Hernia Surgery in Nyeri Provincial General Hospital, Kenya: Our 6 Year Experience

Introduction: Hernia is a common surgical condition world over. Much of hernia surgery in Africa is carried out as an emergency while elective procedures are few. Knowledge of the burden of hernia disease would facilitate optimal resource allocation. Methods: A retrospective audit between 2007 and 2012 was carried out in Nyeri Provincial General Hospital. Results: Hernia surgery accounted for 5.9% (N=239) of all surgeries excluding obstetric operations. The male to female ratio was 1.6:1 and 35.6% were aged below 5 years. Inguinal hernia was the most common type (51.4%) followed by umbilical (21.5%), epigastric (17.5%), incisional (6.2%) and hiatus hernia (3.4%). A painless abdominal or groin swelling was the most common presentation (81.6%). All cases underwent open surgical repair with 93.8% of the operations done electively. The average length of hospital stay was 3 days. Of the inguinal hernias, 81.3% were right while 18.7% were left sided. Methods of inguinal hernia repair included Modified Bassini (79%), Shouldice 4% and Mesh (19%). Surgery was done under general, spinal or local anaesthesia (86%, 12% and 2% respectively). Conclusion: Hernia disease continues to be a significant source of morbidity in our set-up. While majority of the cases can be handled as elective cases, uptake of mesh repair remains low.Key Words: Hernia surgery, Herniorapphy, Groin hernia, Mesh repai

Successful IVF-ICSI with live baby in an azoospermic patient with cryopreserved sperms: Case report

Male factor is one of the most frequent cause of infertility and presents a variety of endocrine, genetic and immunological etiologies, as well as sexual malfunction, varicocele and genital infections. A case of a couple with primary infertilityfor two years is presented. Both partners were evaluated thoroughly, with a finding of male infertility. The man was found to be azoospermic after two semenalysis were performed. The Follicle Stimulating hormone (FSH) was raised with low testosterone levels indicating testicular failure. The recommended treatment was testicular biopsy with cryopreservation of the sperm and subsequent Intra cytoplasmic Sperm Injection (ICSI). This treatment option was undertaken with successful implantation and live baby delivery. The case study presents the diagnostic modalities and management of male infertility with azoospermia

Raised temperatures over the Kericho Tea Estates: revisiting the climate in the East African highlands malaria debate: Supplemental Information

Supplemental information to a study examining a time series of quality controlled daily temperature and rainfall data from Kericho, in the Kenyan Highlands, for the 30-year period 1 January 1979 to 31 December 2009

Raised temperatures over the Kericho tea estates: revisiting the climate in the East African highlands malaria debate

<p>Abstract</p> <p>Background</p> <p>Whether or not observed increases in malaria incidence in the Kenyan Highlands during the last thirty years are associated with co-varying changes in local temperature, possibly connected to global changes in climate, has been debated for over a decade. Studies, using differing data sets and methodologies, produced conflicting results regarding the occurrence of temperature trends and their likelihood of being responsible, at least in part, for the increases in malaria incidence in the highlands of western Kenya. A time series of quality controlled daily temperature and rainfall data from Kericho, in the Kenyan Highlands, may help resolve the controversy. If significant temperature trends over the last three decades have occurred then climate should be included (along with other factors such as land use change and drug resistance) as a potential driver of the observed increases in malaria in the region.</p> <p>Methods</p> <p>Over 30 years (1 January 1979 to 31 December 2009) of quality controlled daily observations ( > 97% complete) of maximum, minimum and mean temperature were used in the analysis of trends at Kericho meteorological station, sited in a tea growing area of Kenya's western highlands. Inhomogeneities in all the time series were identified and corrected. Linear trends were identified via a least-squares regression analysis with statistical significance assessed using a two-tailed t-test. These 'gold standard' meteorological observations were compared with spatially interpolated temperature datasets that have been developed for regional or global applications. The relationship of local climate processes with larger climate variations, including tropical sea surface temperatures (SST), and El Niño-Southern Oscillation (ENSO) was also assessed.</p> <p>Results</p> <p>An upward trend of ≈0.2°C/decade was observed in all three temperature variables (P < 0.01). Mean temperature variations in Kericho were associated with large-scale climate variations including tropical SST (r = 0.50; p < 0.01). Local rainfall was found to have inverse effects on minimum and maximum temperature. Three versions of a spatially interpolated temperature data set showed markedly different trends when compared with each other and with the Kericho station observations.</p> <p>Conclusion</p> <p>This study presents evidence of a warming trend in observed maximum, minimum and mean temperatures at Kericho during the period 1979 to 2009 using gold standard meteorological observations. Although local factors may be contributing to these trends, the findings are consistent with variability and trends that have occurred in correlated global climate processes. Climate should therefore not be dismissed as a potential driver of observed increases in malaria seen in the region during recent decades, however its relative importance compared to other factors needs further elaboration. Climate services, pertinent to the achievement of development targets such as the Millennium Development Goals and the analysis of infectious disease in the context of climate variability and change are being developed and should increase the availability of relevant quality controlled climate data for improving development decisions. The malaria community should seize this opportunity to make their needs heard.</p

