Determinants of the Effectiveness of Antimicrobial Prophylaxis among Neurotrauma Patients at a Referral Hospital in Kenya: Findings and Implications

Background: Surgical site infections can occur adding to morbidity, mortality and costs, and can be particularly problematic in low and middle income countries. This includes infections in neurosurgical patients following surgery despite antimicrobial prophylaxis. The study aimed at measuring the incidence of surgical site infections (SSIs) and identifying factors that influence the effectiveness of antimicrobial prophylaxis in a leading hospital in Kenya. Methods: Prospective cohort study from April to July 2015 in the Neurosurgical ward of a leading referral hospital in Kenya. Adult head injury patients were recruited by universal sampling. Data was collected on prophylactic antibiotics and the occurrence of SSIs. Risk factors for infection were identified by logistic regression. Results: Eighty four patients were recruited, with 69 patients eventually analysed. Incidence of SSIs was 37.7% (n=26). The most common antibiotic used for prophylaxis was ceftriaxone. Patients on prophylaxis were less likely to be infected than those who did not receive prophylaxis; however, this was not statistically significant (RR 0.87, 95% CI 0.40-1.893). The presence of epidural haematoma was a risk factor for the development of SSIs (Crude RR 2.456, 95% CI 1.474-4.090). Overall, antimicrobial prophylaxis was effective only in patients who underwent evacuation of hematoma by craniotomy (risk reduction, 62.5% (CI, 29.0% -96.0%). Conclusion: Evacuation of haematomas through craniotomy increased the effectiveness of prophylaxis, and should be considered in the future. The rationale will be explored further to see if antibiotic prophylaxis can reduce SSIs in other patients with neuro trauma

Clinical and Financial Implications of Medicine Consumption Patterns at a Leading Referral Hospital in Kenya to Guide Future Planning of Care

Background: Medicines can constitute up to 70% of total health care budgets in developing countries as well as considerable expenditure in hospitals. Inventory management techniques can assist with managing resources efficiently. In Kenyatta National Hospital (KNH), a leading hospital in Kenya, over 30% of medical expenses are currently allocated to medicines, and this needs to be optimally managed. Objective: To investigate drug consumption patterns, their costs and morbidity patterns at KNH in recent year. Methodology: Cross-sectional retrospective record review. Inventory control techniques, ABC (Always, Better, Control), VEN (Vital, Essential and Non-essential) and ABC-VEN matrix analysis used to study drug expenditure patterns. Morbidity data extracted from the Medical Records. Results: Out of an average of 811 medicine types procured annually (ATC 5), 80% were formulary drugs and 20% were non-formulary. Class A medicines constituted 13.2% to 14.2% of different medicines procured each year but accounted for an average of 80% of total annual drug expenditure. Class B medicines constituted 15.9%-17% of all the drugs procured yearly but accounted for 15% of the annual expenditure, whilst Class C medicines constituted 70% of total medicines procured but only 5% of the total expenditure. Vital and Essential medicines consumed the highest percentage of drug expenditure. ABC-VEN categorization showed that an average of 31% medicine types consumed an average of 85% of total drug expenditure. Therapeutic category and Morbidity patterns analysis showed a mismatch between drug expenditure and morbidity patterns in over 85% of the categories. Conclusion: Class A medicines are few but consume the largest proportion of hospital drug expenditure. Vital and essential items consume the highest drug expenditure, and need to be carefully managed. ABC-VEN categorization identified medicines were major savings could potentially be made helped by Therapeutic category and Morbidity pattern analysis. There was a high percentage of non-formulary items, which needs to be addressed. Inventory control techniques should be applied routinely to optimize medicine use within available budgets especially in low and middle income countries. This is now being implemented

Dynamics of forest cover conversion in and around Bwindi impenetrable forest, Southwestern Uganda

