Abstract: OBJECTIVE: To determine the effect of two levels of counselling on the provision of Intrauterine Contraceptive Device (IUCD) at six weeks post-partum of the post-placental intrauterine device. SETTING: Embu Provincial General Hospital Kenya. SUBJECTS: One hundred and thirty seven pregnant women at the gestation of 36 weeks to term who attended Antenatal clinic and were followed until delivery and at six weeks post-partum. DESIGN: A randomised "open-label" clinical trial. RESULTS: One hundred and twenty seven study participants were enrolled and randomised to intensive (64 women) or routine FP counselling (63 women). Seventy eight per cent of women in the intensive FP counselled group and 66% in the routine FP counselled group accepted to have the post-placental IUCD inserted. There was no significant difference in uptake in the two-randomisation arms (p-value 0.232). Complications included expulsion (3.7%) allergic reaction (1.8%) pelvic infection (1.8%) and abdominal pain (1.8%).The post-placental IUCD is a favourable method with continuation rates (91%) client (88%) and reported partner (77%) satisfaction were notably high at six weeks. The most critical barrier to uptake was lack of trained medical personnel to insert the post-placental IUCD which occurred in (60%) clients who had consented. CONCLUSION: The post-placental IUCD is an acceptable method among women irrespective of level of counselling. Intensive counselling did not significantly increase acceptance and uptake rates of post-placental IUCD insertion in comparison to routine counselling.

Abstract: Background : Cryptococcal meningitis (CM) is an increasingly prevalent infection among HIV/AIDS patients and is becoming a leading cause of morbidity and mortality in Africa. The short-term prognosis and management of patients with CM may be improved by identifying factors leading to mortality in patients with CM. Objective : To assess the clinical management and mortality associated with cryptococcal meningitis (CM) in patients with acquired immunodeficiency syndrome (AIDS) in Kenya. Design : A retrospective study. Setting : Kenyatta National Hospital and Mbagathi District Hospital, between August 2008 and March 2009. Subjects : Seventy six HIV-infected patients confirmed to be CM positive. Results : Results show that 30 (40%) of 76 patients diagnosed with CM died during hospitalisation after a median hospital stay of ten days (range, 2-73 days). Significant predictors of mortality in the univariate model were Mycobacterium tuberculosis (TB) co-infection (P = 0.04), having been diagnosed with a co-morbid condition such as diabetes mellitus, oral candidiasis and hypertension (P = 0.01), and a low median CD4+ T lymphocyte count (P < 0.001). The multivariable model revealed that male sex, previous or current anti-retroviral therapy (ART) at admission and CD4+ T lymphocyte count less than 50 were significant predictors of mortality. Conversely, a minimum of two weeks of amphotericin B treatment (P < 0.001), initiation of ART (P = 0.007) and monitoring of creatinine and electrolyte levels (P = 0.02) were significantly associated with survival in the univariate model. Conclusions : CM-associated mortality in Kenya is high; there is an opportunity to improve the management and the short-term outcomes of hospitalised HIV positive patients with CM in Kenya.

Abstract: Background : Most of the nutritional surveys that have been carried out in Kenya have concentrated on children aged five years and below who are under the care of their parent(s). The HIV/AIDS, conflict, natural disasters, endemic diseases such as malaria and tuberculosis and rising poverty has claimed the health and lives of millions of productive adults, leaving their children orphaned and vulnerable. This has led to mushrooming of orphanages to take care of these orphans and vulnerable children in Kenya. Objective : Compare the nutrition status and associated risk factors of primary school children living in orphanages and those not living in orphanages in selected public primary schools in Dagoretti Division, Nairobi. Design : Descriptive cross sectional survey. Setting : Four public primary schools in Dagoretti Division. Data were collected from school registers and directly questioning the students, parents /guardians or caretakers. Subjects : Four hundred and sixteen, four to eleven year olds randomly selected orphanage and non-orphanage children who attended the same primary school. Results : The orphanage children had a significantly higher rate of stunting and underweight (p< 0.05) than the non-orphanage children. The orphanage children had also a significantly higher rate of morbidity (p<0.05) than the non-orphanage children. The orphanage children were more than three times more likely to take inadequate calories compared to the non-orphanage children. Conclusions : The main factors associated with the higher rate of malnutrition among orphanage children were high morbidity rate, inadequate amounts and diversity of foods served, low rates of vaccination and basic hygiene.

