Burden And Pattern Of Cancer In Western Kenya

Background: Cancer regisries worldwide have evolved to provide useful information on the burden and diversity of the patterns of cancer, information that is vital for establishing appropriate programmes for disease management. Population based data on cancer in western Kenya as captured in the Eldoret cancer registry established in1999 is analysed and reported in this paper.Objective: To determine the burden and pattern of cancer in Western Kenya by use of data from the Eldoret cancer registry.Design: Retrospective study.Setting: The cancer registry located in the Department of Haematology at the Moi University, School of Medicine situated at the Moi Teaching and Referral Hospital, Eldoret, Kenya. The hospital has a catchment population of 13 to 15 million people forming about 40% of the Kenyan population.Results: A total of 5,366 patients were diagnosed to have cancer and attended to at the MTRH and other hospitals in Eldoret during the period between January 1999 and December 2006 giving an average of 671 cases per year. Among those treated 2,699 were males and 2,667 were females giving a M: F ratio of 1:1. About 21% of the patients had haematological malignancies with non-Hodgkins lymphoma being the most common.Another 79% of the patients had solid tumours with cancer of the oesophagus being the commonest. Cancer of the cervix and prostrate were the commonest among the females and males respectively. A general increase in the number of patients with Kaposis sarcoma associated with HIV/AIDS pandemic was observed.Conclusion: The burden of cancer is a significant health problem in western Kenya and there is need for the development of a comprehensive cancer care programme in the region to address the growing problem

Stakeholders perception of HIV sero-discordant couples in western Kenya

Objective: To describe the perceptions of key stakeholders regarding the counselling needs of HI V sero-discordant couples as part of preparation for a clinical trial involving HIV sero-discordant couples. Design: Qualitative study using key informant and couple interviews. Setting: Moi Teaching and Referral Hospital (MTRH). Subjects: A purposive sample of nine key informants and 31 couple interviews totaling 71 participants. The couple interviews consisted of HI V untested, HI V concordant (positive and negative) and discordant couples. Results: Seventy one individuals participated in nine key informant and 31 couple interviews. The responses identified the following as key issues in counselling HIV discordant couples: The need for education on the meaning of HI V sero-discordancy including potential sources of infection; assistance in disclosing HIV test results to one\'s partner; discussion of the stigma surrounding formula feeding. Overall, the participants supported safer sexual practices in discordant partnerships. Conclusions: Psychosocial support of HI V sero-discordant couples should include messages about the meaning, mechanisms and implications of sero-discordancy. Culturally appropriate HI Vdisclosure and safer sex messages are also needed to support these partnerships. East African Medical Journal Vol. 85 (7) 2008: pp. 326-33

Determinants In HIV Counselling And Testing In Couples In North Rift Kenya

Background: Voluntary HIV counselling and testing (VCT) has been shown to be an acceptable and effective tool in the fight against HIV/AIDS. Couple HIV Counselling and Testing (CHCT) however, is a relatively new concept whose acceptance and efficacy is yet to be determined.Objective: To describe factors that motivate couples to attend VCT as a couple. Design: A cross sectional qualitative study.Setting: Moi Teaching and Referral Hospital and Moi University, School of Medicine, Eldoret, KenyaSubjects: Seventy one individuals were interviewed during KII (9) and dyad interviews (31 couples). Ten FGDs involving a total of 109 individuals were held. Results: Cultural practices, lack of CHCT awareness, stigma and fear of results deter CHCT utilisation. Location of centre where it is unlikely to be associated with HIV testing, qualified professional staff and minimal waiting times would enhance CHCT utilisation.Conclusions: CHCT as a tool in the fight against HIV/AIDS in this region of Kenya is feasible as the factors that would deter couples are not insurmountable

Socio-Economic and Health Consequences of Drugs and Substance Use in Gachie: : A Peri-Urban Town on the Outskirts of Nairobi

