Adverse Event Risk Assessment on Patients Receiving Combination Antiretroviral Therapy in South Africa

Purpose: To determine the risk factors for the development of serious adverse events (AEs) in black adult patients on combination antiretroviral therapy (cART). Methods: This prospective cohort study consisted of 368 adult black HIV positive patients receiving cART at the Grey's Hospital, KwaZulu-Natal, South Africa. Patients were intensively monitored for incidence of adverse events and the factors associated with their development, under the Antiretroviral Cohort Adverse Event Monitoring in KwaZulu-Natal (ACADEMIK). Multiple logistic regression models were used to identify the risk factors for AEs. Results: A total of 406 AEs were reported across the 13 patient hospital visits in the study. Peripheral neuropathy was the most prevalent adverse event (16%), followed by hypercholesterolaemia (14%), lipoatrophy/lipodystrophy (13%) and skin reaction (11%). Cluster differentiation (CD4) counts (p = 0.0280), age (p = 0.0227) and weight (p = 0.0017) were identified as the significant predictors for hypercholesterolaemia, while sex (p = 0.0309) was significant with respect to skin reaction. CD4 counts (p=0.0200) was also significant for lipoatrophy/lipodystrophy. Skin reaction (23%), diarrhea (18%), hypercholesterolaemia (15%), thrombocytopenia (15%) and peripheral neuropathy (13%) were the top five most incident AEs. Overall, about 46% of the regimens administered were tenofovir-based and 31% zidovudine-based. Conclusions: To enhance the prevention of hypercholesterolaemia, lipoatrophy/lipodystrophy and skin reaction among black adult HIV positive patients on cART, we recommend that CD4 counts and weight be closely monitored and documented during clinic visits

Study on Chunking Mechanisms for a 3-layered Associative Memory and Recall Model

Memory models are important components that support AI computational models to learn and remember things. Usually, computers operate using an address-based memory for storage where each memory item resides in a unique location. This study proposes a 3-layered associative memory model based on chunking mechanisms of the brain to store knowledge in form of association between entities. The human brain is a cognitive model that derives information from sensory data like vision, auditory, and touch, associates different patterns to create knowledge and uses chunking mechanisms to package the acquired knowledge into manageable entities. Through Chunking, each item held in the STM is a singular entity (chunk) containing more associations (knowledge) in it. Using chunking mechanisms of the brain, AMR model can store knowledge in manner that enables faster response to stimuli. To represent knowledge and semantic relations effectively, the hyper structure (concept) defined in denotational mathematics is employed. A network of concepts is maintained in a cognitive knowledge base that continually evolves as knowledge accumulates. The chunking mechanisms used in this study are goal-oriented chunking and automatic chunking

Relationship between inquiry-based learning and students’ attitudes towards chemistry

Students’ attitudes towards science subjects and especially chemistry have been attributed to the use of inquiry-based learning (IBL). The students’ attitudes are important predictors of academic achievement. The consistently poor performance in chemistry among secondary school students has been an issue of concern. This study sought to establish whether IBL has been used in the teaching of chemistry and if it had any influence on students’ attitudes towards chemistry. The study employed a correlational research design that involved conducting a survey of 21 teachers who were purposively selected, and 357 students selected through simple random sampling from the 21 classrooms that these teachers taught. The results revealed that teachers used IBL once a week (M=4.062) and students had positive attitudes towards chemistry (M=3.945). Besides, there was a significant association between IBL and the attitudes of students towards chemistry (r=0.997, p<0.05, R²=0.994)

Factors Associated with Uptake of Cervical Cancer Screening among Women Aged 18-49 Years in Njiru Sub-County, Nairobi Kenya

