Seasonality of childhood tuberculosis cases in Kampala, Uganda, 2010-2015.

BackgroundSeasonality in tuberculosis (TB) has been described, especially in children. However, few studies have assessed seasonality of TB in the equatorial region, and none in children.ObjectivesTo assess for seasonality of childhood TB cases in Kampala, Uganda, and determine the role of temperature, rainfall patterns, and influenza cases on TB diagnoses.MethodsWe retrospectively analyzed demographic and clinical data of children (under 15 years) diagnosed with TB at a pediatric TB clinic in Kampala, Uganda from 2010 to 2015. We performed decomposition analysis of the monthly case time series to assess seasonality. We compared monthly mean plots and performed Poisson regression to assess any association between TB diagnoses and temperature, rainfall, and influenza.ResultsOf the 713 childhood TB cases diagnosed at the clinic, 609 (85%) were clinically diagnosed and 492 (69%) were pulmonary cases. There were minimal monthly variations in TB cases, with a trough in December and peaks in July and October, but there was no significant seasonality. Temperature variations did not show a clear pattern with TB diagnoses. Rainfall alternated with TB diagnoses in the first half of the year, but then overlapped in the second half and was significantly associated with TB diagnoses. Influenza cases were significantly related to TB diagnoses with (β = 0.05, 95% CI 0.01 to 0.09, p = 0.01) or without (β = 0.06, 95% CI 0.01 to 0.1, p = 0.01) rainfall, and had particular overlap with pulmonary TB cases.ConclusionsSeasonal variations in childhood TB diagnoses were non-significant. Temperature did not have a clear pattern with TB diagnoses, but rainfall and influenza cases correlated with the primarily clinically diagnosed childhood TB cases

Thyroid function among HIV/AIDS patients on highly active anti-retroviral therapy

Objectives: To assess the thyroid function among Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) patients on anti-retroviral drugs: stavudine, lamivudine and nevirapine and to establish the prevalence of non-thyroid illness.Design: Laboratory based comparative cross-sectional study.Setting: Comprehensive care clinics at KNH and Mbagathi District Hospital.Subjects: Eighty four HIV-infected patients on treatment with ARVs (ARV+ve) and an ARV naive (ARV naive) group of 26 HIV-infected patients.Results: Thyroid stimulating hormone levels were not altered following treatment whereas the levels of FT4 decreased. The frequency of those with low FT4 were increasing with continued ARV use. The prevalence of non-thyroidal illness state defined by TSH within reference ranges and low FT4 was comparable among the ARV +ve and ARV naive groups (44 and 46% respectively).Conclusion: Progressive use of HAART causes decline in FT4 hormone levels. It is debatable whether interventions for low FT4 is necessary in ARV treatment but a longitudinal study would explain the progressive trend of thyroid hormones and implications with HAART treatment. The prevalence of NTI is comparable to both HAART users and non-users. Low levels of thyroid hormone (FT 4) may be an adaptive response by thyroid gland to minimize calorie utilisation as in chronic diseases

Rapid assessment of partograph utilisation in selected maternity units in Kenya

Background: Prolonged labour causes maternal and perinatal morbidity and mortality. Its sequela include obstructed labour, uterine rupture, maternal exhaustion, postpartum haemorrhage, puerperal sepsis, obstetric fistula, stillbirths, birth asphyxia and neonatal sepsis. These complications can be reduced by using the partograph to assess the progress of labour. The Ministry of Health, Kenya has adopted this tool for labour management in the country and the standardised partograph is recommended for use in all delivery units.Objective: To determine the utilisation of the partograph in the management of labour in selected health facilities in Kenya.Design: A descriptive cross sectional study.Setting: Nine health facilities -ranging from a tertiary hospital to health centre, including public private and faith based facilities in four provinces in Kenya.Results: All facilities apart from Pumwani Maternity Hospital and one health centre were using the partograph. The correct use was low, the knowledge on the use of the tool was average and there was minimal formal training being provided. Staff shortage was listed as the most common cause of not using the tool. Contractions were recorded 30-80%, foetal heart rate 53-90% and cervical dilatation 70-97%. Documentation of stateof the liquor, moulding and descent as well as maternal parameters such as pulse, and blood pressure and urinalysis were minimally recorded. Supplies for monitoring labour such as fetoscopes and blood pressure machines were in short supply and sometimes not functional. Overall, the poor usage was contributed to staff shortages, lack of knowledge especially on interpretation of findings, negative attitudes, conflictbetween providers as to their roles in filling the partograph, and senior staff themselves not acting as role models with regards to the use, advocacy and implementation of the partograph.Conclusion: The partograph was available in most units. However, accurate recording of parameters to monitor the foetus, the mother and progress of labour as recommended was mostly not done. Shortage of staff, lack of knowledge, lack of team work, lack of supplies and negative attitude among healthcare providers were some of the obstacles noted to hamper partograph use

