Medicine and Health Sciences Commons^™

High Acceptability, Convenience And Reduced Carbon Emissions Of Tele-Neurology Outpatient Services At A Regional Referral Centre In Kenya, Fazal Yakub, Jasmit Shah, Dilraj Sokhi

Internal Medicine, East Africa

Background: There is severe shortage of neurologists in sub-Saharan Africa. Tele-neurology consultations (TNC) can bridge this service gap, but there is very little published evidence on TNC in our setting, which we addressed through our study.

Methods: We prospectively enrolled patients at our neurology outpatients from October 2020 to October 2021. We administered a post-TNC questionnaire which captured satisfaction/acceptability using Likert scales. A sub-group of participants who also did in-person consultations (IPC) were additionally administered post-IPC questionnaires. Statistical comparisons were made using the paired student t-test, and descriptive data expressed as median (inter-quartile range).

Results: From 219 enrolled patients, 66.7% …

Prevalence, Incidence And Chronicity Of Child Abuse Among Orphaned, Separated, And Street-Connected Children And Adolescents In Western Kenya: What Is The Impact Of Care Environment?, Samuel Ayaya, Allison Delong, Lonnie Embleton, David Ayuku, Edwin Sang, Joseph Hogan, Allan Kamanda, Lukoye Atwoli, Dominic Makori, Mary A. Ott, Caroline Ombok, Paula Braitstein

Internal Medicine, East Africa

Background: The effect of different types of care environment on orphaned and separated children and adolescents’ (OSCA) experiences of abuse in sub-Saharan Africa is uncertain.

Objective: Our two primary objectives were 1) to compare recent child abuse (physical, emotional, and sexual) between OSCA living in institutional environments and those in family-based care; and 2) to understand how recent child abuse among street-connected children and youth compared to these other vulnerable youth populations.

Participants and setting: This project followed a cohort of OSCA in Uasin Gishu County, Kenya (2009–2019). This analysis includes 2393 participants aged 18 years and below, 1017 from …

Cost Utility Of Supporting Family-Based Care To Prevent Hiv And Deaths Among Orphaned And Separated Children In East Africa: A Markov Model–Based Simulation, Marta Wilson-Barthes, Paula Braitstein, Allison Delong, David Ayuku, Lukoye Atwoli, Edwin Sang, Omar Galárraga

Internal Medicine, East Africa

Purpose: Strengthening family-based care is a key policy response to the more than 15 million orphaned and separated children who have lost 1 or both parents in sub-Saharan Africa. This analysis estimated the cost-effectiveness of family-based care environments for preventing HIV and death in this population.

Design: We developed a time-homogeneous Markov model to simulate the incremental cost per disability-adjusted life year (DALY) averted by supporting family-based environments caring for orphaned and separated children in western Kenya. Model parameters were based on data from the longitudinal OSCAR’s Health and Well-Being Project and published literature. We used a societal perspective, …

“Old People Problems”, Uncertainty And Legitimacy: Challenges With Diagnosing Parkinson's Disease In Kenya, Natasha Fothergill-Misbah, Richard Walker, Judith Kwasa, Juzar Hooker, Kate Hampshire

Internal Medicine, East Africa

Very little is known about the experience of people living with Parkinson's disease (PD) in low- and middle-income countries, such as those in sub-Saharan Africa. The number of specialists in the region is low and awareness is limited among the population and healthcare professionals. Drawing on ten months of ethnographic fieldwork in urban and rural Kenya with 55 people living with PD (PwP), 23 family members and 22 healthcare professionals from public and private clinics, we set out to understand the experience of diagnosis among PwP in Kenya. The diagnostic journeys of our study participants were typically long, convoluted and …

A Prospective Observational Study Of Community Acquired Pneumonia In Kenya: The Role Of Viral Pathogens, Jamila Nambafu, Mary Achakolong, Fridah Mwendwa, Jumaa Bwika, Felix Riunga, Samuel Gitau, Hanika Patel, Rodney Adam

Internal Medicine, East Africa

Background: Lower respiratory tract infections continue to contribute significantly to morbidity and mortality across all age groups globally. In sub-Saharan Africa, many studies of community acquired pneumonia in adults have focused on HIV-infected patients and little attention has been given to risk factors and etiologic agents in an urban area with a more moderate HIV prevalence.