Cervical cancer remains a major public health concern in developing countries including Kenya, where it is currently ranked the highest cause of cancer deaths. Early detection of cervical cancer using Pap smear provides an appropriate way of prevention which, would in turn lead to a decrease in incidence and mortality. This study aimed at assessing the awareness, perceptions, reproductive and sexual practices influencing uptake of cervical cancer screening among women aged 18-49 years in Njiru Sub County, Nairobi County. Two hundred and forty seven women participated in this cross-sectional study. Data were collected using semi-structured questionnaires and focused group discussion (FGD). Data was analyzed using SPSS version 19.0. Descriptive statistics were used to give proportions and frequencies. Pearson’s chi square (χ2) was used to test for associations among variables and differences were considered statistically significant at p≤0.05. The mean age of the respondents was 30.7±1.18 years. Most (32%), of the respondents were aged 25-29 years. Majority (96.4%) of the respondents in this study were Christians and most (68%) of them were married. Approximately fifty percent of the study respondents had primary level education followed by secondary (38.9%), tertiary (8.9%) and no formal education 2.4%. About 46% of the respondents were self-employed. Approximately eighty five percent (211/247) of the study respondents were aware of cervical cancer and had commonly (36.4%) obtained their information from media followed by health talks (34.8 %). Of those who were aware 25.6% (54/211) reported cervical cancer to be caused by Human Papilloma Virus (HPV). Most 43.6% (41/94) of the respondents who had ever been screened perceived the cervical screening procedures as uncomfortable followed by 24.5% (23/94) who perceived it as embarrassing. Majority 52.1% (49/94) of those who had been screened reported to have not received any support from their partners. More than ninety percent 94.7% reported that cervical cancer screening was very useful in the prevention of cervical cancer. The factors associated with uptake of cervical cancer screening were awareness (p≤0.035), opinion about cervical screening (p≤0.000), cervical screening usefulness (p≤0.006), frequency of having cervical screening done (p≤0.000) and partner support (p≤0.000). There is need to improve public awareness by educating women on the risk factors associated with cervical cancer and benefits of cervical screening through health talks and promotions, mass media awareness. Health professionals and healthcare workers should take the opportunity to educate and encourage women attending health facilities for other health problems to undergo cervical cancer screening. There is need to include men in education on cervical cancer especially sexual partners/ spouses so that they can encourage their spouses/partners in terms of moral and material support to increase the uptake of cervical cancer screening. Keywords: cervical cancer, screening, uptake, awarenes

Base Deficit as an Indicator of Significant Blunt Abdominal Trauma

Background: Blunt abdominal trauma (BAT) is an important cause of morbidity and mortality among trauma patients. Base deficit (BD) has been proposed as an early available tool alongside focused assessment with sonography for trauma (FAST) in the screening of patients suspected to have BAT and also to help guide the selective use of CT scan. Objective: To determine the use of BD as an indicator of significant BAT. Methods: This was an observational study carried out at the Kenyatta National Hospital from February to May 2015. Patient with suspected BAT admitted into Accident & Emergency were enrolled. Data collected included clinical assessment, BD, FAST findings, CT-scan, and laparotomy were recorded. Data was analyzed using SPSS 17.0. Comparison of mean values of BD between different groups of patients (discharged from A&E, managed conservatively or operated) was performed using ANOVA. Results: Patients who had significant abdominal injury had sensitivity and specificity of 82.98% and 65.91 % respectively at BD of -4.15.The PPV and NPV were 56.52% and 87.88 % respectively. At this cut-off point, AUC was 0.863 (p=0.037). Conclusion: Due to high NPV, BD could rule out significant abdominal injuries but can also predict need for exploratory laparotomy when less than -6.85.Key words: Base deficit, Blunt abdominal trauma, Predictor

Utilization of day surgery services at Upper hill Medical Centre and the Karen hospital in Nairobi: the influence of medical providers, cost and patient awareness

Introduction: Health systems face challenges of improving access to health services due to rising  health care costs. Innovative services such as day surgery would improve service delivery. Day surgery is a concept where patients are admitted for surgical procedures and discharged the same day. Though  used widely in developed countries due to its advantages, utilization in developing countries has been low. This study sought to establish how utilization of day surgery services was influenced by medical  providers, patient awareness and cost among other factors. Methods: The study design was cross sectional with self administered questionnaires used to collect data. Data analysis was done by using statistical package for social science (SPSS) and presented as frequencies, percentages and Spearman's correlation to establish relationship among variables.Results: Medical providers included doctors, their employees and medical insurance providers. Most  doctors were aware of day surgery services but their frequency of utilization was low. Furthermore, medical insurance providers approved only half of the requests for day surgery. Doctors' employees were aware of the services and most of them would recommend it to patients. Although, most patients were not aware of day surgery services those who were aware would prefer day surgery to in patient.  Moreover, doctors and medical insurance providers considered day surgery to be cheaper than in patient.Conclusion: The study showed that medical providers and patient awareness had influence over day  surgery utilization, though, cost alone did not influence day surgery utilization but as a combination with other factors.Key words: Day surgery, health system, medical providers, medical insurance providers, in patient, patient awareness, cost and utilizatio

