An echo cardiographic evaluation of pulmonary pressures in hemodialysis patients at Kenyatta National Hospital, Nairobi, Kenya

Background. A high prevalence of pulmonary hypertension (PH) in patients with end-stage renal disease (ESRD) has been noted. In these patients, PH increases morbidity and mortality and worsens prognosis post-renal transplant. Its aetiopathogenesis may be multifactorial, involving the process of hemodialysis itself.Objective. To determine the prevalence of PH among patients with ESRD undergoing hemodialysis at Kenyatta National Hospital (KNH), using Doppler echocardiography.Design. 117 patients were consecutively recruited into this cross-sectional study. Medical history was used to exclude patients with possible PH of known aetiology. Patients were examined for features of fluid overload. Each patient then underwent hemodialysis followed by echocardiography within two hours. Hemoglobin was measured.Setting. The Renal Unit, KNH, a tertiary hospital in NairobiSubjects. Patients undergoing regular hemodialysis within the renal unit, thirteen years and above, who gave written informed consent or assent.Results. 63.2% of the participants were male. Mean age was 44 years. Prevalence of PH among ESRD patients was 32.5%, with a median PASP of 47.3mmHg and a range of 36.1–79 mmHg. A strong association between PH and EF of less than 50%, as a marker of LV dysfunction, was demonstrated.Conclusion. The prevalence of PH among end-stage renal disease patients was high. This suggests an indication for routinely screening hemodialysis patients for PH

Healthy Heart Africa-Kenya: A 12-Month Prospective Evaluation of Program Impact on Health Care Providers\u27 Knowledge and Treatment of Hypertension

Background: Given the rising burden of hypertension in Africa, the Healthy Heart Africa program was developed to improve access to quality hypertension care in the primary care setting. The Healthy Heart Africa program provides a comprehensive, coordinated intervention directed at health care providers (HCPs) and the general public. Objective: The impact of Healthy Heart Africa on HCPs\u27 knowledge of hypertension and facility-level services in Kenya was evaluated by a 12-month prospective study. Methods: Intervention facilities were selected by stratified random sampling and matched to similar control facilities. Intervention facilities received a hypertension treatment protocol, equipment, training and patient education materials, and improved medical supply chain, whereas control facilities did not. HCPs responsible for hypertension care were surveyed at baseline and 12 months later. Hypertension screening and treatment data were abstracted from service delivery registers. A differences-in-differences analysis estimated the impact of Healthy Heart Africa on HCPs\u27 knowledge, hypertension services, and the number of patients diagnosed with and seeking treatment for hypertension. Results: Sixty-six intervention and 66 control facilities were surveyed. Healthy Heart Africa improved HCPs\u27 knowledge of ≥5 hypertension risk factors and ≥5 methods for reducing/managing hypertension but not hypertension consequences. At end line, more intervention than control facilities measured blood pressure more than once during the same visit to diagnose hypertension, dedicated days to hypertension care, used posters to increase hypertension awareness, and provided access to hypertension medications. The number of patients diagnosed with hypertension and those seeking treatment for hypertension increased with intervention, but the change was not significant relative to control subjects. Conclusions: HCP-directed hypertension education and provision of basic resources positively influenced hypertension care in Kenya in the first 12 months of implementation

Differences in bedding material could alter the growth performance of White Pekin ducks raised for 42 days

The effect of different commercially available bedding materials on the growth performance and carcass characteristics of ducks for 42 days was investigated. 336 one-day-old White-Pekin ducklings (60.48 ± 0.16 g) were randomly allocated into 24-floor pens with one of the three beddings namely i) coco peat, ii) rice husks, or iii) sawdust. 14 ducklings per pen and 8 replicate pens per bedding material were used. Birds were fed a starter diet from days 1–21 and a grower diet from days 22–42. Weekly growth performance evaluation was conducted for the average body weight, weight gains, daily feed intake, and feed conversion efficiency. One bird per pen was sacrificed on day 42 for the evaluation of carcass characteristics including the carcass, breast, and leg muscle percentages. Breast and leg muscle samples were then collected and analyzed for their proximate and pH values. Higher body weights (p < 0.05) were noticed with rice husks on day 42 only. Improved daily gains (p < 0.05) were also noticed for birds raised with rice husks over the entire period (days 1–42). Concerning feed intake, higher values (p < 0.05) were similarly noted with rice husks for the grower phase (days 22–42), and the entire experimental period (days 1–42). Marginally improved feed intake values were also noted with the use of rice husks as the bedding materials on day 42 (p = 0.092). Improved feed efficiency (p < 0.05) was noticed with rice husks on day 35, the grower period, and the entire 42-day period. However, no significant differences were noticed for most of the carcass characteristics that were evaluated. Nevertheless, higher (p < 0.05) pH values for the breast muscle were noticed with the use of coco peat and sawdust as the bedding. Conclusively, the bedding type could have a significant impact on the growth performance of ducks without adverse effects on carcass characteristics. The use of rice husks as bedding might be advantageous and is therefore recommended

The Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa

This paper reviews some research studies on tillage methods influencing soil and moisture conservation in the eastern African countries of Kenya, Tanzania, Malawi and Ethiopia during the past four decades. Most of these studies were conducted in marginal rainfall (semi arid ) areas and on shallow soils of various textures (sandy clay loam, sandy clay, clay and loam). The studies were meant to establish the effects of tillage and residue management practices on physico-chemical soil properties (i.e. structure, bulk density, soil moisture and organic matter contents), runoff and infiltration. This review emphasizes the importance of appropriate tillage and residue management methods (contour bunds and terraces, minimum tillage, tied ridging, mulching and conventional tillage) in providing soil conditions favourable for soil moisture conservation and subsequent crop performance and yield on smallholder farm

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Cost-effectiveness of risk stratified medication management for reducing premature cardiovascular mortality in Kenya.

BackgroundCardiovascular disease (CVD) is a major contributor to the burden from non-communicable diseases in Sub-Saharan Africa and hypertension is the leading risk factor for CVD. The objective of this modeling study is to assess the cost-effectiveness of a risk stratified approach to medication management in Kenya in order to achieve adequate blood pressure control to reduce CVD events.MethodsWe developed a microsimulation model to evaluate CVD risk over the lifetime of a cohort of individuals. Risk groups were assigned utilizing modified Framingham study distributions based on individual level risk factors from the Kenya STEPwise survey which collected details on blood pressure, blood glucose, tobacco and alcohol use and cholesterol levels. We stratified individuals into 4 risk groups: very low, low, moderate and high risk. Mortality could occur due to acute CVD events, subsequent future events (for individual who survive the initial event) and other causes. We present cost and DALYs gained due to medication management for men and women 25 to 69 years.ResultsTreating high risk individuals only was generally more cost-effective that treating high and moderate risk individuals. At the anticipated base levels of effectiveness, medication management was only cost-effective under the low cost scenario. The incremental cost per DALY gained with low cost ranged from $1,505 to$3,608, which is well under $4,785 (3 times GPD per capita) threshold for Kenya. Under the low cost scenario, even lower levels of effectiveness of medication management are likely to be cost-effective for high-risk men and women.ConclusionsIn Kenya, our results indicate that the risk stratified approach to treating hypertension may be cost-effective especially for men and women at a high risk for CVD events, but these results are highly sensitive to the cost of medications. Medication management would require significant financial investment and therefore other interventions, including lifestyle changes, should be evaluated especially for those with elevated blood pressure and overall 10-year risk that is less than 20%

Adequacy of control of cardiovascular risk factors in ambulatory patients with type 2 diabetes attending diabetes out-patients clinic at a county hospital, Kenya

Abstract Background Type 2 diabetes is associated with substantial cardiovascular morbidity and mortality arising from the high prevalence of cardiovascular risk factors such as hypertension, dyslipidaemia, obesity, poor glycaemic control and albuminuria. Adequacy of control of these risk factors determines the frequency and outcome of cardiovascular events in the patients. Current clinical practice guidelines emphasize primary prevention of cardiovascular disease in type 2 diabetes. There is scarce data from the developing countries, Kenya included, on clinical care of patients with type 2 diabetes in the regions that are far away from tertiary health facilities. So we determined the adequacy of control of the modifiable risk factors: glycaemic control, hypertension, dyslipidemia, obesity and albuminuria in the study patients from rural and peri-urban dwelling. Methods This was a cross-sectional study on 385 randomly selected ambulatory patients with type 2 diabetes without overt complications. They were on follow up for at least 6 months at the Out-patient diabetes clinic of Nyeri County Hospital, a public health facility located in the central region of Kenya. Results Females were 65.5%. The study subjects had a mean duration of diabetes of 9.4 years, IQR of 3.0–14 years. Their mean age was 63.3 years, IQR of 56-71 years. Only 20.3% of our subjects had simultaneous optimal control of the three (3) main cardiovascular risk factors of hypertension, high LDL-C and hyperglycaemia at the time of the study. The prevalence of cardiovascular risk factors were as follows: HbA1c above 7% was 60.5% (95% CI, 55.6–65.5), hypertension, 49.6% of whom 76.6% (95% CI, 72.5–80.8) were poorly controlled. High LDL-Cholesterol above 2.0 mmol/L was found in 77.1% (95% CI 73.0–81.3) and Albuminuria occurred in 32.7% (95% CI 27.8–37.4). The prevalence of the other habits with cardiovascular disease risk were: excess alcohol intake at 26.5% (95% CI 27.8–37.4) and cigarette-smoking at 23.6%. A modest 23.4% of the treated patients with hypertension attained target blood pressure of <140/90 mmHg. Out of a paltry 12.5% of the statin-treated patients and others not actively treated, only 22.9% had LDL-Cholesterol of target <2.0 mmol/L. There were no obvious socio-demographic and clinical determinants of poor glycaemic control. However, old age above 50 yrs., longer duration with diabetes above 5 yrs. and advanced stages of CKD were significantly associated with hypertension. Female gender and age, statin non-use and socio-economic factor of employment were the significant determinants of high levels of serum LDL-cholesterol. Conclusion The majority of the study patients attending this government-funded health facility had high prevalence of cardiovascular risk factors that were inadequately controlled. Therefore patients with type 2 diabetes should be risk-stratified by their age, duration of diabetes and cardiovascular risk factor loading. Consequently, composite risk factor reduction strategies are needed in management of these patients to achieve the desired targets safely. This would be achieved through innovative care systems and modes of delivery which would translate into maximum benefit of primary cardiovascular disease prevention in those at high risk. It is a desirable quality objective to have a higher proportion of the patients who access care benefiting maximally more than the numbers we are achieving now

