Medicine and Health Sciences Commons^™

School-Based Study To Assess The Nutritional Status (Bmi Based) Of Adolescents Of Gojra City Of District Toba Tek Singh, Punjab, Pakistan, Shagufta Perveen, Rozina Karmaliani, Rubina Barolia, Rozina Mistry

School of Nursing & Midwifery

Adolescence is the make-or-break stage of life. Major physical, mental, and psychological growth takes place at this age. Adequate and balanced nutrition is a vital requirement to support this phase. Adolescents living in developing and low-income countries are more likely to face nutritional challenges. Poor nutritional status during adolescence is an important determinant of health outcomes.
Objective: To analyze the nutritional status (BMI based) of school-going adolescents in Gojra city, Punjab, Pakistan.
Methods: A school-based cross-sectional survey was carried out covering 635 (6-8 grade) school-going adolescents (boys and girls) from public schools in Gojra city. Data were collected through anthropometric …

The Ethical And Validity Conundrum In Epilepsy Research In Lmic Settings, Pauline Samia, Adeel Shah, Archana Patel, Philip Olielo, Lionel Mudave, Samson Gwer

Paediatrics and Child Health, East Africa

In the last few decades, research in epilepsy has significantly improved understanding of risk factors and etiologies associated with epilepsy, promoting greater access to interventions and medications that have improved health-related outcomes for patients. However, these advances and benefits are not being felt evenly on a global scale due to significant inequalities in access to and utilization of research resources and expertise in Low-and Middle-Income Countries (LMICs).

To promote effective research output, and advance evidence-based practices; the context, disease burden, and challenges that hinder good research need to be re-defined and addressed. This is key in facilitating implementation of coherent …

Psychometric Evaluation Of Phq–9 And Gad–7 Among Community Health Volunteers And Nurses/Midwives In Kenya Following A Nation-Wide Telephonic Survey, Sabina Odero, Paul Mwangi, Rachel Odhiambo, Brenda Nzioka, Constance Shumba, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Background: Nurses/midwives and Community Health Volunteers (CHVs) are exposed to chronic stressors putting them at risk of developing mental health problems. This has been exacerbated by the COVID-19 pandemic. There is limited empirical evidence of the burden of mental health problems among health care workers partly due to the lack of adequately standardized and validated measures for use among health care workers in Sub-Saharan Africa. This study aimed to perform the psychometric evaluation of the PHQ-9 and GAD-7 administered to nurses/midwives and CHVs across 47 counties in Kenya.

Methods: Between June and November 2021, a national survey on mental well-being …

Smartphone-Based Fundus Imaging For Evaluation Of Retinopathy Of Prematurity In A Low-Income Country: A Pilot Study, Roha Ahmad Choudhary, Shiraz Hashmi, Haroon Tayyab

Department of Ophthalmology & Visual Sciences

Objectives: To evaluate the feasibility of a novel and simple smart phone-based Retinopathy of Prematurity (ROP) screening approach in a resource-constrained setting.
Methods: This cross-sectional validation study was conducted at the Department of Ophthalmology and Neonatal Intensive Care Unit (NICU) of The Aga Khan University Hospital, Pakistan, from January 2022 to April 2022. A total of 63 images of eyes with active ROP (stage-1, 2, 3, 4 and/or plus or pre-plus disease) were included in this study. The stage of ROP was documented by the principal investigator using an indirect ophthalmoscope and retinal images were obtained using this novel technique. …

Immunophenotypic Expression Profile Of Multiple Myeloma Cases At A Tertiary Hospital In Nairobi Kenya, Isabella Mengich, Sheerien Rajput, Riyat Malkit, Zahir Moloo, Elizabeth Kagotho, El-Nasir Lalani, Anne Mwirigi

Pathology, East Africa

Introduction: Multiple myeloma (MM) is a plasma cell neoplasm that constitutes 10–15% of all hematopoietic neoplasms. Kenya is placed among the top five African countries for MM incidence and MM-related mortality. Prior studies have suggested that the aberrant expression of Cyclin D1, CD56, CD117 and Ki-67 on neoplastic plasma cells is useful in disease prognostication. The prevalence and significance of expression of these markers in a cohort of MM cases in Kenya has not been studied previously.