Abstract: Objective : To compare the predictive accuracy of foetal trans-cerebellar diameter(TCD) with those of other biometric parameters in the estimation of gestational age (GA). Design : A cross-sectional study. Setting : The University of Benin Teaching Hospital, Nigeria. Subjects : Four hundred and fifty healthy singleton pregnant women, between 14-42 weeks gestation. Main Outcome measures : trans-cerebellar diameter (TCD), biparietal diameter (BPD), femur length (FL), abdominal circumference (AC) values across the gestational age range studied. Correlation and predictive values of TCD compared to those of other biometric parameters. Results : The range of values for TCD was 11.9 -59.7mm (mean =34.2±14.1mm). TCD correlated more significantly with menstrual age compared with other biometric parameters (r=0.984, p=0.000). TCD had a higher predictive accuracy of 96.9%±12 days), BPD (93.8%±14.1days). AC (92.7% ± 15.3days). Conclusion : TCD has a stronger predictive accuracy for gestational age compared to other routinely used foetal biometric parameters among Nigerian Africans.

Abstract: Background : Intestinal schistosomiasis caused by Schistosoma mansoni and urinary schistosomiasis caused by Schistosoma haematobium are widely distributed parasites in several localities of the Lake Victoria basin of Kenya, the former being more prevalent. In Kenya, transmission of the intestinal form of bilharzia ( S. mansoni ) tends to be closely confined to narrow zones along the shores of large bodies of water such as Lake Victoria where it is endemic and the intermediate host is found. The prevalence of S. mansoni along the Kenyan Lake Victoria basin ranges between 40% and 80%. Objective : To assess the community’s knowledge and perceptions of schistosomiasis prevalence, transmission and control in relation to aquatic habitats in the Lake Victoria basin of Kenya. Design : Community-based cross-sectional study. Setting : The Kenyan Lake Victoria basin. Subjects : Two hundred and forty three individuals (both women and men residing in the beaches and surrounding areas) were interviewed about their knowledge and perceptions regarding schistosomiasis. Results : The community regarded schistosomiasis as a naturalistic disease not caused by supernatural forces but by an agent of contamination in water. Knowledge on schistosomiasis transmission and control was low, with 42% of the respondents having no idea on how schistosomiasis is contracted, while 22% and 18% of the respondents mentioned contact with contaminated water and drinking / eating dirty water / food, respectively. Most respondents were familiar with the snails’ habitats, but had poor knowledge on aquatic plants harbouring snails, as 57% of the respondents did not know about aquatic plants being associated with schistosomiasis snails. Only 3% of the respondents associated snails with schistosomiasis transmission. Sixty percent (60%) of the respondents mentioned use of tablets and injections as means of treating schistosomiasis, while 38% had no idea how it is treated and 2% mentioned use of local herbs and services of medicine men. Conclusion : Majority of Kenyan Lake Victoria basin inhabitants had little awareness about schistosomiasis despite high prevalence of the disease in the region. There is need to adapt prevention and control strategies to the people’s livelihoods. There is also need to target the less advantaged members of the community such as women, uneducated and subsistence farmers for intense health education strategies aimed at increasing participation in the control of schistosomiasis. Study to elicit divergence between biomedical and local understandings of schistosomiasis/bilharzia is suggested.

Abstract: Objective : To establish the environmental reservoirs of Cryptococcus neoformans and Cryptococcus gattii in Nairobi, Kenya. Design : Prospective study. Setting : Kenya Medical Research Institute, Mycology laboratory, Nairobi, Kenya. Subjects : A total of 400 environmental samples from different sites were analysed including; avian droppings, tree swabs, soil contaminated with avian droppings and swabs from garbage damping sites. Samples were subjected to various phenotypic tests including microscopic morphology, physiological and biochemical tests, pigmentation on bird seed agar and reaction on Canavanine-Glycine-Bromothymol Blue agar. Results : Cryptococcus neoformans was isolated from 23/200 (11.5%) dropping samples and Cryptococcus gattii in 5/200 (2.5%) of the same samples. Cryptococcus gattii was isolated from 7/60 (11.7%) tree swabs and Cryptococcus neoformans in 5/60 (8.5%) of the same samples. From other sites there was no Cryptococcus gattii recovered with (5/50: 10%), (6/60: 10%), (2/30: 6.7%) Cryptococcus neoformans recovered from chicken cage, garbage damping site and soil respectively. Conclusion : Findings clearly showed a high presence of Cryptococcus neoformans and Cryptococcus gattii from several environmental sites in Nairobi, Kenya .This could probably explain the high incidence of cryptococcal meningitis in HIV/AIDS patients in Kenya.

Abstract: Background : HIV infection, a multi systemic disease has been identified as one of the causes of hearing loss in man. Objectives : To compare the effect of HIV infection on the middle ear dynamics of HIV infected and non-HIV infected individuals using tympanometry. Design : A prospective cross sectional study Setting: HIV Clinic at University of Benin Teaching Hospital (UBTH) in 2010. Subjects : Tympanometry was done on adults (18-45year old) patients with confirmed retroviral disease (RVD) infection and confirmed non-HIV infected adults (18-45year old) as the control group. All the patients certified the inclusion and exclusion criteria. Main Outcome Measures : More women were found with HIV infection than men at a ratio of 1:3.7(men = 21% and females = 79%). There was preponderance of type “B” tympanogram among HIV-infected individuals. Result : There was a significant correlation between CD4 cell count and type “B” tympanogram (P=0.03). The CD4 cell count measured severity of HIV infection while the type “B” tympanogram detected middle ear effusion. Conclusions : Middle ear effusion is the genesis of middle ear pathology in HIV infected population.

