The Clinical Classification of Seizures among Children with Epilepsy Seen at The Moi Teaching and Referral Hospital in

Epilepsy continues to take its toll among children causing impaired physical, psychological and social functioning of those affected. The  annual rate of new cases of epilepsy is approximately 5-7 cases per 10,000 children from birth to age 15 years, and in any given year, about 5 of every 1,000 will have epilepsy. Classification of epileptic seizures relies on clinical phenomenology as well as electroencephalography (EEG), and accurate classification is important since it impacts on choice of medication as well as prognostication. This paper sought to describe the Clinical Classification of epilepsy in children seen at Moi Teaching and Referral Hospital, Eldoret. A cross sectional study was carried out between January 2011 and July 2011 in the general peadiatric wards and the paediatric outpatient clinic at the MTRH. The study subjects were all children aged one month to 14 years. Consecutive sampling of children who had clinical features consistent with epilepsy was done for in the recruitment of study subjects. Data was collected in a structured questionnaire and EEGs were recorded in the hospital’s EEG laboratory. Descriptive data was grouped in frequencies and mean and range was used to summate data. Association between factors was analysed by linear regression and Chi-square was used to analyse differences in epilepsy classification based on clinical features or EEG independently. From the study,  fifty-six children with epilepsy were enrolled into the study, 35(62.5 %) of whom were male and 21(37.5%) were female (M:F 1:0.6). The youngest age at onset of seizures recorded in the study was one month and the mean age was 4.2 years. Twenty-six patients (46.4%) had generalized tonic clonic seizures, nine (16.1%) had partial seizures, eight (14.3%) had mixed seizures, six children (10.7%) had absence seizures, six (10.7%) had tonic seizures and one (1.8%) had myoclonic seizures. The commonest seizure types in children seen at MTRH are generalized tonic-clonic and partial seizures. The generalized spike-and-wave patterns and focal spike-and-wave patterns were the commonest EEG patterns. However, EEG findings increased the proportion of children with partial (focal onset) seizures. Therefore, physicians should use both clinical phenomenology and EEG patterns in classifying patients with epilepsy so as to improve on treatment and follow-up. Keywords: Clinical Classification, Seizures, Epilepsy, Children, Referral Hospital, Keny

A case of pediatric stiff-person syndrome in Kenya

Background: Stiff-person syndrome (SPS) is a rare progressive autoimmune disease that is especially uncommon in the pediatric population. SPS is often undiagnosed for years. Case: Here we present a 12 year-old girl with a history of insulin dependent diabetes mellitus who presented with epigastric pain and whole body rigidity to a hospital in Eldoret, Kenya. A high-clinical suspicion led to targeted autoimmune testing and diagnosis in 15 days. The serum anti–glutamic acid decarboxylase (GAD) level was greater than 2000 (normal 0-10 IU/ml), strongly supporting the diagnosis of stiff-person syndrome plus. The patient recovered with diazepam, baclofen, and supportive care. Intravenous immunoglobulin was unavailable due to the patient’s economic constraints and challenges in accessing the health facility. Several weeks later she returned with recrudescence of her symptoms. Conclusion: We hope this case presentation will help illustrate the need to build care systems that can address the longitudinal care of patients with neurologic diseases in resource-limited settings.   French title:Un cas pédiatrique de syndrome de la personne raide au Kenya Introduction: Le syndrome de la personne raide (SPR) est une maladie auto-immune progressive rare qui est particulièrement rare dans la population pédiatrique. Le SPR n'y est souvent pas diagnostiqué pendant des années. Observation: Nous présentons ici le cas d’une fille de 12 ans ayant des antécédents de diabète sucré insulino-dépendant qui s'est présentée avec des douleurs épigastriques et une rigidité corporelle totale dans un hôpital d'Eldoret, au Kenya. Une forte suspicion clinique a conduit à des tests auto-immuns ciblés et à un diagnostic en 15 jours. Le taux sérique d'acide anti-glutamique décarboxylase (GAD) était supérieur à 2000 (normal 0-10 UI/ml), ce qui étaye fortement le diagnostic du syndrome de la personne raide plus. Le patient s'est rétabli avec du diazépam, du baclofène et des soins de soutien. L’immunoglobuline intraveineuse n’était pas disponible en raison des contraintes économiques du patient et des difficultés d’accès au centre de santé. Plusieurs semaines plus tard, elle est revenue avec une recrudescence de ses symptômes. Conclusion Nous espérons que cette observation aidera à illustrer la nécessité de créer des systèmes de soins capables de prendre en charge les soins longitudinaux des patients atteints de maladies neurologiques dans des milieux à ressources limitées