Forest cover has been converted to agricultural land use in and around the protected areas of Uganda. The objectives of this study were; to examine the dynamics of forest cover change in and around Bwindi impenetrable forest between 1973 and 2010 and to identify the drivers of forest cover change. The trend in forest cover change was assessed by analyzing a series of orthorectified landsat imageries of 1973, 1987 and 2001 using unsupervised and supervised classification. Land use/cover map for 2010 was reconstructed by analyzing 2001 image, validated and/or reconstructed by ground truthing, use of secondary data and key informant interviews. A series of focused group discussions and key informant interviews were also used to identify drivers of land use/cover change. Policies and institutional arrangements that could have affected forest cover change for the studied time period were also identified. Results showed that protected forest and woodlot in unprotected area had declined by 7.8% and 70.7% respectively as small scale farming and tea plantations had increased by 13.9% and 78.3% respectively between 1973 and 2010. The conversions were attributed to land use pressure due to population growth, change in socio-economic conditions and institutional arrangements. The severe loss of woodlot outside the protected area not only poses a potential threat to the protected forest but also calls for intervention measures if efforts to mitigate climate change impacts are to be realized

Clinical and financial implications of medicine consumption patterns in Kenya

Introduction: Medicines can constitute up to 70% of total health care budgets in developing countries and considerable expenditure in hospitals. Inventory management techniques can assist with managing resources efficiently. In Kenyatta National Hospital (KNH) over 30% of expenditures are for medicines and this needs optimal management. Consequently, we investigated drug consumption patterns, their costs and morbidity patterns at KNH. Methodology: Cross-sectional retrospective record review. Inventory control techniques, ABC (Always, Better, Control), VEN (Vital, Essential and Non-essential) and ABC-VEN matrix analyses were used to study drug expenditure patterns. Morbidity data extracted from Medical Records. Results: An average of 811 medicine types are procured annually (ATC 5), 80% were formulary drugs and 20% were non-formulary. Class A medicines constituted 13.2% to 14.2% of different medicines procured each year but accounted for an average of 80% of total annual drug expenditure. Class B medicines constituted 15.9%-17% of all medicines procured but accounted for 15% of annual expenditure, whilst Class C medicines constituted 70% of total medicines procured but only 5% of total expenditure. Vital and Essential medicines consumed the highest proportion of drug expenditure. ABC-VEN categorization showed 31% medicine types consumed an average of 85% of total expenditure. Therapeutic category and morbidity patterns analysis showed a mismatch between expenditure and morbidity which needs investigation. Conclusion: Class A medicines are few but consume the largest proportion of hospital drug expenditure. Vital and essential items account for the highest drug expenditure, and also need to be carefully managed. ABC-VEN categorization identified medicines were major savings could potentially be made helped by Therapeutic category and Morbidity pattern analysis. There was a high percentage of non-formulary items, which needs to be addressed. Inventory control techniques should be applied routinely to optimize medicine use within hospitals within available budgets especially in low and middle income countries. This is now being implemented

Dynamics of forest cover conversion in and around Bwindi impenetrable forest, Southwestern Uganda

Forest cover has been converted to agricultural land use in and around the protected areas of Uganda. The objectives of this study were; to examine the dynamics of forest cover change in and around Bwindi impenetrable forest between 1973 and 2010 and to identify the drivers of forest cover change. The trend in forest cover change was assessed by analyzing a series of orthorectified landsat imageries of 1973, 1987 and 2001 using unsupervised and supervised classification. Land use/cover map for 2010 was reconstructed by analyzing 2001 image, validated and/or reconstructed by ground truthing, use of secondary data and key informant interviews. A series of focused group discussions and key informant interviews were also used to identify drivers of land use/cover change. Policies and institutional arrangements that could have affected forest cover change for the studied time period were also identified. Results showed that protected forest and woodlot in unprotected area had declined by 7.8% and 70.7% respectively as small scale farming and tea plantations had increased by 13.9% and 78.3% respectively between 1973 and 2010. The conversions were attributed to land use pressure due to population growth, change in socio-economic conditions and institutional arrangements. The severe loss of woodlot outside the protected area not only poses a potential threat to the protected forest but also calls for intervention measures if efforts to mitigate climate change impacts are to be realized

