The East African Medical Journal (EAMJ) is a peer-reviewed scientific journal that publishes original research articles, review articles, and clinical case reports across all fields of medicine. The first issue of the journal was published in 1923 with the aim of serving the medical fraternity, and the journal has remained in continuous publication since then. EAMJ is indexed in several authoritative databases, including Index Medicus (MEDLINE), SCISEARCH, and EMBASE. The journal is committed to promoting openness and transparency in research through mandated data sharing, the use of recognized reporting guidelines, and strict adherence to the highest standards of research and publication ethics. The success of journal editing, quality assurance, and indexing is driven by strong editorial leadership—editorial teams composed of experts with up-to-date knowledge in scientific editing and publishing, and who actively advocate for the advancement of their journals. Like most academic journals, EAMJ operates under the guidance of an Editorial Board that provides expert advice on journal content, attracts high-quality submissions, and encourages engagement from authors. The Editorial (or Advisory) Board comprises experts in relevant medical and scientific fields. Academic Editors are responsible for overseeing the peer-review process and making independent decisions to accept, request revisions for, or reject submitted manuscripts. Members of the EAMJ Editorial Board are selected by the National Executive Committee (NEC) and are required to apply and undergo a formal selection process based on predefined qualifications. EAMJ strictly adheres to the criteria and standards specified by its online publisher, Africa Journals Online (AJOL). Accordingly, all editors are required to uphold the following ethical responsibilities throughout the editorial process: Be accountable for and take responsibility for the content they publish. Protect the confidentiality of authors’ submissions and ensure that reviewers do the same. Select appropriate and qualified reviewers for each submission. Safeguard reviewers’ identities unless reviewers choose to disclose them. Ensure a fair, unbiased, and independent peer-review process. Adopt editorial policies that promote transparency and complete, honest reporting. Identify, investigate, and address suspected research, publication, reviewer, or editorial misconduct appropriately. Avoid and disclose any potential conflicts of interest. Maintain clear, timely, and transparent communication with authors and reviewers regarding the status of submissions. The East African Medical Journal is dedicated to publishing original research and comprehensive reviews covering all aspects of medicine. Manuscripts addressing clinical and basic research issues relevant to East Africa and other African countries receive special consideration. Through this focus, EAMJ aims to enhance the practice of medicine and improve health care delivery across the region and beyond.
TWO LEVELS OF NEGATIVE PRESSURE IN OPEN TRACHEAL SUCTIONING AND THEIR EFFECT ON CARDIO-RESPIRATORY INDICES AMONG ADULT PATIENTS IN CRITICAL CARE UNIT AT MACHAKOS LEVEL FIVE HOSPITAL- A RANDOMIZED CONTROLLED TRIAL STUDY DONE IN KENYA
Background: Tracheal Tube Suctioning is an important procedure performed on intubated patients receiving mechanical ventilation to ensure optimal oxygenation and ventilation. Unfortunately, the most effective and safe negative suction pressure is not yet defined. Objective: To establish safe and effective level of negative pressure in open tracheal tube suctioning based on positive cardio-respiratory indices among adult patients in Intensive Care Unit at Machakos Level Five Hospital. Methods: This was randomized controlled trial study in which 76 participants were randomly allocated to 180mmHg and to 100mmHg negative suction groups to determine the effect of open tracheal tube suctioning on the cardiorespiratory indices of heart rate, respiration rate, peripheral oxygen saturation and blood pressure at four suction time points. Repeated measure analysis of variance and independent t-test were used to assess the differences in the means of the indices within and between groups respectively. Results: The two levels of suctioning caused significant increase in heart rate (p<0.001), respiration rate (p<0.001), systolic (p<0.001), diastolic (p<0.05) and mean arterial pressure (p<0.001) and significant decrease in peripheral oxygen saturation during suctioning (p<0.001), and there were significant differences between the groups in diastolic (p=0.013) and in mean arterial pressure (p=0.015), where the lower suction level caused a bigger increase in blood pressure. Conclusion: Suctioning at a higher level of 180mmHg does not cause significant additional physiological disturbances compared to a lower level of 100mmHg. The lower suction pressure of 100mmHg elevates blood pressure more and may therefore be of clinical benefit to hypotensive patients.
Copyright (c) 2025 East African Medical Journal
PREVALENCE OF HYPERLIPIDEMIA AND ITS ASSOCIATED FACTORS AMONG ADULT PATIENTS WITH CARDIOVASCULAR DISEASE ATTENDING JAKAYA KIKWETE CARDIAC INSTITUTE
Background: Hyperlipidemia is a significant risk factor for life-threatening illnesses like cardiovascular disease (CVD). It is modifiable and common in patients with obesity, hypertension, and diabetes. It interacts with other risk factors to increase the risk of developing CVD. An unhealthy diet and physical inactivity cause increased body fat. Objective: This study aimed to determine the prevalence of hyperlipidemia and its associated factors among patients with cardiovascular disease attending the Jakaya Kikwete cardiac (JKCI) clinic. Methodology: A cross-sectional study on 424 adult patients with cardiovascular disease was conducted at the JKCI clinic. It collected data on demographics, Body Mass Index (BMI), Blood pressure (BP), waist-hip ratio, and lipid profiles for analysis at the JKCI laboratory. Dyslipidemia cut-off points were based on the European Society of Cardiology (ESC) guideline. The study used SPSS 25 for data analysis, and results were presented using tables and text. Chi-square was used to determine significant associations (P≤0.05) Results: A total of 424 participants were involved in the study. The majority of them were aged above 40 years 338 (79.7%). There was a female predominance of 222 (52.4). The prevalence of Dyslipidemia was found to be 223(52.6%), with 70 (16.5%) participants having high levels of total cholesterol, followed by high low-density lipoprotein(LDL)67 (15.8%) participants, then 48 (11.3%) with hypertriglyceridemia, and low high-density lipoprotein (HDL) 38 (9%). Diabetes and hypertension were found to be statistically significantly associated with dyslipidemia, p value=0.039 and 0.027, respectively. Conclusion: This study reveals a high prevalence of dyslipidemia among adult patients with cardiovascular diseases, which is associated with diabetes and hypertension
MRI FINDINGS IN FUNCTIONALLY IMPAIRED KNEES: A PRELIMINARY REPORT
Background: Magnetic Resonance Imaging (MRI) is a non-invasive, non-ionizing imaging modality with excellent soft tissue resolution capable of depicting the internally deranged structures within the knee Joint (KJ) in multiple planes. The aim of this study is to highlight the role of MRI in the diagnosis of certain disease entities from various etiologies which would have been difficult to accomplish using the more available imaging modalities in our resource poor environment. Method: This is a cross-sectional observational study of knee MRI. All patients presented with functional knee impairment indicated by the requesting physician. T1 and T2 weighted images, proton density weighted (PDW) and fat saturated images were acquired in the axial, sagittal and coronal planes using the flexi coil of a 1.5 Tesla Elan Vantage Toshiba MRI machine. Result: Eighteen patients made up of 8 males (44.4%) and 10 females (55.6%) with functional knee impairment did knee MRI during the period of the study. They had various indications including; persistent and increasing knee pain (n = 10, 55.6%); trauma to knee (n = 5, 27.8%) and knee swelling (n=3, 16.7%). Imaging findings include neoplastic condition in 5 (27.8%), complex ligamental and menisci tears in 4 (22.2%), moderate to severe osteoarthritis in 22.2% (n = 4) and mild osteoarthritis in 3 (16.7%). Two others (11.2%) had normal knee joints. Conclusion: MRI with its high soft tissue resolution is a powerful tool for assessing functionally impaired knees. Bone and joint space related injuries were the most common pathologies encountered in this study.
