Emergency resection of sigmoid volvulus

Objectives: To determine the outcome of emergency resection of sigmoid volvulus and to determine the factors associated with adverse outcome. Design: Retrospective case series review. Setting: Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Subjects: All cases of sigmoid volvulus operated at MTRH during the six years period between year 2000-2005. Main outcome measures: Mortality rate; morbidity rate; and duration of hospital stay. Results: Ninety two case files were analysed. Sigmoid volvulus accounted for 14.1% of all cases of intestinal obstruction and 80% of large gut obstruction. The mean age was 47.3 years and the median was 50 years. The range was 16 to 86 years. The male to female ratio was 29.3:1. Mortality was three (3.3%) cases and the morbidity was 20 (21.7%) cases. The mean duration of hospital stay was 11.8 days. Inadequate intravenous fluid therapy had a statistically significant adverse effect on outcome in this study. The yearly outcome remained unchanged during the six years of the study. Conclusions: Emergency resection in cases with a viable colon had a similar outcome to the traditional standard treatment by emergency endoscopic derotation followed by semi-elective or elective resection. The overall outcome was comparable to global standards. Inadequate postoperative intravenous fluid therapy significantly affected the outcome.East African Medical Journal Vol. 85 (8) 2008: pp. 398-40

Pattern of anorectal malformations and early outcomes of management at Moi Teaching and Referral Hospital Eldoret-Kenya

Objectives: To describe the anatomical sub-types of Anorectal  malformations, their management and the early outcome at Moi Teaching and Referral Hospital (MTRH) over a 16 month period.Design: A prospective study.Setting: MTRH, in the neonatal Unit and paediatric surgical wards for the initial capture of patients and initial follow up. The Paediatric Surgical out- patient clinic was used for the subsequent follow ups.Subjects: All infants diagnosed with ARM (Anorectal malformations) at MTRH from November 2011 to April 2013.Main outcome measures: Sub-types of the Anorectal malformations, coexisting abnormalities morbidity and mortality rates.Results: There were 42 participants including 24 (57%) males and 18 (43%) females. Neonates presented at an average age of 4±3, three days and older children presented on average age of 152±118, three days. There were 30 (71%) neonates and 12 (29%) older infants. In males, the predominant sub-type was imperforate anus without a fistula found in ten participants (42% of males). In females, the predominant sub-type wasrecto-vestibular fistula found in 14 participants (78% of females). Mortality occurred in 13 (31%) participants among them ten (24%) had coexisting abnormalities. The main causes of morbidity were: colostomy complications in four (9.5%); wound infections in one (5%); and wound dehiscence in one (5%).Conclusions: Patients with Anorectal malformations presented late at MTRH. The diagnosis at birth was missed in babies born at home as well as those delivered in health institutions

Patient Transfer Practices By Hospitals In Western Kenya

Background: Patients who are critically ill and those requiring emergency care are transported within and between hospitals on a regular basis seeking diagnostic or therapeutic services not available at the bed side or within the referring institution. The emergency of specialty systems often determines the ultimate destination of patients rather than proximity of facility and this has heightened the need for patient transfer. To achieve a favorable outcome, it is necessary to ensure that any transfer is carried out safely and effectively with minimum disruption of the continuum of care. Objectives: To determine the gap between existing knowledge of patient transfer principles and the practice by hospitals in Western Kenya referring patients to Moi Teaching and Referral Hospital (MTRH). Design: Cross-sectional descriptive study. Setting: Accident and emergency department at MTRH. Subjects: Patients transferred in over a period of six months for critical/emergency care. Results: Evaluation was done for 97 transfers during the six months period. Age ranged from four days old to 70 years with a median of 28 years. A wide spectrum of diseases were seen. However in order of frequency the leading five were; trauma and accidents, vascular disorders, infections; anaemia and malignancies. Of the infections, respiratory infections topped the list with pulmonary tuberculosis as the leading disease entity. Majority of patients 43 (44%) were referred within 24 hours of being seen at the primary hospital. Only 56% were transported by ambulance; appropriate escort(nurse) was provided in 60%; documentation was provided in 85%; monitoring enroute was done in 24%; warmth was provided in 62%, 27% were dehydrated requiring resuscitation; respiratory support was inadequate as only 14% (of those who required) had airway and 32% had oxygen provided; intravenous fluids were provided in 34% of those who required; nasogastric intubation was provided in 30% of those who required; urethral catheterisation was provided in 23% of those who required; 50% of those with long bone fractures were splinted and only 3% of those who required cervical spine stabilisation had cervical collar. Conclusion: There was significant failure by hospitals in Western Kenya in the application of principles of patient transfer while referring patients to MTRH

Postoperative Pain Management: Clinicians’ Knowledge and Practices on Assessment and Measurement at Moi Teaching and Referral Hospital.