Clinical and Financial Implications of Medicine Consumption Patterns at a Leading Referral Hospital in Kenya to Guide Future Planning of Care

Background: Medicines can constitute up to 70% of total health care budgets in developing countries as well as considerable expenditure in hospitals. Inventory management techniques can assist with managing resources efficiently. In Kenyatta National Hospital (KNH), a leading hospital in Kenya, over 30% of expenditure is currently allocated to medicines, and this needs to be optimally managed.Objective: To investigate drug consumption patterns, their costs and morbidity patterns at KNH in recent years.Methodology: Cross-sectional retrospective record review. Inventory control techniques, ABC (Always, Better, and Control), VEN (Vital, Essential, and Non-essential) and ABC-VEN matrix analyses were used to study drug expenditure patterns. Morbidity data was extracted from the Medical Records.Results: Out of an average of 811 medicine types procured annually (ATC 5), 80% were formulary drugs and 20% were non-formulary. Class A medicines constituted 13.2–14.2% of different medicines procured each year but accounted for an average of 80% of total annual drug expenditure. Class B medicines constituted 15.9–17% of all the drugs procured yearly but accounted for 15% of the annual expenditure, whilst Class C medicines constituted 70% of total medicines procured but only 5% of the total expenditure. Vital and Essential medicines consumed the highest percentage of drug expenditure. ABC-VEN categorization showed that an average of 31% of medicine types consumed an average of 85% of total drug expenditure. Therapeutic category and Morbidity patterns analysis showed a mismatch between drug expenditure and morbidity patterns in over 85% of the categories.Conclusion: Class A medicines are few but consume the largest proportion of hospital drug expenditure. Vital and essential items account for the highest drug expenditure, and need to be carefully managed. ABC-VEN categorization identified medicines where major savings could potentially be made helped by Therapeutic category and Morbidity pattern analysis. There was a high percentage of non-formulary items, which needs to be addressed. Inventory control techniques should be applied routinely to optimize medicine use within available budgets especially in low and middle income countries

The Effect of Land Cover Change on Soil Properties around Kibale National Park in South Western Uganda

The change from natural forest cover to tea and Eucalyptus is rampant in protected areas of western Uganda. The objectives were; to examine the trend in land-use /cover change and determine the effect of these changes on the physico-chemical properties of soils around Kibale National Park. The trend in land use/cover change was assessed by analyzing a series of landsat images. Focused group discussions and key informant interviews were used for land-use/cover reconstruction. Three major land uses were included; woodlot (Eucalyptus grandis; 5 years old) ), tea (57 years old) and natural forest used as a control. Each of these land-uses were selected at two different North facing landscape positions and were replicated three times. A total of 36 composite soil samples were taken at 0–15 and 15–30 cm depth from natural forest, Tea plantation and eucalyptus on three ridges. Results showed that small scale farming, tea and eucalyptus plantation and built up area have increased over time, to the expense of woodlot and forest cover. Tea and Eucalyptus have induced changes in: exchangeable Mg and Ca, available P, SOM, pH, and bulk density of sub soil (P<.05). Landscape positions within land use also significantly influenced most soil properties (P<.05). Similar findings were observed by Wang et al. (2006) in commercial tea plantations in China that received nitrogen fertilizers

Patient-related beliefs and adherence toward their medications among the adult hypertensive outpatients in Tanzania