FACTORS ASSOCIATED WITH UTILIZATION OF CERVICAL CANCER SCREENING SERVICES AMONG FEMALE NURSES WORKING AT HOMABAY COUNTY TEACHING AND REFERRAL HOSPITAL, HOMABAY COUNTY, KENYA
Background: Cervical cancer screening is an important service aimed at early detection of cancer. However, factors associated with service utilization tend to vary even among health care providers. A better understanding of the issues that abound would inform strategies to improve the uptake of screening services Objective: To determine factors associated with utilization of cervical cancer screening services among female nurses at Homabay County Hospital in Kenya Methodology: A cross-sectional descriptive study with a sample size of 116 female nurses. The researcher employed a simple random sampling technique. Utilization of cervical cancer screening and sociodemographic factors were gathered in the face-to-face interview structured questionnaire. Analyses done by Statistical Package for Social Science software version 25. Proportions and percentages for descriptive statistics. Binary logistic regression to determine factors associated to cervical cancer utilization on adjusted odds ratio with a 95% CI and p value < 0.05. Results: Of the 106 respondents, (60%, n=99) participated in the study. Forty-three (43.4%, n=43) were aged 31-40 years. Christians were (87.9%, n=87) while (86.9%, n=86) had more than one sexual partners. Of respondents 85 (85.5%, n=85) were multiparous. Majority (68.7%, n=68) had work experience more than 7 years with (31.3%, n=31) having 1- 4 years. In all cervical cancer screening utilization among the female nurses was 63.64% while the WHO target is 70%. Multi parity and department of work were the factors significantly associated to cervical cancer screening services utilization. Multi parity (AOR = 7.5, 95% CI = 1.75-32.00, p = 0.006). Inpatient department. (AOR = 3.1, 95% CI = 1.22-7.69, p = 0.017) respectively. Conclusion: This study showed that utilization of cervical cancer screening services was below the WHO target. This calls for developing effective cervical cancer screening uptake among nurses
DIABETES KNOWLEDGE AND ASSOCIATED FACTORS AMONG PATIENTS WITH DIABETES TYPE 2 ATTENDING KITUI COUNTY REFERRAL AND TEACHING HOSPITAL, KENYA
Objective: To assess diabetes knowledge and associated factors among patients with diabetes type 2 attending Kitui County and Referral Hospital, Kenya. Methodology: A hospital based cross-sectional analytical study design with a sample size of 154 type 2 diabetes patients selected through systematic random sampling. Diabetes knowledge assessed by Diabetes Knowledge Questionnaire. Binary logistic regression analysis done to identify factors associated to diabetes knowledge. Results: 152 respondents participated, females were the majority (63.2%, n=96). The age group of 50-59 years was predominant (43.4%, n=66), (40.4%, n=61) had attained a primary education. More than two thirds respondents’ modality of treatment was oral drugs (79.6%, n=121). Study participants having diabetes 2-5 years were (34.2%, n= 52) and 6-10 years (29.6%, n=45). Participants demonstrating good knowledge were (44.6%, n=68). However, significant knowledge gap existed in identifying hypoglycemia (47.4%, n=72) and hyperglycemia (20.4%, n=31). In binary logistic regression, level of education had significant positive association to diabetes knowledge (Adjusted Odds Ratio (AOR) = 2.82, CI = 1.05, 8.32). The duration of disease (AOR = 0.15, CI = 0.04, 0.54) and mode of treatment (AOR = 0.20, CI = 0.06, 0.60) demonstrated a significant negative association to diabetes knowledge. Conclusion: The study findings urges for a structured, patient-centered education interventions targeting high-risk strata groups particularly those with limited formal education, long-standing diabetes and oral antidiabetic medication regimens.
DETERMINANTS OF ANAEMIA IN CHILDREN AGED 6–59 MONTHS IN RWANDA: A MULTILEVEL MIXED-EFFECTS ANALYSIS, 2019-20 RWANDA DEMOGRAPHIC AND HEALTH SURVEY
Background: Anaemia remains a critical public health issue in low- and middle-income countries, particularly affecting children by causing cognitive difficulties, stunted growth, and increased infection risk. Despite its importance, knowledge about the factors influencing anaemia prevalence in young Rwandan children is limited. This study investigated individual and community determinants of anaemia among children aged 6-59 months in Rwanda. Methods: We analysed data from the 2019–2020 Rwanda Demographic and Health Survey (RDHS), focusing on a weighted sample of 3,699 children aged 6-59 months. A stratified two-stage cluster sampling design was used, and data were weighted to adjust for survey design effects. Multilevel mixed-effects logistic regression was performed to assess associations between anaemia and individual/community factors, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) reported. Results: Children aged 24-42 months (AOR 0.4, 95% CI: 0.34-0.47) and 43- 59 months (AOR 0.2, 95% CI: 0.20-0.29) were less likely to be anaemic compared to those aged 6-23 months. The likelihood of anaemia was higher among children who tested positive for malaria (AOR 8.3, 95% CI:3.32-20.63), were underweight (AOR 1.3, 95% CI: 1.01-1.78), or those using unimproved toilet facilities (AOR 1.9, 95% CI: 1.22-3.02). Children from lower wealth categories had higher odds of anaemia (AOR 1.3, 95% CI:1.04-1.52), while those in the Southern (AOR 0.6, 95% CI: 0.45-0.80) and Eastern (AOR 0.7, 95% CI: 0.54-0.94) regions were less likely to be anaemic compared to those in the Northern region. Conclusion: Age, underweight, malaria, sanitation, wealth, and regional factors significantly influence anaemia in young children. Further strengthening of the existing interventions such as malaria prevention strategies and treatment, child nutrition programmes, access to improved sanitation and delivery of equitable health and social services can help to further reduce anaemia and improve child health outcomes in Rwanda.
DELAYED INTERVAL DELIVERY OF A TWIN PREGNANCY AFTER A FAILED ABDOMINAL CERCLAGE
Recurrent pregnancy loss has many causes, and it is not always possible to elicit the exact etiology. One of the known etiologies is cervical anatomical defects, and this is often addressed with transvaginal or abdominal cerclage, which, despite careful placement, may not always work, leading to pregnancy loss. In twin gestation, the loss of a pregnancy can be traumatic for a mother. This has led to the practice of delayed interval delivery, whereby when the first twin is miscarried, attempts are made to prolong the pregnancy to salvage the second twin. We present the case of a mother who was pregnant with twins after many pregnancy losses, had an abdominal cerclage that failed and led to miscarriage of the first twin, but she still had a live birth of the second twin 139 days later.
