Correlation of oral health home-care practices, snacking habits and dental caries experience among HIV-positive children in Nairobi, Kenya

Objective: To determine the correlation of oral health home-care practices, snacking habits and dental caries experience among 3-15 year-old- HIV-positive children attending out-patient clinic at the Kenyatta National Hospital, Kenya.Design: Cross-sectional descriptive study.Setting: Kenyatta National Hospital comprehensive care centre out-patient clinic.Subjects:Two hundred and twenty participants were selected by consecutive sampling. The children’s socio-demographic characteristics and oral health home-care practices were obtained from parent or guardian interviews. Oral examination of the children was carried out to determine the presence of dental caries.Results: Of the 220 children in the study, 126 (57.3%) brushed their teeth at least once a day. Forty one (18.6%) children regularly consumed sweetened snacks daily. Almost all children (75.5%) were taking medication in the form of tablets and capsules. One hundred and seventy nine (81.4%) children had never had a dental visit. The prevalence of dental caries was 65% while the mean dmft and DMFT scores were 1.75 and 1.08 respectively. Caries experience was significantly higher for those children who frequently consumed sweetened snacks and those who took their medication in the form of sweetened syrups while it was lowest in those who brushed their teeth at least twice a day.Conclusion: Dental caries experience was significantly higher among HIV-infected children who had increased frequency of consumption of sweetened snacks and those who used syrupy medication. There was poor attendance for dental treatment among the children

Local anesthetic wound infusion versus standard analgesia in paediatric post-operative pain control : a randomised control trial

Post-operative analgesia currently relies on multimodal therapy including epidural analgesia, intravenous morphine and/or paracetamol (Perfalgan ®) infusion. Local wound infusion has been effectively utilized in adults with promising results but has not been prospectively tested in children undergoing different abdominal operations. The aim of this study was to compare continuous local anesthetic wound infusion to the current standard of care in post-operative pain control in children. Methods: We conducted a prospective randomized, pain assessor blinded trial comparing Bupivacaine wound infusion {Continuous Local Anaesthetic Wound Infusion - CLAWI) in addition to intravenous paracetamol (Perfalgan®) and morphine for rescue analgesia. This was compared to: (a) epidural bupivacaine plus intravenous morphine and Perfalgan® [EPI] for children undergoing open abdominal surgery and (b) intravenous morphine and Perfalgan® infusion alone [standard post-operative analgesia - SAPA] in children undergoing Lanz incision laparotomy for complicated appendicitis. Patients aged between 3 months and 12 years undergoing laparotomy or open appendectomy were randomly selected for local anesthetic wound infusion (CLAWI) versus EPI or CLAWI versus (SAPA) respectively. Exclusion criteria were neurological impairment, post-operative ventilation and history of adverse reaction to bupivacaine. Consent from the guardian, assent from patients above the age of 7 years and ethics approval from the University of Cape Town Human Ethics Research Committee was obtained. The wound infusion catheter ('lnfiltralLong', PANJUNK®) was placed sub-fascially after suture of the peritoneum and 0.2 % bupivacaine 2mls/kg infused on anesthetic reversal followed by 0.2ml/kg/hour thereafter for 48 hours. Pain assessments were performed for each patient at regular intervals by a single assessor who had training in pediatric pain management and who was blinded to the group allocation. The duration of surgery, length of incision, perioperative antibiotics, wound class risk of surgical site infection, time to return to full feeds, drug reactions; hospital stay, surgical site infection and wound catheter and epidural catheter complications were recorded for each patient. Primary outcome measure was total morphine used in the appendectomy-SAPA vs appendectomy-CLAW! group and rescue morphine requirements in the laparotomy-EPI vs laparotomy-CLAWI group. The secondary outcomes were pain control as measured using the FLACC scale, time to full feeds, mobilization and requirement for urinary catheter

Conservative management of a high output enterocutaneous fistula in abdominal tuberculosis

A 25-year-old lady with a high-output, tuberculous, entero-cutaneous fi stula was managed successfully by conservative means in a teaching hospital in Nairobi, Kenya