The following article has been retracted from Journal of Comparative Effectiveness Research as it did not meet the ethical standards of the Journal and the Universities, owing to the use of an invalidated MMAS-8 scale: Jande M, Katabalo DM, Sravanam P, Marwa C, Madlan B, Burger J, Godman B, Oluka M, Massele A, Mwita S. Patient-related beliefs and adherence toward their medications among the adult hypertensive outpatients in Tanzania. J. Comp. Eff. Res. 6(3), 185–193 (2017). The authors and editors of the Journal of Comparative Effectiveness Research regret any negative consequences this publication might have caused in the scientific and medical communities.</jats:p

Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the Future

Background: The COVID-19 pandemic has already claimed considerable lives. There are major concerns in Africa due to existing high prevalence rates for both infectious and non-infectious diseases and limited resources in terms of personnel, beds and equipment. Alongside this, concerns that lockdown and other measures will have on prevention and management of other infectious diseases and non-communicable diseases (NCDs). NCDs are an increasing issue with rising morbidity and mortality rates. The World Health Organization (WHO) warns that a lack of nets and treatment could result in up to 18 million additional cases of malaria and up to 30,000 additional deaths in sub-Saharan Africa. Objective: Document current prevalence and mortality rates from COVID-19 alongside economic and other measures to reduce its spread and impact across Africa. In addition, suggested ways forward among all key stakeholder groups. Our Approach: Contextualise the findings from a wide range of publications including internet-based publications coupled with input from senior-level personnel. Ongoing Activities: Prevalence and mortality rates are currently lower in Africa than among several Western countries and the USA. This could be due to a number of factors including early instigation of lockdown and border closures, the younger age of the population, lack of robust reporting systems and as yet unidentified genetic and other factors. Innovation is accelerating to address concerns with available equipment. There are ongoing steps to address the level of misinformation and its consequences including fines. There are also ongoing initiatives across Africa to start addressing the unintended consequences of COVID-19 activities including lockdown measures and their impact on NCDs including the likely rise in mental health disorders, exacerbated by increasing stigma associated with COVID-19. Strategies include extending prescription lengths, telemedicine and encouraging vaccination. However, these need to be accelerated to prevent increased morbidity and mortality. Conclusion: There are multiple activities across Africa to reduce the spread of COVID-19 and address misinformation, which can have catastrophic consequences, assisted by the WHO and others, which appear to be working in a number of countries. Research is ongoing to clarify the unintended consequences given ongoing concerns to guide future activities. Countries are learning from each other

Ongoing and planned activities to improve the management of patients with Type 1 diabetes across Africa : implications for the future

BACKGROUND: Currently about 19 million people in Africa are known to be living with diabetes, mainly Type 2 diabetes (T2DM) (95%), estimated to grow to 47 million people by 2045. However, there are concerns with early diagnosis of patients with Type 1 diabetes (T1DM) as often patients present late with complications. There are also challenges with access and affordability of insulin, monitoring equipment and test strips with typically high patient co-payments, which can be catastrophic for families. These challenges negatively impact on the quality of care of patients with T1DM increasing morbidity and mortality. There are also issues of patient education and psychosocial support adversely affecting patients' quality of life. These challenges need to be debated and potential future activities discussed to improve the future care of patients with T1DM across Africa. METHODOLOGY: Documentation of the current situation across Africa for patients with T1DM including the epidemiology, economics, and available treatments within public healthcare systems as well as ongoing activities to improve their future care. Subsequently, provide guidance to all key stakeholder groups going forward utilizing input from senior-level government, academic and other professionals from across Africa. RESULTS: Whilst prevalence rates for T1DM are considerably lower than T2DM, there are concerns with late diagnosis as well as the routine provision of insulin and monitoring equipment across Africa. High patient co-payments exacerbate the situation. However, there are ongoing developments to address the multiple challenges including the instigation of universal health care and partnerships with non-governmental organizations, patient organizations, and pharmaceutical companies. Their impact though remains to be seen. In the meantime, a range of activities has been documented for all key stakeholder groups to improve future care. CONCLUSION: There are concerns with the management of patients with T1DM across Africa. A number of activities has been suggested to address this and will be monitored