Treatment of chronic heart failure in adults at a referral hospital in Kenya: adverse drug reactions and determinants of adherence

Background: Chronic Heart Failure is a major health problem with a prevalence of between 1 and 12% in USA and Europe, and approximately 5.7% in Sub-Saharan Africa, and has socio-economic relevance owing to its high prevalence, mortality and impact on young economically active individuals. In 1999 chronic heart failure constituted 3.3% of all medical admissions at Kenyatta National Hospital. Objective: The purpose of the current study was to determine factors that affect adherence to treatment among patients with Chronic Heart Failure at Kenyatta National Hospital and assess any association between any such factors Methodology: This was a descriptive cross-sectional study involving patients >18 years diagnosed with Chronic Heart Failure at Kenyatta National Hospital. Eighty three eligible and consenting study participants were recruited into the study using a convenient sampling technique. Data were collected by means of an interviewer administered questionnaire adapted from the Revised HF Adherence Questionnaire. Results: Data from 83 patients was analyzed majority (n=51, 61.4%) of whom were women. The age of the patients ranged from 18 to 80 years with the majority (n= 37, 44.6%), between 21-40 years. Majority (n=58, 68.9%) of the patients considered appointment keeping, compliance to medication (n= 64, 77.1%), dietary restriction (n=59, 72%), regular exercise (n=49 59.0%), smoking cessation (n=59, 71%), and alcohol cessation (n=58, 69.9%) as very important. Fifty three (63.9%) respondents had not failed to take their medicines at any time.  Majority (n=72, 86.8%) of the study participants were aware of the disease condition they were suffering from while valvular heart disease was the commonest comorbidity (n= 17 27.9%). The study revealed an association between sex and some adverse drug reactions using Pearson χ² test through bivariate analysis. Sleep disturbances and nausea occurred more in males than females while headache and drowsiness were more prevalent in females and in both cases the relationships were statistically significant (p< 0.05) Conclusions: Adherence to medicines among patients with Chronic Heart Failure is reasonably high at Kenyatta National Hospital despite patients’ knowledge level about the condition being generally low. Valvular heart disease was the most common comorbidity while hyponatremia was the most prevalent electrolyte disturbance, and tachycardia, vomiting and rash the most common adverse drug effects. Key words Chronic heart failure; adherence; compliance; adverse drug reactions

Predictors of non-adherence to antihypertensive therapy in a rural health facility in Kenya

Background: The effectiveness of antihypertensive medicines depends on whether the patient uses the drugs as instructed by the health care provider. Failure to adhere to therapy may lead to uncontrolled blood pressure and possibly preventable complications. The factors which may impact on adherence to medicines among patients in rural health facilities have not been adequately documented. Objective: To determine the predictors of non- adherence to antihypertensive therapy in Murang’a South Sub-county Hospital. Methods: A descriptive cross-sectional study design was used. One hundred and sixty-seven adult hypertensive patients who were on therapy at Murang’a South Sub-county Hospital were included. Participants who satisfied the inclusion criteria were selected using simple random sampling. Data was collected using a researcher administered questionnaire. Analysis was carried out using STATA version 14 statistical software and p</=0.05 was considered statistically significant. Permission to conduct the study was granted by the Kenyatta National Hospital-University of Nairobi Ethical and Research committee and the management of the hospital. Results: There was female predominance (124, 74.3%).One hundred and twelve (67.5%) participants were adherent to medications. The independent predictors of non-adherence were; lack of finances (p=0.000), inadequate knowledge on treatment (p=0.005), long duration of treatment (p=0.001), forgetfulness (p=0.003), side effects of drugs (p=0.019) and fear of dependence (p=0.008). Conclusion: Patient factors were major contributors to non- adherence. Clinicians should be encouraged to provide adequate counseling to improve adherence. Keywords: adherence, antihypertensive therapy, predictor

Impact of depression on adherence to antiretroviral therapy among HIV/AIDS patients at a Kenyan referral hospital