Abstract: Background : The anthropometric parameters of the umbilical cord have clinical significance. Current parameters of the cord, its correlates and related foetal outcome are lacking in our parturients. Objectives : To describe the anthropometric parameters and abnormalities of the umbilical cord; and determine their maternal correlates and foetal outcome. Design : A cross sectional analytical study. Setting : The Obstetric and Gynaecology Department of the University of Ilorin Teaching Hospital, between September 2012 and June 2013. Subjects : Healthy pregnant women with singleton pregnancies. Results : Four hundred and twenty- eight (428) singleton deliveries were studied. The respective mean values of the cord length and width were 526.87±115.5mm and 19.56±11.12mm. Short cord ( 69cm) was found in 9.3% of the parturient. The incidences of single umbilical artery, cord round the body and knots were 7%, 8.4% and 14.5% respectively. Nuchal cord was the most common (91.4%). Only gestational age had significant statistical relationship with cord length abnormalities (P = 0.0093). The cord length was an important correlate of cord helices, knots and vessels (P< 0.05).Parity had correlations with the number of vessels(R= 0.099, P=0.042). The cord coiling index was statistically related to the presence of congenital abnormalities (P=0.011). Other perinatal events were not related to umbilical cord parameters. Perinatal asphyxia was the most common indication for NICU admission (3.5%) but there was no significant statistical difference between NICU admission and cord parameters. Conclusion : The umbilical cord parameters in apparently healthy parturients in Ilorin were comparable with others elsewhere. The cord length and helix are important correlates of gestational age and congenital abnormalities. Parity may be related to abnormal umbilical vessels. Cord length, coils, coil index and umbilical vessels should be examined post-natally.

Abstract: Background Genetic variability is a common feature of many organisms. The existence of genetic variation in man is caused by many factors along with selection, migration, gene flow and genetic drift. Human genetics are known as hereditary traits, these hereditary traits include the dominant and recessive traits in humans. Most of the genes are transmitted in the Mendelian pattern and a few are transmitted through the non-Mendelian pattern. Objective To show variation pattern in earlobe attachment, hair line distribution and presence or absence of cheek dimples and to determine prevalence of these traits among the Esan ethnic group of Southern Nigeria. Design Descriptive study. Setting The target populations for this study are the Esan ethnic group of Southern Nigeria. Esan land is bordered to the south by Benin City, to the east by Agbor City, to the north by Etsako and to the west by River Niger. Subject A simple random sampling technique was used to select 400 volunteered subjects (176 males, 224 females). They were between the ages of 17-60. Their parents and grandparents were from Esan backgrounds. Data on cheek dimple (present or absent), widow's peak or straight hairline and earlobe attachment was gathered. Result Results showed 12.5% of Males and 21.3% of females had cheek dimples while 31.5% of males and 34.7% of female had no dimple. 29.0% Males and 40.0% females had unattached earlobe while 15.0% Males and 16.0% females had their earlobes attached. Results for widow's peak showed 14.7% males and 16.5% females had widow's peak while 29.3% males and females 39.5% didn't have a peak. The chi-squared analysis of variance showed that there is a no significant difference between gender for earlobe attachment, hair line variation and cheek dimple (p > 0.05). Conclusion The study concluded that these traits varies in the population but do not vary with gender.

Abstract: Objectives : To describe the prevalence, treatment and control of hypertension among type 2 diabetic patients at Moi Teaching and Referral Hospital (MTRH) and to determine predictors of blood pressure (BP) control. Design : A cross-sectional study. Setting : Diabetic Outpatient Clinic at MTRH, Eldoret, Kenya Subjects : Type 2 diabetic patients Interventions : The study collected socio-demographic (age, gender, employment status, monthly income, education level, marital status, cigarette smoking and alcohol use), clinical (BP, weight, height and waist circumference) and laboratory (serum fasting lipids and creatinine, urine proteins) data from type 2 diabetic patients. Good BP control was defined as 1 anti-hypertensive agent prescribed. Good BP control was associated with compliance to anti-hypertensives (OR= 0.342, 95% CI: 0.105- 1.432) and having HDL at goal (OR = 0.247, 95% CI: 0.126-0.845). Poor BP control was associated with a higher number of prescribed anti-hypertensive agents (OR=1.377, 95% CI: 1.112- 2.302). Conclusion : Prevalence of hypertension among type 2 diabetic patients in MTRH is high and BP control is poor despite anti-hypertensive treatment. Significant predictors of BP control include compliance to anti-hypertensives and control of HDL.