Methods: A retrospective cross-sectional study was carried out at the Aga Khan University Hospital, Nairobi. The study population included 83 MM …

Neonatal Reference Intervals For Thyroid Stimulating Hormone And Free Thyroxine Assayed On A Siemens Atellica® Im Analyzer: A Cross Sectional Study, Geoffrey Omuse, David Kawalya, Patrick Mugaine, Assumpta Chege, Daniel Maina

Pathology, East Africa

Background Deriving population specific reference intervals (RIs) or at the very least verifying any RI before adoption is good laboratory practice. Siemens has provided RIs for thyroid stimulating hormone (TSH) and free thyroxine (FT4) determined on their Atellica® IM analyzer for all age groups except the neonatal age group which provides a challenge for laboratories that intend to use it to screen for congenital hypothyroidism (CH) and other thyroid disorders in neonates. We set out to determine RIs for TSH and FT4 using data obtained from neonates undergoing routine screening for CH at the Aga Khan University Hospital, Nairobi, Kenya. …

Factors Associated With Depressive Symptoms In Patients With Benign Prostatic Enlargement, Husni Abdalla, Jasmit Shah, Tabitha A.N. Nyanja, Jacob Shabani

Family Medicine, East Africa

Background: Depression is a common condition that may lead to suicide at its worst. It is considered one of the primary causes of morbidity globally. Among the urological causes of depression is benign prostatic enlargement (BPE).

Aim: To determine the prevalence and factors associated with depressive symptoms among BPE patients.

Setting: This study was conducted in the Urology and Family Medicine Clinic at the Aga Khan University Hospital, Nairobi and Urology clinic at the Aga Khan Hospital Mombasa.

Methods: The study was a cross-sectional design recruiting 308 males above the age of 40. Patient Health Questionnaire-9 …

Mental Health And Psychological Well-Being Of Kenyan Adolescents From Nairobi And The Coast Regions In The Context Of Covid-19, Gideon Mbithi, Adam Mabrouk, Ahmed Sarki, Rachel Odhiambo, Mary Namuguzi, Judith Dzombo, Joseph Atukwatse, Margaret Kabue, Paul Mwangi, Amina Abubakar

Institute for Human Development, East Africa

Background Despite the high burden of mental health problems during adolescence and its associated nega- tive consequences, it has remained neglected especially in sub-Saharan Africa. The 2019 novel Coronavirus disease (COVID-19) pandemic has placed additional stress on adolescent mental health. However, there are few studies docu- menting the burden of mental health problems and even fewer mental health services in the region. In relation to the limited body of knowledge, the present study aims to determine the psychological well-being of adolescents and to assess the risks and associated factors of mental health problems among adolescents in the context of COVID-19 …

Dengue Virus And Blood Safety: A Mini-Review Of Research Publications, Festus Mulakoli, George Gachara, Eric Ndombi, Samoel Khamadi

School of Nursing & Midwifery, East Africa

The growing demand for donated whole blood and blood products to save lives has both health benefits and health risks for blood recipients at the same time. Dengue virus, a re-emerging viral disease poses a threat to blood safety, and it has spread to over 128 countries in the world. Several studies have documented transfusion-transmitted (TT) dengue, with the first cases being reported in China in 2002 and Singapore in 2008. To understand the magnitude and broader picture of the dengue virus and blood safety, we conducted a mini-review of published literature from the Scopus database. The review focused on …

Using Social Practice Theory In Measuring Perceived Stigma Among Female Sex Workers In Mombasa, Kenya, Joseph Newton Guni, Stanley Wechuli Wanjala, Griffins Manguro, Caroline Gichuki, Megan Sc Lim, Minh D. Pham, Stanley Luchters, James Orwa

Institute for Human Development, East Africa

Background Perceived stigma is a complex societal phenomenon that is harboured especially by female sex workers because of the interplay of a myriad of factors. As such, a precise measure of the contribution of different social practices and characteristics is necessary for both understanding and intervening in matters related to perceived stigma. We developed a Perceived Stigma Index that measures the factors that greatly contribute to the stigma among sex workers in Kenya, and thereby inform a framework for future interventions.