Species distribution and antifungal sensitivity patterns of vaginal yeasts

Objectives: To identify yeast isolates in vaginal specimens to species level and determine their antifungal susceptibility patterns.Design: Cross-sectional laboratory-based study.Setting: The Aga Khan University Hospital (AKUH), Nairobi.Subjects: Yeast isolates from high vaginal swabs presented to the laboratory for culture and sensitivity were identified to species level using the API Candida system and subjected to broth microdilution susceptibility testing.Main outcome measures: Frequency tables and graphs were used to summarise the data. Susceptibility data was analysed by the non-parametric Fisher’s exact test. P0.05) between the susceptibility of C.albicans and non-albicans isolates to flucytosine and amphotericin B, however there was a significant difference (

Fertility rate of epileptic women at Kenyatta National Hospital

Background: Reproductive health issues of women with epilepsy (WWE ) are complex and multifaceted, and both epilepsy and antiepileptic drug (AE Ds) use may alter fertility and pregnancy outcomes in these women. Objective: To determine the fertility rate of women with epilepsy at Kenyatta National ospital (KNH). Design: Cross-sectional study. Setting: Neurology clinic, KNH, Nairobi, Kenya, between October 2006 and March 2007. Subjects: A total of 191 women with epilepsy (aged 15-49 years) who had been epileptic for at least one year were interviewed regarding their pregnancy and birth histories, and the information validated with medical records where available. Results: The general fertility rate (GFR) for reproductive-aged epileptic women for the three-year period (2003-2006) preceding the study was 46 livebirths per 1000 women-years (95% CI 35.13- 63.59). Conclusion: Fertility rate in epileptic women is decreased by two thirds (compared to that of general population of women in Kenya). Reasons for this are probably miltifactorial. East African Medical Journal Vol. 85 (7) 2008: pp. 341-34

Identity tags: A vector for cross-infection?

Background. Nosocomial infections represent one of the challenging problems of modern medicine. Healthcare providers play an important role in the transmission of these infections on their hands, clothing and equipment. Modern security systems require personnel to wear clearly displayed identity (ID) tags, and to have an easily accessible access disc. These access and ID tags are often worn around the neck on a lanyard, and could possibly harbour bacteria and be a vector for cross-infection.Method. Saline-moistened swabs of the front and back of ID tags of 50 healthcare workers were taken for bacterial culture. Swabs were inoculated onto standard microbiological media. Potential pathogens were subjected to sensitivity testing while organisms resembling normal skin commensals were reported as such.Results. Twenty-eight of the 50 (56%) ID swabs cultured exhibited no bacterial growth. Eighteen (36%) swabs grew primarily skin flora. Neutrophils were observed under microscopy on two (4%) swabs. Seven (14%) swabs grew potentially pathogenic bacteria. Doctors were found to have almost three times the risk of carrying pathogenic bacteria on their ID tags compared with nurses. Recent patient contact also showed a higher incidence of colonisation. There were no statistically significant differences between variables such as ward or area of work, nature of patient contact, time since qualification, level of qualification or length of employment at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa.Conclusions. Prevention of hospital-acquired infections is important in any setting. The ID tag has been identified as a possible source of infection spread in this and previous studies. The ID tag has to date been neglected as a potential source of pathogen spread, and efforts to make staff aware of this potential danger should be considered in every institution

Antenatal care visits and pregnancy outcomes at a Kenyan rural district hospital: a retrospective cohort study

