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.
VACCINATION COVERAGE AND ASSOCIATED FACTORS AMONG CHILDREN AGED 12-23 MONTHS: A CROSS-SECTIONAL STUDY IN NAROK COUNTY, KENYA
Background: The utilization of childhood vaccines is still below the universal coverage. This has led to occurrences of vaccine preventable diseases. This study examined the vaccination coverage and associated factors among children aged 12-23 months in Narok County, Kenya. Methods: This was a cross-sectional study that entailed determination of vaccination coverage among 378 children. A stratified sampling technique was used to sample children in the County. Statistical analysis was done using STATA. Descriptive statistics was presented in form of variables’ frequencies and percentages. Inferential statistics involved univariate and multivariate logistic regression analysis. Variables that were significant at univariate regression analysis were included in multivariate analysis regression model. Results: The full vaccination coverage was 251(66.4%). Subtly, 362 (95.8%) children received Bacillus Calmette–Guérin (BCG)_vaccine, 341 (90.21%) Oral Polio Vaccine (OPV) dose zero, 344 (91.1%) OPV1, 353 (93.4%) OPV2, 326 (86.2%) OPV 3, Inactivated Polio Vaccine (IPV) 322 (86.2%), 300 (79.4%) for Measles Virus Containing Vaccine (MCV) dose one and 76 (61.8%) for MCV2. The factors significantly associated with vaccination coverage were at least secondary education level (p<0.001), formal employment (p<0.001), good facility-readiness to vaccinate (p=0.006) and ≥4 Antenatal Care (ANC) visits (p=0.004). Conclusion and recommendations: The findings indicated suboptimal vaccination coverage below the target for universal coverage. Encouraging pregnant women to attend at least 4 ANC visits, capacity boosting of facilities’ vaccine financing, monitoring and forecasting improves availability of vaccines and reduce missed opportunities for vaccination.
Copyright (c) 2026 East African Medical Journal
SUDDEN FATAL ANAPHYLACTIC REACTION TO HUMAN ALBUMIN INFUSION IN A PATIENT WITH RHEUMATIC HEART DISEASE: A CASE REPORT
Human serum albumin (HSA) is widely used to manage critical conditions that need fine fluid homeostasis, such as hypoalbuminemia, cirrhosis, and heart failure. While generally safe, rare cases of hypersensitivity and anaphylaxis have been reported. We report a case of fatal anaphylaxis following HSA infusion in a 49-year-old woman with rheumatic heart disease, acute decompensated heart failure, and congestive hepatopathy. After initial infusion, she developed urticaria, abdominal pain, diarrhea, dyspnea, and hypotension, consistent with anaphylaxis. Despite stopping the infusion and treatment, a second administration led to a more severe reaction, resulting in cardiac arrest and death. Anaphylaxis related to albumin is extremely rare and can be difficult to diagnose in patients with underlying conditions. The mechanisms are not fully understood, but they may involve both IgE-mediated and non-IgE-mediated pathways. Treatment follows standard anaphylaxis protocols, with epinephrine as first-line therapy. No standardized protocols exist for albumin allergy, emphasizing the need for heightened clinical awareness. This case highlights the potential for fatal anaphylactic reactions to albumin, especially upon re-exposure, and underscores the importance of vigilance and avoidance of repeat administration after initial hypersensitivity
MOLECULAR TESTING OF MINIMALLY INVASIVE CYTOLOGY SPECIMENS IN PRECISION ONCOLOGY: ANALYTICAL CHALLENGES AND CLINICAL IMPLICATIONS: A SCOPING REVIEW
Background: The increasing use of molecular testing in oncology has amplified reliance on diagnostic material obtained through minimally invasive procedures. In numerous clinical scenarios, cytological specimens represent the only available substrate for molecular and genomic analysis. Despite their growing clinical relevance, published studies addressing molecular testing in minimally invasive cytology remain methodologically diverse and analytically heterogeneous, complicating interpretation and comparison. Objective: This scoping review sought to systematically identify molecular testing methodologies applied to minimally invasive cytology specimens, describe patterns of specimen utilization, classify reported clinical applications, evaluate laboratory and technical factors affecting analytical feasibility and reliability, and highlight recurrent methodological limitations and knowledge gaps within the literature. Methods: The review followed the Arksey and O’Malley scoping review framework and was reported according to PRISMA-ScR guidance. A comprehensive search of major biomedical databases was conducted to identify studies describing molecular or genomic analyses performed on minimally invasive cytological specimens. Following duplicate removal, records underwent structured title, abstract, and full-text screening using predefined eligibility criteria. Relevant study characteristics and methodological data were extracted using a standardized charting approach. Results: Two hundred studies met eligibility criteria and were included. The literature demonstrated substantial variability in molecular platforms,specimen preparation techniques, and clinical contexts. Next-generation sequencing and PCR-based assays were most commonly reported, with many studies employing multiple analytical approaches. Fine-needle aspiration cytology and cell block preparations predominated. Analytical feasibility was consistently influenced by specimen adequacy, cellularity, nucleic acid yield, and pre-analytical variability. Frequent methodological limitations included retrospective designs and inconsistent reporting practices. Conclusion: The evidence reflects expanding integration of minimally invasive cytology into molecular diagnostic workflows across oncologic applications. However, heterogeneity in study design, laboratory practices, and reporting standards limits comparability and definitive assessment of analytical performance. Standardization efforts and prospective validation studies are needed to strengthen the evidence base.
