8.9(IQR.7.4, 12.75) mmol/L; P=0.741). The prevalence of reported neuropathy, retinopathy and nephropathy were 41, 33 and 0.9% respectively. Discussion: The diagnosis, management and monitoring of most patients fell short of the ICSI treatment guideline recommendations especially to monitoring of blood sugar, lipid levels and weight. The presence of anomalies calls for sensitization of healthcare workers on the importance of adoption and adherence to evidence based, up to date treatment guidelines and optimize patient health outcomes. Key words: Type 2 diabetes, treatment guidelines, healthcare provider

Antimicrobial susceptibility of bacteria that infect diabetic foot ulcers at Kenyatta National Hospital, Kenya

Background: Diabetic foot ulcers are prone to bacterial infection and this forms the major cause of hospital admission among patients with diabetes. Local bacterial sensitivity patterns to antimicrobials used to treat the infections is necessary in guiding drug selection for prompt management of the diabetic foot infections. Objective: To determine the etiology and antimicrobial sensitivity patterns of bacteria that infects diabetic foot ulcers at Kenyatta National Hospital. Methodology: A cross- sectional study was carried out on 75 adult diabetic patients attending Kenyatta National Hospital.  The patients were selected by convenient sampling and data obtained via a questionnaire and antimicrobial susceptibility determination of bacteria from the diabetic foot ulcers using disk diffusion method. Results: A total of 85 bacterial isolates were identified with Staphylococcus aureus (37.3%), Proteus spp (21.3%) and Klebsiella spp (14.7%) as the most prevalent organisms.  Among the Staphylococcus aureus, 39.3% were methicillin resistant. All the bacteria were sensitive to imipenem.   Gram positive and negative bacteria were sensitive to ciprofloxacin and piperacillin-tazobactam, respectively. Varied sensitivities to commonly used antibiotics: amoxicillin-clavulanate, meropenem, clindamycin, ceftriaxone, piperacillin-tazobactam and ciprofloxacin to different isolates are reported. Conclusion: In Kenyatta National Hospital, diabetic foot ulcers are infected with both gram negative and positive bacteria that are highly sensitive to imipenem. This study recommends the initiation of empirical antibiotic therapy with imipenem for moderate to severe diabetic foot infections as culture and sensitivity tests to determine more specific antimicrobials are awaited. Key words: Antimicrobial, Antimicrobial susceptibility, Diabetic foot ulcers

Accessibility of medicines used in the management of substance use disorders in selected hospitals in Nairobi

Background: Substance use disorder is a complex chronic disease that requires a multidisciplinary approach in treatment. Pharmacotherapy is one of the components in the treatment of this condition. This study sought to assess the accessibility of medicines used in the treatment of substance use disorders in both a public and a private health facility in Nairobi. Methodology: This descriptive cross-sectional study with both qualitative and quantitative components was carried out in April and May 2015 at two hospitals in Nairobi, Mathare Mental Hospital (public) and Chiromo Lane Medical Centre (private).  Data on availability and affordability was collected from the two sites and the WHO performance indicators for health facilities used to assess availability. Affordability was determined using the daily wage of the lowest paid government worker. Interviews with the key informants were conducted to determine factors that influence the accessibility of the medicines. Results: About 50% of medicines on the Kenya Essential Medicines List for management of substance use disorders were available in Mathare while Chiromo Lane had all of them. The mean stock out duration was 8 months and 0.5 months in Mathare and Chiromo Lane, respectively.  More than 67 % of the medicines required less than a single day’s wage to buy a month’s supply in Mathare while in Chiromo Lane all the medicines required more than a single day’s wage to purchase.  The cheapest medicine required 0.3 days wage to purchase while the most expensive drug required 50 days wage to purchase. Conclusion: Medicines for the treatment of substance use disorders had limited availability but were relatively affordable in Mathare while their availability was better in Chiromo Lane but with limited affordability.  The Kenya Essential Medicines List for substance use disorders requires updating to include newer and more efficacious medicines. National guidelines for the treatment of substance use disorders should be developed and disseminated. Key words: Substance use disorders, pharmacotherapy, accessibility and affordabilit

Quality Control Report of Drugs Analyzed in the Drug Analysis and Research Unit during the Period 2011-2015

During the period 2011-2015, the Drug Analysis and Research Unit (DARU) analyzed 1972 drug samples. The samples consisted of 21.5% locally manufactured and 78.2% imported products while the origin of 0.3% of products was indeterminate. Samples were subjected to compendial and/or in-house analytical specifications. The overall non-compliance rate was 4.5% comprising 2.5% local products and 2.0% imports. High failure rates were recorded for uterotonics (37.5%), hemostatics (33%), anthelmintics (17%) and anticancers (10.5%) while ophthalmic, immunomodulatory, musculoskeletal and endocrine drugs all complied with the quality acceptance criteria. Erectile dysfunction drugs, received by the laboratory for the first time, all complied with specifications. The results obtained demonstrate an improvement in the quality of samples submitted to DARU when compared to previous performance

Combined Antibacterial and Antifungal Activities of Eucalyptus citriodora and Syzygium aromaticum Essential Oils