Background: The goal of antenatal care (ANC) is to improve maternal and neonatal outcomes. Fewer ANC visits in focused antenatal care (FANC) model can affect maternal and perinatal outcomes in low income settings where the number ANC visits are often low.Objective: To determine the number of ANC visits and their influence on maternal and perinatal outcomes at a rural Kenyan hospital.Study design: Retrospective cohort.Study population: Women who received ANC and were admitted at Longisa District Hospital postnatal ward after delivery at or above 28 weeks gestation.Study site: Postnatal ward, Longisa District Hospital, Bomet County, Kenya.Results: Between 1st July and 31st August 2014, 200 (83%) of the screened postpartum (n=241) women were found to be eligible. Majority (n=122, 61.0%) of the women received less than 4 ANC visits. Most women were: married (83.5%), housewives (65.5%), and had: parity of 2 to 4 (50.5%); primary education (66.5%); live births (93.0%); spontaneous vertex delivery (82.5%); spontaneous onset of labour (n=192, 96.0%) and no complication at or post-partum (n=175, 87.5%). Majority of the neonates had 5 minute APGAR score >7 (88.0%); and were with their mothers after 24 hours postpartum (81.5%). High parity (≥5) was associated with reduced frequency of ANC visits (OR=0.29, 95% CI 0.1-0.87, p=0.027). Early perinatal and maternal outcomes were not significantly associated with the number of ANC visits.Conclusion: In this rural Kenyan hospital, few women had 4 or more ANC visits. Parity of 5 or greater was significantly associated with fewer than 4 ANC visits. Early perinatal and maternal outcomes did not vary with the number of visits. Quality rather than number of ANC visits should be evaluated as a measure of ANC

An unusual abdominal mass: case report

The causes of intra-abdominal masses associated with chronic abdominal pain range from the benign to malignant; common to bizarre and some raise major medical legal issues. We present a case of a 40-year old African lady who presented with chronic right-sided abdominal pain with an associated mass on the right mid-abdomen. She had had a Caesarian section one year prior to presentation. Antecedent history of surgery and typical imaging features enabled a preoperative diagnosis of abdominal mass secondary to retained surgical gauze.The case illustrates the fallibility of the men and women in the operating theatres and the vital role of correct instrument and sponge counts

Disseminated mucormycosis and necrotizing fasciitis in immune-compromised patients: Two case reports

We present two case reports of disseminated mucormycosis and necrotizing fasciitis in an immunecompromised patient. First, a 3-month-old with untreated HIV infection presented in septic shock with abdominal wall-necrotizing fasciitis. Laparotomy  revealed extensive abdominal wall necrosis, bowel, liver, kidney and subsequent retroperitoneal, posterior diaphragm and inferior vena cava involvement. Second, a  3-year-old on chemotherapy for Burkitt’s lymphoma presented with pancytopenia, sepsis, abdominal wall-necrotizing fasciitis and left lower limb ischaemia. At surgery, there was necrosis of the abdominal wall, the large bowel and the ureter and thrombosis of the iliac vessels. Histology in both cases showed necrosis with fungal invasion consistent with mucormycosis. Both patients suffered mortality. We discuss  mucormycosis and review the literature regarding mucormycosis in immune-compromised paediatric patients.Keywords: child, immune-compromised, mucormycosis, necrotizing fasciitis, paediatri

Risk Factors for Esophageal Squamous Cell Carcinoma in a Kenyan Population

Background: Esophageal squamous cell carcinoma (ESCC) is common in some parts of Kenya. Both the regional factors associated with ESCC in  Kenya and geographic distribution has not been completely described. Methods: We analyzed the association of ESCC with smoking, khat  chewing, alcohol, diet, socioeconomic status, caustic ingestion and firstdegree family history of ESCC in a multi-center based matched case-control study. We also determined the geographic origin, age, gender and ethnicity of patients visiting the participating centers between August 2008 and April 2009. Results: Eighty three cases and 166 controls matched for age and gender were studied. The male to female ratio of cases was 2.1:1, majority were from Central and Eastern provinces of Kenya, about one fifth (19%) were younger than 45 years of age. On multivariate analysis, caustic ingestion (OR 11.3 CI 3.0 – 42.5), first degree family history of ESCC (OR 3.5 CI 1.3 – 9.5) and poor housing (OR 2.0 CI 1.1 – 3.5) were independent predictors.Conclusions: Majority hailed from the Central and Eastern provinces  probably due to proximity to the study centres. A large proportion of cases were young compared to studies in other high incidence regions in the world. Low socio-economic status, family history of ESCC and a history of caustic ingestion were significant risk factors.Key Words: Esophageal, Squamous Cell Carcinoma, Risk Factors, Keny