Abstract: Objectives : To conduct clinical breast cancer screening in three sites in Western Kenya and explore community barriers to screening uptake Design : Cross-sectional study Setting : Western Kenya specifically, Mosoriot, Turbo, and Kapsokwony Subjects : Community members (18 years and older) who did not attend the screening events Outcome Measure : The outcome measure was having heard about the breast cancer screening events Both structured and open-ended questions were used for data collection Item frequency, correlations, and content analyses were performed Results : A total of 733 community members were surveyed (63% women, median age 33 years, IQR=26-43) More than half (55%) of respondents had heard about the screening but did not attend The majority of those who had heard about this particular screening had knowledge of screening availability in general (45% vs 25%, p<0001) Only 80% of those who heard and 60% of those who had not heard of the screening event had previously undergone clinical breast exam (p=020) Reasons for not attending the screening event were personal factors, including busy schedule (410%), perceived low personal risk (127%), lack of transport (42%), as well as health facility factors such as poor publicity (144%) and long queues (87%) Conclusion : Barriers to breast cancer screening uptake were associated with inadequate publicity, perceived long waits at event and busy lives among community women

Abstract: Objectives: To establish the prevalence of cervical cytology abnormalities, determine the correlation between CD4+ cell count and abnormal Pap smear, determine the correlation between WHO-HIV staging and abnormal pap smear among HIV infected women attending HIV clinic at Rwanda Military Hospital. Design : Cross-sectional descriptive study Setting : Rwanda Military Hospital Kigali, Rwanda Subjects: All HIV-positive women, 18-69 years who had been or were sexually active and were attending the HIV-clinic and consented to participate in the study. Results : Two hundred and ninety three women infected with HIV had cervical smear taken for cytology. Of the 293 women who were recruited for the study, cervical Squamous Intra epithelial Lesion (SIL) were present in 58 (20%). Of those with cervical SIL, 33 (56.89%) women had low-grade SIL, 15(25.86%) had Atypical Squamous Cells of Undetermined Significance (ASCUS), six (10.34%) had high-grade SIL, three (5.17%) had Squamous cell carcinoma ( SCC) and one (1.72%) had Atypical Glandular Cells of Undetermined Significance (AGUS). In the current study, use of ARV drugs was not associated with a reduction in the risk of cervical SIL Conclusion: A high prevalence of cervical SIL was found among HIV-infected women at Rwanda Military Hospital. Increased immune suppression was significantly associated with cervical SIL.

Abstract: Background : Pre-labour rupture of membranes (PROM) at term is a common event whose management varies from centre to centre. The practice at the Kenyatta National Hospital (KNH) for patients with PROM at term is to initiate delivery of the patient soon on admission with intravenous oxytocin, if there are no contraindications to vaginal delivery. However, in PROM at term, if the cervix is not ripe,vaginal administration of prostaglandin pessaries for cervical ripening is not possible when there is active draining of liquor, thus use of intravenous oxytocin may take a very long time or fail all together. Oral misoprostol at low doses has been found to be a safe and effective agent for labour induction in numerous studies carried out in the developed world, where there are better resources for monitoring of labour. None of the studies has been carried out in Kenya, a limited resource country. Therefore, there is a need to determine the effectiveness and safety of oral misoprostol solution at the KNH, a limited resource set up. Objective : To determine the effectiveness and safety of 2-hourly 20 mcg oral misoprostol solution compared to the standard intravenous oxytocinin labour induction in mothers with pre-labour rupture of membranes at term at the Kenyatta National Hospital. Design : An unblinded randomised clinical trial. Setting : Kenyatta National Hospital Labour Ward Unit. Participants : Eighty three pregnant women with pre-labour rupture of membranes at term without an indication for Caeserian section were consented and randomised for labour induction with either oral misoprostol at a dose of 20mcg 2-hourly up to a maximum of 4-doses, or with intravenous oxytocin according to the WHO protocol. Main outcome measures : Induction to delivery interval; maternal complications and early neonatal outcomes. Results : The overall induction success rates in the misoprostol arm was 81% versus 83% in the oxytocin arm (P=0.447). The mean induction to vaginal delivery interval in the misoprostol arm was 8.4 hours as compared to 9.45 hours in the oxytocin arm (P=0.116). The induction to active labour interval was similar in the two study arms. The mean induction to active labour in the misoprostol arm was 4.02 hours as versus 4.51 hours in the oxytocin arm (P=0.223 ). Two women who had failed induction with misoprostol were augmented with oxytocin and delivered vaginally. The Caesarean section rates were 19% in the misoprostol arm and 17% in the oxytocin arm (P=0.447), which was not statistically significant. The maternal outcomes were similar in the two study arms. Four women had tachysystole in the misoprostol arm, compared to three in the oxytocin arm (P=0.253). In the misoprostol arm two women had hypertonus compared to three in the oxytocin arm (P=0.322).There was one case of hyperstimulation in the misoprostol arm and two in in the oxytocin arm. There were no differences in the foetal/ neonatal outcomes. No baby had an Apgar score of less than seven at one or five minutes. No baby was admitted to the New Born Unit in either of the two arms. There was no case of a still birth in either of the study arms. There was no significant difference in the passage of meconium between the two arms, 39% in the misoprostol arm and 35.7% in the oxytocin arm (P=0.755). The passage of meconium did not impact on the neonatal outcomes. Conclusion : Oral misoprostol solution 20mcg 2-hourly is as safe and effective as the standard intravenous oxytocin for labour induction in women presenting with prelabour rupture of membranes at term at the Kenyatta National Hospital.