Independent impact assessment report: Participatory Rangeland Management (PRM) in Kenya and Tanzania

This report comprises findings from an independent impact assessment of the Piloting Participatory Rangeland Management project in Kenya and Tanzania. The study was conducted in November and December 2021 by African Re search and Economic Development Consultants (AFREDEC), contracted by ILRI Livestock CRP (CGIAR Research Program). The main objective was to determine the impacts of participatory rangeland management (PRM) on rangelands, environment, good governance and management processes, security of rights to land and resources, livestock production, gender issues, women’s empowerment and other social equity aspects and on policy influence. The study identified key lessons learnt and best practices and opportunities for scaling up. The assessment applied a mixed-method approach comprising quantitative data collected using household surveys and qualitative data collected using key informant interviews and focus group discussions. In total, 2,000 household representatives were interviewed through the survey, with almost 150 focus group discussion participants and more than 40 key informants

Utility of healthcare-worker-targeted antimicrobial stewardship interventions in hospitals of low- and lower-middle-income countries: a scoping review of systematic reviews

Background Antimicrobial stewardship (AMS) initiatives in hospitals often include the implementation of clustered intervention components to improve the surveillance and targeting of antibiotics. However, impacts of the individual components of AMS interventions are not well known, especially in low- and lower-middle-income countries (LLMICs). Objective A scoping review was conducted to summarize evidence from systematic reviews (SRs) on the impact of common hospital-implemented healthcare-worker-targeted components of AMS interventions that may be appropriate for LLMICs. Methods Major databases were searched systematically for SRs of AMS interventions that were evaluated in hospitals. For SRs to be eligible, they had to report on at least one intervention that could be categorized according to the Effective Practice and Organisation of Care taxonomy. Clinical and process outcomes were considered. Primary studies from LLMICs were consulted for additional information. Results Eighteen SRs of the evaluation of intervention components met the inclusion criteria. The evidence shows that audit and feedback, and clinical practice guidelines improved several clinical and process outcomes in hospitals. An unintended consequence of interventions was an increase in the use of antibiotics. There was a cumulative total of 547 unique studies, but only 2% (N=12) were conducted in hospitals in LLMICs. Two studies in LLMICs reported that guidelines and educational meetings were effective in hospitals. Conclusion Evidence from high- and upper-middle-income countries suggests that audit and feedback, and clinical practice guidelines have the potential to improve various clinical and process outcomes in hospitals. The lack of evidence in LLMIC settings prevents firm conclusions from being drawn, and highlights the need for further research

Detection and Quantification of Oestrogenic Endocrine Disruptors in Water in Mwanza Gulf in the Lake Victoria Basin, Tanzania