Methods: We prospectively enrolled 77 patients admitted to a 280 bed teaching hospital in Kenya with radiographically confirmed community acquired pneumonia from May 2019 to March 2020. The patients were followed for etiology and clinical outcomes. Viral PCR testing was performed using …

Multiple Sclerosis In Kenya: Demographic And Clinical Characteristics Of A Registry Cohort, Imran Jamal, Jasmit Shah, Peter Mativo, Juzar Hooker, Mitchell Wallin, Dilraj Sokhi

Internal Medicine, East Africa

Background: Multiple Sclerosis (MS) is the leading cause of non-traumatic neurological disability in young adults. There is limited literature regarding the burden of MS in sub-Saharan Africa (SSA).

Objective: To describe the demographic and clinical characteristics of patients with MS (PwMS) presenting to a tertiary referral hospital in Nairobi.

Methods: We conducted a retrospective descriptive study for PwMS presenting to Aga Khan University Hospital, Nairobi from 2008–2018.

Results: 99 cases met the diagnostic criteria for MS with a male to female ratio of 1:4. Majority (68.7%) of PwMS were indigenous Africans with a mean age of onset …

Cases Of Neuromyelitis Optica Spectrum Disorder From The East Africa Region, Highlighting Challenges In Diagnostics And Healthcare Access, Dilraj Sokhi, Adil Suleiman, Soraiya Manji, Juzar Hooker, Peter Mativo

Internal Medicine, East Africa

Background: Neuromyelitis optica spectrum disorder (NMOSD) is an auto-immune disease of the central nervous system (CNS) associated with the IgG-antibody against aquaporin-4 (AQP4-IgG). There is little published epidemiology of NMOSD from sub-Saharan Africa (SSA).

Methods: We retrospectively collated NMOSD cases admitted to our tertiary regional neurology centre.

Results: We identified 11 cases (10 female, average age 30 years). 64% (7/11) were seropositive for AQP4-IgG, measured using indirect immunofluorescence. The remaining cases could either not afford tests, or had patho-gnomonic radiological features. 57% (4/7) of seropositive cases had concurrent/recent CNS infection. All pa-tients were treated with high-dose intravenous …

Out-Patient Neurological Disorders In Tanzania: Experience From A Private Institution In Dar Es Salaam, Philip Adebayo, Omar Aziz, Rose E. Mwakabatika, Mandela Makakala, Mugisha Clement, Shabbir Adamjee, Noureen Mushi, Ahmed Jusabani, Eric Aris

Internal Medicine, East Africa

Background and introduction: Low and middle-income countries (LMIC) have a considerable burden of neurological disorders. Available profile of neurological disorders in our environment is biased towards neurological admissions. There is a paucity of data on out-patient neurological conditions in sub-Saharan Africa.

Objective: To determine the frequency and demographic data of neurological illnesses being managed at the adult out-patient neurology clinic of the Aga Khan Hospital, Dar es Salaam (AKHD).

Materials and methods: The electronic medical records of all cases with neurological diseases who presented to the adult neurology clinic of the AKHD between January 2018, and December 2019 were retrospectively …

Symptoms Of Depression Among Patients Attending A Diabetes Care Clinic In Rural Western Kenya, Kristen Shirey, Simon M. Manyara, Lukoye Atwoli, Ryan Tomlin, Benson Gakinya, Stephanie Cheng, Jemima Kamano, Jeremiah Laktabai, Sonak Pastakia

Internal Medicine, East Africa

Objective: The prevalence of diabetes in sub-Saharan Africa is rising, but its relationship to depression is not well-characterized. This report describes depressive symptom prevalence and associations with adherence and outcomes among patients with diabetes in a rural, resource-constrained setting.