KNOWLEDGE, ATTITUDES AND ADOPTION OF AMALGAM PHASEDOWN AMONGST DENTISTS IN NAIROBI COUNTY: A CROSS-SECTIONAL STUDY
Background: Dental amalgam has long been used as a durable restorative material; however, global efforts to phase it down have intensified due to concerns regarding mercury exposure and its environmental and health effects. This study aimed to assess the knowledge, attitudes, and adoption of amalgam phasedown among practicing dentists in Nairobi County, Kenya. Methods: This descriptive cross-sectional study was conducted among 83 practicing dentists in Nairobi County. Participants were recruited using a non-probability sampling approach. Data was collected using a self-administered questionnaire assessing knowledge, attitudes, and practices related to amalgam phasedown. Data were analyzed using Microsoft Excel and SPSS. Descriptive statistics were presented as frequencies and percentages, and associations between variables were tested using the Chi-square test, with statistical significance set at p < 0.05. Results: All 83 (100%) participants were aware of amalgam phasedown. Ministry of Health circulars 44 (53.0%) were the most common source of information, closely followed by Kenya Dental Association communications 38 (45.8%). Regarding attitudes, 37 (44.6%) participants opposed the complete phase-out of amalgam, 30 (36.1%) supported it, and 16 (19.3%) were neutral. In terms of adoption, 45 (54.2%) participants reported rarely using amalgam, 21 (25.3%) used it occasionally, and 17 (20.5%) no longer used it in practice. A statistically significant association was found between reduced amalgam use and continuous training on posterior composite placement (χ² = 9.351, p = 0.009). Conclusion: Dentists in Nairobi County demonstrated good knowledge and a generally positive orientation toward amalgam phasedown, with a substantial shift toward reduced use of amalgam. However, financial constraints and concerns regarding alternative materials remain key barriers to the phasedown. Strengthening continuous professional training and improving affordability of alternative restorative materials through government sponsored initiatives are recommended strategies to support an effective and equitable transition away from dental amalgam.
KNOWLEDGE OF GESTATIONAL DIABETES MELLITUS AMONG WOMEN ATTENDING SELECTED HOSPITALS IN NAIROBI COUNTY, KENYA: A CROSS-SECTIONAL STUDY
Background: Gestational diabetes mellitus (GDM) is pregnancy related diabetes caused by increased insulin resistance and glucose intolerance. Majority of the women have limited or no knowledge on GDM. Objectives: This study therefore aimed at assessing demographic characteristics and knowledge of GDM among women. Design; Cross-sectional study was employed. Setting: The study sites were Pumwani Maternity Hospital (PMH) and Mama Lucy Kibaki Hospital (MLKH) both in Nairobi County, Kenya. These hospitals were purposively sampled because they matched the unique characteristics of the desired population. Period for study was between October to December 2024. Participants: Fisher’s formula was used to determine the sample size, which yielded 141 participants from each facility. Data was collected using an interviewer administered questionnaire guided by Patient Diabetic Knowledge. Main outcome measure: Level of knowledge among GDM mothers. Results: A total of 128 (90%) mothers participated in the study, (PMH; 71 [100%]; MLKH 57 [80%]). Most 82% (n=105) of the mothers were married, 75.8% (n=97) self-employed, and 55.5% (n-71) were aged between 35-49 years, there was a strong significant difference between the two hospitals regarding level of education (X2=15.687, d=3, P= 0.0001). Majority 91.4% (n = 117) of women had poor knowledge of GDM, and only 8.6% (n = 11) revealed moderate knowledge. Conclusion: Many women were in the advanced age and had poor GDM knowledge on risk factors, clinical features, management, prevention and consequences associated with GDM. Hence, health education to GDM mothers was recommended.