The aim of this study was to detect the presence and quantify the total oestrogens (estriol (E1), estradiol (E2), and estrone (E3)) in Lake Victoria water with a view of assessing their contribution to the health status of fish. A total of 27 water samples; three from each of the nine sampling sites were collected in Mwanza gulf in the city in May 2012. Solvent extraction procedures were used to obtain extracts of pollutants that were further analysed using the competitive Enzyme- Linked Immunosorbent Assay (ELISA) technique to detect and quantify the total oestrogens. Overall, the concentration of total oestrogens was low and ranged from 10 – 200 pg/L. Concentrations of these chemicals decreased along the gradient, being highest (107±81.4 pg/L) in rivers before entering into the lake and lowest (19±5.4 pg/L) in water samples collected in the lake at about 100 meters from inshore (intermediate sampling points). Levels of total oestrogens were significantly different between categories of water sources (P = 0.009). Two most polluted rivers were Butimba and Nyakurunduma with concentrations at 150 pg/L and 200 pg/L respectively. Dumping of wastes in rivers without treatment was the most likely source of the pollutants. Findings from this study have revealed the existence of oestrogens with endocrine disrupting properties at different concentrations, and that rivers are the main sources of oestrogenic endocrine disruptors in Lake Victoria water near Mwanza City.Keywords: ELISA, endocrine disruptors, oestrogens, pollutio

PLoS One

Introduction Patient-centered care (PCC) is an approach to involve patients in health care delivery, to contribute to quality of care, and to strengthen health systems responsiveness. This article aims to highlight patient perspectives by showcasing their perceptions of their experience of PCC at primary health facilities in two districts in Uganda. Methods A mixed methods cross-sectional study was conducted in three public and two private primary health care facilities in rural eastern Uganda. In total, 300 patient exit survey questionnaires, 31 semi-structured Interviews (SSIs), 5 Focus Group Discussions (FGDs) and 5 feedback meetings were conducted. Data analysis was guided by a conceptual framework focusing on (1) understanding patients’ health needs, preferences and expectations, (2) describing patients perceptions of their care experience according to five distinct PCC dimensions, and (3) reporting patient reported outcomes and their recommendations on how to improve quality of care. Results Patient expectations were shaped by their access to the facility, costs incurred and perceived quality of care. Patients using public facilities reported doing so because of their proximity (78.3% in public PHCs versus 23.3% in private PHCs) and because of the free services availed. On the other hand, patients attending private facilities did so because of their perception of better quality of care (84.2% in private PHCs versus 21.7% in public PHCs). Patients expectations of quality care were expressed as the availability of medication, shorter waiting times, flexible facility opening hours and courteous health workers. Analysis of the 300 responses from patients interviewed on their perception of the care they received, pointed to higher normalized scores for two out of the five PCC dimensions considered: namely, exploration of the patient’s health and illness experience, and the quality of the relationship between patient and health worker (range 62.1–78.4 out of 100). The qualitative analysis indicated that patients felt that communication with health workers was enhanced where there was trust and in case of positive past experiences. Patients however felt uncomfortable discussing psychological or family matters with health workers and found it difficult to make decisions when they did not fully understand the care provided. In terms of outcomes, our findings suggest that patient enablement was more sensitive than patient satisfaction in measuring the effect of interpersonal patient experience on patient reported outcomes. Discussion and conclusion Our findings show that Ugandan patients have some understanding of PCC related concepts and express a demand for it. The results offer a starting point for small scale PCC interventions. However, we need to be cognizant of the challenges PCC implementation faces in resource constrained settings. Patients’ expectations in terms of quality health care are still largely driven by biomedical and technical aspects. In addition, patients are largely unaware of their right to participate in the evaluation of health care. To mitigate these challenges, targeted health education focusing on patients’ responsibilities and patient’s rights are essential. Last but not least, all stakeholders must be involved in developing and validating methods to measure PCC

The development of bone char-based filters for the removal of flouride from drinking water

Millions of people rely on drinking water that contains excess fluoride. Only few fluoride removal techniques have been implemented on a wider scale in low and middle income countries. One of these methods, bone char filtration, is highly efficient. However, its lifespan is rather limited. This paper presents first laboratory results and field testing of a new fluoride removal technology, based on a combination of bone char and calcium-phosphate pellets. These chemicals are slowly released to the water for fluoride precipitation. Although this method, commonly referred to as contact precipitation is known, the development of such pellets is new. Fixed-bed laboratory experiments show that this mixture of materials can increase filter uptake capacity by a factor of 3 and more. However, to reduce the phosphate concentration in the treated water, the design of full-scale community filters for field testing has to be slightly modified