Methods Social Practice Theory was adopted in the development of the Perceived Stigma Index in which three social domains …

Evaluation Of Hydrocortisone, Vitamin C, And Thiamine For The Treatment Of Septic Shock: A Randomized Controlled Trial (The Hyvits Trial), Adham Mohamed, Mohamed Abdelaty, Mohamed O. Saad, Ahmed Shible, Hassan Mitwally, Abdel-Rauof Akkari, Abdurrahmaan Elbuzidi, Awadh Bintaher, Ahmed Hashim, Marcus Lance

Anaesthesiology, East Africa

Purpose: The aim of the study is to evaluate the effect of combined hydrocortisone, vitamin C, and thiamine (triple therapy) on the mortality of patients with septic shock.

Methods: This multicenter, open-label, two-arm parallel-group, randomized controlled trial was conducted in four intensive care units in Qatar. Adult patients diagnosed with septic shock requiring norepinephrine at a rate of ≥0.1 μg/kg/min for ≥6 h were randomized to a triple therapy group or a control group. The primary outcome was in-hospital mortality at 60 days or at discharge, whichever occurred first. Secondary outcomes included time to death, change in Sequential Organ …

Reducing The Mental Health Treatment Gap In Kashmir: Scaling Up To Maximise The Potential Of Telepsychiatry, Arshad Hussain, Bhupinder Kumar, Manasi Kumar, Fazle Roub

Brain and Mind Institute

No abstract provided.

The Ethical And Validity Conundrum In Epilepsy Research In Lmic Settings, Pauline Samia, Adeel Shah, Archana Patel, Philip Olielo, Lionel Mudave, Samson Gwer

Brain and Mind Institute

In the last few decades, research in epilepsy has significantly improved understanding of risk factors and etiologies associated with epilepsy, promoting greater access to interventions and medications that have improved health-related outcomes for patients. However, these advances and benefits are not being felt evenly on a global scale due to significant inequalities in access to and utilization of research resources and expertise in Low-and Middle-Income Countries (LMICs).

To promote effective research output, and advance evidence-based practices; the context, disease burden, and challenges that hinder good research need to be re-defined and addressed. This is key in facilitating implementation of coherent …

Psychometric Evaluation Of The Computerized Battery For Neuropsychological Evaluation Of Children (Benci) Among School Aged Children In The Context Of Hiv In An Urban Kenyan Setting, Rachel Maina, He Jia, Amina Abubakar, Miguel Perez-Garcia, Manasi Kumar, Jelte M. Wicherts

Brain and Mind Institute

Introduction Culturally validated neurocognitive measures for children in Low‐ and Middle‐Income Countries are important in the timely and correct identification of neurocognitive impairments. Such measures can inform develop‐ ment of interventions for children exposed to additional vulnerabilities like HIV infection. The Battery for Neuropsy‐ chological Evaluation of Children (BENCI) is an openly available, computerized neuropsychological battery specifically developed to evaluate neurocognitive impairment. This study adapted the BENCI and evaluated its reliability and validity in Kenya.

Methodology The BENCI was adapted using translation and back‐translation from Spanish to English. The psy‐ chometric properties were evaluated in a case–control study of 328 …

Strengthening The Understanding Of South Partnerships And Rigor In Addressing Social Determinants Of Child And Adolescent Mental Health, Manasi Kumar

Brain and Mind Institute

The Journal of Adolescent Health's current supplement presents the work of a highly active team of researchers who are focusing on developing a strong body of evidence around child and adolescent mental health in Sub-Saharan Africa. The supplement lays out scholarship generated through years of partnership between researchers based in the United States—some of whom are from Sub-Saharan context, specifically Uganda—in connecting applied social work, community mental health for children and adolescents, and family development. The work comprises a series of articles embedded within several National Institutes of Health–funded grants by authors based in the United States in partnership with …

Barriers And Facilitators To Anti-Retroviral Therapy Adherence Among Adolescents Aged 10 To 19 Years Living With Hiv In Sub-Saharan Africa: A Mixed-Methods Systematic Review And Meta-Analysis, Londiwe D. Hlophe, Jacques L. Tamuzi, Constance Shumba, Peter S. Nyasulu

School of Nursing & Midwifery, East Africa

Background: Human Immunodeficiency Virus (HIV) significantly affects adolescents globally, with the sub-Saharan Africa (SSA) reporting a high burden of the disease. HIV testing, treatment, and retention to care are low among adolescents. We conducted a mixed-method systematic review to assess anti-retroviral therapy (ART) adherence; barriers and facilitators to ART adherence and ART outcomes among adolescents living with HIV and on ART in sub-Saharan Africa.

