The pattern of hearing disorders in HIV positive patients on anti-retrovirals at Kenyatta National Hospital

Objectives: To determine if patients on Anti - retroviral drugs (ARVs) develop hearing impairment.Design: The comprehensive care clinic (CCC), Kenyatta National Hospital (KNH), Nairobi.Setting: Case controlled study.Subjects: Two hundred and seventy one human immunodeficiency virus (HIV) positive patients on ARVs were matched for age and sex with 273 HIV positive patients who were not on ARVs.Results: Thirty four percent of HIV positive patients not on ARVs had a hearing loss compared to only 28% in patients who were on ARVs. sensorineural hearing loss was the most frequent hearing disorder in both groups. Majority of the patients had mild hearing loss and the higher frequencies were the most affected. There was a notable worsening of hearing loss with increase in age, but this was not statistically significant.It was noted that HIV positive patients hearing level worsened on starting ARVs but this improved after six months of ARV treatment.Conclusion: Prolonged usage of ARVs is not associated with decreased hearing function. The most common hearing loss found in patients on ARVs is sensorineural hearing loss (SNHL)

Knowledge, Attitude and Practice in First Aid Management of Epistaxis by Accident and Emergency Clinical Staff at Kenyatta National Hospital

Background: Epistaxis is one of the commonest emergencies in Accident & Emergency and Ear, Nose & Throat departments. A vast majority of these patients settle with simple standard first aid measures. The aim of this study was evaluate knowledge, attitude and practice in first aid  management of epistaxis among the clinical staff at the Accident and Emergency (A&E) Department of Kenyatta National Hospital, Kenya.Methods: This was a prospective descriptive cross- sectional study  conducted at the Accident and Emergency Department of Kenyatta National Hospital, Kenya. The principal researcher administered a questionnaire to the clinical staffs who were doctors and nurses in the department.Results: Data was collected from 70 clinical staff between October and December 2010. Nurses were the most respondents (68.6%); 17.1% were medical officers and 14.3% were senior house officers. Majority of the respondents had worked for over 10 years after highest qualification. The commonest first aid measures reported to be known by respondents included pinching the nose (94%), nasal packing (80.6%) and sitting leaning forward position (76.1%). Only 38.1% of respondents  demonstrated the correct site for pinching the nose. The main source of information for first aid measures was the curriculum in training (64.2%) while 16.4% sourced from a first aid course they had done. On positioning of patient with epistaxis, 60% gave correct responses while 51% correctlysaid patient should be referred if epistaxis persists. All the 70 respondents felt that first aid was necessary in treatment of epistaxis. Majority (72.9%) of the respondents said they had ever given first aid to a patient with epistaxis.Conclusion: The clinical staffs in the A & E Department have inadequate knowledge on the standard first aid measures of epistaxis. However, most had good attitude and had provided first aid to patients presenting with epistaxis. There is need for training the staff on these measures.Keywords: Epistaxis, first aid, clinical staff

Bronchoscopy for Removal of Aspirated Tracheobronchial Foreign Bodies at Kenyatta National Hospital, in Kenya

Background: This study was aimed at defining the presentation, morbidity and mortality following inhalation and subsequent removal of  tracheobronchial foreign body using a rigid bronchoscope.Methods: This was a retrospective, cross-sectional study undertaken in the Ear Nose and Throat-Head and Neck Surgery Unit of Kenyatta National Hospital. The study population consisted of patients with brochoscopically proven tracheobronchial foreign body. Case notes of 107 consecutive admissions with brochoscopically verified tracheobronchial foreign bodieswere analyzed for age, sex, time interval between inhalation and removal, duration of stay in hospital, complications and mortality.Results: The vast majority of patients were below 3 years of age and 63% of them presented within 3 days after onset of symptoms. The right bronchus was the most frequent destination of inhaled foreign bodies (50.5%) followed by the left bronchus (17.8%) and carina (14.2%) inthat order. The turnover of patients with inhaled foreign bodies was high with 86.9% being discharged within 6 days after surgery. The bronchoscopic procedure was uneventful in 76.6% of patients. Repeat bronchoscopy was performed in three patients with one undergoing eventual thoracotomy.Intraoperative cardiac arrest occurred in 5 cases (4.6%) with successful resuscitation in 2 and mortality in three (2.7%) % cases.Conclusion: Bronchoscopic removal of inhaled foreign bodies remains one of the riskiest otolaryngologic emergencies in Kenyatta National Hospital partly because of involvement of the life sustaining airway and partly because of lack of ideal equipment and adequate expertise. The need for hands on experience and close cooperation and familiarity between theanaesthesiologist and the bonchoscopist is emphasized