KEY LESSONS FROM PREPARATORY AND EARLY IMPLEMENTATION PHASE OF A REGIONAL MPOX RESPONSE WITHIN A MULTI-SECTORAL PREPARE PROJECT FRAMEWORK
Background: Outbreaks of viral and zoonotic diseases are increasingly frequent, with Sub-Saharan Africa representing a significant global source of emerging infectious diseases. Health security threats posed by the pandemics and epidemics call for regional, multi-stakeholder, and multi-sectoral approaches. Objectives: To examine and document events' chronologies and critical lessons during the preparatory and early implementation stages of a three-year Preparedness for Pandemic Response (PREPARE) project in the Intergovernmental Authority on Development (IGAD) region. Methods: This narrative review synthesizes the evolution of the mpox outbreak, the regional and country level response considerations, and the key lessons learned during the initial implementation phase of the regional PREPARE project from 2024 to 2025. Discussion: The regional PREPARE project was fast-tracked to respond to the mpox outbreak in IGAD region from November 2024, at a time when Uganda was the only IGAD country that had reported active cases. Lessons from the preparatory and early stages of the initiative arose from: IGAD's vulnerable geo-location in respect to the pandemics epicenters; the sporadic yet important paradigm shift from predominantly single-sector (health) response to a multi-sector approach; the adjustment from the initial ‘regional preparedness for response to pandemics and epidemics’ to ‘securing regional impact through supporting country-level mpox response’; the unpredictable trajectory of mpox transmission and spread; perplexing observations during the initial phase of the mpox outbreak; administrative challenges arising from the new partnerships; and opportunity presented for policy and strategy reviews, and harmonization across countries. Conclusions and Recommendations: Regional mpox response presents increased relevance and draw support for expedited implementation when particularly initiated in proximity to the outbreak epicenter. Insights from the initial phase of the PREPARE project provide critical lessons applicable to regional responses to infectious disease outbreaks and other public health emergencies; and may inform refinement of context-specific health security policies and strategic frameworks.
HEALTH SERVICE PROVISION FACTORS INFLUENCING UTILIZATION OF HIV TESTING SERVICES AMONG PASTORALISTS (A CROSS-SECTIONAL DESCRIPTIVE STUDY UNDERTAKEN IN KAJIADO EAST SUB-COUNTY, KAJIADO COUNTY -KENYA)
Background: HIV Testing Services (HTS) are essential for HIV prevention, detection, treatment, and care. Despite progress in Kenya, factors influencing HTS utilization among pastoralists remain underexplored. Objective: This study assessed health service provision factors influencing HTS utilization among pastoralists in Kajiado East Sub-County, Kajiado County in Kenya. Methodology: A cross-sectional mixed-methods study was conducted. Quantitative data were collected via questionnaire and analyzed using SPSS version 25. Odds ratios and binary logistic regression were used to determine associations (p≤0.05). Qualitative data from 8 key informant interviews and 4 focus group discussions were analyzed thematically using NVivo. Results: A total of 395 respondents were enrolled but those who consented to the study was 384 respondents among pastoralists (response rate 97%). HTS utilization was low at 39.4% (149 out of 378); factors attributed to this included HTS counselor sex (p=0.005), counsellor age (p=0.044), availability of HTS centre, as well as presence of community health promoters (CHP). A good percentage 33.5% (n=129) of respondents preferred community health promoters as HTS counsellor. Respondents recommended more staff diversity, mobile HTS units as well as integration of HTS services in primary health care. Upon adjusting; Recommendation of HTS services to others: Respondents who would not recommend HTS had 96.3% lower odds of utilization (AOR = 0.037, 95% CI: 0.0073–0.1894, p < 0.001). Availability of HTS services: Lack of availability remained significantly associated with reduced odds of utilization (AOR = 0.21, 95% CI: 0.05–0.78, p = 0.02). Community health promoter: Having a community health promoter was strongly associated with nearly eight times higher odds of utilization (AOR = 7.93, 95% CI: 1.30–48.55, p = 0.025) were independently associated with HTS utilization among pastoralists. Conclusion: The independent predictors of HTS utilization were willingness to recommend HTS, availability of HTS services, and presence of community health promoters among pastoralist communities. There is need to develop frameworks aimed towards the unique context of pastoralist communities including provision of mobile HTS services in order to improve service uptake.