Background: Kenya is faced with an increasing challenge of co-morbid psychological and social factors among HIV-Infected patients which has had a profound impact on their medication adherence. A major psychosocial factor that is a barrier in adherence is depression associated with HIV. This study aimed at measuring the effect of depression on participants’ own reported adherence to antiretroviral therapy. Objectives: To determine the impact depression has had on adherence to antiretroviral therapy among HIV-infected patients at a Kenyatta Hospital. Methodology: A cross-sectional study design was carried out at Kenyatta National Hospital, Nairobi, Kenya. Three hundred and eighty four (384) HIV infected participants were assessed for HIV related depression and adherence to ART. Levels of HIV related depression and adherence to ART were ascertained. Results: The prevalence of depression was 23.3 %.  The prevalence of mild, moderate and severe depression was 21.2 %, 1.8 % and 0.3 % respectively. The mean non adherence and average mean adherence rate were 27.9 % and 22.4 % respectively. Conclusion: There was a minimal relationship between depression and non-adherence to antiretroviral therapy among adult HIV infected patients. Depression was not statistically significantly associated with adherence to antiretroviral therapy. Key words: Depression, adherence, antiretroviral therap

Using mobile devices in the Bachelor of Nursing Sciences blended program at University of Nairobi: student perceptions and experiences

Centre for Health Professions Educatio

Determinants of Adherence to Anticonvulsants Therapy among Outpatient Epileptic Children in a Kenyan Referral Hospital

Background: Epilepsy is a chronic disease requiring prolonged adherence to treatment. Adherence to anticonvulsants by epileptic children is important as studies have shown that about two-thirds of epileptic children can be completely freed from seizure if they persistently adhere to treatment for a period of 2-5 years.  Conversely, non-adherence to anticonvulsants may lead to increased frequencies of status epilepticus and sudden unexplained death from epilepsy. There is scant literature on factors impacting on the adherence to anticonvulsants among children. Objectives: To determine rate of adherence and parents/caregivers’ factors influencing adherence to anticonvulsants among outpatient epileptic children attending neurology clinic. Methods: Cross-sectional study design was carried out at Kenyatta National Hospital from May to July 2014. Systematic sampling was used to recruit a sample of 176 parents/guardians of children with epilepsy. Predesigned questionnaires and Morisky tool for assessing medication adherence were used to capture participant’s socio-demographics and factors impacting on adherence to antiepileptics.  Data were analysed using STATA software version 10.  Discrete variables were summarized with frequencies and percentages while continuous variables were summarized using measures of central tendency and dispersion. Results: The rates of adherence, when classified in terms of high, medium and low, were 36.9 %, 39.8 % and 23.3 %, respectively.  Adherence rate was associated with parents/guardian marital status (Adjusted OR= 5.72, 95% CI= (1.50, 21.78), p=0.01) and education level (Adjusted OR=5.16, 95% CI= (1.88, 14.02), p< 0.01). Unavailability and inaccessibility of drugs were also shown to influence adherence. Conclusion: Adherence to antiepileptic medication was poor.  This was partly due to parents/guardian’s related factors.  Health care workers should explore ways and means of minimising these factors to improve on adherence. Key words: Adherence, anticonvulsants, epilepsy, children

Effect of Pesticide Exposure on Serum Cholinesterase Levels among Asthmatic Children in Naivasha Sub-County, Kenya

Background: Pesticide exposure is a risk factor for asthma exacerbations in flower farm regions in the world.  Data on levels of serum cholinesterase among asthmatic children exposed to pesticides in Kenya is scanty. Objectives: To compare and identify variables which affect the concentration of serum cholinesterases in children who are exposed and unexposed to pesticides. Methodology: The design was a comparative cross-sectional study that involved exposed and unexposed children.  The study was conducted between May and July, 2014 in Naivasha, Kenya.  Patients were interviewed and serum samples were analysed for cholinesterase levels.  Multi-linear regression was done to identify variables that affected cholinesterase activity. Results: Children who were exposed to pesticides had a lower median ChE activity of 5828 [IQR 4863, 6443] compared to the unexposed arm whose median was 7133 [IQR 6063, 8179].  Five predictor variables were found to be significantly associated with depression of serum cholinesterase levels.  The most important predictor variable for the levels of ChE in children, was not using protective clothing by the parent [adjusted β -1457.0 (95% CI - 2594, 1319.8)].  Others were not using household pesticides [adjusted β 96.3, (95% CI 22.6, 170.0)], female sex [adjusted β -695.7 (95% CI -1296.2, - 95.3)], non school attendance [adjusted β -1676.8 (95% CI -3371.6, 18.1)] and not taking a break after spraying [adjusted β 1105.5 (95% CI (315.0, 1895.2)]. Conclusion: Children who were exposed to pesticides had low cholinesterase levels. Parents should therefore be encouraged to wear protective gear as this conferred protection of children from the effects of pesticide exposure. Key words: asthma, exposure, children, pesticides, cholinesterase