Background: The increasing proportion of skin infections encountered in general practice represents a substantial level of morbidity. The emergence of multi-drug resistant strains is a formidable threat to the fight against skin diseases and hence alternative forms of treatment are essential. Syzygium aromaticum and Eucalyptus citriodora oils as single entities have demonstrated potency against some of the concerned micro-organisms and any synergistic activity between the two oils could minimise development of resistance by the microorganisms to the two oils. Objective: The aim of this study was to evaluate for synergism between Eucalyptus citriodora and Syzygium aromaticum essential oils against selected pathogenic microorganisms of the skin. Materials and methods: Eucalyptus citriodora (eucalyptus oil) and Syzygium aromaticum (clove oil) essential oils were used in this study. In-vitro antimicrobial activities of Sysygium aromaticum and Eucalyptus citriodora oils, alone and in combination were tested against Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa, E. coli ATCC 25922, MRSA, Candida albicans, Trichophyton mentagrophytes, Microsporum gypseum and Cryptococcus neoformans. Results: The combination of the two oils exhibited synergistic activity against Staphylococcus aureus (FICI: 0.240), E. coli (FICI: 0.54), MRSA (FICI: 0.48), and Microsporum gypseum (FICI: 0.36) while the combination exhibited additive activity against Candida albicans (FICI: 2.04). Conclusion: The combination of clove and eucalyptus oils possesses synergistic activity against most of the test pathogens and therefore may be combined for enhanced antimicrobial activity against a wide range of skin disease-causing microorganisms. Keywords: antifungal, antibacterial, synergism, Eucalyptus citriodora, Syzygium aromaticum, essential oil

Combined Antibacterial and Antifungal Activities of Eucalyptus citriodora and Syzygium aromaticum Essential Oils - Supporting Information

Background: The increasing proportion of skin infections encountered in general practice represents a substantial level of morbidity. The emergence of multi-drug resistant strains is a formidable threat to the fight against skin diseases and hence alternative forms of treatment are essential. Syzygium aromaticum and Eucalyptus citriodora oils as single entities have demonstrated potency against some of the concerned micro-organisms and any synergistic activity between the two oils could minimise development of resistance by the microorganisms to the two oils. Objective: The aim of this study was to evaluate for synergism between Eucalyptus citriodora and Syzygium aromaticum essential oils against selected pathogenic microorganisms of the skin. Materials and methods: Eucalyptus citriodora (eucalyptus oil) and Syzygium aromaticum (clove oil) essential oils were used in this study. In-vitro antimicrobial activities of Sysygium aromaticum and Eucalyptus citriodora oils, alone and in combination were tested against Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa, E. coli ATCC 25922, MRSA, Candida albicans, Trichophyton mentagrophytes, Microsporum gypseum and Cryptococcus neoformans. Results: The combination of the two oils exhibited synergistic activity against Staphylococcus aureus (FICI: 0.240), E. coli (FICI: 0.54), MRSA (FICI: 0.48), and Microsporum gypseum (FICI: 0.36) while the combination exhibited additive activity against Candida albicans (FICI: 2.04). Conclusion: The combination of clove and eucalyptus oils possesses synergistic activity against most of the test pathogens and therefore may be combined for enhanced antimicrobial activity against a wide range of skin disease-causing microorganisms. Keywords: antifungal, antibacterial, synergism, Eucalyptus citriodora, Syzygium aromaticum, essential oil

Antibacterial and Antifungal Activity of Dombeya torrida (J.F. Gmel) and Hydnora abyssinica (A. Braun)

Background: The decoction of Dombeya torrida bark is used to treat indigestion while its roots are used for treatment of chest pains and colds. Hydnora abyssinica decoction is used as a cure for throat complaints, as an astringent in dysentery, for treatment of typhoid, anthrax, and East Coast Fever. Objectives: The present study was aimed at investigating the antibacterial and antifungal activities of D. torrida and H. abyssinica. Methodology: The D. torrida stem-bark and leaves and H. abyssinica whole plant were collected from Kiambu County and Embu County, respectively. Extraction of the plants was carried out using chloroform, methanol and water. The extracts were screened for activity against Staphylococcus aureus, Staphylococcus epididermis, Bacillus pumilus, Escherichia coli, Saccromyces cerevisiae and Candida albicans using agar diffusion assay and autobioassay. Results: Dombeya torrida bark decoction had the highest activity against S. aureus with an inhibition zone diameter of 16.91 mm. Hydnora abyssinica macerate had least activity against S. aureus with a zone diameter of 8.86 mm. Dombeya torrida bark decoction had the highest activity against S. Epididermis with a diameter of 17.05 mm with Hydnora abyssinica macerate having the least activity. Activity against E. coli was highest for D. torrida bark decoction with zone diameter of 16.56 mm. Hydnora abyssinica chloroform extract had the highest activity against B. pumilus with a zone diameter of 17.04 mm. The highest activity observed against S. cerevisiae was with D. torrida chloroform extract with a zone diameter of 17.69 mm with H. abyssinica macerate having the least activity (7.70 mm). Dombeya torrida chloroform extract was the most active extract against C. albicans with a zone diameter of 20.09 mm. Conclusion: The plants under study, D. torrida and H. abyssinica were chosen on the basis of folklore. Above results support the folklore that H. abyssinica is used as a cure for throat complaints, as an astringent in dysentery, treatment of diarrhoea and amoebic dysentery. Results of D. torrida extracts also supports its folklore use to treat chest pains and colds as many of these conditions are usually caused by bacterial infections. Keywords: antibacterial, antifungal, Dombeya torrida, Hydnora abyssinica, autobioassa