Knowledge and practice of community and facility health workers in case management of diarrhea in Langas Estate, Kenya

Background: Acute childhood diarrhoeal diseases cause about 1.87 million deaths among children below five years, but the majority of the deaths are preventable through the implementation of case management guidelines. Despite the existence of evidence-based guidelines, mortality from diarrhoea remains high, begging the question of whether healthcare workers adhere to the guidelines.Aim: To describe the knowledge and practice of community and facility healthcare workers concerning case management of diarrhea.Methodology: A descriptive cross-sectional study carried out in Langas Estate and Moi Teaching and Referral Hospital, Eldoret, Kenya. The study population comprised of 11 Community health workers and 13 Facility healthcare workers.Analysis: Data was summarized using frequency and presented in tables, bar graphs, and pie charts. Statistical difference was calculated using Pearson's Chi-square or Fisher's exact test.Results: All the Community Health Workers knew that diarrhoea should be treated with ORS. None of them knew that all children with diarrhoea should receive zinc. None of the CHW knew all the steps in the preparation and administration of ORS. Nine (69.2%) of facility health workers had received training in case management of diarrhoea, but only 53.8% knew all the four major symptoms to assess. Treatment and referral of a child with diarrhoea was known by 69.2% and 23.1, respectively. Correct classification of diarrhoea, prescription of antibiotics, ORS and zinc, were found in 37.5%, 87.5%, 66.7%, and 50% cases, respectively.Conclusion: Community and facility healthcare workers do not adhere to case management guidelines, which could be contributing to increased mortality

Opsoclonus myoclonus syndrome in a two-year-old girl: A case report

Opsoclonus Myoclonus Syndrome (OMS) is a rare disease that presents with disturbance in gait, muscle spasms, and irregular eye movements. and whose diagnosis and treatment can be challenging in a resource-constrained setting. This is a report of possibly the first documented childhood OMS in Kenya. The diagnosis is was challenging but successful treatment was achieved in a resource-constrained setting

Factors that precipitate heart failure among children with rheumatic heart disease

Objective: To identify factors that precipitates heart failure in children with rheumatic heart disease.Design: a descriptive cross-sectional study.Setting: Paediatric wards at the Moi Teaching and Referral Hospital.Subjects: Children with Rheumatic heart disease admitted for in-patient care due to decompensated heart failure.Results: A total of 33 patients were studied, thirty two of whom were in the New York Heart Association (NYHA) class IV and one in class III. Non-compliance to antifailure therapy was the most common precipitating factor occurring in 87.9% cases.Arrhythmia, recurrent rheumatic fever, pneumonia, infective endocarditis, anaemia and overexertion were identified as other precipitating factors. Seventy percent of the patients did not adhere to secondary prophylaxis against rheumatic fever.Conclusion: Non compliance to anti-failure therapy was the most common precipitating factor

Community acquired pneumonia among children admitted in a tertiary hospital: The burden and related factors

Objective: To find out the hospital burden of pneumonia and preventable factors associated with the disease.Design: Prospective cross sectional study.Setting: The paediatric ward of Moi Teaching and Referral Hospital in Western Kenya.Subjects: All the children admitted to the paediatric wards and found to have clinical features consistent with pneumonia.Results: One thousand eight hundred and eighty two children were included in the study out of whom pneumonia was responsible for 13.23% and 5.5% of all deaths. Degree of severity was used to classify patients into mild pneumonia, severe pneumonia and very severe pneumonia each group comprised 12%, 70% and 18% respectively. Parents in age group 21 to 25 years (OR 2, CI 1.07 – 3.63) and use of firewood /charcoal (OR 4.23, CI 3.9 – 4.6) were risk factors for mild pneumonia. Unemployment (OR 2.7, CI 2 – 3.2), age group 21 to 25 years (OR 4, CI 1.2 – 6.4) and use of firewood/charcoal (OR 1.1, CI 1.02 – 1.26) were risk factors for severe pneumonia.Conclusion: Pneumonia accounted for less number of admitted children compared to previous study. Use of firewood or charcoal as source of fuel and mothers in age group 21 – 25 years were independent risk factors for mild pneumonia and severe pneumonia

EFFECT OF CATHA EDULIS (KHAT) ON BEHAVIOUR AND ITS POTENTIAL TO INDUCE SEIZURES IN SPRAGUE DAWLEY RATS

Background: Khat is a plant whose young shoots and leaves are habitually used in Eastern Africaand the Arabian Peninsula as a drug of recreation. Although it is used without any control in theseregions, it contains two controlled substances, cathinone (schedule I) which is present in fresh khatand cathine (schedule VI) which is a degradation product of cathinone abundant in old khat.Objective: To determine the effect of khat on locomotor behaviour and seizures in rats.Design: Experimental study.Setting: University of Nairobi.Subjects: Adult male rats in groups of six were given fresh khat, old khat, methylphenidate andsaline at varying doses and observed over three hours.Results: Fresh khat at low doses and old khat at high doses stimulated locomotor activity. Highdoses of fresh and old khat induced stereotype behaviour and seizures.Conclusion: The results show that khat stimulates locomotor and stereotypic behavioural activityand can induce seizures; results similar to those observed with amphetamine analogs

Bacteriological profile of expressed breast milk at the newborn unit of Moi Teaching and Referral Hospital, Eldoret Kenya

Background: Expressed breast milk (EBM) is defined as milk removed from a mother’s breast without an infant's mouth at her nipple. Mothers breast milk is not sterile and can be a vehicle for commensal and pathogenic microorganisms derived from the mother or the newborn unit environment leading to neonatal sepsis, a leading cause of neonatal mortality. Knowledge of the contaminants is of importance in trying to establish enhanced safety of the breast milk. Objectives: The aim of this study was to ascertain the prevalence and common bacterial contaminants of EBM. Design: A descriptive cross sectional Setting: Newborn Unit of Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Participants: The study randomly sampled 170 mothers with babies admitted at the Newborn Unit of MTRH, expressing breast milk for the purpose of feeding their newborns Interventions: Collected breast milk samples were subjected to laboratory analysis, including culture, microbiology and biochemical tests. Outcome measures: contamination was defined as the presence of any type of bacteria while acceptable contamination was defined as Colony Forming Units of less than 1.0x104 /ml. Results: 78.2% (n=133) of the EBM samples had bacterial contamination. The bacterial contaminants isolated include Staphylococcus epidermidis (54.9%), Staphylococcus aureus (42.1%), Staphylococcus saprophyticus (2.3%), and Enterococcus sp. (0.8%). The CFU/ml on all the samples were less than 1.0x104 /ml and, therefore, within acceptable limits. Multivariate analysis of both neonatal and maternal factors revealed, there was no statistically significant association with bacterial contamination of EBM (p>0.05). Conclusion: A significant proportion of the EBM at the NBU of MTRH has bacterial contamination but within acceptable limits. There was no statistically significant association between contamination and factors considered in this study

Effect of catha edulis (Khat) on behaviour and its potential to induce seizures in sprague dawley rats

No Abstract. East African Medical Journal Vol. 84 (5) 2007: pp. 219-22