Methods: We conducted searches in four scientific databases for studies conducted between 2010 and March 2022 to identify relevant primary studies. Studies were screened against inclusion criteria and assessed for quality, and data was …

High Prevalence Of Vaccine-Preventable Anal Human Papillomavirus Infections Is Associated With Hiv Infection Among Gay, Bisexual, And Men Who Have Sex With Men In Nairobi, Kenya, Myo Minn Oo, Samantha Moore, Suzanne Gibbons, Wendy Adhiambo, Peter Muthoga, Naomi Siele, Maureen Akolo, Henok Gebrebrhan, Aida Sivro, Blake T. Ball

School of Nursing & Midwifery, East Africa

Background: Human papillomavirus (HPV) infection is associated with anal cancers and is more prevalent in gay, bisexual, and men who have sex with men (gbMSM), partly due to their vulnerability to HIV infection. Baseline HPV genotype distributions and risk factors can inform the design of next-generation HPV vaccines to prevent anal cancer.

Methods: A cross-sectional study was conducted among gbMSM receiving care at a HIV/STI clinic in Nairobi, Kenya. Anal swabs were genotyped using a Luminex microsphere array. Multiple logistic regression methods were used to identify risk factors for four HPV outcomes (any HPV, any HR-HPV, and 4- …

Highlights From The Second Choosing Wisely Africa Conference: A Roadmap To Value-Based Cancer Care In East Africa (9–10 February 2023, Dar Es Salaam, Tanzania), Rugengamanzi Eulade, Godwin Abdiel Nnko, Jerry Ndumbalo, Nazima Dharsee, Larry O. Akoko, Christian Ntizimira, Beda Likonda, Harrison Chuwa, Salum Lidenge, Verna Vanderpuye, Nazik Hammad, Sikudhani Muya, Rubagumya Rubagumya

Internal Medicine, East Africa

The ecancer Choosing Wisely conference was held for the second time in Africa in Dar es Salaam, Tanzania, from the 9th to 10th of February 2023. ecancer in collaboration with the Tanzania Oncology Society organised this conference which was attended by more than 150 local and international delegates. During the 2 days of the conference, more than ten speakers from different specialties in the field of oncology gave insights into Choosing Wisely in oncology. Topics from all fields linked to cancer care such as radiation oncology, medical oncology, prevention, oncological surgery, palliative care, patient advocacy, pathology, radiology, clinical trials, research …

Integrating Human Papillomavirus Testing As A Point-Of Care Service Using Genexpert Platforms: Findings And Lessons From A Kenyan Pilot Study (2019–2020), Valerian Mwenda, Joan-Paula Bor, Mary Nyangasi, James Njeru, Sharon Olwande, Patricia Njiri, Marc Arbyn, Philippe Tummers, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Globally, cervical cancer is a major public health problem, with about 604,000 new cases and over 340,000 deaths in 2020. In Kenya, it is the leading cause of cancer deaths, with over 3,000 women dying in 2020 alone. Both the Kenyan cancer screening guidelines and the World Health Organization’s Global Cervical Cancer Elimination Strategy recommend human papillomavirus (HPV) testing as the primary screening test. However, HPV testing is not widely available in the public healthcare system in Kenya. We conducted a pilot study using a point of care (POC) HPV test to inform national roll-out.

Methods: The …

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 …

Prevalence Of Antimicrobial Resistance And Association With Patient Outcomes In A Rural Kenyan Hospital, Ian C. Drobish, Immaculate K. Barasa, George Otieno, Moses Odhiambo Osoo, Solomon K. Thuo, Kaya S. Belknap, Arianna Mclain Shirk, S. Taylor Mcclanahan, Elizabeth Irungu, Felix Riunga