Maize response to Tithonia diversifolia and rock phosphate application under two maize cropping systems in Kenya

Objective: The experiment was conducted with the aim of investigating maize response to Tithonia diversifolia and Minjingu Rock phosphate (MPR) applied under maize-bean intercrop as compared to the traditional maize monocrop to improve maize grain yields. Methodology: The experiment was conducted in pots in a greenhouse for the duration of 8 weeks.. The trial was laid out in a split plot arrangement with three replicates. The main plots comprised of sole maize crop and maize-bean intercrop whereas the sub plots included the control (no input), Tithonia biomass applied alone, MPR also applied alone, TSP again applied alone and Tithonia biomass co-applied with MPR. Soil samplings were done at 4 and 8 weeks after planting and assessed for .P availability and soil labile P. Data was also taken on maize dry matter yield at 8 weeks. ANOVA was done using SAS (version 9.2) and means separated at 5% probability level using DMRT. Results: Maize-bean intercrop was effective in increasing PR solubilisation, P availability and shoot dry matter production. At the same level of P input from MPR, P availability under maize-bean intercrop increased above the ones under sole maize by 154.8% and 91.4% in the first and second samplings, respectively. The increase is thought to have been partly due to the effect of the rhizosphere acidification by bean (Phaseolus vulgaris) during the process of biologically nitrogen fixation. Implications: This farmers-practices matching and also environmentally-friendly low input approach enables farmers to boost production, cut down the cost of production and consequently increase the profit margin.Keywords: Maize-bean intercrop; Maize shoot dry matter yield; P availability; Rock phosphate solubility

Topical quinolone vs. antiseptic for treating chronic suppurative otitis media: a randomized controlled trial

OBJECTIVE To compare a topical quinolone antibiotic (ciprofloxacin) with a cheaper topical antiseptic (boric acid) for treating chronic suppurative otitis media in children. DESIGN Randomized controlled trial. SETTING AND PARTICIPANTS A total of 427 children with chronic suppurative otitis media enrolled from 141 schools following screens of 39 841 schoolchildren in Kenya. INTERVENTION Topical ciprofloxacin (n = 216) or boric acid in alcohol (n = 211); child-to-child treatment twice daily for 2 weeks. MAIN OUTCOME MEASURES Resolution of discharge (at 2 weeks for primary outcome), healing of the tympanic membrane, and change in hearing threshold from baseline, all at 2 and 4 weeks. RESULTS At 2 weeks, discharge was resolved in 123 of 207 (59%) CI 1.48-2.35; P < 0.0001). This effect was also significant at 4 weeks, and ciprofloxacin was associated with better hearing at both visits. No difference with respect to tympanic membrane healing was detected. There were significantly fewer adverse events of ear pain, irritation, and bleeding on mopping with ciprofloxacin than boric acid. CONCLUSIONS Ciprofloxacin performed better than boric acid and alcohol for treating chronic suppurative otitis media in children in Kenya

Kenya’s low carbon futures: an assessment using the KCERT model

KCERT 2050 is a modelling tool designed to assist in the identification and evaluation of synergies and trade-offs within sectoral decarbonization pathways for Kenya. KCERT 2050 is positioned as a user-friendly and dynamic tool that bridges complex energy systems and emissions models with integrated impact assessment tools, aimed at aiding decision making towards carbon neutrality in both public and private sectors. The tool considers greenhouse gas emissions from various economic sectors and is validated through a collaborative process involving experts from diverse backgrounds. This study uses KCERT 2050 to examine the prospects of achieving a net−zero emissions pathway by 2050. In the baseline scenario, a significant emission trajectory is observed, with the transport sector emerging as the largest contributor. Transitioning to the net−zero pathway reveals substantial reductions across key sectors, such as transport, industry, and land use, driven by strategies including electrification, waste reduction, and afforestation. The sensitivity analysis underscores the potential for emission mitigation through various levers, including land use optimization and the adoption of cleaner transportation modes. In conclusion, our findings emphasize the potential and feasibility of Kenya’s ambitious net−zero emissions target. To attain this goal, it is imperative to prioritize sustainable land use and innovative waste management strategies