Adherence with childhood cancer treatment in Kenya

Kaspers, G.J.L. [Promotor]Mostert, S. [Copromotor

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd

Newborn screening for sickle cell disease at Kisumu County Hospital, Kisumu –Kenya

Background: Sickle cell disease(SCD), a hereditary blood disorder of the haemoglobin molecule, has been acknowledged by World Health Organization(WHO) as a major public health priority. Newborn screening(NBS) for SCD coupled with provision of comprehensive medical care has been associated with a significant reduction in related morbidity and mortality.Objectives: To estimate the birth prevalence of Sickle Cell Disease (SCD) and trait (SCT), assess acceptability of NBS and determine factors that influence acceptability of NBS at Kisumu County Hospital(KCH), Kenya during the period between November 2015 to June 2016.Design: Cross Sectional StudySetting: The postnatal ward at the KCH which serves a population of about one million people with about 300 deliveries occuring every month.Results: Data was collected from 1785 parents/guardians and 1810 new-borns (23 sets of twins and one set of triplets). There were 921 (50.9%) male new-borns. The parents/guardians were aged between 18 and 42 years (median 23 years), 11(0.6%) had no formal education, 1129 (63.2%) had heard about SCD but only 14(1.2 %) had ever been tested for SCD. Birth prevalence of SCD and SCT among the new-borns was 57(3.2%) and 250(13.9%) respectively. Almost all parents/caregivers, 1774(99.4%) accepted to have their new-borns screened. Among those who declined, 8 cited fear of the unknown as the main reason. All the parents/guardians who had no formal education and all those who had ever been tested for SCD before accepted NBS. Agreeing that SCD is preventable was the only statistically significant factor on bivariate and multivariate logistic regression analysis (OR 4.68, CI (1.15-19.17), P =0.014).Conclusion: NBS for SCD was highly acceptable. The birth prevalence of sickle cell disease and trait was high according to the WHO.Recommendations: Implementation of routine NBS for SCD in Kisumu County and other high SCD prevalence regions in Kenya. &nbsp

Clinicians’ adherence to national pneumonia management guidelines at Kitale County Hospital, Kenya

Objectives: To determine adherence to national pneumonia guidelines in children aged 2-59 months admitted at Kitale County Hospital. Design: Retrospective Setting: Pediatric wards of Kitale County hospital in Trans Nzoia County, Kenya. Participants: Children under 5 years admitted with a diagnosis of pneumonia to Kitale County Hospital Pediatric ward. Interventions: Data were collected from the participant’s inpatient records upon discharge or death. All files were included till a sample size of 380 was achieved. Data on demographics and management was extracted from the pediatric admission form, daily ward round notes and treatment sheet. Data were then compared against the national guidelines to assess adherence. Main outcome measures: Adherence to the guidelines. Results: The median age was 12 months (IQR 7, 24). The males constituted 198 (52%) of the participants. The diagnosis was severe  pneumonia in 213 (56%) and pneumonia in 167 (44%) of the participants. Adherence at admission was 121 (32%) of the cases. Appropriate diagnosis was made in 202 (53%), correct drug chosen in 212 (56%) and correct dosage prescribed in 270 (71%) of theparticipants. The proportion of the patients correctly managed in accordance with guidelines during the inpatient stay was 2 (0.6%). Complete adherence from admission to discharge was in 8 (2%) of the cases. Conclusion: The level of adherence to the guidelines was low, markedly decreasing from admission to discharge

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran