An unusual presentation of acute lymphoblastic leukaemia with peri-cardial effusion causing cardiac tamponade

Peri-cardial effusion is most commonly associated with tuberculous infection in the developing world. Peri-cardial effusion causes symptoms when it is large or when it has accumulated rapidly. Non-tuberculous causes of peri-cardial effusion include bacterial infections, uraemia, viral infections, rheumatic fever, connective tissue disorders, post – peri-cardiotomy syndromes and malignancy. We present a case of acute lymphoblastic leukaemia first presenting as a large peri-cardial effusion causing tamponade

Determinants of active trachoma among children aged 1-9 years in Ol Donyo Nyokie location, Kajiado County, Kenya

Objective: To determine the factors associated with active trachoma among children aged 1-9 years in Ol Donyo Nyokie, Kajiado County.Methods: This was a descriptive cross-sectional study which utilized both quantitative and qualitative techniques for data collection and was carried out at Ol Donyo Nyokie, Kajiado County. Sequential sampling procedure was used to select study participants. A total of 345 mothers together with their children were sampled. The random start was adopted using lottery method and then every 3rd household until a desired sample size of 345 had been achieved. In households with more than one child, one among them was selected by lottery method. Physical examination on the children’s eyes was done while their respective mothers participated in the questionnaire survey supported by observation checklist. Two Focus group discussions were also conducted among mothers and Key Informant interviews among healthcare providers. Results: The overall prevalence of active trachoma was found to be 15.7%. Stratified by age and sex, the younger age group (1-5) years had a 2.13-fold risk of getting active trachoma (χ2 (1) =5.93, p< 0.017; AOR=2.13 [95%: CI=1.15-3.96] compared to the older group (6-9) years. There was however no significant difference between males and females (P>0.05). In the final logistic regression model; Face washing frequency (P<0.001), child’s dirty face(P<0.005), water access >30 mins(P<0.006), mother’s level of education(P<0.017), age of child(P<0.021), monthly income(P<0.029), pit latrine ownership(P<0.039), open defecation(P<0.054) and pit latrine usage (P<0.055) were identified as the predictors of active trachoma. In the Focus Group Discussion, about three quarters (74%) of the mothers were aware of trachoma. Majority of the mothers who were aware of trachoma indicated that water was a major challenge in the area without which trachoma could not be eliminated. Majority of the respondents did not own pit latrines and few of them also disregarded their use. From the Key Informant Interviews most of the respondents confirmed that water, lack of formal education and poverty were the major problems facing the community in the study area.Conclusion: The prevalence was found to be high, which indicates that active trachoma is still a major public health concern in the study area. Poor socio-economic and environmental conditions exacerbate the suffering of the community and make it difficult to prevent and control trachoma. Enhancement of interventions, therefore, particularly of facial cleanliness and environmental sanitation should be addressed to ensure effective prevention and control of trachoma and to bring down the prevalence levels below the WHO threshold of (>10 % prevalence). Community participation in education and outreach services are also crucial.Keywords: Active trachoma, children 1-9 years, risk factors, control and prevention, Kenya.Afr J Health Sci. 2017; 30(2):77-8

Complementary techniques of percutaneous closure of ductus arteriosus using detachable cook coils and amplatzer devices

Background: Patent Ductus Arteriosus (PDA) is a common cardiac malformation whose treatment locally has been surgical ligation via a lateral thoracotomy. Device closure of the ductus was first performed at the Mater hospital in 1999 in a ten year old male using a five millilitre detachable cook coil. In 2000 the Amplatzer device was introduced to close larger ducts. Subsequently these devices have been used interchangeably to close both small and large ducts. We report this single centre experience of percutaneous PDA closure in a resource-limited setting; utilising the two techniques.Objective: To describe our experience of trans-catheter closure of small and large ducts using either the detachable Cook coils or the Amplatzer occluders at the Mater Hospital Nairobi.Design: A descriptive retrospective cohort study.Setting: The Mater Hospital, Nairobi, Kenya.Subjects: Patients with clinical and echo-cardiographic features of patent ductus arteriosus who underwent cardiac catheterisation and angiography followed by device embolisation of the ductus.Results: From April 1999 to October 2009 a total of ninety eight subjects were recruited into the study. Sixty nine (70%) of these subjects had the ducts closed using the Amplatzer devices, while twenty nine (30%) were embolised using the cook detachable coils. Three of the subjects in the coil group had the ducts embolised using the double technique while the rest were embolised using single coils. Various coil sizes four to eight millimetres were used in patients with small to medium ducts (two to seven millimetres) whereas the Amplatzer duct occluder was successfully used in all the duct sizes. The Amplatzer atrial septal occluder device was used to close very large ducts in two of the patients. The overall success rate was 93.1%, but the coil group had higher failure rate of 6.9% compared to the  Amplatzer group of 3%. One patient in the Amplatzer group had a late embolisation requiring surgical retrieval at one month post occlusion. There were no mortalities.Conclusion: Transcatheter device occlusion of PDA is a safe and alternative to surgery associated with minimal morbidity and no mortalit

A Grounded Theory Investigation into the Process and Effects of Service-Learning in Counselor Education

Service-learning is an approach to experiential learning that is relatively unexplored among graduate students. The authors of this study sought to understand the process and effects of service-learning among 76 graduate counseling students enrolled in an “Introduction to Community Counseling” course over three semesters, 40 of whom engaged in service-learning. Analyzing students’ reflection papers, projects, and blog entries via a grounded-theory approach, the study generated a model of how service-learning impacted these students’ learning and sense of counselor identity. Students went through a process of development: They began with personal engagement, became overwhelmed, readjusted their expectations, and then reconstructed their individual counselor identities.