Abstract: Background : Health related quality of life (HRQOL) is increasingly being recognised as a primary outcome measure in the treatment of end stage renal disease. In addition to being an important surrogate marker of quality of care in patients on maintenance haemodialysis, HRQOL measures have being shown to be robust predictors of mortality and morbidity. Objective: To determine the health related quality of life and its determinants in patients on maintenance haemodialysis at the Kenyatta National Hospital. Design: A cross-sectional descriptive study. Setting: Renal unit, Kenyatta National Hospital Subjects : Adult patients with end stage renal disease on maintenance haemodialysis. Results: The mean physical composite summary and mental composite summary scores were 39.09±9.49 and 41.87±10.56 respectively. The burden of kidney disease sub-scale, symptom and problems sub-scale and effect of kidney disease on daily life sub-scale scores were 16.15±21.83, 73.46±18.06 and 67.63±23.45 respectively. No significant correlations were found between the health-related quality of life scores, socio-demographic and clinical factors assessed. Conclusion: The health-related quality of life of patients on maintenance haemodialysis is reduced. The physical quality of life is more affected than the mental quality of life. No independent determinants of health-related quality of life were identified.

Abstract: Background : Voluntary Medical Male Circumcision (VMMC) is the surgical removal of all or part of the foreskin from the penis. It is done for medical reasons as it has been shown to reduce the risk of female to male transmission of HIV by up to 60%. It has also been associated with lower transmission of sexually transmitted infections. Voluntary Medical Male Circumcision services have been scaled up in countries with high prevalence, generalised heterosexual HIV epidemics and low rates of male circumcision. Kibera is inhabited by a multi-ethnic community with a sizeable number of un-circumcising ethnic groups. Objectives: To determine the uptake of voluntary medical male circumcision among men in Kibera Division and to identify factors associated with circumcision preference. Design: Descriptive cross-sectional study. Setting: Kibera Division of Nairobi County. Subjects : Simple random sampling was used to enrol 387 participants. A 42-item questionnaire was administered to the participants for determining the uptake of VMMC. It had three sub-sections: demographic characteristics, general knowledge about VMMC and AIDS and acceptability of VMMC, which collected data on the main outcome measures. Data captured was entered into EpiInfo and converted to Stata13 for validation and analysis. Bivariate statistics were generated for all the variables in accordance to the study questions. Categorical variables were analysed using chi-square tests, while the qualitative variables were analysed using the t-test. Multivariate logistic regression analysis was performed to identify factors associated with the acceptability of male circumcision. Results : The study analysed data for a sample of 341 individuals whose mean age was 31 years (95%= 31+-9.1) and 62% were married. A total of 54% of the respondents had completed secondary and tertiary level of education. The level of understanding about VMMC was above average. Fifty nine percent of the respondents (95% CI = 0.54 - 0.64) knew about VMMC. Of these, 31% had obtained information about VMMC from TV and radio. The most frequently mentioned reason for undergoing VMMC was prevention of HIV and sexually transmitted infections. The level of uptake of VMMC was high at 75%. The study established that the prefered age group for circumcision was during adolescence. Using multivariate logistic regression, the factors associated with uptake of VMMC were education level, medical and hygiene reasons for VMMC. Barriers for uptake were cost, pain and long recovery period after the operation. Conclusion: The uptake and acceptability of male circumcision is high among the general population in Kibera. Participant understanding of HIV and VMMC was also high. There is need for heightened awareness creation in educational institutes. This will specifically target young men before or shortly after their sexual debut when they may still be free of HIV and HSV-2 infections. Circumcision by medical providers should be increased in traditionally circumcising regions to reduce incidence of adverse events.