CORRELATES OF CERVICAL CANCER SCREENING UPTAKE AMONG WOMEN LIVING WITH HIV AT EMBU COUNTY REFERRAL HOSPITAL, KENYA
Background: Cervical cancer screening has been shown to reduce the time to disease detection and significantly improve overall management outcomes. This study aimed to assess factors influencing the uptake of cervical cancer screening among HIV-positive women seeking care at Embu County Referral Hospital, Kenya. Methodology: The study used an analytical cross-sectional design with a mixed-methods design approach. Systematic random sampling was employed. Chi-square tests guided bivariate analysis, and significant variables (p ≤ 0.05) were modeled using binary logistic regression. Results: The study evaluated 149 women, and of these (n=59,39.6%) had sought cervical cancer screening services. Study findings showed that participants with tertiary education were 16.3 times more likely to seek cervical cancer screening (OR = 16.3, 95% CI = 2.809–95.118, p = 0.002). Those knowledgeable about cervical cancer were 4.5 times more likely to utilize screening services (OR = 4.5, 95% CI = 1.091– 5.532, p = 0.001). Multiparous women had similarly increased odds (OR = 4.5, 95% CI = 1.085–5.583, p = 0.002). The absence of a cervical cancer history significantly reduced screening uptake by 57% (OR = 0.43, 95% CI = 0.176–0.837, p = 0.05). Conclusion: Uptake was significantly higher among women with tertiary education, knowledge about cervical cancer, and multiparity, while the absence of a cervical cancer history reduced the likelihood of screening. To improve uptake, health education campaigns, community outreach, and counseling programs should be strengthened, with a focus on raising awareness and targeting women with low risk perception or limited education.
CAUSES AND SURGICAL OUTCOMES OF NEONATAL INTESTINAL OBSTRUCTION AT A KENYAN TERTIARY HOSPITAL
Background: Neonatal intestinal obstruction (NIO) is a major indication for admissions globally with high morbidity and mortality rates. Availability of adequate and contextual data about the causes and surgical outcomes of NIO could inform prevention and management modalities. Objective: To determine aetiology and surgical outcomes among neonates with intestinal obstruction at Moi Teaching and Referral Hospital (MTRH), Eldoret,Kenya. Methods: A hospital-based observational prospective study conducted among sixty-three (63) neonates with NIO who had undergone surgery at MTRH between 10th August 2022 and 9th August 2023. After obtaining parental consent, neonatal clinical characteristics and maternal antenatal profile data were collected. The neonates were then followed for a maximum of seven days postsurgery to determine surgical management and outcomes. A test of associations was conducted between independent variables (etiology and clinical presentation) and surgical outcomes using Fisher exact tests (critical value of ≤0.05) with odds computed at a 95% confidence interval. Results: The mean neonatal age at presentation was 9.75 ± 6.75 days. Forty-one (65.1%) were male, and 84.1% had congenital anomalies. The overall mean birthweight and gestation age were 2,670 ± 597.25 grams and 37.19 ± 2.53 weeks, respectively. The most common NIO aetiology was anorectal malformation (22.3%; n=16) followed by malrotation (18.4%; n=13). Bowel resection and anastomosis (32.9%; n=24) were the most common type of surgical management offered, followed by colostomy (19.2%; n=14). Mortality was reported among 27% of all neonates enrolled. Prolonged hospitalization was the leading (73%; n=46) secondary surgical outcome with a mean duration of 21.98 ±12.96 days, followed by neonatal sepsis (33.3%; n=21). Elevated platelet count (p=0.016) and C-Reactive Protein (p=0.021) at admission were significantly associated with post-surgical mortality. Conclusion: The most common cause of NIO was anorectal malformation. About three-quarters of the neonates who underwent surgery survived. Post-surgical elevated platelet counts and C-reactive protein values significantly predicted the likelihood of mortality.
CAREGIVER AND HEALTH WORKERS' PERCEPTIONS OF READY-TO-USE-THERAPEUTIC FOOD AND LOCAL FOODS FOR SEVERE ACUTE MALNUTRITION MANAGEMENT AT A SECONDARY LEVEL HEALTH FACILITY IN NAIROBI, KENYA
Background: Child malnutrition accounts for approximately 1 million deaths among children aged less than 5 years each year globally. World Health Organization (WHO) recommends Ready-to-Use-Therapeutic-Food (RUTF), a commercially prepared high-calorie semi-solid food, for home management of severe acute malnutrition (SAM). While studies in Kenya, Senegal, Malawi and Ethiopia have reported poor adherence and misuse of RUTF by children within community settings there is paucity of data on how caregivers view use of RUTF and the role of local foods in SAM management. In this study, we sought to understand caregivers’ experiences with RUTF and local foods for SAM management as well as health workers’ perspectives on local foods provided to children with SAM. Methodology: In November 2019, we conducted two focus group discussions (FGDs) with caregivers of children with SAM and eleven in-depth interviews (IDIs) with healthcare workers (HCWs) at Mbagathi County Hospital (MCyH), Nairobi, based on saturation of ideas. Interviews and discussions were audio-recorded and transcribed verbatim. Thematic analysis using open coding was done to identify emerging themes. Results: We identified the following five themes from FGDs and IDIs: 1) RUTF perceived by caregivers as beneficial in SAM management. 2) Children do not, however, adhere to RUTF prescriptions. 3) Caregivers prefer to give home foods in place of RUTF. 4) Low-nutrient home foods provided to children are associated with poor caregiver knowledge 5) Need for enhanced facility-based caregiver counselling on locally available high-nutrient foods. Conclusion: This paper demonstrates that, despite caregivers' understanding of the importance of RUTF, locally available foods play a central role in the home management of severe malnutrition. It also highlights the importance of ensuring adequate caregiver counselling on appropriate local high-nutrient foods that they should provide to children.
SPATIOTEMPORAL GAIT PARAMETERS ARE ASSOCIATED WITH ANTHROPOMETRIC INDICES OF 2–3 YEARS CHILDREN IN KUMASI, GHANA: A CROSS-SECTIONAL STUDY
Background: Spatiotemporal gait parameters provide objective markers of locomotor development, and their association with anthropometric indices in children aged 2–3 years may offer critical insights into growth and motor maturation. Objective: To establish the correlation between spatiotemporal gait parameters and anthropometric characteristics of 2–3 years in Kumasi, Ghana. Methods: Descriptive cross-sectional study design was employed. Thirty-two healthy children (19 girls,13 boys) were recruited from four pre-primary schools in Kumasi, Ashanti region of Ghana. The primary outcomes were spatiotemporal data (step length, stride length, step width, cadence, & gait speed) and their associations with anthropometric indices (height, weight, body mass index, & waist to hip ratio). Results: Waist-to-hip was negatively correlated with step length (r = -0.43, P < 0.05) and stride length (r = -0.35, P < 0.05). Stride length was significantly correlated with step length (r = 0.82, P < 0.01). Gait speed showed positive associations with both step width (r = 0.38, P < 0.05) and cadence (r = 0.62, P < 0.01). No significant sex differences were observed. Conclusions: Body mass index and waist-to-hip ratio correlate with the step length, stride length, step width, cadence, and gait speed of the children in this study. Since the waist-to-hip ratio showed significant negative correlations with step and stride length, while gait speed correlates positively with cadence and step width, clinical interventions should emphasise weight and central adiposity management in early childhood to promote more efficient gait development and prevent long-term locomotor limitations.