Methods: In the Webuye, Kenya diabetes clinic, we conducted a chart review, analyzing data including medication adherence, hemoglobin A1c (HbA1c), clinic attendance, and PHQ-2 depression screening results.

Results: Among 253 patients, 20.9% screened positive for depression. Prevalence in females was higher than in males; 27% vs 15% (p = 0.023). Glycemic control trends were better in those screening negative; at 24 …

Clinical Features, Proximate Causes, And Consequences Of Active Convulsive Epilepsy In Africa, Symon M. Kariuki, William Matuja, Albert Akpalu, Angelina Kakooza-Mwesige, Martin Chabi, Ryan G. Wagner, Myles Connor, Eddie Chengo, Anthony K. Ngugi, Rachael Odhiambo, Christian Bottomley, Steven White, Josemir W. Sander, Brian G. R. Neville, Charles R. J. C. Newton

Internal Medicine, East Africa

Purpose: Epilepsy is common in sub-Saharan Africa (SSA), but the clinical features and consequences are poorly characterized. Most studies are hospital-based, and few studies have compared different ecological sites in SSA. We described active convulsive epilepsy (ACE) identified in cross-sectional community-based surveys in SSA, to understand the proximate causes, features, and consequences.

Methods: We performed a detailed clinical and neurophysiologic description of ACE cases identified from a community survey of 584,586 people using medical history, neurologic examination, and electroencephalography (EEG) data from five sites in Africa: South Africa; Tanzania; Uganda; Kenya; and Ghana. The cases were examined by clinicians to …

Readmission And Death After An Acute Heart Failure Event: Predictors And Outcomes In Sub-Saharan Africa: Results From The Thesus-Hf Registry, K. Sliwa, B. A. Davison, B. M. Mayosi, A. Damasceno, M. Sani, O. S. Ogah, C. Mondo, D. Ojji, A. Dzudie, C. K. Kouam, A. Suliman, N. Schrueder, Gerald Yonga, S. A. Ba, F. Maru, B. Alemayehu, C. Edwards, G. Cotter

Internal Medicine, East Africa

Aims: Contrary to elderly patients with ischaemic-related acute heart failure (AHF) typically enrolled in North American and European registries, patients enrolled in the sub-Saharan Africa Survey of Heart Failure (THESUS-HF) were middle-aged with AHF due primarily to non-ischaemic causes.We sought to describe factors prognostic of re-admission and death in this developing population.

Methods and results: Prognostic models were developed from data collected on 1006 patients enrolled in THESUS-HF, a prospective registry of AHF patients in 12 hospitals in nine sub-Saharan African countries, mostly in Nigeria, Uganda, and South Africa. The main predictors of 60-day re-admission or death in …

Harnessing The Power Of The Grassroots To Conduct Public Health Research In Sub-Saharan Africa: A Case Study From Western Kenya In The Adaptation Of Community-Based Participatory Research (Cbpr) Approaches, Allan Kamanda, Lonnie Embleton, David Ayuku, Lukoye Atwoli, Peter Gisore, Samuel Ayaya, Rachel Vreeman, Paula Braitstein

Internal Medicine, East Africa

Background: Community-based participatory research (CBPR) is a collaborative approach to research that involves the equitable participation of those affected by an issue. As the field of global public health grows, the potential of CBPR to build capacity and to engage communities in identification of problems and development and implementation of solutions in sub-Saharan Africa has yet to be fully tapped. The Orphaned and Separated Children’s Assessments Related to their Health and Well-Being (OSCAR) project is a longitudinal cohort of orphaned and non-orphaned children in Kenya. This paper will describe how CBPR approaches and principles can be incorporated and adapted into …