Abstract: Background : Khat ( Catha edulis ) chewing leads to a number of health related problems in the gastro-intestinal tract (GIT). Few studies have examined the effects of regular Khat chewing in relation to gastritis. Experimental studies with animals have shown that an association exists between Khat chewing and the incidence of gastritis. Objective : To compare the prevalence of Khat chewing among cases with gastritis cases and cases without gastritis. Design : Individual matched case control study. Setting : Kenya Medical Research Institute's Centre for Clinical Research (CCR) and St. Michael’s Digestive Disease and Medical Care. Subjects : Ninety three cases were selected using Rome III criteria for functional dyspepsia, and the controls (n=93) were matched on age and gender. Results : Among the 93 dyspepsia cases, 64.5% were Khat chewers and 35.5% were nonchewers. Khat chewing was associated with the presence of functional dyspepsia (OR 3.8, 95% CI 1.6- 9.4). Of the 60 Khat chewers, 60% (36/60) had erosions in the upper GIT. Chewing Khat was associated with upper GIT erosions (OR 4.095% CI: 1.6, 10.1) It was determined that Khat chewers are four times more likely to have upper GIT erosions than non-chewers.. Khat chewers are 5.5 times (OR 5.5 95% CI: 1.9, 22.0)) more likely to have OGD (Oesophagitis, Gastritis and Duodenitis) compared to non-chewers. Among cases and controls, smoker (p-value<0.001) and non-smoker (p-value<0.001) Khat chewers were significantly different. The prevalence of H. pylori among Khat chewers was significantly found to be higher (62.9%, p = 0.042); the two groups (Khat chewers and non-chewers) showed significant difference Conclusion : These results reveal that regular Khat chewing is positively associated with gastritis, which is consistent with previous experimental studies on animals.

Abstract: Objective : To find out the determinants of functional motor recovery in stroke survivors. Design : A prospective cross-sectional study Setting : Stroke outpatient clinic tertiary care hospital Subjects : One hundred and two stroke survivors had their basic data captured as well as the modified Rankin score (both at the time of discharge after admission and at the time of evaluation in the clinic). Results : Twenty nine (28.4%) had functional recovery versus 73(71.6%) that did not. Younger age (OR = 0.95{CI 0.90-0.99} P=0.048), higher Rankin score at discharge (OR = 2.35{CI 1.40-3.95} P = 0.001), fewer informal caregivers at home (OR = 0.68{0.48-0.97} P = 0.034) and higher frequency of visits to the physical therapist (OR = 1.30{0.99-1.71} P = 0.05) predicted functional recovery. Age, modified Rankin score at discharge, duration between discharge from in-patient care and evaluation in clinic and frequency of visits to the physical therapist predicted group membership between functional recovery and others. Conclusion : In spite of the lean neurorehabilitation facilities in the setting of this study, increased frequency of visits to the physical therapist predicted functional recovery in stroke survivors as in more resource robust climates. It should therefore be prescribed until functional recovery is achieved.

Abstract: Objectives : To assess the performance of the API20E bacteria identification system at a teaching hospital in Kenya. Design : Retrospective study. Setting : The microbiology laboratoryoratory of the Aga Khan University teaching Hospital. Subjects : One thousand six hundred and fifty eight API20E records. Main outcome measures : The accuracy in identifying the bacteria species. Results : One thousand four hundred and forty two (87.6%) isolates had the exact identity, 199 (12%) nearest identity, and seven (0.4%) no identity. The performance varied among the species; Acinetobacter baumanii had 140 (99.3%) isolates with the exact identity and only one (0.7%) with the nearest identity compared with Aeromonas hydrophila which had five (17.2%) with exact and 24 (82.8%) with nearest. Conclusions : The API20E system is a robust bacteria identification method which can serve small and medium clinical microbiology laboratoryoratories that may not afford automated systems. Adhering to the manufacturer’s instructions and good laboratoryoratory practice can improve the performance of this method.

Abstract: Background : Meat is a major source of food and raw materials for a number of industries, yet a lot of meat is wasted each year due to deterioration as a result of spoilage by microorganisms such as Pseudomonas, Acinetobacter, Moraxella, Bacillus, Campylobacter, Escherichia, Listeria, Clostridium, Salmonella and Staphylococcus species . Objective : To determine efficacy of antimicrobial activity of garlic extracts on bacterial pathogens commonly found to contaminate meat. Design : A cross sectional study. Setting : The Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine University of Nairobi. Subjects : Garlic from Nganoini farm in Laikipia County, Kenya Results : The results indicated that garlic absolute ethanol extract had the highest efficacy of antimicrobial activity inhibiting all test micro-organisms. Conclusion : Ethanolic extract can be used as a meat preservative or decontaminant.

