Adherence to antiretroviral drug therapy by adult patients attending HIV/AIDS clinic at a Kenyan tertiary helath institution

Objective: To determine antiretroviral drug adherence levels of HIV/AIDS in adult patients.Design: A cross sectional study.Setting: Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya.Subjects: Three hundred and eighty four HIV/AIDS adult patients who attended HIV/AIDS clinic in MTRH for antiretroviral treatment and had been on treatment for at least three months as confirmed by clinicians.Results: Three hundred and eighty four respondents participated in this research; two third of whom were females (68%) and a third were males (32%). Fifty two per cent of these had attained secondary or post secondary education. The mean age was 36.1±8.5, years and ranged 18-63 years. While 93.5% of the participants adhered to clinic appointments, only 43.2% adhered to taking the drugs as per time schedule.Conclusion: Adherence to time of taking medications was low and could result in reduced efficacy

A computer-based medical record system and personal digital assistants to assess and follow patients with respiratory tract infections visiting a rural Kenyan health centre

BACKGROUND: Clinical research can be facilitated by the use of informatics tools. We used an existing electronic medical record (EMR) system and personal data assistants (PDAs) to assess the characteristics and outcomes of patients with acute respiratory illnesses (ARIs) visiting a Kenyan rural health center. METHODS: We modified the existing EMR to include details on patients with ARIs. The EMR database was then used to identify patients with ARIs who were prospectively followed up by a research assistant who rode a bicycle to patients' homes and entered data into a PDA. RESULTS: A total of 2986 clinic visits for 2009 adult patients with respiratory infections were registered in the database between August 2002 and January 2005; 433 patients were selected for outcome assessments. These patients were followed up in the villages and assessed at 7 and 30 days later. Complete follow-up data were obtained on 381 patients (88%) and merged with data from the enrollment visit's electronic medical records and subsequent health center visits to assess duration of illness and complications. Symptoms improved at 7 and 30 days, but a substantial minority of patients had persistent symptoms. Eleven percent of patients sought additional care for their respiratory infection. CONCLUSION: EMRs and PDA are useful tools for performing prospective clinical research in resource constrained developing countries

Evaluation of the Performance of Routine Information System Management (PRISM) framework: evidence from Uganda

<p>Abstract</p> <p>Background</p> <p>Sound policy, resource allocation and day-to-day management decisions in the health sector require timely information from routine health information systems (RHIS). In most low- and middle-income countries, the RHIS is viewed as being inadequate in providing quality data and continuous information that can be used to help improve health system performance. In addition, there is limited evidence on the effectiveness of RHIS strengthening interventions in improving data quality and use. The purpose of this study is to evaluate the usefulness of the newly developed Performance of Routine Information System Management (PRISM) framework, which consists of a conceptual framework and associated data collection and analysis tools to assess, design, strengthen and evaluate RHIS. The specific objectives of the study are: a) to assess the reliability and validity of the PRISM instruments and b) to assess the validity of the PRISM conceptual framework.</p> <p>Methods</p> <p>Facility- and worker-level data were collected from 110 health care facilities in twelve districts in Uganda in 2004 and 2007 using records reviews, structured interviews and self-administered questionnaires. The analysis procedures include Cronbach's alpha to assess internal consistency of selected instruments, test-retest analysis to assess the reliability and sensitivity of the instruments, and bivariate and multivariate statistical techniques to assess validity of the PRISM instruments and conceptual framework.</p> <p>Results</p> <p>Cronbach's alpha analysis suggests high reliability (0.7 or greater) for the indices measuring a promotion of a culture of information, RHIS tasks self-efficacy and motivation. The study results also suggest that a promotion of a culture of information influences RHIS tasks self-efficacy, RHIS tasks competence and motivation, and that self-efficacy and the presence of RHIS staff have a direct influence on the use of RHIS information, a key aspect of RHIS performance.</p> <p>Conclusions</p> <p>The study results provide some empirical support for the reliability and validity of the PRISM instruments and the validity of the PRISM conceptual framework, suggesting that the PRISM approach can be effectively used by RHIS policy makers and practitioners to assess the RHIS and evaluate RHIS strengthening interventions. However, additional studies with larger sample sizes are needed to further investigate the value of the PRISM instruments in exploring the linkages between RHIS data quality and use, and health systems performance.</p

Child abuse and neglect as seen in a tertiary hospital in Western Kenya: paediatricians’ perspective