Copyright (c) 2026 East African Medical Journal
SERO-PREVALENCE AND RISK FACTORS FOR HEPATITIS B INFECTION AMONG WOMEN ATTENDING ANTENATAL CARE AT ST. ORSOLA HOSPITAL, THARAKA NITHI COUNTY, KENYA. A CROSS-SECTIONAL STUDY
Background: Like many Sub-Saharan African countries, Hepatitis B virus (HBV) is endemic in Kenya, where diagnosis and patient management remain challenging, particularly in cases involving HBV comorbidities. However, the burden of the disease among pregnant women in Kenya remains unclear. Objectives: To determine the prevalence, disease stages and associated risk factors for HBV infection among women attending Antenatal care (ANC) at St. Orsola Hospital in Tharaka Nithi County, Kenya. Design: A cross-sectional study was conducted on women attending Antenatal care. Subjects: Pregnant mothers attending ANC between September to December 2023. Main outcome measures: For each woman, age, marital status, occupation, level of education and risk factors were captured using a questionnaire after consenting. Hepatitis B serological markers; hepatitis B surface antigen (HBsAg), antibody to hepatitis B surface antigen (anti-HBs), antibody to hepatitis B core antigen (anti-HBc), and hepatitis B envelope antigen (HBeAg) were also profiled. Results: The overall prevalence of HBsAg was 6.5% (25/385; 95% CI: 4.3%–9.4%), indicating intermediate endemicity. Most infected participants were classified as inactive carriers 72% (n=18), while 16% (n=4) were chronically infected, 8% (n=2) had acute infection and 4% (n=1) were in recovery. Multivariable logistic regression analysis identified history of liver disease (AOR = 5.21; 95% CI: 1.11–24.43; p = 0.036), HIV infection (AOR = 9.84; 95% CI: 1.02–94.51; p = 0.047) and education level (AOR = 11.8; 95% CI: 1.5–93.4; p = 0.019), as independent predictors of HBV infection. Other factors including blood transfusion, dental procedures, tattooing, caesarean section, abortion and female genital mutilation were not significantly associated with HBV infection. Conclusion: HBV remain endemic in this region like rest of the country with age, education levels, liver problems and human immunodeficiency virus (HIV) status being risk factors among pregnant women. The outcome of this research indicated a need for increased awareness and preventive measures not just among gravid women but also on entire population.
RISK FACTORS TO ENTERIC BACTERIAL PREVALENCE AND ANTIMICROBIAL RESISTANCE AMONG FOOD HANDLERS IN NAIROBI COUNTY, KENYA
Objectives: Enteric bacteria’s antimicrobial resistance expose humans to superbugs and biofilms producing strains. This study aimed at investigating the prevalence of enteric bacteria, antimicrobial resistance patterns and potential risk factors associated with enteric bacterial pathogens transmission among food handlers in Nairobi County, Kenya. Methodology: A cross-sectional study was conducted and systematic random sampling used to obtain 355 stool samples from food handlers who presented to Centre for Microbiology, Kenya Medical Research Institute, for routine health assessment. The stool samples were cultured for E. coli, Salmonella typhi and Shigella flexneri and Vibrio cholerae using the standard enteric media. Questionnaires were administered to obtain sociodemographic data. Conventional biochemical tests were used in identification of the recovered isolates and antimicrobial susceptibility patterns determined. Factors associated with enteric bacterial infection were evaluated using logistic regression analysis. Results: An overall enteric bacteria prevalence of 54(15.21%) was found. The most predominant enteric bacteria recovered were 39 (11%) Escherichia coli (11(53.85%) non-pathogenic E. coli, 13(33.33%) enterotoxigenic E. coli, 5(12.82%) enteroaggregative (E. coli), 11(3.1%), 11(3.1%) Shigella flexneri and 4(1.1%) Salmonella typhi. Amoxicillin clavulanic acid, nalidixic acid, cefuroxime and ciprofloxacin were the least effective antimicrobials while meropenem, chloramphenicol and gentamicin were most effective antimicrobials with 0%, 1.85% and 5.56% resistance. Insufficient hygienic food handling practices training was independently associated with enteric bacterial infection (AOR: 9.117; 95% CI: 2.157 – 18.534; P=0.003). However, the insufficient food handling practices training had low odds of antimicrobial resistance despite P-value indicating as statistically significant (AOR:0.118; 95% CI: 0.028 – 0.489; P=0.003). Conclusion: Enteric bacteria prevalence and resistance continue to soar among food handlers despite periodic medical assessment, threatening public health as potential source of transmission. Insufficient training on hygienic food handling practices was significantly associated with enteric bacterial infection and corresponding antimicrobial resistance
NAVIGATING COMPLICATIONS FROM CULTURAL CIRCUMCISION: A QUALITATIVE CASE SERIES OF PATIENT EXPERIENCES AT A TERTIARY REFERRAL HOSPITAL IN KENYA
Background: Male circumcision is widely practiced across Kenya through either voluntary medical circumcision, performed in healthcare facilities, or traditional cultural circumcision (CC), conducted within community settings. There has been an alarming increase in circumcision-related complications presenting to Kenyan hospitals, particularly associated with CC. These findings emphasize a need for evidence-based management protocols to reduce circumcision-related complications, but the culturally charged nature of CC demands respect and preservation of traditional practices. We aimed to explore patient and family experiences in managing post-circumcision complications to better understand key values and opportunities amenable to intervention for improving the safety of circumcision practices in our setting. Methods: This study is a case-series report anchored in qualitative interviews with a cohort of patients who presented to our hospital with three categories of circumcision-related complications including wound infection/sepsis, bleeding, and penile amputation. The study team completed phone interviews with families of eligible patients, and rapid qualitative matrix techniques were used to analyse data. Results: We enrolled six boys in our study with two representative patients in each main complication category. We identified four main thematic domains: “Lack of standardized practices increases risk for complications”, “families lack insight into qualifications of circumcision providers”, “families remain a major source of post-procedural care”, and “financial and psychological consequences of circumcision complications are significant”. We have also included a section for requests made by families regarding circumcision care. Conclusion: Societal pressure to conform to tradition drives a preference for CC, despite high practice variability which leads to increased complication risks. Collaborating with communities and traditional providers is key to developing standardized procedural methods. Empowering patients and families in their care, improving provider accountability, and providing multifaceted support in the presence of complications are critical to ensuring positive results from this important traditional rite.
KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARDS CERVICAL CANCER AND SCREENING AMONG MARKET WOMEN IN MILE 3 DIOBU, RIVERS STATE, NIGERIA
Background: Cervical cancer remains a significant public health concern among women in Nigeria, largely due to limited awareness and poor screening practices. Although effective prevention strategies such as Human papilloma virus vaccination, cervical screening awareness and utilization remain low, particularly among women in the informal sector. Cervical cancer prevention is facilitated through health education, HPV vaccination advocacy, and promotion of screening services at community levels. However, interventions require an understanding of women’s knowledge, attitudes, and perceived barriers. Objective: This study assessed the knowledge, attitude, and practice toward cervical cancer and its screening among market women in Port Harcourt Local Government Area, Port Harcourt. Methods: A descriptive cross-sectional survey design was adopted. Data were collected using a structured questionnaire administered to 202 respondents. Descriptive statistics were used to summarize knowledge, attitudes, practices, and barriers to screening. Results: 126 (62.37%) of respondents had heard of cervical cancer, only 26 (12.87%) demonstrated very good knowledge, with an overall mean knowledge score of 2.52, indicating a fair level of knowledge. Despite this, actual screening practice was low: only 22 (10.83%) had ever undergone screening, and 14 (6.93%) reported regular annual screening. Major barriers identified. High cost was the most commonly reported barrier, with 111 respondents (54.95%) either strongly agreeing or agreeing that screening is expensive. This item had the highest mean score (mean = 2.58). Barriers were measured using a four-point Likert scale (Strongly Agree = 4, Agree = 3, Disagree = 2, Strongly Disagree = 1), and mean scores were calculated using a weighted mean approach. Conclusion: Awareness and attitudes toward cervical cancer screening among market women are moderate, actual practice remains poor. The study recommends intensified health education, subsidized screening services, and improved accessibility to enhance early detection and prevention among women
GIARDIA DUODENALIS GLUTAMATE DEHYDROGENASE AND TRIOSE-PHOSPHATE ISOMERASE PCR-RFLP GENOTYPING EFFICIENCY AND PARASITE DENSITY
Background. Giardia duodenalis is an intestinal protozoan parasite, with human infections predominantly caused by assemblages A and B. Genotyping of G. duodenalis infections commonly relies on GDH and TPI gene targets using PCR-RFLP and sequencing approaches, which are widely applied across diverse epidemiological settings. However, the performance and discriminatory power of these molecular tools can vary depending on parasite density, DNA quality, and the infecting assemblage, with assemblage B often demonstrating higher genetic heterogeneity. As such this study evaluates the effectiveness of GDH- and TPI-PCR-RFLP in characterizing G. duodenalis in relation to parasite density in patients with giardiasis at Busia county referral hospital, Kenya. Methodology This hospital-based cross-sectional study was done at Busia County Referral Hospital from 2017 to 2020. A total of 147 patients referred to the clinical laboratory for stool analysis were recruited into the study. Genomic DNA was isolated from stool samples of 88 patients who tested positive for G. duodenalis by microscopic examination. The isolates were genotyped at the GDH and TPI gene loci using a semi-nested PCR-RFLP technique. Genotyping agreement between the GDH and TPI gene loci was analysed using Cohen's kappa statistics. Whereas parasite density were compared across the assemblages and sub-assemblages by Kruskal wallis and post hot dunnes analysis. Results. This study showed that GDH and TPI single locus genotyping demonstrated no agreement in overall DNA amplification (Cohen’s kappa, 0.125; P = 0.228) and assemblage (Cohen’s kappa, 0.024; P = 0.234) genotyping success. Nevertheless, moderate or lack of agreement between GDH and TPI was detected for assemblage (Cohen’s kappa, 0.435; P < 0.001) and sub-assemblage (Cohen’s kappa, 0.027; P = 0.117) genotypes, respectively. The parasite density was marginally significantly higher in GDH (P = 0.067) but significantly lower in TPI (P = 0.032) in amplified cases. Furthermore, the parasite densities were significantly different amongst the assemblages (P = 0.014) and sub-assemblages (P = 0.003). Post-hoc analyses indicated a significantly higher parasite density in assemblage B relative to assemblage A (P < 0.001); BIII sub-assemblage compared to AI (P < 0.001), AIII (P < 0.001), and mixed AI/AIII (P < 0.001) sub-assemblages; as well as BIV versus AI (P < 0.001) sub-assemblages. Conclusions. The findings show the influence of parasite density and genetic heterogeneity on genotyping efficiency and support the use of multi-locus approaches for more reliable characterisation of G. duodenalis infections.
EFFECT OF PROPHYLACTIC ONDANSETRON ON SPINAL ANAESTHESIA - INDUCED HYPOTENSION DURING CAESAREAN SECTION AT MOI TEACHING AND REFERRAL HOSPITAL, ELDORET, KENYA
Objective: To determine the effect of prophylactic ondansetron on the incidence of spinal anaesthesia- induced hypotension during caesarean section at Moi Teaching and Referral Hospital (MTRH), Kenya. Materials and Methods: A randomized, double-blind, control trial was conducted at MTRH involving 194 parturients at term gestation who underwent elective caesarean sections under spinal anaesthesia. Block randomization and consecutive sampling were employed. Participants were divided into two groups of 97: Group O received 4 mg intravenous ondansetron, and Group S received an equivalent volume of saline, both administered 15 minutes before spinal anaesthesia. Data on demographics, clinical, anaesthesia and surgical outcomes, vasopressor usage, and neonatal results were collected using a structured questionnaire and analyzed using STATA version 16. Statistical tests included the two proportions z-test, t-test, Fisher’s exact and Mann-Whitney U test, with significance set at P < 0.05. Results: Both groups exhibited comparable baseline demographic and clinical characteristics. The mean age of participants was comparable between Group S (29.9 ± 4.8 years) and Group O (30.3 ± 4.7 years; P=0.56). A majority in both groups were under 35 years of age (Group S: 80.4%, Group O: 77.3%), with no statistically significant difference (P=0.598). The incidence proportion of spinal anaesthesia- induced hypotension (SAIH) was 85.6%. Group O had lower SAIH occurrence (77.3%, n=75) compared to group S (93.8%, n=91), P=0.001. Mean systolic blood pressure variations across time intervals did not differ significantly between Group S and Group O (P>0.05). Conclusion: Prophylactic 4mg intravenous ondansetron is effective in reducing the incidence of SAIH.
DIAGNOSTIC UTILITY OF CALRETININ IN SUSPECTED CASES OF HIRSCHSPRUNG’S DISEASE FROM COLORECTAL BIOPSIES TAKEN FROM CHILDREN AT THE KENYATTA NATIONAL HOSPITAL IN NAIROBI, KENYA- A RETROSPECTIVE CASE SERIES STUDY
Background: Hirschsprung’s disease (HSD) is a pediatric colonic disorder marked by the absence of ganglion cells in the mucosa and myenteric plexi, causing functional intestinal obstruction. Diagnosis relies on rectal biopsy with Hematoxylin and Eosin (H&E), but subjectivity in ganglion cell recognition limits accuracy. Ancillary stains such as acetylcholinesterase have drawbacks, making Calretinin, which is a calcium-binding protein with immunoreactivity in ganglion cells and nerve fibers, the preferred marker. Its absence in the submucosa and myenteric plexus confirms HSD. Objective: To determine the diagnostic utility of Calretinin in suspected HSD cases from colorectal biopsies at Kenyatta National Hospital. Methodology: Paraffin blocks archived between January 2018 and December 2022 were retrieved. Slides were stained with H&E for initial diagnosis, then subjected to Calretinin immunohistochemistry (IHC) to assess ganglia and nerve fiber expression. Results were then analyzed using SPSS. Results: Forty-eight cases were studied; median age was 1 year (range: 3 days-9 years), with males comprising 56.3%. Five biopsies (10.4%) were inadequate. Of 43 evaluable cases, 23 showed ganglion cells, and 20 were negative on H&E. Calretinin stained ganglion cells in 22 cases and was absent in 21, including one missed by H&E. Hypertrophied nerve fibers were consistently present in ganglion-negative cases. Agreement between H&E and Calretinin was excellent (κ = 0.953, p<0.001). Conclusion: Calretinin IHC demonstrates high sensitivity, specificity, and diagnostic accuracy, with excellent agreement to H&E, supporting its role in confirming HSD.