Abstract: Objective : To assess the predictors of C-reactive protein response in plasmodium falciparum malaria as seen in children in a malaria endemic region of Nigeria. Design : A prospective cross-sectional study. Setting : The Children Out-patient (CHOP) Clinic, Children Emergency Unit (CHEU), Child Welfare/Growth Monitoring Clinic, Immunisation Centre and Paediatric Ward of the University of Uyo Teaching Hospital (UUTH), Uyo in Akwa-Ibom State. Subjects : Three hundred and sixty children aged six to sixty months with microscopically confirmed P. falciparum malaria compared with 360 healthy children without malaria parasitaemia matched for age and gender. Results : The predictors of the C-reactive protein response in malaria (CRP ≥ 10mg/l) were fever (t = 6.867; p = 0.001), malaria parasite count (t = 5.387; p = 0.001), severe anaemia (t = -11.23; p = 0.001) and age. Younger children had a greater CRP response. The logistic regression curve showed a 66.9% sensitivity, 92.1% specificity, positive predictive value, 83.2% and negative predictive value of 82.2% of predicting C-reactive protein response in malaria. Conclusion : P. falciparum malaria induces significant CRP responses. Younger children who present with fever, hyperparasitaemia and severe anaemia are more likely to have C-reactive protein response with malaria.

Abstract: Objective : To determine the effect of enteral glutamine in reducing the incidence of post burn infections in patients with severe burns Design : A double blind randomised clinical trial Setting : Burns unit and ward 4D of Kenyatta National Hospital, Kenya Subjects : Sixty patients with severe burns who were randomised to two arms of treatment: (1) the glutamine group and (2) isonitrogenous arm acting as the control Results : Patients’ demographic and baseline clinical characteristics were similar in both arms of treatment For the entire four-week treatment period, the odds ratio of a positive blood culture was almost three-fold higher among patients in the control group compared to those in the Glutamine group (p = 004) There was also a higher incidence of positive swab cultures from the non glutamine group Conclusion : Enteral glutamine supplementation in severely burnt adult patients reduces blood infection by a factor of three It also significantly reduces the incidence of burn wound infections

Abstract: Background : Fever is one of the most common complaints presented to the Paediatric Emergency Unit (PEU). It is a sign that there is an underlying pathologic process, the most common being infection. Many childhood illnesses are accompanied by fever, many of which are treated at home prior to presentation to hospital. Most febrile episodes are benign. Caregivers are the primary contacts to children with fever. Adequate caregivers’ knowledge and proper management of fever at home leads to better management of febrile illnesses and reduces complications. Objective : To determine the caregivers’ knowledge and practices regarding fever in children. Design : A cross-sectional study. Setting : Peadiatric Emergency Unit at Kenyatta National Hospital (KNH) Subjects : Two hundred and fifty caregivers of children under 12 years presenting with fever in August to October 2011 to the PEU. Results : Three quarters of the caregivers’ defined fever correctly. Their knowledge on the normal body was at 47.6%. Infection was cited as the leading cause of fever (95.2%). Brain damage (77.6%) and dehydration (65.6%) were viewed as the most common complication. Fever was treated at home by 97.2% of caregivers, most of them used medication. Conclusions : Fever was defined correctly by 75.2% of the study participants and a majority of them used touch to detect fever. Fever was managed at home with medications. Public Health Education should be implemented in order to enlighten caregivers on fever and advocate for the use of a clinical thermometer to monitor fever at home.

Abstract: Background : very little is known about musculoskeletal features of multiple myeloma (MM) in Africa. Objectives : To describe the musculoskeletalfeatures of multiple myeloma at presentation in a tertiary health care centre in sub-Saharan Africa. Design : A Cross sectional observational study. Setting : The Douala General Hospital, Cameroon from 2007 to 2013. Subjects : A patient was said to have MM according the current international consensus criteria for diagnosis and staging of MM. Patients with monoclonal gammopathy of undetermined significance, solitary plamocytoma and other haematologic malignancies were excluded. Results : A total of 62 patients were diagnosed with multiple myeloma, 63% were female. Mean age was 57± 12,1 (19-81) years. Musculoskeletal presentation included spine bone pains (75.6%); vertebral fracture with spinal cord compression in 46.8 %. Other clinical features at presentation included anaemia (70.93%), and nephropathy (17.74%). The average percentage of bone marrow plasmacytosis at diagnosis was 33% and Immunoglobulin G was found in 86% of patients. Sixty three per cent of patients were diagnosed at stage III of the disease. Conclusion : Presence of bone pain and anaemia should alert the clinician to investigate along the lines of multiple myeloma. Majority of the patients have osteolytic lesions and pathologic fractures at the time of diagnosis.

Abstract: Background: Reliability and validity studies of different lumbar curvature analysis and measurement techniques have been documented however there is limited literature on the reliability and validity of subjective visual analysis. Radiological assessment of lumbar lordotic curve aids in early diagnosis of conditions even before neurologic changes set in. Objective: To ascertain the level of reliability and validity of subjective assessment of lumbar lordosis in conventional radiography. Design : A blinded, repeated-measures diagnostic test was carried out on lumbar spine x-ray radiographs. Setting : Radiology Department at Joint Clinical Research Centre (JCRC), Mengo- Kampala-Uganda. Subjects: Seventy (70) lateral lumbar x-ray films were used for this study and were obtained from the archive of JCRC radiology department at Butikiro house, Mengo- Kampala. Results: Poor observer agreement, both inter- and intra-observer, with kappa values of 0.16 was found. Inter-observer agreement was poorer than intra-observer agreement. Kappa values significantly rose when the lumbar lordosis was clustered into four categories without grading each abnormality Conclusion : The results confirm that subjective assessment of lumbar lordosis has low reliability and validity. Film quality has limited influence on the observer reliability. This study further shows that fewer scale categories of lordosis abnormalities produce better observer reliability.