Impact of Drought on the Spatial Pattern of Transmission of Sehistosoma haematobium in Coastal Kenya

We analyzed temporal changes in spatial patterns of active Schistosoma haematobium infection in different age groups and associated them with ponds infested with Bulinus snails. A major drought between 2001 and 2009 resulted in drying of ponds that were known sources of infection, and we detected very few or no snails in ponds that were infested in the past. The household-level spatial pattern of infection for children of various age groups in 2009 was contrasted with historical data from 2000. The significant local clustering of high- and low-infection levels among school-aged children that occurred in 2000 was absent in 2009. We attribute the disappearance of significant clustering around historical transmission hot spots to a decade-long drought in our study area. The implications of extreme weather and climate conditions on risk and transmission of S. haematobium and their relevance to control strategies are discussed. Copyright © 2011 by The American Society of Tropical Medicine and Hygiene

Anemia among Children Exposed to Polyparasitism in Coastal Kenya

Anemia represents a substantial problem for children living in areas with limited resources and significant parasite burden. We performed a cross-sectional study of 254 Kenyan preschool-and early school-age children in a setting endemic for multiple chronic parasitic infections to explore mechanisms of their anemia. Complete venous blood cell counts revealed a high prevalence of local childhood anemia (79%). Evaluating the potential links between low hemoglobin and socioeconomic factors, nutritional status, hemoglobinopathy, and/or parasite infection, we identified age < 9 years (odds ratio [OR]: 12.0, 95% confidence interval [CI]: 4.4, 33) and the presence of asymptomatic malaria infection (OR: 6.8, 95% CI: 2.1, 22) as the strongest independent correlates of having anemia. A total of 130/155 (84%) of anemic children with iron studies had evidence of iron-deficiency anemia (IDA), 16% had non-IDA; 50/52 of additionally tested anemic children met soluble transferrin-receptor (sTfR) criteria for combined anemia of inflammation (AI) with IDA. Children in the youngest age group had the greatest odds of iron deficiency (OR: 10.0, 95% CI: 3.9, 26). Although older children aged 9-11 years had less anemia, they had more detectable malaria, Schistosoma infection, hookworm, and proportionately more non-IDA. Anemia in this setting appears multifactorial such that chronic inflammation and iron deficiency need to be addressed together as part of integrated management of childhood anemia

Can Prenatal Malaria Exposure Produce an Immune Tolerant Phenotype?: A Prospective Birth Cohort Study in Kenya

In a prospective cohort study of newborns residing in a malaria holoendemic area of Kenya, Christopher King and colleagues find a subset of children born to malaria-infected women who acquire a tolerant phenotype, which persists into childhood and is associated with increased susceptibility to malarial infection and anemia

The Association of Parasitic Infections in Pregnancy and Maternal and Fetal Anemia: A Cohort Study in Coastal Kenya

Background: Relative contribution of these infections on anemia in pregnancy is not certain. While measures to protect pregnant women against malaria have been scaling up, interventions against helminthes have received much less attention. In this study, we determine the relative impact of helminthes and malaria on maternal anemia. Methods: A prospective observational study was conducted in coastal Kenya among a cohort of pregnant women who were recruited at their first antenatal care (ANC) visit and tested for malaria, hookworm, and other parasitic infections and anemia at enrollment. All women enrolled in the study received presumptive treatment with sulfadoxine-pyrimethamine, iron and multi-vitamins and women diagnosed with helminthic infections were treated with albendazole. Women delivering a live, term birth, were also tested for maternal anemia, fetal anemia and presence of infection at delivery. Principal Findings: Of the 706 women studied, at the first ANC visit, 27% had moderate/severe anemia and 71% of women were anemic overall. The infections with highest prevalence were hookworm (24%), urogenital schistosomiasis (17%), trichuria (10%), and malaria (9%). In adjusted and unadjusted analyses, moderate/severe anemia at first ANC visit was associated with the higher intensities of hookworm and P. falciparum microscopy-malaria infections. At delivery, 34% of women had moderate/severe anemia and 18% of infants' cord hemoglobin was consistent with fetal anemia. While none of the maternal infections were significantly associated with fetal anemia, moderate/severe maternal anemia was associated with fetal anemia. Conclusions: More than one quarter of women receiving standard ANC with IPTp for malaria had moderate/severe anemia in pregnancy and high rates of parasitic infection. Thus, addressing the role of co-infections, such as hookworm, as well as under-nutrition, and their contribution to anemia is needed