Gestational Thyrotoxicosis Associated With Emesis In Early Pregnancy

Objectives: To determine the thyroid profile and the prevalence of gestational thyrotoxicosis among women with emesis during early pregnancy.Design: A descriptive cross - sectional study.Setting: Kenyatta National Hospital acute gynaecology ward and the ante-natal clinic.Subjects: Seventy two women presenting with emesis up to 16 weeks gestation.Main outcome measures: The levels of FT3, FT4, TSH and &beta;-hCG during the first 16 weeks of gestation. Correlation between the thyroid hormones and &beta;-hCG as well as the severity of vomiting was also done.Results: The point prevalence of gestational thyrotoxicosis was 8.3%. There was a significant positive correlation between &beta;-hCG levels and FT3 and FT4 (P-values < 0.05), and a significant negative correlation between &beta;-hCG and TSH (P < 0.05).Correlation between the severity of vomiting and the thyroid hormones as well as &beta;-hCG was not statistically significant. Patients' age ranged from 14-38 years (median 26). Majority of the women studied were at a gestation of 8 to 11 weeks (38.9%). Most patients (84.7%) had one to five episodes of vomiting per day. Peak &beta;-hCG was at 12 - 15 weeks gestation.Conclusions: Thyrotoxicosis does occur among women with emesis in pregnancy in this set-up. Screening for it may be beneficial to such women and also those with high serum &beta;-hCG levels above the median for the gestational age

Outcomes Of Assisted Reproductive Technologies At The Nairobi In Vitro Fertilisation Centre

Background: Infertility is a common problem affecting up to ten per cent of married couples. A systematic evaluation of aetiologic factors forms the basis for choice of treatment and future fertility. On the global perspective, Assisted Reproductive Technologies (ART) has become internationally recognised treatment option for some infertile couples. A report on the current outcomes of ART practice at The Nairobi IVF Centre is presented.Objective: To describe the practice of assisted reproduction and present a report on the current outcomes. Design: A retrospective survey of data on assisted reproduction practice from August 2005 to July 2008.Setting: The Nairobi IVF Centre a private medical practice in Nairobi, Kenya.Interventions: Treatment of infertile couples by various assisted reproductive technologies including in vitro fertilisation (IVF), intra-cytoplasmic sperm injection (ICSI), uterine fresh embryo transfer (ET), and frozen/thawed uterine ET (FTET).Main outcome measures: Fertilisation, embryo cleavage, ET, embryo freeze/thaw survival, pre-clinical pregnancy and clinical pregnancy rates, live births and other obstetric outcomes.Results: A total of 362 IVF cycles were performed. Following controlled ovarian hyperstimulation, an average of 12 oocytes were retrieved per patient while the fertilisation and subsequent embryo cleavage rates were 67 and 91.2% respectively. An average of three embryos were transferred and the embryo transfer rate was 93.3% per cycle started and 96.6% per oocyte retrieval. Surplus embryos were available for cryopreservation in 106 (50.1%) cycles. On thawing frozen embryos, the survival rate was 65.5%. Following ET, the overall pre-clinical pregnancies were 124 (36.2%) of which 99 (28.9%) developed into clinical pregnancies per cycle. Of the clinical pregnancies, 72 (73%) were singletons, 23 (23%) twin gestations and four triplets (4%). A total of 52 mothers have been delivered either by Caesarian section 45 (86.5%) or spontaneous vertex delivery seven (13.5%) to 61 live babies of whom 36 were females and 25 males. A further 28 IVF clinical pregnancies are ongoing, 26 following fresh embryo transfer and two from frozen/thawed embryos.Conclusion: Our results on ART practice reflects a pregnancy outcome comparable to that reported by other fertility centres globally. Couples with infertility in East and Central Africa for whom ART treatment is indicated may now access the service locally

Efavirenz poisoning in a 12 year old HIV negative African boy

Efavirenz is an oral antiretroviral drug in the class of non nucleoside reverse transcriptase inhibitors. Toxicity at therapeutic doses has been documented but there is scarcity of data on presentation and management of Efavirenz overdose. We describe a case of Efavirenz poisoning in a 12-year old HIV Negative African boy with a very unique presentation after ingesting 3 grams of Efavirenz as a single dose. The most prominent problems were burning sensation in the throat immediately after ingestion then visual impairment one hour later then tremors, screaming at night and motor deficits in lower limbs for 5 days before admission. His medical history, physical exam and investigations revealed no other cause of his presentation other than the EFV. Unfortunately, it was not possible to do EFV levels. He was given supportive treatment and 10 days later he was completely well.Key words: Efavirenz, poisoning, intoxication, adverse reaction, HI