CYTOSCRAPE CELL BLOCK IMPROVES CYTOLOGICAL EVALUATION OF FINE NEEDLE ASPIRATION SMEARS AT KENYATTA NATIONAL HOSPITAL (NAIROBI, KENYA): A CROSS- SECTIONAL STUDY
Background: There are more than nine methods used to prepare cell-blocks. Cytoscrape cell-blocks have been found to be effective for haemorrhagic and overly thick smears. Our study utilized the direct formalin method for the preparation of cytoscrape cell-blocks. Objective: to assess the utility of cytoscrape cell-blocks for evaluation of fine needle aspiration (FNA) smears at Kenyatta National Hospital, Nairobi, Kenya. Methodology: This was a cross-sectional (laboratory-based) study involving 55 smears of breast and axillary lymph node aspirations reported as ‘suspicious’ or ‘malignant’. Scrapings from fine needle aspiration smears were processed as a micro-biopsy. The cytoscrape block findings were compared with smear findings, and cyto-histological correlation was made whenever available. Data were analyzed using Microsoft Excel 2019 and Cohen’s Kappa test for agreement. Categorical data were summarized, and Kappa was calculated at a 95% CI. P-values <0.05 were considered statistically significant. Results: cellular material was successfully recovered in 85.2% (47 of 55) of smears. Architectural picture was improved in 58.5% (n=16) of cases, providing additional information. The overall agreement between the cytoscrape technique and conventional smears was 72.3% with a kappa score of 0.43 (95% CI; p<0.001). Cytohistological correlations were performed in 20 cases. The agreement between the cytoscrape technique and histology was 85%, with a Kappa score of 0.69 (95% CI; p = 0.006). Conclusion: The cytoscrape technique could enhance the utility of cytology in diagnostic workflows. It is an essential tool for secondary analysis of conventional specimens when FNA slides are the only available specimens.
CARDIAC TROPONIN T LEVELS IN END-STAGE RENAL DISEASE PATIENTS UNDERGOING HEMODIALYSIS AT JARAMOGI OGINGA ODINGA TEACHING HOSPITAL, WESTERN KENYA: CROSS-SECIONAL STUDY DESIGN
Background: End-Stage Kidney Disease (ESKD) is a critical global health issue, particularly in low-resource settings like Kenya, where limited access to specialized care and dialysis exacerbates its rising prevalence and underreporting. Methods: This study aimed at determining the cardiac troponin T levels in ESKD patients undergoing hemodialysis at Jaramogi Oginga Odinga Teaching Hospital (JOOTRH), Kisumu County, Kenya. This study employed a cross-sectional descriptive research design, examining 71 patients with ESKD. Besides cardiac troponin T, the whole blood (3-5 mL) was analyzed for kidney biochemical parameters. Descriptive statistics and Chi-square test was used to examine associations between dependent and independent variables using SPSS software version 25. Results: The study included 71 (n=100) participants, 50.7% (n=36) were female and 49.3% (n=35) were male. The study observed that 98.6% (n=70) had elevated levels of cardiac Troponin T. Gender was significantly associated with phosphorus levels, with an odds ratio of 0.33 (95% CI: 0.11–0.98) and a p-value of 0.042. While no kidney biochemical parameters, except chloride, were significantly linked to cardiac Troponin T levels. Conclusion: This study highlights the interplay between dialysis practices, biochemical disturbance, and cardiovascular risk in ESKD. Recommendation: Management of ESKD to adopt a personalized approach that incorporates, the demographic factors, biochemical profiles to optimize renal and cardiovascular outcomes.
BONE AGE ESTIMATION USING THE MATURATION PROCESS OF THE LATERAL CLAVICULAR EPIPHYSIS AMONG THE BLACK SOUTH AFRICAN POPULATION: A RETROSPECTIVE RADIOLOGICAL STUDY
Objective: To estimate the age of living individuals through radiological analysis of the ossification process of the lateral clavicular epiphysis, evaluate the sex dimorphism and population-specific variations within the Black South African population. Materials and Methods: This was a cross-sectional study where 771 clear chest radiographs showing acromioclavicular joints were retrospectively collected from select radiological departments in KwaZulu Natal province of South Africa. The appearance of the maturation centers was examined and recorded in line with the 3 phases of maturation of the lateral clavicular epiphysis. The hospital radiologist was engaged as an inter-observer reviewer who cross examined and confirmed each of the stages of the maturation process. Regression analysis was employed to assess linearity by plotting the mean variation between chronological age and actual age for every respondent against their age distribution. Results: It was observed that the age range for the total population was 14-24 years in stage 1, 14-26 years in stage 2, and 17-30 years in stage 3. Stages 2 and 3 were the most widely distributed along the age set. The ossification stages of the lateral clavicular epiphysis in this group were 32.7% (252/771) in stage 1, 24.3% (187/771) in stage 2, and 43.1% (332/771) in stage 3. The chronological age in the current cohort was approximated with a margin of error of ±1.46 years using linear regression analysis. Furthermore, it was observed that there was a greater tendency to overestimate the actual age by 0.19 years among the current population group using Bland Altman’s plot. Conclusion: The fusion process of the lateral clavicular epiphysis may be used to approximate age, especially in individuals without birth records. To improve reliability, the lateral clavicular epiphysis may be used in combination with other skeletal indicators, such as the development of the iliac crest and the fusion of the distal femur, for forensic accuracy.
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.
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.