Patient characteristics of the Accident and Emergency Department of Kenyatta National Hospital, Nairobi, Kenya: a cross-sectional, prospective analysis

Background Resource-limited settings are increasingly experiencing a ‘triple burden’ of disease, composed of trauma, non-communicable diseases (NCDs) and known communicable disease patterns. However, the epidemiology of acute and emergency care is not well characterised and this limits efforts to further develop emergency care capacity. Objective To define the burden of disease by describing the patient population presenting to the Accident and Emergency Department (A&E) at Kenyatta National Hospital (KNH) in Kenya. Methods We completed a prospective descriptive assessment of patients in KNH’s A&E obtained via systematic sampling over 3 months. Research assistants collected data directly from patients and their charts. Chief complaint and diagnosis codes were grouped for analysis. Patient demographic characteristics were described using the mean and SD for age and n and percentages for categorical variables. International Classification of Disease 10 codes were categorised by 2013 Global Burden of Disease Study methods. Results Data were collected prospectively on 402 patients with an average age of 36 years (SD 19), and of whom, 50% were female. Patients were most likely to arrive by taxi or bus (39%), walking (28%) or ambulance (17%). Thirty-five per cent of patients were diagnosed with NCDs, 24% with injuries and 16% with communicable diseases, maternal and neonatal conditions. Overall, head injury was the single most common final diagnosis and occurred in 32 (8%) patients. The most common patient-reported mechanism for head injury was road traffic accident (39%). Conclusion This study estimates the characteristics of the A&E population at a tertiary centre in Kenya and highlights the triple burden of disease. Our findings emphasise the need for further development of emergency care resources and training to better address patient needs in resource-limited settings, such as KNH

Retrospective Review of the Patient Cases at a Major Trauma Center in Nairobi, Kenya and Implications for Emergency Care Development

Introduction Low- and middle-income countries (LMICs) are continuing to experience a “triple burden” of disease - traumatic injury, non-communicable diseases (NCDs), and communicable disease with maternal and neonatal conditions (CD&Ms). The epidemiology of this triad is not well characterised and poses significant challenges to resource allocations, administration, and education of emergency care providers. The data collected in this study provide a comprehensive description of the emergency centre at Kenya\u27s largest public tertiary care hospital. Methods This study is a retrospective chart review conducted at Kenyatta National Hospital of all patient encounters over a four-month period. Data were collected from financial and emergency centre triage records along with admission and mortality logbooks. Chief complaints and discharge diagnoses collected by specially trained research assistants were manually converted to standardised diagnoses using International Classification of Disease 10 (ICD-10) codes. ICD-10 codes were categorised into groups based on the ICD-10 classification system for presentation. Results A total of 23,941 patients presented to the emergency centre during the study period for an estimated annual census of 71,823. The majority of patients were aged 18-64 years (58%) with 50% of patients being male and only 3% of unknown sex. The majority of patients (61%) were treated in the emergency centre, observed, and discharged home. Admission was the next most common disposition (33%) followed by death (6%). Head injury was the overall most common diagnosis (11%) associated with admission. Conclusions Trends toward NCDs and traumatic diseases have been described by this study and merit further investigation in both the urban and rural setting. Specifically, the significance of head injury on healthcare cost, utilisation, and patient death and disability points to the growing need of additional resources at Kenyatta National Hospital for acute care. It further demonstrates the mounting impact of trauma in Kenya and throughout the developing world

Putting Children First: New Frontiers in the Fight Against Child Poverty in Africa

Despite important strides in the fight against poverty in the past two decades, child poverty remains widespread and persistent, particularly in Africa. Poverty in all its dimensions is detrimental for early childhood development and often results in unreversed damage to the lives of girls and boys, locking children and families into intergenerational poverty. This edited volume contributes to the policy initiatives aiming to reduce child poverty and academic understanding of child poverty and its solutions by bringing together applied research from across the continent. With the Sustainable Development Goals having opened up an important space for the fight against child poverty, not least by broadening its conceptualization to be multidimensional, this collection aims to push the frontiers by challenging existing narratives and exploring alternative understandings of the complexities and dynamics underpinning child poverty. Furthermore, it examines policy options that work to address this critical challenge.Comparative Research Programme on Poverty (CROP) at the University of Bergen.publishedVersio

