Factors associated with time in therapeutic range among patients on oral anticoagulation therapy in a tertiary teaching and referral hospital in Kenya

Oral anticoagulation with warfarin is challenging owing to the drug’s narrow therapeutic index. Achievement of therapeutic range ensures safety and efficacy of warfarin therapy. A retrospective study of four hundred and six patients on warfarin anticoagulation was conducted at Kenyatta National Hospital, Kenya for the period between January 2014 and June 2016. The percentage of follow-up time spent in therapeutic international normalized ratio range was computed by Rosendaal linear interpolation method. Factors associated with this time were also explored. The mean age of the participants was 42.7±16.9 years and the ratio of females to males was 3:1. The mean percentage of time spent in therapeutic international normalized ratio range was 31.1%. Poor anticoagulation control was associated with congestive heart failure (p=0.047) and the independent predictor of time in therapeutic range was renal dysfunction (β= -13.3, 95% CI: -25.9, -0.8, p=0.038) suggesting that management of these patients needs to be intensified.Keywords: Warfarin, time in therapeutic range, oral anticoagulatio

Prevalence of adverse drug reactions in adult patients on antiretrovirals at Kenyatta National Hospital, comprehensive Care Centre

Background: There has been an increased access to anti-retrovirals in resourceconstrainedsettings. However, few studies have addressed the area of adverse drugreactions in these settings.Objective: To determine the prevalence of adverse drugs reactions in HIV-infectedpersons receiving anti-retrovirals.Design: A retrospective cohort study.Setting: Kenyatta National Hospital, Comprehensive Care Centre.Subjects: Adult patients receiving anti-retroviral drug during the four year periodbetween January 2003 and December 2006.Main outcome measures: The primary outcome was a documented adverse drug reactionafter exposure to antiretrovirals.Results: Systematic random sampling was used to pick 350 patients’ files. There were219 recorded adverse drug reactions in 170 (48.6%) patients (some patients had morethan one adverse drug reaction). Peripheral neuropathy was the most common adversedrug reaction with a prevalence of 28.9% followed by lipid abnormalities at 14.3%.Conclusion: This study indicates a high prevalence of adverse drug reactionsamong HIV/AIDS patients on anti-retroviral therapy at Kenyatta National Hospital,Comprehensive Care Centre

Trends of anticoagulation control among adult outpatients on long-term Warfarin therapy in a Tertiary Teaching and Referral Hospital in Kenya

Background: Anticoagulation control using warfarin therapy has several challenges especially in resource constrained settings.Objective: To describe the trends of anticoagulation control among adult outpatients on warfarin therapy at Kenyatta National Hospital. Design: Cross-sectional study.Setting: Anticoagulation clinics in the hospital. Participants: 180 outpatients aged ≥18 years.Main outcome measures: Level of anticoagulation and adverse drug reactions (ADRs). Methods: Participants’ sociodemographic characteristics and details of ADRs were acquired through face-to-face interviews. The level of anticoagulation was determined through assessment of international normalized ratios (INRs) for the six clinic attendances with INR of 2-3 being considered therapeutic. Data analysis was conducted onto IBM Statistical Package for Social Sciences version 23. Pearson’s Chi square was used to determine the strength of associations between outcome measures and  sociodemographics, with statistical significance set at p≤0.05. Results: Females were majority (76.7%) and the mean age of participants was 43.4 (±13.2) years. Therapeutic anticoagulation was maintained by 35.2-48.4% patients across six follow-ups and was better among the males (p=0.0398) especially those suffering from heart diseases. ADRs were experienced by almost 50% of the patients where bleeding (27.8%) mainly occurred at INR>3(80.0%). ADRs were significantly more common among the participants without spouses, who were primarily suffering from heart diseases (p=0.0081).Conclusions: Anticoagulation control is poor though patients with cardioembolic disorders have better INRs but more ADRs. Clinical and laboratory monitoring of warfarin therapy should be intensified among females. Future studies should correlate warfarin anticoagulation control with patient, clinician or hospital related factors

Predictors of inappropriate prescribing of acid suppressive medications among medical inpatients in a referral hospital in Kenya