Short term survival of premature infants admitted to the new born unit at Moi Teaching and Referral Hospital, Kenya

Background: Short and long term survival rates of premature infants have been well documented in developed countries. However, there are few data in low resource settings describing the survival of preterm infants. Data on short term survival rates of preterm infants may inform clinicians in a resource limited setting when counseling families on expected outcomes of care.Objective: To determine survival to hospital discharge of preterm infants in a public tertiary hospital in Kenya.Design: Prospective hospital cohort study design was used.Setting: Moi Teaching and Referral Hospital New Born Unit, Kenya.Participants: Premature Infants and their mothersInterventions: No study specific interventions were performed. We prospectively evaluated survival from admission until discharge from the hospital of 175 premature infants admitted to the newborn unit at Moi Teaching and Referral Hospital, a tertiary public hospital, between December 2012 and August 2013. We determined the overall survival rate and gestational age and birth weight category survival rates.Main outcome measures and Analysis: Death or discharge was the main outcomes of interest. Cox Proportional Hazards model was used to determine factors associated with survival and Kaplan-Meier survival curves drawn.Results: Of the 175 infants, 53.1% were female, mean birth weight was 1342g (± 355.5) and 37% were born before arrival. There were 15.4% neonates born less than 28 weeks, 30.9% aged 28- 31 weeks and 53.7% above 32-37 weeks. The overall survival to hospital discharge was 60.6% (95% CI 0.53-0.68). The survival rate was 29.6% for infants born less than 28 weeks’ gestation, 50% for those born at 28-31 weeks and 75.5% for those born at or above 32 weeks. Gestation age of ≥ 32 weeks (HR 0.39, 95% CI 0.18-0.8), birth weight >1000g (HR 0.27, 95% CI 0.20-0.78) and maternal antenatal care attendance (HR 0.52, 95% CI 0.3-0.9) were associated with better survival. Caesarian section delivery was associated with increased risk of death (HR 4.26, 95% CI 1.88-9.66). Most of deaths (81%) occurred within the first seven days.Conclusions: Sixty percent of premature infants admitted to MTRH new born unit survived to hospital discharge. The survival limit defined as the gestation at which a prematurely born infant has a 50% chance of survival was at the gestational age category of 28-32 weeks

Pattern and frequency of neurological and neurosurgical care of adult inpatients and outpatients at a tertiary referral hospital in Kenya

Objective: To describe the patterns and burden of neurological and neurosurgical disorders at a national tertiary level referral hospital in western Kenya. Methods: We conducted a three-month period prevalence study. We recruited consecutive adult patients seeking neurological-neurosurgical care in both inpatient and outpatient settings at Moi Teaching and Referral Hospital. Results: 833 participants were included. The age range was between 19 year and 99 years (mean age = 45.3 years). The most common diagnoses among neurology inpatients were meningitis (12%), ischemic stroke (11.0%) and epilepsy/seizure (6.7%). Among neurology outpatients, epilepsy (35.1%) and ischemic stroke (18.8%) were the most common diagnoses. The most common neurosurgery inpatient diagnosis was hemorrhagic stroke (16.3%) and among outpatients, the most common diagnoses were traumatic brain injury (17.4%) and hemorrhagic stroke (16.3%). Overall, 471 (56.5%) patients underwent HIV testing, of which, 89 (18.9%) were HIV positive and 382 (81.1%) were HIV negative. Thirty-one inpatient deaths (male 58%), attributable to neurological and neurosurgical disorders, occurred during the study period. Meningitis was the most common cause of death. Conclusions: The findings suggest that meningitis, stroke, epilepsy, and traumatic brain injury were the most common diagnosis. More resources and efforts should be directed towards prevention, diagnosis and management of these conditions in the region

Early Childhood Development in Children Born to HIV-Infected Mothers: Perspectives From Kenyan Clinical Providers and Caregivers

Objective. To understand the perspectives of clinical providers and caregivers regarding early childhood development (ECD) in children born to HIV-infected mothers in Kenya. Methods. This was a qualitative study of provider and caregiver perspectives on ECD at 5 Kenyan HIV clinics, using semistructured interviews and focus group discussions. Constant comparison and triangulation methods were employed to elucidate the concepts of ECD. Results. Twenty-five providers and 67 caregivers participated. While providers understood ECD in terms of milestones, caregivers strongly equated ECD with physical growth. Factors affecting ECD, such as nutrition, perinatal effects, and illness, were perceived differently by providers and caregivers. Both groups generally believed that HIV-infected children would have typical ECD if adherent to their HIV treatment. Conclusions. Important considerations regarding ECD in this population were uncovered. Understanding provider and caregiver perspectives’ on ECD in HIV-exposed children is critical for promoting ECD in this community

Interventions for Developmental Delays in Children Born to HIV-infected Mothers: A Systematic Review

Children born to HIV-infected mothers have worse developmental outcomes compared to HIV-unexposed children. However, little is known about interventions to improve developmental outcomes in this population. This study systematically reviews the literature on interventions to improve development in children born to HIV-infected mothers. We systematically searched the following electronic bibliographic databases: Ovid MEDLINE, Embase, PsycINFO, Education Resources Information Center, and the Cochrane Database of Systematic Reviews. Studies were selected on the basis of defined inclusion criteria and excluded if antiretroviral medication was the only intervention. Titles, abstracts, and full texts were assessed by 2 independent reviewers. Data were collected on characteristics of the study design, intervention, and developmental outcomes measured. Risk of bias and strength of evidence were assessed on all included articles. Our search resulted in 11,218 records. After our initial review, 43 records were appraised in their entirety and 9 studies met all inclusion criteria. Six were performed in sub-Saharan Africa, while the remaining 3 were performed in the United States. Eight were randomized-controlled trials and one was a retrospective chart review. Four studies focused on caregiver-training, 2 studied massage therapy, and the remaining studies focused on maternal vitamin supplementation, video-based cognitive therapy, or center-based interventions. Massage therapy had the most consistent improvements in the domains measured, while caregiver training and cognitive therapy interventions had limited benefits. The center-based intervention showed no benefit. Only 3 studies had a low risk of bias, and 4 studies had good strength of evidence. Most studies found some benefit. However, these findings are limited by the quality of the study designs, small sample size, and heterogeneity of the interventions and assessments used to measure outcomes. There is a critical need for the creation of evidence-based interventions to promote development in this vulnerable population

Anemia and Iron-Deficiency Anemia in Children Born to Mothers with HIV in Western Kenya

The objective of this study was to determine and compare anemia and iron-deficiency anemia (IDA) rates in young Kenyan children who are HIV infected (HI), HIV exposed, uninfected (HEU), and HIV unexposed (HU). Questionnaires, anthropometrics, and blood samples were collected from HI, HEU, and HU aged 18 to 36 months. Descriptive statistics, Fisher’s exact tests, and linear regression were used for analysis. Of 137 total participants, HI (n = 18), HEU (n = 70), and HU (n = 49), 61.1%, 53.6%, and 36.7%, respectively, were anemic, with mean hemoglobin levels highest in HU (P = .006). After adjusting for covariates, HI (β = −9.6, 95% CI:−17.3 to −2.0) and HEU (β = −7.4, 95% CI: −12.9 to −1.9) had lower hemoglobin levels compared with HU. The proportion of children with IDA did not differ significantly across groups (P = .08). HEU have rates of anemia and IDA similar to HI. Anemia risk is generally higher in HEU than HU, even after adjusting for covariates

Preventive Health Service Coverage Among Infants and Children at Six Maternal-Child Health Clinics in Western Kenya: A Cross-Sectional Assessment

Objectives Despite the substantial reduction of child mortality in recent decades, Kenya still strives to provide universal healthcare access and to meet other international benchmarks for child health. This study aimed to describe child health service coverage among children visiting six maternal and child health (MCH) clinics in western Kenya. Methods In a cross-sectional study of Kenyan children who are under the age of 5 years presenting to MCH clinics, child health records were reviewed to determine coverage of immunizations, growth monitoring, vitamin A supplementation, and deworming. Among 78 children and their caregivers, nearly 70% of children were fully vaccinated for their age. Results We found a significant disparity in full vaccination coverage by gender (p = 0.017), as males had 3.5 × higher odds of being fully vaccinated compared to females. Further, full vaccination coverage also varied across MCH clinic sites ranging from 43.8 to 92.9%. Conclusions for Practice Health service coverage for Kenyan children in this study is consistent with national and sub-national findings; however, our study found a significant gender equity gap in coverage at these six clinics that warrants further investigation to ensure that all children receive critical preventative services

Curriculum and training needs of mid-level health workers in Africa: a situational review from Kenya, Nigeria, South Africa and Uganda.