Drug and substance abuse is a major socioeconomic and health problem to the drug users, family and society and is reported to be on a steady global rise. In Kenya, drug abuse is a major societal problem especially in many cosmopolitan cities such as Nairobi and Mombasa and the surrounding immediate environs. The objective of this study was to evaluate the types of drugs, the socio-economic and health consequences of drug abuse among the inhabitants of Gachie Sub-Location, Kiambu County a town within the Nairobi suburbs. A snowballing sampling method was used to recruit a total of 246 study participants aged between 15-65years recruited into the study after consenting and meeting drug and substance use and dependence clinical evaluation according to UNCOPE criteria. Data on the type of drugs abused, socio-economic and health implications of drug use on both drug abusers and the community was captured using a structured questionnaire and the resulting data analysed using SPSS version 21. Over-the counter prescription drugs including, benzodiazepine, Cozepam (“ma-cc”), rohypnol (“ma-blue”), and benzhexol (“ma-white”) as well as the traditional heroine were the major abused drugs reported in the study. Approximately 85% of the sampled drug abusers were men abusing mainly the licit over- the counter prescription drugs and heroine as a result of their easy affordability and accessibility. Failed marriages, conflictual family and communal relationships, unemployment, life of destitution and poverty were the main socioeconomic consequences of drug abuse reported in the study, corroborating reports of some previous studies. Participants’s self-reported feeling of hyperactiveness and euphoria was the major health consequence repoted. This study thus indicates that drug use is slowly creeping into rural areas in the vicinity of major towns with prescription over the counter drugs taking a centre stage than the traditional hard drugs due to the associated low costs, availability and accessibility and can result in myriad socioeconomic consequences in the society. This data provides an insight of the spread of drugs from the traditional cities to the surrounding town environments as these areas provide a safe haven for drug peddlers and thus should be of great focus by drug law enforcers as they strategize and seek to curb drug abuse problem. Future similar studies involving larger area are recommended to acquire more dynamics of this proble

Prevalence Of Anemia Among Teenage Pregnant Girls Attending Antenatal Clinic In Two Health Facilities In Bungoma District, Western Kenya

Severe anemia is an important cause of maternal morbidity and mortality among teenage pregnant girls who are susceptible because of their rapid growth and associated high iron requirements. Teenage girls often enter pregnancy with less adequate stores of nutrients and are thus unable to withstand the demands imposed by pregnancy. The aim of the study was to determine the prevalence of anemia and associated factors among teenage pregnant girls. The study was conducted at Maternal Child Health Clinic of   Bungoma district hospital and Bumula Health Centre. This was a cross section study. Teenage pregnant girls attending ANC were recruited. Food frequency questionnaires were used to assess the dietary intake and factors associated with anemia. Blood sample and stool were used to determine the hemoglobin levels and presence of intestinal worms. The prevalence of anemia was 61% (Hemoglobin < 110 g/L). 20.5% had severe anemia, (hemoglobin < 60 g/L), 31.2% had moderate anemia (hemoglobin < or = 90 g/L), and 48.3% had mild anemia.  Iron intake was significantly associated with perceived food shortage (OR: 2.548; 95% CI: 1.632 – 3.980). Hookworm affected calcium intake (OR: 3.074; 95% CI: 1.089 – 8.698) and malaria parasites affected folate intake (OR: 0.355; 95% CI: 0.226 – 0.557). Those with hookworm were 3 times more likely to have inadequate calcium intake as compared to those without. Anemia was high in the study population. Parasitic infestation and food intake were associated with anemia. De-worming with correction of anemia should be encouraged. Keywords:Anemia, teenage girls, pregnancy, nutrient intake, iro

Management and outcome of patients with Wilms’ Tumour (Nephroblastoma) at the Moi Teaching and Referral Hospital, Eldoret, Kenya