Prevalence and predictors of physical inactivity levels among Kenyan adults (18–69 years): an analysis of STEPS survey 2015

Abstract Background Physical inactivity accounts for more than 3 million deaths worldwide, and is implicated in causing 6% of coronary heart diseases, 7% of diabetes, and 10% of colon or breast cancer. Globally, research has shown that modifying four commonly shared risky behaviours, including poor nutrition, tobacco use, harmful use of alcohol, and physical inactivity, can reduce occurrence of non-communicable diseases (NCDs). Risk factor surveillance through population-based periodic surveys, has been identified as an effective strategy to inform public health interventions in NCD control. The stepwise approach to surveillance (STEPS) survey is one such initiative, and Kenya carried out its first survey in 2015. This study sought to describe the physical inactivity risk factors from the findings of the Kenya STEPS survey. Methods This study employed countrywide representative survey administered between April and June 2015. A three stage cluster sampling design was used to select clusters, households and eligible individuals. All adults between 18 and 69 years in selected households were eligible. Data on demographic, behavioural, and biochemical characteristics were collected. Prevalence of physical inactivity was computed. Logistic regression used to explore factors associated with physical inactivity. Results A total of 4500 individuals consented to participate from eligible 6000 households. The mean age was 40.5 (39.9–41.1) years, with 51.3% of the respondents being female. Overall 346 (7.7%) of respondents were classified as physically inactive. Physical inactivity was associated with female gender, middle age (30–49 years), and increasing level of education, increasing wealth index and low levels of High Density Lipoproteins (HDL). Conclusion A modest prevalence of physical inactivity slightly higher than in neighbouring countries was found in this study. Gender, age, education level and wealth index are evident areas that predict physical inactivity which can be focused on to develop programs that would work towards reducing physical inactivity among adults in Kenya

Healthy Heart Africa: a prospective evaluation of programme outcomes on individuals\u27 hypertension awareness, screening, diagnosis and treatment in rural Kenya at 12 months

Objective: To evaluate the impact of Healthy Heart Africa (HHA), a comprehensive hypertension intervention programme, on hypertension awareness, knowledge, screening and diagnosis among rural communities in Kenya. Methods: Individuals from rural households near intervention and matched control healthcare facilities were randomly surveyed at baseline and the end point (after 12 months). A difference-in-differences analysis estimated the impact of HHA. Results: This analysis included 838 individuals (intervention, n = 432; control, n = 406) at baseline and 698 (n = 364 and n = 334, respectively) at the end point. At baseline, both groups had high hypertension awareness (\u3e 80%) but poor knowledge. After 12 months, healthcare providers were the primary information source for the intervention group only (p \u3c 0.05). At the end point, respondents\u27 knowledge of hypertension risk factors, consequences and management trended higher among the intervention versus the control group. Hypertension screening/diagnosis and patient recall of provider recommendations remained unchanged in both groups. Conclusions: HHA improved hypertension knowledge but screening and diagnosis remained unchanged after 12 months

Factors Associated with Uncontrolled Hypertension among Renal Transplant Recipients Attending Nephrology Clinics in Nairobi, Kenya

Objective. To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource-limited setting. Methods. A cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital. Sociodemographic details, blood pressure, urine albumin : creatinine ratio, and adherence using the MMAS-8 questionnaire were noted. Independent factors associated with uncontrolled hypertension were determined using logistic regression analysis. Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80 mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4–9.5, p=0.006), higher levels of proteinuria (p=0.042), and nonadherence to antihypertensives (OR 18, 95% CI 5.2–65.7, p<0.001) were associated with uncontrolled hypertension. On logistic regression analysis, male sex (adjusted OR 4.6, 95% CI 1.1–19.0, p=0.034) and nonadherence (adjusted OR 33.8, 95% CI 8.6–73.0, p<0.001) were independently associated with uncontrolled hypertension. Conclusion. Factors associated with poor blood pressure control in this cohort were male sex and nonadherence to antihypertensives. Emphasis on adherence to antihypertensive therapy must be pursued within this population