BILATERAL HYDROURETERONEPHROSIS AS A SEQUELAE OF PELVIC LIPOMATOSIS: A RARE CASE REPORT
Background: Pelvic lipomatosis as a cause of incidental bilateral hydrouereteronephrosis is very rare. It is considered a benign condition but can cause variable symptoms and presentations due to compression of pelvic organs, although it is mostly asymptomatic. The symptoms can include urinary tract obstruction which can cause deranged renal function tests, constipation, tenesmus, lower limb oedema and deep venous thrombosis. Case: We present a case of incidental bilateral hydroureteronephrosis resulting from compression of distal ureters by pelvic lipomatosis identified on KUB ultrasound (kidney, ureter, bladder) in a patient being evaluated for infertility. This prompted further evaluation with CT urography which revealed abundance of fat in the pelvis surrounding the bladder resulting in extrinsic compression and elevation as well as surrounding the rectum and sigmoid colon with elongated sigmoid colon and peripherally displaced bowel loops. There was also moderate bilateral hydroureteronephrosis with tapered narrowing of the ureters in the distal third (just below the pelvic brim. Conclusion: Pelvic lipomatosis is a rare benign condition which is mostly asymptomatic but can present with symptoms due to compression of the pelvic organs with subsequent systemic symptoms such as hypertension. Radiological cross-sectional imaging with CT scan or MRI is adequate for accurate diagnosis and identification of some of the associated complications of this very rare condition.
ASSOCIATION BETWEEN BURNOUT AND JOB SATISFACTION AMONG RESIDENT DOCTORS IN CLINICAL SPECIALTIES IN ENUGU STATE, NIGERIA: A CROSS-SECTIONAL STUDY
Background: Resident doctors are currently and consistently strained by high workload, migration and poor remuneration which could potentially affect the quality of healthcare provision. Objectives: The study aimed to assess the association between burnout and job satisfaction among resident doctors in clinical specialties in Enugu State, Nigeria. Methodology: This was a cross-sectional analytical study of 420 resident doctors in tertiary hospitals in Enugu State, Nigeria. Data were collected using Oldenburg Burnout Inventory and Minnesota Satisfaction Questionnaire from selected departments. Data were analysed using IBM statistical package 23.0. Test of significance was set at 0.05. Results: The mean age of participants was 34.11 ± 5.08 with age range 23 to 53 years. The prevalence of overall burnout among resident doctors was 84.3%, disengagement group was 4.8%, exhaustion group was 6.9% and non – burnout group was 4.0%. The prevalence of general satisfaction among resident doctors was 39.2%, intrinsic satisfaction was 40% and extrinsic satisfaction was 58.8%. There was a significant weak negative correlation with Job satisfaction. Burnout Vs General satisfaction (R = -0.366, p < 0.0001), Intrinsic satisfaction (R = -0.318, p < 0.0001) and Extrinsic satisfaction (R = -0.342, p < 0.0001). Conclusion: Resident doctors were found to have high prevalence of burnout with low job satisfaction and a significant weak negative linear correlation. The required number of resident doctors should be ensured at all times for improved quality of life and patient care.
UPTAKE OF LONG-ACTING AND PERMANENT METHODS OF CONTRACEPTION AMONG WOMEN OF REPRODUCTIVE AGE IN KAJIADO COUNTY, KENYA
Background: Long acting and permanent methods of contraception (LAPM) are among the most effective family planning (FP) approaches but remain underutilized in Kajiado County. Despite global and national advancements in FP, socio-demographic, knowledge-related and systemic barriers persist, particularly in marginalized populations. Objective: This study assessed factors influencing the uptake of LAPM among women of reproductive age (WRA) (15–49 years) in Kajiado County. Methods: A mixed method (Explanatory sequential) study design was used. Data was collected from 428 WRA (15-49) in Oloolua and Kiserian Townships. Systematic random sampling was used to select households, with a sampling frame created from 1900 and 7800 WRA respectively. Using a sampling interval of approximately 4 (1900/428) and 18(7800/428), WRA in the selected households were included in the study. Data was collected via semi-structured questionnaires and focus group discussions (FGD) and analyzed using R version 4.1.2 and Colaizzi’s thematic analysis having secured ethical approval and permits. Statistical level was set at p≤0.05 with a confidence interval (CI) set at 95%. Results: The uptake of LAPM among the study participants was (22.7%, n=78) with a response rate of (80.1%, n =343.) Educational attainment (above secondary) significantly increased the likelihood of LAPM uptake (A.O.R 4.43, 95% CI (1.92- 10.73), P<0.001. This study did not uncover a statistically significant link between culture, health-related factors and knowledge of contraception on the uptake of LAPM. Notably, no woman opted for a permanent method of contraception. Conclusion: The uptake of LAPM in Kajiado County remains low, with no woman opting for a permanent method of contraception. Higher education increased uptake. Therefore, targeted interventions should focus on educational empowerment for women
TABLE SALT FOR TREATMENT OF UMBILICAL GRANULOMA IN INFANTS: A REPORT ON TWO CASES
Umbilical granulomas are among the most common neonatal umbilical abnormalities, often triggering concern in parents despite their benign nature. They result from excess granulation tissue that fails to epithelialize properly after the umbilical cord falls off. Standard treatments such as silver nitrate cauterization, while effective, may not always be accessible or acceptable due to associated risks, costs, or parental concerns. This report presents two cases of infants with persistent umbilical granulomas that responded successfully to table salt application following unsuccessful or impractical conventional interventions. The treatment led to rapid lesion resolution within a few days, without adverse effects. Differential diagnoses such as umbilical polyps and patent urachus were clinically ruled out. This case report underscores table salt as a feasible and cost-effective therapeutic option, especially in resource-constrained environments. Nevertheless, findings should be interpreted cautiously due to the small sample size.
PREVALENCE OF SCABIES AMONG CHILDREN IN CHARITABLE CHILDREN’S INSTITUTIONS IN NAIROBI COUNTY
Background: Human scabies is a papular pruritic skin rash following infestation with the ectoparasite Sarcoptes scabiei. Primary mode of transmission is through skin-to-skin contact and it is therefore common in institutionalized individuals. Objectives: The objective of this study was to determine the prevalence of scabies among children domiciled in charitable children's institutions (CCIs) within Nairobi County and evaluate the knowledge level of CCI managers about scabies. Methods: A cross-sectional survey was conducted among children aged 6 months to 18 years in 10 CCIs from Langata and Dagoretti sub counties in Nairobi County using multi-stage random selection. Additionally, the knowledge of all 10 CCI managers regarding scabies was assessed using questionnaires. Results: The prevalence of scabies was 6.4%. The prevalence was higher among males and in the age group of 6-12 years. Most CCI managers demonstrated good knowledge about scabies, with a significant association found between scabies and sleeping with a child exhibiting itchy skin. Conclusion: The prevalence of scabies among children in the selected CCIs in Nairobi County was relatively low, and CCI managers exhibited good knowledge of scabies prevention and management. Recommendations include regular medical visits and education for CCI managers on scabies prevention and management, alongside the need for larger studies to ascertain the true extent of scabies in CCIs nationwide.