Background: Wilms’ tumour is a common malignant neoplasm of the kidney and is ranked among the top six solid tumours in children in Kenya. Despite its rapid growth and therefore debilitating effects on its victims, it is one tumour that has shown good response to combined modality approach to its treatment with encouraging possibilities of survival even in resource poor settings.Objective: To evaluate the management and outcome of patients with Wilms’ tumour attended to at Moi Teaching and Referral Hospital (MTRH) during the period between January 2000 and December 2007.Design: Retrospective Study.Setting: The Paediatric Oncology Service (Oncology unit in the Paediatric Ward, the Paediatric Surgical Ward and the Outpatient Oncology Clinic) at the Moi Teaching and Referral Hospital, Eldoret, Kenya.Results: Information of 45 patients diagnosed with Wilms’ tumour was analysed. Forty two (93%) of the patients were referrals from various health facilities in the region. Twenty three (51%) were male and 34 (76%) were aged less than 48 months. Twenty five (56%) had the left kidney affected, 19 (42%) the right kidney and one (2%) bilateral. All the 45 (100%) had an abdominal ultrasound done but none had exhaustive investigations done to stage the disease. Only eight (18%) of the patients had a medical insurance cover. Fourty one (91%) of the patients received specific cancer treatment with 28 (62%) getting combined modality treatment. Nineteen (42%) were lost to follow up. Thirty (67%), 21 (47%), 15 (33%) and 13 (29%) patients were alive six months, one year, two years and three years respectively from the time of diagnosis. 29% survived beyond three years of diagnosis .Conclusion: Staging of Wilms tumour fell short of the expected. Neo-adjuvant chemotherapy reduced morbidity and mortality of patients managed for Wilms’ tumour. Loss to follow up and cost of treatment had a negative impact on the outcome, a situation that requires to be improved

A Needs Assessment to Build International Research Ethics Capacity at Moi University

International Research Ethics Partnership. This online version is the post-print version (final, peer-reviewed and accepted for publication version) of the published article. For the published version, refer to the article citation within the item record.International collaborators in biomedical sciences face ethical challenges in the design,review, and conduct of research. Challenges include differences in research ethics capacity, cultural differences in interpretation and application of ethical principles, and cooperation between ethics review boards at collaborating institutions. Indiana University School of Medicine (Indianapolis, USA) and Moi University Faculty of Health Sciences (Eldoret, Kenya)developed a Memorandum of Understanding (MOU) to establish greater cooperation between their ethics review boards, followed by a joint needs assessment to assess barriers to implementing the MOU. Focus groups and interviews at each institution revealed that while each side verbalized understanding and respect for the other's culture, there were misunderstandings deeply rooted in each culture that could potentially derail the collaboration. Although the participants at each university agreed on the major principles and issues in research ethics and on the importance attributed to them, a more in-depth evaluation of the responses revealed important differences. Methods to address these misunderstandings are outlined in the recommended Best Practices.Fogarty International Center at the NIH, Indiana University Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indiana University International Development Fund, Indiana Genomics Initiative, Lilly Endowment, Inc

Anatomical features of renal artery in a black Kenyan population: Correlation with markers of atherosclerosis

Knowledge of anatomical features of the renal artery is important in prediction,  management and control of atherosclerotic renal artery stenosis. These features show population variations but data from black African populations are scarce. The aim of this study was therefore to describe the anatomical features of the renal artery in a black Kenyan population. Six hundred and ten (610) single renal arteries from 305 adult black Kenyans [206 males, 99 females; age range 22 – 79 years] were studied by dissection at Department of Human Anatomy, University of Nairobi, Kenya. Specimens with macroscopic features of stenosis and dilatation were excluded. The implantation angle, length and branching pattern were studied. These features were correlated with intima-media thickness and luminal diameter. The  latter were determined by micrometry on Eosin/hematoxylin stained 5 micron  sections obtained from the proximal segment of the renal artery. Data was analysed by SPSS version 16.0. Student’s t-test, was used to test for statistical significance at 95% confidence interval where P value of < 0.05 was taken as significant. The results are presented in a bar graph, tables and macrographs. The mean  implantation angle was 940±150 (range 580-1250). In 26.7% cases, the angle was more than 1000. Mean length was 34±1.4 mm with 21.6 % of arteries measuring ≤ 20 mm. Variant branching pattern was present in 40.5 % of cases. It comprised trifurcation (33 %), quadrifurcation (6.6 %) and pentafurcation (0.8 %). Higher implantation angle, short arteries and variant branching were associated with  statistically significant higher intima - media thickness and luminal diameter. These results suggest that higher implantation angle, shorter length and variant branching pattern constitute geometric risk factors for renal artery atherosclerosis.  Ultrasound screening for individuals with suboptimal geometric features for renal artery atherosclerosis is recommended.Keywords: anatomical risk factors, atherosclerosis, renal arter