Background: Child abuse is defined as denying a child his or her rights such as food, clothing, education, health and emotional support. The forms of child abuse include physical, sexual, emotional, nutritional, child labour and abandonment.Objective: To describe the types of child abuse seen among the children admitted to the Moi Teaching and Referral Hospital (MTRH) paediatric wards.Design: Cross-sectional descriptive study.Setting: Moi Teaching and Referral Hospital wards in Eldoret.Subjects: Children aged below 18 years with suspected features of child abuse.Results: Of 119 children studied, 67(56.3%) were female. Types of abuse were: nutritional 65(39%) neglect 44(26.4%), abandonment 35(21%), physical 13(7.8%) and sexual 10(6%). Presenting complaints were gastroenteritis 46(38.7%), abandoned 31(26.1%) cough 29(24.4%) and burns 12(10.1%). Common clinical signs of abuse seen were malnutrition 63(52.9%), apathy 23(19.3%), and burns 13(10.9%), while 20(16.8%) had no signs of abuse. Factors significantly associated with: nutritional abuse were perpetrator being father 3.18(1.31, 7.69 p=0.009l), perpetrator being mother 3.00(1.27, 7.10 p=0.0112), neglect were alcoholic father 0.25(0.08, 0.73 p=0.0100), apathetic child 4.33(1.65, 11.34 p=0.0018), severe infection in the child 5.34(2.23,12.75 p=0.0001),Conclusions: The most common form of abuse seen was nutritional abuse. Most children presented with common childhood illnesses. Fathers were the predominant perpetrators of nutritional abuse and neglect. We recommend routine screening of children for features of abuse

The oral health knowledge and oral hygiene practices among primary school children age 5-17 years in a rural area of Uasin Gishu District, Enya

Objective: To determine the oral health knowledge and oral hygiene practices among school children in the study regionMethods: This was a descriptive cross-sectional study carried out among primary school going children in Kapsaret Educational division, Uasin-Gishu District, Kenya.A researcher administered questionnaire was used to determine the oral health knowledge and practices in a random sample of 401 students in the period March to June 2002.Results: 92% of the students claimed they brushed their teeth. About 48% brushed at least twice daily. More students (59.1%) reported using the chewing stick compared to those using commercial toothbrushes (p=0.000).Female students brushed more frequently than their male counterparts (p=0.000, ÷2=24.65).39.9% of the students knew the cause of tooth decay,48.2% could state at least one method of prevention, while 16.5% knew the importance of teeth. Use of toothpaste was reported by 38.9% of the students.Conclusion. Less than half of the students knew the causes of tooth decay and how to prevent it. Only about half of the students brushed their teeth twice daily with the chewing stick being more frequently used.Recommendation: There is need to increase the oral health knowledge through well Planned school based oral health education programmes in the primary schools .This would hopefully lead to improvement on the oral hygiene practice

Self-reported adherence to single dose nevirapine in the prevention of mother to child transmission of HIV at Kitale District Hospital

No Abstract. East African Medical Journal Vol. 84 (12) 2007 pp. 571-57

Infant feeding practices among HIV infected women receiving prevention of mother-to-child transmission services at Kitale District Hospital, Kenya

No Abstract. East African Medical Journal Vol. 85 (4) 2008: pp. 156-16

Characteristics of hiv infected patients cared for at “academic model for the prevention and treatment of hiv/aids” clinics in Western Kenya

Background: With the new initiatives to treat large numbers of HIV infected individuals in sub- Saharan Africa, policy makers require accurate estimates of the numbers and characteristics of patients likely to seek treatment in these countries. Objective: To describe characteristics of adults receiving care in two Kenyan public HIV clinics. Design: Cross-sectional cohort analysis of data extracted from an electronic medical records system. Setting: Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) HIV clinics in Kenya's second national referral (urban) hospital and a nearby rural health center. Subjects: Adult patients presenting for care at HIV clinics. Main outcome measures: Gender and inter-clinic stratified comparisons of demographic, clinical, and treatment data. Results: In the first nineteen months, 790 adults visited the urban clinic and 294 the rural clinic. Mean age was 36±9 (SD) years. Two-thirds were women; a quarter had spouses who had died of acquired immune deficiency syndrome (AIDS). HIV/AIDS behavioural risk factors (multiple sexual partners, rare condom use) and constitutional symptoms (fatigue, weight loss, cough, fever, chills) were common. Rural patients had more symptoms and less prior and current tuberculosis. Men more commonly presented with symptoms than women. The cohort CD4 count was low (223 ± 197mm3), with men having significantly lower CD4 count than women (185 ±175 vs 242 ± 205 p = 0.0007). Eighteen percent had an infiltrate on chest radiograph. Five percent (most often men) had received prior antiretroviral drug therapy, (7% in urban and 1% in rural patients, p = 0.0006). Overall, 393 (36%) received antiretroviral drugs, 89% the combination of lamivudine, stavudine, and nevirapine. Half received prophylaxis for tuberculosis and Pneumocystis jirovecii. Men were sicker and more often received antiretroviral drugs. The East African Medical Journal Vol. 83(8) 2006: 424-43