Abstract: Background : Emerging resistance to antimicrobial drugs increases morbidity and mortality by hampering the provision of effective chemotherapy, and makes treatment more costly. The emergence of resistance to antimicrobial agents is a global public health problem, especially in pathogens causing nosocomial infections. Objectives : To determine the carriage of E. coli from wounds and urine in catheterised inpatients at Thika District Hospital (TDH) and to determine antimicrobial resistance patterns to β-lactams, aminoglycosides and (fluoro) quinolones. Design : A cross-sectional study. Setting : Thika District Hospital among hospitalised patients. Subjects : A total of 450 specimens were collected and forty two (42) Escherichia coli isolated. Pus swabs were collected from wounds and urine was collected aseptically from the inpatients with catheters. Escherichia coli were identified by culture methods and biochemical tests. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method and interpreted according to Clinical Laboratory Standards Institute recommendations. Results : Susceptibility results in aminoglycosides were, resistance for amikacin, gentamicin and kanamycin was 20%, 39% and 51% respectively. Resistance in penicillin was ampicillin 85% and piperacillin 83%. Resistance for sulfamethoxazole was 83%, tetracycline 66 %, nalidixic acid 44 % and chloramphenicol 39%. In amoxicillin/clavulanic acid, resistance was 68%. Cephalosporins’ resistance was ceftazidime 22 %, cefotaxime 56 %. Resistance for imipenem and tazobactam was 7% and 12 % respectively. Conclusion : Due to observations on resistance to antimicrobial agents commonly used in Thika District Hospital, this shows that there is need to revise antimicrobial policy in this region in the treatment of E. coli infections.

Abstract: Objectives : The Malawi Ministry of Health (MOH) and its immunisation partners conducted a training needs assessment in May 2013 to assess the current status of immunisation training programmemes in health training institutions, to identify unmet training needs, and to recommend possible solutions for training of health workers on a regular basis. Design : A cross-sectional, descriptive study. Setting : Health training institutions in Malawi, a developing country that does not regularly update its curricula to include new vaccines and management tools, nor train healthcare workers on a regular basis. Subjects : Researchers interviewed Malawi’s central immunisation manager, three zonal immunisation officers, six district officers, 12 health facility immunisation coordinators, and eight principals of training institutions. Results : All health training institutions in Malawi include immunisation in their preservice training curricula. However, the curriculum is not regularly updated; thus, the graduates are not well equipped to provide quality services. In addition, the duration of the training curriculum is inadequate, and in-service training sessions for managers and service providers are conducted only on an ad hoc basis. Conclusion : All levels of Malawi’s health system have not met sufficient training needs for providing immunisations, and the health training institutions teach their students with outdated materials. It is recommended that the training institutions update their training curricula regularly and the service providers are trained on a regular basis.

Abstract: 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.

Abstract: Objective : To determine the uptake and factors associated with the uptake of modern contraceptives among women of reproductive age (15-49 years) attending Maternal Child Health and Family Planning Clinics/Units in Rift Valley Provincial Hospital in Kenya. Design : A descriptive cross-sectional study. Setting : Rift Valley Provincial hospital which is a level five health facility situated in Nakuru County, Kenya. Subjects : Women of reproductive age (15-49 years) who were attending Maternal Child Health and Family Planning Clinics at the Rift Valley Provincial Hospital. The respondents were identified by systematic random sampling Results : Modern contraceptive uptake is over ninety percent (90.4,n=218). The factors that are significantly associated with uptake of modern contraceptives are perceived convenience to use modern contraceptives (OR 0.39, CI: 0.16 - 0.93, p value- 0.04), experience of unmet needs of contraception (OR 0.08, CI: 0.03 – 0.2, p value- 0.001), history of a modern contraception discontinuation (OR 5.5, CI: 1.7 – 9.2, p value- 0.036) and knowledge of modern contraceptives (OR 19.1, CI: 12.3 – 27.5, p value-0.001). Conclusion : This study concluded that uptake of modern contraceptive is relatively high in Nakuru, Kenya and there is need for programmes to focus more on the client of modern contraceptive and the attributes of the modern contraceptives in up-scaling the uptake of modern contraceptives.

Abstract: Sternal cleft is a rare congenital anomaly and very few cases have been described especially in Africa. This is a case of an isolated superior sternal cleft in a term neonate in Western Kenya.