Perception to Cadaver Dissection and Views on Anatomy as a Subject between Two Pioneer Cohorts in a Kenyan Medical School

Cadaver dissection has been used as the main method of teaching human anatomy for the last five centuries. There are emerging concerns on the negative consequences of cadaver dissection on medical students, leading to suggestions on use of alternative technological advancements to cadaver dissection. However, literature on medical students’ perceptions on cadaver dissection and their opinions on anatomy as a subject is scanty particularly for newly established medical schools. We provided a structured questionnaire with 17 items requiring ‘yes, no or undecided’ responses and 6 items with Likert-type questions ranging from strongly agree to strongly disagree to all preclinical students pursuing Bachelor of Medicine and Bachelor of Surgery at the new school of Medicine, Kenya Methodist University. Out of a total of 78 students, 75 correctly filled the questionnaires and were analyzed. An overwhelming majority (85.3%) found their first visit to the dissection room exciting. Most consider dissection the best method of learning anatomy, and do not support the view that it should be replaced by computer aided programs or plastic models. Despite most students indicating that they like anatomy, and find it exciting, very few are willing to take up careers as anatomists. More emphasis needs to be placed on pre-dissection training and counseling to make the experience better for students. There is need to mentor students on taking up anatomy as a career, in view of the great need for anatomists in the region.Key words: Dissection, Perceptions, Cadaver, Anatom

Home-based HIV counselling and testing in Western Kenya

Background Objective: To describe our experience with the feasibility and acceptance of home-based HIV counselling and testing (HBCT) in two large, rural, administrative divisions of western Kenya.Design: Setting: Results: Conclusion : Home-based HIV counselling and testing was feasible among this rural population in western Kenya, with a majority of the population accepting to get tested. These data suggest that scaling-up of HBCT is possible and may enable large numbers of individuals to know their HIV serostatus in sub-Saharan Africa. More research is needed to describe the cost-effectiveness and clinical impact of this approach. There were 47,066 households approached in 294 villages: 97% of households allowed entry. Of the 138,026 individuals captured, 101,167 individuals were eligible for testing: 89% of adults and 58% of children consented to HIV testing. The prevalence of HIV in these communities was 3.0%: 2.7% in adults and 3.7% among children. Prevalence was highest in the 36-45 year age group and was almost always higher among women and girls. All persons testing HIV-positive were referred to Academic Model Providing Access to Healthcare (AMPATH) for further assessment and care; all consenting persons were counselled on HIV risk-lowering behaviours.Kosirai and Turbo Divisions, Rift Valley Province, Kenya.The USAID-AMPATH Partnership conducted  population-based, house-to-house HIV counselling and testing in western Kenya between June 2007 and June 2009. All individuals aged ≥13 years and all eligible children were offered HBCT. Children were eligible if they were above 13 years of age, and their mother was either HIVpositive or had unknown HIV serostatus, or if their mother was deceased or whose vital status was unknown.: The World Health Organisation (WHO) estimates that only 12% of men and 10% of women in sub-Saharan Africa have been tested for HIV and know their test results. Home-based counselling and testing (HBCT) offers a novel approach to complement facility-based provider initiated testing and counselling (PITC) and voluntary counselling and testing (VCT) and could greatly increase HIV prevention opportunities. However, there is almost no evidence that large-scale, door-to-door testing is even feasible in settings with both limited resources and significant stigma around HIV and AIDS

Decentralization of viral load testing to improve HIV care and treatment cascade in rural Tanzania: observational study from the Kilombero and Ulanga Antiretroviral Cohort

INTRODUCTION: Monitoring HIV viral load (HVL) in people living with HIV (PLHIV) on antiretroviral therapy (ART) is recommended by the World Health Organization. Implementation of HVL testing programs have been affected by logistic and organizational challenges. Here we describe the HVL monitoring cascade in a rural setting in Tanzania and compare turnaround times (TAT) between an on-site and a referral laboratory. METHODS: In a nested study of the prospective Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) we included PLHIV aged >/= 15 years, on ART for >/= 6 months after implementation of routine HVL monitoring in 2017. We assessed proportions of PLHIV with a blood sample taken for HVL, whose results came back, and who were virally suppressed (HVL /= 1000 copies/mL). We described the proportion of PLHIV with unsuppressed HVL and adequate measures taken as per national guidelines and outcomes among those with low-level viremia (LLV; 100-999 copies/mL). We compare TAT between on-site and referral laboratories by Wilcoxon rank sum tests. RESULTS: From 2017 to 2020, among 4,454 PLHIV, 4,238 (95%) had a blood sample taken and 4,177 (99%) of those had a result. Of those, 3,683 (88%) were virally suppressed. In the 494 (12%) unsuppressed PLHIV, 425 (86%) had a follow-up HVL (102 (24%) within 4 months and 158 (37%) had virologic failure. Of these, 103 (65%) were already on second-line ART and 32/55 (58%) switched from first- to second-line ART after a median of 7.7 months (IQR 4.7-12.7). In the 371 (9%) PLHIV with LLV, 327 (88%) had a follow-up HVL. Of these, 267 (82%) resuppressed to < 100 copies/ml, 41 (13%) had persistent LLV and 19 (6%) had unsuppressed HVL. The median TAT for return of HVL results was 21 days (IQR 13-39) at the on-site versus 59 days (IQR 27-99) at the referral laboratory (p < 0.001) with PLHIV receiving the HVL results after a median of 91 days (IQR 36-94; similar for both laboratories). CONCLUSION: Robust HVL monitoring is achievable in remote resource-limited settings. More focus is needed on care models for PLHIV with high viral loads to timely address results from routine HVL monitoring