Environmental and occupational exposure to lead

Objective: To determine the status of environmental and occupational lead exposure in selected areas in Nairobi, Kenya. Design: Cross sectional study. Setting: Kariobangi North, Babadogo, Waithaka and Pumwani for assessment of environmental exposure to lead (Pb) and Ziwani Jua Kali works for assessment of occupational lead exposure. Olkalou in Nyandarua District was the covariate study area. Subjects: Three hundred and eight children and adults participated. Results: Blood lead levels (BLLs) obtained for the entire sample (n = 308) ranged from 0.4 to 65&#956;g/ dl of blood. One hundred and sixty nine (55%) of the total sample had levels equal to or below 4.9&#956;g/dl, while 62 (20%) of the sample had levels ranging from 5.0 to 9.9&#956;g/dl. Blood lead levels above 10&#956;g/dl were recorded in 77 (25%) of the total sample. Within Nairobi, 32 (15.3%) of the study subjects in areas meant for assessment of environmental lead exposure had levels above the WHO/CDC action levels of 10&#956;g/dl of blood. The mean BLL for the occupationally exposed (Ziwani Jua kali) was 22.6 ± 13.4&#956;g/dl. Among the workers, 89% had BLLs above 10&#956;g/dl. In general, 15% of the entire sample (for both environmental and occupational groups) in Nairobi had BLLs above 15&#956;g/dl. The covariate group at Olkalou had a mean BLL of 1.3 ± 0.9&#956;g/dl. Conclusion: The prevalence of environmental lead exposure to the general public is high in Nairobi compared to Olkalou where non exposure was reported. Occupational lead exposure has been identified to be at alarming levels and urgent intervention measures are recommended. East African Medical Journla Vol. 85 (6) 2008: pp. 284-29

Experience with UIDC insertion outside of menses in Kenya

Objective: To determine if women receiving intrauterine devices (IUCDs) outside of menses have an acceptable rate of insertion problems and subsequent IUCD-related complications.Design: Cross-sectional and prospective cohort study of insertions at times other than during menses.Setting: The study was carried out in two government family planning (FP) clinics in Nairobi,Kenya.Subjects: After appropriate pre-test and post-test HIV counselling, 1686 women requesting IUCDs at two FP clinics between 1994 and 1995 in Nairobi were enrolled at baseline into a study examining the effect of human complications. Six hundred and forty nine women (156 HIV-infected and 493 HIVuninfected) were selected for the four month follow up study. They were classified according to their menstrual cycle status at time of IUCD insertion.Main outcome measures: Problems at the time of insertion (pain, bleeding, immediate expulsion) and IUCD-related complications through four months.Results: Rates of immediate insertion problems were low in the women who had insertions during menses (7.0%), outside of menses (4.0%) or had oligomenorrhea/amenorrhea (2.6%). The adjusted odds ratios for IUCD insertion problems outside of menses and in oligomenorrhea/amenorrhea (versus women with insertion during menses) were 0.54 (95% CI 0.18 -1.59) and 0.39 (95% CI 0.12 -1.29) respectively. IUCD-related complications were higher in the iligomenorrhea/amenorrhea (11.5%) or insertion outside of menses (6.9%), than the within menses (4.3%) groups. However, the differences were not statistically significant. Adjusted odds ratios for IUCD outside of menses and oligomenorrhoea/amenorrhea groups were 1.65 (95% CI 0.21 - 12.91) and 2.72 (95% CI 0.34 - 21.71) respectively.Conclusion: The results confirm that the IUCD can be safely inserted outside of menses with minimal insertion difficulties and subsequent complications. Availability of IUCDs outside of menses may enhance IUCD acceptance in Kenya and create better opportunity for visualscreening of the cervix for sexually transmitted infections

Prospective Changes in Serum Levels of Some Proinflammatory Cytokines and Erythropoietin among Anaemic HIV-infected Patients Attending Kenyatta National Hospital Comprehensive Care Centre

Between 70 to 80% of HIV infected patients develop anaemia which is a major complication in advanced HIV infection. The multifactorial etiology of the HIV-associated anaemia requires extensive studies on its unique pathophysiology as a step towards improving therapeutic options and disease management.The objective of this study is to monitor changes in serum levels of erythropoietin (Epo), Tumor necrosis factor-alpha (TNF-α), Interleukin-6 (IL-6), C-Reactive Protein (CRP) and anaemia in HIV infected patients over six months’ period. This study is Longitudinal descriptive study and it was conducted at Kenyatta National Hospital, Kenyatta National Hospital can be considered as Comprehensive Care Centre.The study used one hundred and eighty-four (184) seropositive adults aged 18 to 60 years.The results shows that Blood cells exhibited pathologies ranging from: Rouleaux formation, round macrocytes, microcytic hypochromic cells and target cells in frequencies that decreased with increase in CD4+ cells. Normochromic, macrocytic normochromic and dimorphic anaemias were observed. Bicytopenia (erythrocytopenia and leucopenia), reactive thrombocytosis with giant platelets, neutrophil and eosinophil hypersegmentations were also observed. Persistent increase in Epo and CRP levels were demonstrated among subjects throughout the study period. Increases in TNF-α levels without corresponding increase in IL-6 levels were observed. Persistence anaemia in presence of high Epo levels is suggestive of hyposensitivity to Epo by erythroid precursors. Asynchronized increases in TNF-α and IL- 6 levels may have deprived the duo the synergy required to effectively inhibit Epo production further facilitating the escalating levels of Epo observed. High levels of CRP observed indicate enhanced inflammation processes associated with HIV infection. Iron studies to rule out the role of iron-restricted erythropoiesis in the development microcytic, dimorphic anaemias and the granulocytic hypersegmentations noted are recommended. Studies on the possibility of Epo hyposensitivity derailing the effectiveness of recombinant human Epo in the management of HIV – associated anaemia are recommended.