PREVALENCE AND RISK FACTORS OF GESTATIONAL DIABETES MELLITUS IN SUB-SAHARAN AFRICA: A SYSTEMATIC REVIEW
Background: Gestational Diabetes Mellitus (GDM) is a major public health concern globally, which carries a double burden for the mother and the fetus. Objectives: This systematic review aimed to investigate the prevalence and risk factors of GDM in Sub-Saharan Africa (SSA). Methods: Researchers systematically searched five databases: PubMed, PubMed Central, ProQuest Central, Cochrane, and Articles from the reference lists and grey literature. The review included studies conducted (2012 - 2024) and published (2017 - 2024). Eligibility criteria included studies that reported prevalence or risk factors of GDM, conducted in SSA, published in English, provided full-text access, and employed a cross-sectional, cohort, or interventional study design. Studies were required to use oral glucose tolerance tests as the diagnostic standard. The risk of bias was assessed using the ROBIS Tool. A total of 47 articles met the inclusion criteria. Results: Out of 55 countries in SSA, only 11 conducted studies meeting the criteria, resulting in 47 relevant studies on GDM risk factors and prevalence. Ethiopia had the highest number of studies (eight), while Gabon had the fewest (one). Kenya had no studies reporting the prevalence rate. The mean prevalence of GDM across the 47 studies was 14%, with individual study prevalence rates ranging from 3% to a high level of 39%. Among the included studies, 16 were hospital-based cross-sectional studies, while 11 were population-based studies. Collectively, the studies' total sample size is 42,952 participants. Conclusion: The study revealed an increasing trend in the prevalence of GDM in SSA. The identified risk factors are largely modifiable and therefore present opportunities for prevention. The researcher recommends targeted intervention to address these risk factors and reduce the prevalence of GDM. Lack of similar evidence in many SSA Countries suggests that existing practices and guidelines may not be based on the most current relevant data.
PREDICTIVE UTILITY OF COLDS SCORE IN DEVELOPMENT OF LARYNGOSPASM IN CHILDREN UNDERGOING ELECTIVE ADENOTONSILLECTOMY AT KENYATTA NATIONAL TEACHING ANDREFERRAL HOSPITAL, NAIROBI, KENYA
Background: Children with upper respiratory tract infections, including adenotonsillitis, are at a higher risk of perioperatively developing pediatric respiratory adverse events. Frequent inflammation of adenoids and tonsils can lead to serious complications with growth and developmental consequences, warranting their surgical removal. The COLDS score, developed by Lee and August, is a validated clinical screening tool designed to assist in the pre-anesthetic evaluation of children with upper respiratory tract infections. Objective: To investigate the utility of the COLDS score in predicting a laryngospasm in children undergoing adenotonsillectomy at Kenyatta National Hospital (KNH), Nairobi, Kenya. Methods: Eighty-four children aged 12 years and below were recruited in this single-center study, excluding those with uncorrected cardiac disease, gastroesophageal reflux disease, and neuromuscular disorders. Laryngospasm occurrence was the dependent variable, while patient and anesthetic factors were independent variables analyzed using STATA version 15. Descriptive statistics were applied to age, sex, body mass index, and upper respiratory tract infection data. The COLDS score and laryngospasm occurrence generated a receiver operating characteristic curve, with a cut-off value of 16.5 used to determine sensitivity, specificity, positive predictive value, and negative predictive value. Results: The incidence of laryngospasm was 4/84 (4.8%). The sensitivity of COLDS score above and including 16.5 was 75.0% (95% CI, 19.4% - 99.4%) with specificity of 65.0% (95% CI, 53.5% - 75.3%) and overall accuracy of 65.5% (95% CI, 54.3% - 75.5%). The Positive Predictive Value (PPV) was 9.68% (95% CI, 5.4% - 16.9%) and Negative Predicitve Value (NPV) 98.1% (95% CI, 90.4% - 99.7%). Conclusion: The preoperative risk assessment for laryngospasm of children prone to recurrent upper respiratory tract infections (URTIs) scheduled for adenotonsillectomy remains subjective. Based on the findings of our study, while the COLDS score may not be adequate as an independent diagnostic tool, it provides predictive potential for ruling out laryngospasm
POSTNATAL GROWTH AMONG VERY LOW BIRTH WEIGHT NEONATES AT KENYATTA NATIONAL HOSPITAL (KNH), KENYA
Background: Very Low Birth Weight (VLBW) are neonates with birth weight between 1000 grams(g) and 1499 g. They are predominantly premature having been born before attaining 37 weeks of gestation. Their postnatal growth is associated with short term and long-term effects. Little is known about postnatal growth and enteral feeding of VLBW in Low- and Middle-Income Countries (LMICs). In Kenya, a previous study was published more than a decade ago. Objectives: To determine the in-patient postnatal growth patterns and nutrition of VLBW new-borns at Kenyatta National Hospital (KNH), a tertiary referral hospital in Nairobi, Kenya Methods: A six-month prospective cohort study was conducted at the KNH Newborn Unit (NBU) in 2022. Seventy-nine VLBW neonates admitted within the first 24 hours of life and surviving to day 14 were consecutively enrolled, excluding those with congenital malformations. Data on socio-demographic characteristics, anthropometric measurements, feeding practices, and comorbidities were collected using a structured tool. Analysis was performed using SPSS version 23.0. The population was described by summarizing variables into percentages and means. Postnatal growth was measured by analysing the proportion of VLBW regaining birthweight at 14 days of life and median time in days to achieving full enteral feeds of 150ml/kg /day. Statistical significance was interpreted at 95% confidence level. Growth velocities were expressed as means or medians with standard deviations (SD) or interquartile ranges (IQR). Statistical significance was set at p ≤ 0.05 Results: By day 14 of life, 39 VLBW new-borns (49%) had regained their birth weight. The median postnatal growth rates were weight gain of 14.4 g/kg/day, length gain of 0.48 cm/week, and head circumference increase of 0.43 cm/week. The most common comorbidities observed were respiratory distress syndrome, neonatal jaundice, and neonatal sepsis. No independent factors were found to be significantly associated with regaining birth weight by day 14. Conclusion: This study found that the feeding practices and postnatal growth rates at KNH are approaching the World Health Organization (WHO)- recommended weight gain rate of 15 g/kg/day. Recommendation: Standard care practices and ongoing quality improvement initiatives at KNH should be maintained and strengthened to continue improving outcomes for VLBW neonates.