Background: Pain is the cardinal symptom common to diverse disease conditions and it is what drives many patients to seek treatment. It, therefore, commands a central position in health seeking behavior. In the post-operative period, the main concern about pain is not only the suffering it causes, but also because of its negative effects on the process of recovery. Its management has, however, remained a major challenge. Numerous myths and insufficient knowledge of pain assessment, measurement and treatment contribute to the challenges encountered by health providers in their service to patients. This study was aimed at determining the knowledge and practices among clinicians who manage postsurgical pain in a hospital setting at The Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. It was a cross-sectional survey. Methods: The study population consisted of Nurses, Clinical Officers and Doctors working in the post-operative areas at MTRH. A standardized questionnaire was administered to 236 hospital – based clinicians including medical doctors, nurses and clinical officers. The questionnaire consisted of diverse objective questions set according to internationally recognized pain assessment instruments. Results: Among the 236 health care professionals who were included in the study, 38 (16%) were doctors, 170 (72%) nurses and 28 (12%) clinical officers. On average the duration of time since they were engaged as healthcare providers was 9.3 years (SD=+6.7yrs). Almost all (96%) confirmed that they routinely managed post-operative pain. Clinicians who indicated that they had knowledge on how to assess and manage postoperative pain constituted 88%. Among doctors, 54% felt that they had sufficient knowledge to recognize and manage post-operative pain while the proportions of nurses and clinical officers were 41% and 43% respectively. Fifty seven percent of the participants indicated that they had inadequate knowledge regarding the tools that may be employed for pain assessment and measurement. Those who had never had any formal teaching in relation to pain evaluation and management constituted 21%. Conclusion: Overall, a significant proportion of clinicians indicated an inadequacy of knowledge regarding objective evaluation and management of post-operative pain

Burden And Pattern Of Cancer In Western Kenya

Background: Cancer regisries worldwide have evolved to provide useful information on the burden and diversity of the patterns of cancer, information that is vital for establishing appropriate programmes for disease management. Population based data on cancer in western Kenya as captured in the Eldoret cancer registry established in1999 is analysed and reported in this paper.Objective: To determine the burden and pattern of cancer in Western Kenya by use of data from the Eldoret cancer registry.Design: Retrospective study.Setting: The cancer registry located in the Department of Haematology at the Moi University, School of Medicine situated at the Moi Teaching and Referral Hospital, Eldoret, Kenya. The hospital has a catchment population of 13 to 15 million people forming about 40% of the Kenyan population.Results: A total of 5,366 patients were diagnosed to have cancer and attended to at the MTRH and other hospitals in Eldoret during the period between January 1999 and December 2006 giving an average of 671 cases per year. Among those treated 2,699 were males and 2,667 were females giving a M: F ratio of 1:1. About 21% of the patients had haematological malignancies with non-Hodgkins lymphoma being the most common.Another 79% of the patients had solid tumours with cancer of the oesophagus being the commonest. Cancer of the cervix and prostrate were the commonest among the females and males respectively. A general increase in the number of patients with Kaposis sarcoma associated with HIV/AIDS pandemic was observed.Conclusion: The burden of cancer is a significant health problem in western Kenya and there is need for the development of a comprehensive cancer care programme in the region to address the growing problem

Management and outcome of patients with Wilms’ Tumour (Nephroblastoma) at the Moi Teaching and Referral Hospital, Eldoret, Kenya