Sociocultural and epidemiological aspects of HIV/AIDS in Mozambique

<p>Abstract</p> <p>Background</p> <p>A legacy of colonial rule coupled with a devastating 16-year civil war through 1992 left Mozambique economically impoverished just as the human immunodeficiency virus (HIV) epidemic swept over southern Africa in the late 1980s. The crumbling Mozambican health care system was wholly inadequate to support the need for new chronic disease services for people with the acquired immunodeficiency syndrome (AIDS).</p> <p>Methods</p> <p>To review the unique challenges faced by Mozambique as they have attempted to stem the HIV epidemic, we undertook a systematic literature review through multiple search engines (PubMed, Google Scholar™, SSRN, AnthropologyPlus, AnthroSource) using Mozambique as a required keyword. We searched for any articles that included the required keyword as well as the terms 'HIV' and/or 'AIDS', 'prevalence', 'behaviors', 'knowledge', 'attitudes', 'perceptions', 'prevention', 'gender', drugs, alcohol, and/or 'health care infrastructure'.</p> <p>Results</p> <p>UNAIDS 2008 prevalence estimates ranked Mozambique as the 8^thmost HIV-afflicted nation globally. In 2007, measured HIV prevalence in 36 antenatal clinic sites ranged from 3% to 35%; the national estimate of was 16%. Evidence suggests that the Mozambican HIV epidemic is characterized by a preponderance of heterosexual infections, among the world's most severe health worker shortages, relatively poor knowledge of HIV/AIDS in the general population, and lagging access to HIV preventive and therapeutic services compared to counterpart nations in southern Africa. Poor education systems, high levels of poverty and gender inequality further exacerbate HIV incidence.</p> <p>Conclusions</p> <p>Recommendations to reduce HIV incidence and AIDS mortality rates in Mozambique include: health system strengthening, rural outreach to increase testing and linkage to care, education about risk reduction and drug adherence, and partnerships with traditional healers and midwives to effect a lessening of stigma.</p

Applied Time Series Analysis: STS 502

Applied Time Series Analysis: STS 502, Honours examinatino June 2011

Post-surgical management of patients with breast cancer at Kenyatta National Hospital

Objective: To assess post-surgical management of patients with breast cancer at the Kenyatta National Hospital. Design: Retrospective analysis of patients treated for breast carcinoma at Kenyatta National Hospital between January 1989 and January 2000. Setting: Kenyatta National Hospital. Subjects: Three hundred and seventy-four patients who had surgery or biopsy for breast cancer at the Kenyatta National Hospital. Intervention: Chemo-hormonal therapy and/or radiotherapy for adjuvant, metastatic, or palliative purposes. Results: Twenty-two patients received adjuvant chemotherapy, and 21 patients received chemotherapy for metastatic disease. Forty-six patients received adjuvant radiotherapy and 53 had radiotherapy for palliative purposes. One hundred and twenty-six patients were given tamoxifen for adjuvant and metastatic purposes. The median duration of follow-up was 20 months. Conclusion: Chemotherapy is grossly underutilized in the treatment of breast cancer at the Kenyatta National Hospital, and radiotherapy is also underutilized. Follow-up durations are dismal and if this is used as a surrogate measure for survival then survival durations for breast cancer patients are also dismal at the Kenyatta National Hospital. (East African Medical Journal: 2002 79(3): 156-162

Non-hodgkin's lymphomas at Kenyatta the National Hospital Nairobi in the 1990's

Objectives: To determine the clinico-pathologic and prognostic factors, treatment and outcome of non-Hodgkin's lymphomas as seen at the Kenyatta National Hospital in the 1990s. Design: Retrospective study of patients with non-Hodgkin's Iymphoma. Setting: Kenyatta National Hospital, Nairobi, Kenya, between January 1990 and January 2000 inclusive. Subjects: Patients aged 13 years and above, with non-Hodgkin's Iymphomas. Results: Case records were available for 207 patients, 146 males and 60 females, with one having had gender not clarified. Fifty two per cent of the patients were aged less than 40 years and 18.4% over 60 years. Forty one per cent were not properly classified histologically, seventy patients out of 190 evaluable (36.8%) had stages IVA and IVB disease at diagnosis. Twenty five out of 77(32.5%) tested positive for HIV infection, none of them being of the indolent variety. Up to 57.1% of cases of Burkitt's lymphoma tested positive for HIV infection. Cyclophosphamide, doxorubicin, vincristine and prednisone, (CHOP) chemotherapy was given to 68.7% of the patients with complete remission rates of 55.6% for those who got a minimum of six courses of chemotherapy. Only 15.3% of 105 patients evaluable were followed up for 36 months and above, the majority of patients having been lost to follow-up. Poor performance status at diagnosis correlated with shorter follow-up durations (