A Health Production Approach to Bone Health in Kenya

Reduced density and quality in bones increase fracture risk, which becomes evident later in life through recognition of osteoporosis which is a skeletal disorder characterized by compromised bone strength, pre-disposing to an increased risk of fracture and is a global health problem that affects men as well as women. Shocks are inevitable to everyone everywhere and in the wake of shock of chronic/severe illness like Corona virus (Covid-19) which is infecting and affecting individuals worldwide and countrywide; the response may be negative or positive. The negative responses acts like additional shocks, hence focus will be on the positive responses (good reports) which are meant to counter the shocks and improve individuals and consequently household’s welfare. In some cases covid-19 results to death of a household member, this calls for immediate response to the shock. During the outbreak of corona virus, many individuals have lost their employment and at such a time when loss of salaried employment or non-payment of salary results, individuals may need to respond to the shock positively. A time like this the health care facilities are overstrained with many hospitalizations as a result of day to day increase in the shocks (corona virus) and its associated shocks like loss of employment and death. Likewise, the governments’ curfews have made individuals to experience business failure, limit their movements, reduce physical activity, and change their food and nutrition and as a result may affect their health outcomes. This study sought to establish the determinants of bone health, based on the health production approach by isolating the effects of response to shocks, and food and nutrition on bone health. The current study found that good report (positive response to shocks), exercising (through use of non-motorized transport), completing secondary education, taking wine, consuming fruits like apples, pineapples and melons and vegetables such as lettuce, cucumber and courgette, and increased consumption of peanut butter, tinned fish, and minced meat, chocolate and cheese significantly helps in improvement of bone health as they reduce bone fracture. However, bad reports deteriorate bone health, increased consumption of bread and corned beef significantly depletes bone health as they increase the occurrence of fracture. This study recommends that in order to improve individuals’ bone health there is need to convey good reports especially during shocks like Covid-19. Individuals who have experienced non-agricultural household business failure due to the outbreak of corona virus, they need not to give up but ought to respond by starting a new business. For improved bone health, individuals also need to continually exercise by using non-motorized means of travel like walking or cycling; they may need to take a little wine especially as their age increases; and strengthening their bones through increased consumption of apples, pineapples and melons, lettuce, cucumber and courgette, peanut butter, tinned fish, and minced meat, chocolate and cheese. Keywords: Bone Health, Health Production, Corona Virus, Covid-19, Response to Shocks, Food and Nutrition DOI: 10.7176/JHMN/85-15 Publication date: January 31st 202

Rapid radiation of ant parasitic butterflies during the Miocene aridification of Africa

Abstract Africa has undergone a progressive aridification during the last 20 My that presumably impacted organisms and fostered the evolution of life history adaptations. We test the hypothesis that shift to living in ant nests and feeding on ant brood by larvae of phyto‐predaceous Lepidochrysops butterflies was an adaptive response to the aridification of Africa that facilitated the subsequent radiation of butterflies in this genus. Using anchored hybrid enrichment we constructed a time‐calibrated phylogeny for Lepidochrysops and its closest, non‐parasitic relatives in the Euchrysops section (Poloyommatini). We estimated ancestral areas across the phylogeny with process‐based biogeographical models and diversification rates relying on time‐variable and clade‐heterogeneous birth‐death models. The Euchrysops section originated with the emerging Miombo woodlands about 22 million years ago (Mya) and spread to drier biomes as they became available in the late Miocene. The diversification of the non‐parasitic lineages decreased as aridification intensified around 10 Mya, culminating in diversity decline. In contrast, the diversification of the phyto‐predaceous Lepidochrysops lineage proceeded rapidly from about 6.5 Mya when this unusual life history likely first evolved. The Miombo woodlands were the cradle for diversification of the Euchrysops section, and our findings are consistent with the hypothesis that aridification during the Miocene selected for a phyto‐predaceous life history in species of Lepidochrysops, with ant nests likely providing caterpillars a safe refuge from fire and a source of food when vegetation was scarce

Putting Children First: New Frontiers in the Fight Against Child Poverty in Africa

Despite important strides in the fight against poverty in the past two decades, child poverty remains widespread and persistent, particularly in Africa. Poverty in all its dimensions is detrimental for early childhood development and often results in unreversed damage to the lives of girls and boys, locking children and families into intergenerational poverty. This edited volume contributes to the policy initiatives aiming to reduce child poverty and academic understanding of child poverty and its solutions by bringing together applied research from across the continent. With the Sustainable Development Goals having opened up an important space for the fight against child poverty, not least by broadening its conceptualization to be multidimensional, this collection aims to push the frontiers by challenging existing narratives and exploring alternative understandings of the complexities and dynamics underpinning child poverty. Furthermore, it examines policy options that work to address this critical challenge