Background: Wilms’ tumour is a common malignant neoplasm of the kidney and is ranked among the top six solid tumours in children in Kenya. Despite its rapid growth and therefore debilitating effects on its victims, it is one tumour that has shown good response to combined modality approach to its treatment with encouraging possibilities of survival even in resource poor settings.Objective: To evaluate the management and outcome of patients with Wilms’ tumour attended to at Moi Teaching and Referral Hospital (MTRH) during the period between January 2000 and December 2007.Design: Retrospective Study.Setting: The Paediatric Oncology Service (Oncology unit in the Paediatric Ward, the Paediatric Surgical Ward and the Outpatient Oncology Clinic) at the Moi Teaching and Referral Hospital, Eldoret, Kenya.Results: Information of 45 patients diagnosed with Wilms’ tumour was analysed. Forty two (93%) of the patients were referrals from various health facilities in the region. Twenty three (51%) were male and 34 (76%) were aged less than 48 months. Twenty five (56%) had the left kidney affected, 19 (42%) the right kidney and one (2%) bilateral. All the 45 (100%) had an abdominal ultrasound done but none had exhaustive investigations done to stage the disease. Only eight (18%) of the patients had a medical insurance cover. Fourty one (91%) of the patients received specific cancer treatment with 28 (62%) getting combined modality treatment. Nineteen (42%) were lost to follow up. Thirty (67%), 21 (47%), 15 (33%) and 13 (29%) patients were alive six months, one year, two years and three years respectively from the time of diagnosis. 29% survived beyond three years of diagnosis .Conclusion: Staging of Wilms tumour fell short of the expected. Neo-adjuvant chemotherapy reduced morbidity and mortality of patients managed for Wilms’ tumour. Loss to follow up and cost of treatment had a negative impact on the outcome, a situation that requires to be improved

Testicular torsion: case report

This is a report of bilateral testicular torsion. The objective of the report is to highlight the serious implications of misdiagnosis of testicular torsion. Other than loss of the testis due to necrosis in unilateral torsion, immunological damage of the opposite testis occurs. Early, accurate diagnosis, and institution of the appropriate treatment are desirable to prevent total loss of reproductive potential in the affected male. East African Medical Journal Vol. 81 No. 5 May 2004: 274-27

Gastroschisis: immediate reduction by Bianchi procedure at Moi teaching and referral hospital, Eldoret: case report

This is a report of the only case of gastroschisis that has survived at the Moi Teaching and Referral Hospital in the past five years. Others, who have been referred to this hospital arriving occasionally without the necessary care for this problem in place, have not even managed to survive through the period of resuscitation. The objective of this report is to show that these children can survive. Immediate post-natal care for protruded abdominal organs, fluid resuscitation and adherence to the principles of neonatal transport are essential.East African Medical Journal Vol 82(10) 2005: 541-54

Childhood intussusception at the Moi teaching and referral hospital Eldoret: management challenges in a rural setting

Objective: To review the management of childhood intussusception at the Moi Teaching and Referral Hospital, Eldoret and identify factors that require attention for improved outcome. Design: A retrospective descriptive study covering the period January 2000 to December 2003. Setting: Moi Teaching and Referral Hospital, Eldoret. Patients: Thirty six children. Results: Of the 36 children, 28 (78%) were males and eight (22%) females giving a ratio of 3.5:1. Median age was six months with a range of 2-72 months. The duration of symptoms was a mean of 5 days with a range of 1-14 days. Sixty one percent were referrals. Initial diagnosis of intussusception based on signs and symptoms was made in 6 out of 36 (17%) patients. The rest were initially treated for other problems. Decision to refer to surgeons, was based on abdominal distension. Plain x-ray was done in four patients and barium enema in one patient. Seventy five percent of the patients required fluid resuscitation before operation. All patients (100%) were managed operatively. Seventy two percent had ileo-colic intussusception, 8% ile-oileal and 22% colo-colic. Perforation was found in 22% and gangrene in 31%. Sixty seven percent were successfully reduced by "milking" while 33% required resection and anastomosis/or stoma creation. Complications included: anastomatic breakdown, bronchopneumonial renal failure, sepsis, recurrent intussusception and death. Mortality was 14% overall. Conclusion: Early diagnosis and presentation coupled with improved peri-operative management are essential in improving outcome. East African Medical Journal Vol.81(9) 2004: 443-44