BACKGROUND: Africa's health systems rely on services provided by mid-level health workers (MLWs). Investment in their training is worthwhile since they are more likely to be retained in underserved areas, require shorter training courses and are less dependent on technology and investigations in their clinical practice than physicians. Their training programs and curricula need up-dating to be relevant to their practice and to reflect advances in health professional education. This study was conducted to review the training and curricula of MLWs in Kenya, Nigeria, South Africa and Uganda, to ascertain areas for improvement. METHODS: Key informants from professional associations, regulatory bodies, training institutions, labour organisations and government ministries were interviewed in each country. Policy documents and training curricula were reviewed for relevant content. Feedback was provided through stakeholder and participant meetings and comments recorded. 421 District managers and 975 MLWs from urban and rural government district health facilities completed self-administered questionnaires regarding MLW training and performance. RESULTS: Qualitative data indicated commonalities in scope of practice and in training programs across the four countries, with a focus on basic diagnosis and medical treatment. Older programs tended to be more didactic in their training approach and were often lacking in resources. Significant concerns regarding skills gaps and quality of training were raised. Nevertheless, quantitative data showed that most MLWs felt their basic training was adequate for the work they do. MLWs and district managers indicated that training methods needed updating with additional skills offered. MLWs wanted their training to include more problem-solving approaches and practical procedures that could be life-saving. CONCLUSIONS: MLWs are essential frontline workers in health services, not just a stop-gap. In Kenya, Nigeria and Uganda, their important role is appreciated by health service managers. At the same time, significant deficiencies in training program content and educational methodologies exist in these countries, whereas programs in South Africa appear to have benefited from their more recent origin. Improvements to training and curricula, based on international educational developments as well as the local burden of disease, will enable them to function with greater effectiveness and contribute to better quality care and outcomes

Creating the Map of Interactive Services Aiding and Assisting Persons With Disabilities (MSAADA) Project: Tutorial for the Novel Use of a Store Locator App

BackgroundAn estimated 15% of the global population is living with a disability. In Kenya, children with disabilities remain among the most vulnerable populations, experiencing substantial barriers to wellness and inclusion. Smartphone ownership and internet access have been increasing across sub-Saharan Africa, including in Kenya. Despite these advances, online or mobile resources remain limited and difficult to find and navigate. ObjectiveThis paper aims to describe the novel use of a store locator app to develop an interactive map of organizations that provide medical, educational, and socioeconomic resources to individuals with disabilities in Kenya. The target audience is individuals with disabilities, medical professionals, and organization leaders. MethodsA comprehensive list of organizations, government county offices, educational assessment and resource centers, and institutions was compiled. Organizations were contacted via email, WhatsApp, or in person for semistructured interviews. Based on the services offered, each organization was assigned categorical search tags. The data were entered into a third-party store locator app. The resulting map was inserted into a page on the Academic Model Providing Access to Healthcare (AMPATH) website. ResultsThe Map of Interactive Services Aiding and Assisting Persons With Disabilities (MSAADA; this abbreviation is also Swahili for “help”) was launched in July 2020 in both English and Swahili. The map included 89 organizations across Kenya. Of these, 51 were reached for an interview (for a 57% response rate). Interviewees cited limited paid staff and dependence on grant-based funding as primary challenges to growth and sustainability. ConclusionsMSAADA is an interactive, virtual map that aims to connect individuals with disabilities, medical professionals, and organization leaders to resources in Kenya. The novel use of a store locator app to compile resources in remote settings has the potential to improve access to health care for a wide variety of specialties and patient populations. Innovators in global health should consider the use of store locator apps to connect individuals to resources in regions with limited mapping