METHODOLOGICAL CHALLENGES OF ESTIMATING THE DISEASE BURDEN OF MRSA-ASSOCIATED SEPSIS IN NICU, A SYSTEMATIC REVIEW
Objectives: This systematic review aimed to assess the burden of methicillin-resistant Staphylococcus aureus (MRSA)-associated neonatal sepsis (NS) in neonatal intensive care units (NICUs). We examined MRSA-related mortality and described resistance patterns of MRSA strains in NICUs. Materials and Methods: We searched four databases up to 2023 for observational studies on MRSA or antimicrobial resistance in neonates with culture-confirmed sepsis in NICUs. Studies included all sepsis types, diagnostic methods, and neonatal characteristics. We extracted data on study features, MRSA prevalence, resistance, and mortality. We used a random-effects model for pooled proportions, with subgroup analyses by sepsis type and WHO region, and assessed heterogeneity using the I² statistic. Results: We included 37 studies published between 2000 and 2021 from 23 countries These studies reported 2948 cases of culture-confirmed NS with MRSA prevalence ranged from 0.0 to 32.2% across studies. Among 2948 total NS cases, the pooled MRSA proportion was 8.8% (95% CI: 4.5–14.1; I² = 94.2%). The pooled MRSA proportion in early-onset neonatal sepsis was 2.7% (95% CI: 1.3– 4.6; I² = 0%). The pooled MRSA proportion in late-onset neonatal sepsis was 4.6% (95% CI: 2.1–7.8; I² = 90.3%). Two studies reported 6 deaths among 14 MRSA-positive neonates from a total cohort of 184 infants. In Egypt and Saudi Arabia, MRSA strains showed resistance to multiple antibiotic classes, including aminoglycosides, chloramphenicols, drug combinations, fluoroquinolones, lincosamides, macrolides, penicillins, rifamycins, and cephalosporins (both second and third generation). Conclusion and recommendations: These findings highlight the role of MRSA as a significant cause of neonatal sepsis. High resistance rates in some settings may compromise empirical treatment strategies. There is an urgent need to strengthen surveillance and antimicrobial stewardship in neonatal care. Standardized methods in future studies will improve comparability and support global policy on neonatal infection management.
INFLUENCE OF INTEGRATED HEALTHCARE INFORMATION SYSTEMS ON HEALTHCARE SERVICE DELIVERY TENETS AT KENYATTA NATIONALHOSPITAL, KENYA
Background: Health Information Systems (HIS) is one of the pillars of a functional health system. However, efforts to expand HIS and Digital health technology in sub-Saharan Africa are hindered by many factors including weak health information system governance and inadequate infrastructure. The main objective of this study was to determine the influence of integrated healthcare information systems on healthcare service delivery tenets in Kenyatta National Hospital, Kenya. Methodology: This study adopted a cross-sectional study design. Stratified and simple random sampling were used in this study. Data was collected using a self-administered questionnaire. SPSS version 29 was used for quantitative data analysis. Both descriptive and inferential statistics were done including chi-square were done. Statistical significance was set at P ≤0.05. Results: There were 210 respondents with the majority (56.2%, n=118) of being female. Nurses (30.5%, n=64) constituted the highest number of respondents in the study, followed by health information officers (25.7%, n=54). A bigger proportion (61.4%, n=129) of respondents had a diploma level of education, followed by those with a bachelor's degree (30.5%, n=64) with a majority of study participants (60.5%, n=127) having less than 8 years of work experience. Mobile health technology (χ2(2)=27.347,p=0.001), telehealthcare technology (χ2(2)=12.944,p=0.000), telemedicine technology (χ2(2)=7.105,p=0.029), and cloud computing technology (χ2(2)=16.219,p=0.000) were significantly associated with service delivery satisfaction. Electronic medical health records (EMHR) system use(χ2(2)=16.222,p=0.001), Electronic Health Records (EHR) systems (χ2(2)=20.137,p=0.000), Clinical Decision Support Systems (CDSS) (χ2(2)=44.504,p=0.000), and Patient Administration Records Systems (PARS) (χ2(2)=29.745,p=0.000) had a significant association with service delivery satisfaction . Conclusion: In conclusion the integration of Clinical Decision Support Systems, mobile health technology, efficient patient administration record systems, and telehealthcare technologies significantly enhanced healthcare service delivery. These findings underscore the importance of adopting digital medical technologies as well as healthcare information systems in hospital settings.
EFFICACY AND SAFETY OF PERCUTANEOUS SCLEROTHERAPY IN THE MANAGEMENT OF HYDATID CYSTS
Background: Percutaneous sclerotherapy of hydatid cysts offers a less invasive management of hydatid cysts. The procedure has been documented to yield significant cyst volume reduction of 76%-100%, with up to 100% symptom relief. It is particularly advantageous due to its shorter hospital stay and fewer complications compared to surgery. Long-term follow-up data show that the recurrence rates of percutaneous sclerotherapy are comparable to surgery, but with a safer profile, making it an effective treatment option. Factors like cyst size and location influence treatment success, with smaller cysts responding better. Complications are generally rare, with major adverse events seldom reported. Objective: To review the efficacy and safety of percutaneous sclerotherapy as an essential treatment modality for hydatid cysts. Sources: The search strategy involved systematically searching databases such as PubMed, Scopus, and the Cochrane Library. Studies published from 2015 onwards were included, focusing on those addressing percutaneous sclerotherapy for hydatid cysts. Content: The review provides a comprehensive understanding of the efficacy, safety, and potential complications of percutaneous sclerotherapy of hydatid cysts. This review also highlights the growing role of percutaneous sclerotherapy in hydatid cyst disease management. Implications: To enhance the integration of percutaneous sclerotherapy of hydatid cysts into clinical practice to complement existing treatment strategies, offering a reliable alternative for managing hydatid cysts.
DIVERSITY OF MUCOSAL ASSOCIATED GUT MICROBIOTA IN COLORECTAL AND NON-COLORECTAL CANCER TISSUES FROM PATIENTS IN NAIROBI,KENYA
Background: There is growing evidence that gut microbiota could significantly influence the development of colorectal cancer (CRC) a malignancy that currently ranks among the top causes of cancer-related illness and death globally. This study was purposed to examine the microbial diversity found in both malignant and nonmalignant colon tissues. Objective: To determine the diversity of the colon bacterial flora in malignant and non-malignant tissues from the colon / rectum of patients attending the Aga Khan Cancer Clinic in Nairobi, Kenya. Design: A retrospective case-control study Setting: Aga Khan University Hospital and Jomo Kenyatta University of Agriculture & Technology Materials and methods: A total of sixty tissue blocks comprising those with cancer (thirty) and those without (thirty) were examined. The main outcome measures were ; age, sex, colorectal malignancy, Colorectal non-malignancy, Cancer stage, Cancer grade, and subtype and type of microbiota. In addition history of changes in bowel habits, rectal bleeding, and abdominal pain were documented. Results: The males were 18 (60%), while the females were 12 (40%) of the total (30). Oscillospiraceae bacterium, Clostridales bacterium, Acetivibro sp, Eubacterium, Texcoconibacilllus texcoconensis and Staphylococcus sp were found in malignant Invasive adenocarcinoma was the most dominant subtype, followed by mucinous adenocarcinoma. Distribution by stage; stage I had three, stage II sixteen and stage III were eleven tissues. Conclusion: This study shows that colorectal cancer patients have different patterns of mucosal-associated gut microbiota. These varied with sex and age. Further studies should be done to support the potential use of microbial markers for risk assessment and early CRC detection (CRC) tissues.