Objective: To characterize the patterns and determinants of acid suppressive medications use among adult medical inpatients of Kenyatta National Hospital.Design: Cross-sectional study.Setting: Medical wards in the hospital.Participants: Inpatients aged ≥18 years.Interventions: Demographic, clinical characteristics and details of acid suppressant use were examined both by records review and patient interviewMain outcome measures: Demographic characteristics: age, gender; Acid suppressant use: prevalence, types, indication; Factors associated with inappropriate prescribing of acid suppressants.Results: 272 patients were included in the study. The mean age was 45.4 ± 16.6 years. 55.9% of the participants were on acid suppressive medications, majority (57.0%) being females. Proton pump inhibitors were the most frequently (95.2%) used acid suppressants. Acid suppressive medications were inappropriately prescribed in 178 (65.4%) patients. Internationally recognized indications of acid suppressive therapies accounted for 27 (28.7%) while stress ulcer prophylaxis was indicated in 55 (58.5%) of the patient in whom it was justified. Logistic regression revealed that use of cardiovascular drugs (P = 0.020), corticosteroids (P = 0.001) and anti-cancers (P = 0.012) as well as a diagnosis of pneumonia (P = 0.016) were significantly associated with inappropriate prescription of acid suppressive therapies.Conclusion: Acid suppressive medication use is high and generally unjustified among the medical inpatients of the Kenyatta National Hospital. Measures aimed at controlling their use by intensifying the evaluation of patients’ in need for appropriate prescribing should be encouraged. Future studies should assess prescribers and hospital contextual factors associated with appropriate use of acid suppressive medications

Correlates and management of anaemia of chronic kidney disease in a Kenyan Tertiary Hospital

Background: Anaemia is a common complication of chronic kidney disease. There is paucity of published local and regional data regarding its associated factors and management.Objective: To assess the correlates and management of anaemia in chronic kidney disease.Design: Cross sectional descriptive studySetting: Kenyatta National Hospital, Nairobi County, Kenya.Subjects: Two hundred and twelve (212) chronic kidney disease patients attending the renal clinic from March 2015 to June 2015 were recruited consecutively.Results: The prevalence of anaemia was high at 67.0%. There was a positive correlation between anaemia and stage of renal disease (p<0.0001), diabetes (p=0.015), glomerulonephritis (p=0.028) and systemic lupus erythematosus (p=0.002). Although correction of anaemia was done in less than half of the patients presenting with it, treatment using erythropoietin, iron sucrose and blood transfusion correlated positively with the severity (p<0.05).Conclusion: Anaemia of the chronic kidney disease is prevalent, and the severity increases with the degree of renal damage, but it is sub-optimally managed. Screening and management of anaemia for patients with renal failure should focus more on patients with diabetes, glomerulonephritis and systemic lupus erythematosus

RISK FACTORS, MANAGEMENT AND OUTCOMES OF ADVERSE DRUG REACTIONS IN ADULT PATIENTS ON ANTIRETROVIRALS AT KENYATTA NATIONAL HOSPITAL, NAIROBI

Background: Antiretrovirals have been associated with serious adverse drug reactions.Several factors have been suggested as independent risk factors for their development.Identification of these factors may help in prevention and management of the adversedrug reactions.Objective: To describe the factors associated with adverse drug reactions, theirmanagement, and the clinical outcomes.Design: A retrospective cohort study.Setting: Kenyatta National Hospital, Comprehensive Care Centre.Subjects: Adult patients receiving antiretrovirals from 2003 to 2006.Main outcome measures: The primary outcomes were the risk-factors, interventions and outcomes of documented adverse drug reaction after exposure to antiretrovirals.Results: Systematic random sampling was used to pick 350 patients’ files. The risk factors for experiencing at least one adverse drug reaction were: having a baseline CD4 count less than 123 (odds ratio [OR] = 1.82, 95% confidence interval [CI]: 1.18 to 2.79; p=0.006); treatment with antiretrovirals for more than 32 months (OR =1.76, CI:1.15 to 2.71; p=0.010), using didanosine containing regimens (OR=3.7, CI: 1.40 to 9.70; p=0.008) or being on stavudine containing regimens (OR=4.4, CI: 2.53 to 7.71; p=0.001).The most common intervention was addition of a non-antiretroviral while 41% of events resulted in a change of anti-retroviral therapy.Conclusions: Current standard regimens in resource-limited countries are associated with an increased risk of adverse drug reactions. Almost half of adverse reactions are managed by addition of a non-anti-retroviral drug alone but 41% necessitated achange of anti-retrovirals