National study to review existing policy documents and identification of upcoming priority national health policy issues in East African community partner states : Kenya country report

There is lack of clearly referenced verifiable evidence for selected approaches to health issues in Kenya. The paper provides a review of literature, further identifying policy gaps, and to confirm main actors in the primary healthcare sector. Priority areas requiring research evidence are: Health care financing and access; Human resources/personnel for the Health Sector with equitable distribution of health workers to rural and urban areas; government delinking from direct provision of healthcare to concentrate on policy formulation, stewardship and regulatory functions; Shifting from curative services to preventive services

The estimation and projection package age-sex model and the r-hybrid model: new tools for estimating HIV incidence trends in sub-Saharan Africa.

OBJECTIVES: Improve models for estimating HIV epidemic trends in sub-Saharan Africa (SSA). DESIGN: Mathematical epidemic model fit to national HIV survey and ANC sentinel surveillance (ANC-SS) data. METHODS: We modified EPP to incorporate age and sex stratification (EPP-ASM) to more accurately capture the shifting demographics of maturing HIV epidemics. Secondly, we developed a new functional form for the HIV transmission rate, termed 'r-hybrid', which combines a four-parameter logistic function for the initial epidemic growth, peak, and decline followed by a first-order random walk for recent trends after epidemic stabilization. We fitted the r-hybrid model along with previously developed r-spline and r-trend models to HIV prevalence data from household surveys and ANC-SS in 177 regions in 34 SSA countries. We used leave-one-out cross validation with household survey HIV prevalence to compare model predictions. RESULTS: The r-hybrid and r-spline models typically provided similar HIV prevalence trends, but sometimes qualitatively different assessments of recent incidence trends because of different structural assumptions about the HIV transmission rate. The r-hybrid model had the lowest average continuous ranked probability score, indicating the best model predictions. Coverage of 95% posterior predictive intervals was 91.5% for the r-hybrid model, versus 87.2 and 85.5% for r-spline and r-trend, respectively. CONCLUSION: The EPP-ASM and r-hybrid models improve consistency of EPP and Spectrum, improve the epidemiological assumptions underpinning recent HIV incidence estimates, and improve estimates and short-term projections of HIV prevalence trends. Countries that use general population survey and ANC-SS data to estimate HIV epidemic trends should consider using these tools

Western Indian Ocean marine and terrestrial records of climate variability: a review and new concepts on land-ocean interactions since AD 1660

We examine the relationship between three tropical and two subtropical western Indian Ocean coral oxygen isotope time series to surface air temperatures (SAT) and rainfall over India, tropical East Africa and southeast Africa. We review established relationships, provide new concepts with regard to distinct rainfall seasons, and mean annual temperatures. Tropical corals are coherent with SAT over western India and East Africa at interannual and multidecadal periodicities. The subtropical corals correlate with Southeast African SAT at periodicities of 16–30 years. The relationship between the coral records and land rainfall is more complex. Running correlations suggest varying strength of interannual teleconnections between the tropical coral oxygen isotope records and rainfall over equatorial East Africa. The relationship with rainfall over India changed in the 1970s. The subtropical oxygen isotope records are coherent with South African rainfall at interdecadal periodicities. Paleoclimatological reconstructions of land rainfall and SAT reveal that the inferred relationships generally hold during the last 350 years. Thus, the Indian Ocean corals prove invaluable for investigating land–ocean interactions during past centuries

Indian Ocean Dipole drives malaria resurgence in East African highlands

Malaria resurgence in African highlands in the 1990s has raised questions about the underlying drivers of the increase in disease incidence including the role of El-Niño-Southern Oscillation (ENSO). However, climatic anomalies other than the ENSO are clearly associated with malaria outbreaks in the highlands. Here we show that the Indian Ocean Dipole (IOD), a coupled ocean-atmosphere interaction in the Indian Ocean, affected highland malaria re-emergence. Using cross-wavelet coherence analysis, we found four-year long coherent cycles between the malaria time series and the dipole mode index (DMI) in the 1990s in three highland localities. Conversely, we found a less pronounced coherence between malaria and DMI in lowland localities. The highland/lowland contrast can be explained by the effects of mesoscale systems generated by Lake Victoria on its climate basin. Our results support the need to consider IOD as a driving force in the resurgence of malaria in the East African highlands