Management of differences in sexual development: evolution of an approach for a resource-limited setting

Background: The approach to management of patients with disorders of sex development (DSD) has been refined over the past two decades. We sought to review DSD cases at our hospital and hypothesized that age at presentation would decline over time. Methods: A retrospective review of patients presenting to our hospital between January 1, 2005 and July 31, 2018, with findings of ambiguous genitalia was performed. Results: A total of 44 patients were identified, 3 with cloacal exstrophy. Of the 41 remaining patients, the majority (n = 24) had ovotesticular DSD. Three time periods in the evolution to a multidisciplinary team (MDT) approach were identified: Period 1 (2003–2009), Period 2 (2010– 2013), and Period 3 (2014–present). Median presenting age in Periods 1, 2, and 3 were 7 years (95% CI: 0.5–15), 6.5 years (95% CI: 1–19), and 11 years (95% CI: 2–17), respectively, and were not statistically different. Conclusion: Management of patients with DSD poses a challenge to healthcare providers across the globe. The gradual evolution of patient management with incorporation of MDTs and progression toward delayed surgery is seen in this study. There is indeed a need to set up regional centers of excellence, public awareness programs, and healthcare personnel training programs for optimal management of these patients in low- and middle-income countries (LMICs)

Embracing the challenge of adolescent health in Kenya

In sub-Saharan Africa, adolescents (age 10–19 years) are growing up in challenging social contexts and carry a much heavier burden of disease than their peers in high-income settings. Poverty, early school leaving, child marriage and pregnancy, low health literacy, poor health-seeking behaviour, the long-term effects of childhood malnutrition that persist into adolescence, and a relatively high burden of infectious diseases are key determinants of poor adolescent health status in this region. The HIV epidemic has resulted in a major reorganisation of family roles and responsibilities, disrupting the lives of many adolescents who are also inherently vulnerable to HIV infection because of the developmental changes and characteristic risk-taking behaviour that occurs in this period of life

Effects of Acidification and Preservatives on Microbial Growth during Storage of Orange Fleshed Sweet Potato Puree

Orange Fleshed Sweet Potato (OFSP) puree, a versatile food ingredient, is highly perishable limiting its use in resource constrained environments. It is therefore important to develop shelf-stable puree. A challenge test study was carried out to determine the effect of combinations of chemical preservatives and acidification on microbial growth in stored puree. Puree was prepared and treated as follows: control (A); 0.05% potassium sorbate+0.05% sodium benzoate+1% citric acid (B); 0.1% potassium sorbate+0.1% sodium benzoate+1% citric acid (C); 0.2% potassium sorbate+0.2% sodium benzoate+1% citric acid (D); 1% citric acid (E). Samples were inoculated with Escherichia coli and Staphylococcus aureus at levels of 5.2 x 109 cfu/100g and 1.5 x 109 cfu/100g, respectively, before being evaluated during storage for 10 weeks at prevailing ambient temperature (15-25°C) and refrigeration temperature (4°C). Total aerobic counts, yeasts, and molds were also evaluated. E. coli and S. aureus counts declined significantly (p<0.05) by 4 log cycles in all puree treatments except for control and puree with only citric acid. Total viable count, yeasts, and molds were completely inhibited except for puree with only citric acid. Combination of chemical preservatives and acidification is effective in inhibiting pathogens and spoilage microorganisms in sweet potato puree

Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya : a mixed-methods survey

CITATION: Opiyo, R. O., et al. 2019. Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya : a mixed-methods survey. Renal Replacement Therapy, 5:41, doi:10.1186/s41100-019-0237-4.The original publication is available at https://rrtjournal.biomedcentral.comIntroduction: Adherence to dietary prescriptions among patients with chronic kidney disease is known to prevent deterioration of kidney functions and slow down the risk for morbidity and mortality. This study determined factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis. Methods: A mixed-methods study, using parallel mixed design, was conducted at the renal clinics and dialysis units at the national teaching and referral hospitals in Kenya from September 2018 to January 2019. The study followed a QUAN + qual paradigm, with quantitative survey as the primary method. Adult patients with chronic kidney disease on hemodialysis without kidney transplant were purposively sampled for the quantitative survey. A sub-sample of adult patients and their caregivers were purposively sampled for the qualitative survey. Numeric data were collected using a structured, self-reported questionnaire using Open Data Kit “Collect software” while qualitative data were collected using in-depth interview guides and voice recording. Analysis on STATA software for quantitative and NVIV0 12 for qualitative data was conducted. The dependent variable, “adherence to diet prescription” was analyzed as a binary variable. P values < 0.1 and < 0.05 were considered as statistically significant in univariate and multivariate logistic regression models respectively. Qualitative data were thematically analyzed. Results: Only 36.3% of the study population adhered to their dietary prescriptions. Factors that were independently associated with adherence to diet prescriptions were “flexibility in the diets” (AOR 2.65, 95% CI 1.11–6.30, P 0.028), “difficulties in following diet recommendations” (AOR 0.24, 95% CI 0.13–0.46, P < 001), and “adherence to limiting fluid intake” (AOR 9.74, 95% CI 4.90–19.38, P < 0.001). Conclusions: For patients with chronic kidney disease on hemodialysis, diet prescriptions with less restrictions and requiring minimal extra efforts and resources are more likely to be adhered to than the restrictive ones. Patients who adhere to their fluid intake restrictions easily follow their diet prescriptions. Prescribed diets should be based on the individual patient’s usual dietary habits and assessed levels of challenges in using such diets. Additionally, diet adherence messages should be integrated with fluid limitation messages. Further research on understanding patients’ adherence to fluid restriction is also suggested.Publisher's versio