Internal Medicine, East Africa

Data on antimicrobial resistance (AMR) and association with outcomes in resource-variable intensive care units (ICU) are lacking. Data currently available are limited to large, urban centers. We attempted to understand this locally through a dual-purpose, retrospective study. Cohort A consisted of adult and pediatric patients who had blood, urine, or cerebrospinal fluid cultures obtained from 2016 to 2020. A total of 3,013 isolates were used to create the Kijabe Hospital’s first antibiogram. Gram-negative organisms were found to be less than 50% susceptible to third- and fourth-generation cephalosporins, 67% susceptible to piperacillin–tazobactam, 87% susceptible to amikacin, and 93% susceptible to meropenem. …

Inspire : Vol 6, Issue 5, Department Of Medicine

INSPIRE – Department of Medicine Archives

• Message from the Chair
• Medicine at National and International Forums
• IHME Visit | May 2-3
• Featured Faculty Farzana Irfan Nursing Manager, Clinical section “…maintain a positive attitude toward others, give respect and continuously seek opportunities…”
• Poem Section ‘Don’t Quit’
• What Academics are Reading?
• Publications
• Upcoming Events

Lessons From Canada’S Notice Of Compliance With Conditions Policy For The Life-Cycle Regulation Of Drugs, Melanie Mcphail, Howard Zhang, Zohra Bhimani, Tania M. Bubela

Office of the Provost

Innovative health technologies are not well regulated under current pathways, leading regulators to adopt contextual, life-cycle regulatory models, which authorize drugs based on earlier clinical evidence subject to the conduct of post-market trials that confirm clinical benefit and safety. In this paper, we evaluate all drugs authorized in Canada under the Notice of Compliance with conditions (NOC/c) policy from 1998 to 2021 to analyze its function, identify challenges and areas for improvement, and make recommendations to inform Health Canada's regulatory reforms. We analyzed a sample of 148 drugs authorized between 1998 and 2021, including characteristics about the pre- and post-market …

Dpp8 Selective Inhibitor Tominostat As A Novel And Broad-Spectrum Anticancer Agent Against Hematological Malignancies, Shohei Kikuchi, Akinori Wada, Yusuke Kamihara, Kosuke Okazaki, Paras Jawaid, Mati Ur Rehman, Eiji Kobayashi, Takeshi Susukida, Tomoki Minemura, Yoshimi Nabe

Department of Biological & Biomedical Sciences

DPP8/9 inhibition induces either pyroptotic or apoptotic cell death in hematological malignancies. We previously reported that treatment with the DPP8/9 inhibitor 1G244 resulted in apoptotic cell death in myeloma, and our current study further evaluates the mechanism of action of 1G244 in different blood cancer cell lines. Specifically, 1G244 inhibited DPP9 to induce GSDMD-mediated-pyroptosis at low concentrations and inhibited DPP8 to cause caspase-3-mediated-apoptosis at high concentrations. HCK expression is necessary to induce susceptibility to pyroptosis but does not participate in the induction of apoptosis. To further characterize this DPP8-dependent broad-spectrum apoptosis induction effect, we evaluated the potential antineoplastic role for …

The Distribution Of Cardiovascular Risk Factors And The Association With Cadre Amongst Healthcare Workers At A Tertiary University Hospital In Nairobi City, Kenya, Emma Andrea Khabure

Master of Medicine in Family Medicine

Introduction: According to the World Health Organization (WHO), non-communicable diseases such as stroke, contribute to about 70% of the top ten causes of mortality in the world. The growing burden of Cardiovascular (CVD) risk factors has also been noted to affect the health workforce. According to the Ministry of Health in Kenya employing the WHO STEPS survey, 27% of Kenyans are either overweight or obese. Few studies have been done in Kenya to highlight the prevalence and impact of cardiovascular risk factors amongst healthcare workers. The variety of findings and paucity of data bring about the need to evaluate this …

Psychology University Students’ Mental Health Status During Covid-19 Pandemic In Karachi, Pakistan, Aisha Noorullah, Mubarak Mansoor, Ayesha Zahid

Department of Psychiatry

Purpose: The COVID-19 pandemic has brought challenges in various domains of life but for low and middle-income country university students very demanding situations have emerged. University students’ psychological well-being has always been an area of concern worldwide and higher rates of anxiety and depression have been extensively reported among this cohort.
Objective: To determine the frequency of depressive symptoms, anxiety symptoms, and quality of sleep and the association of sleep quality and personality traits with anxiety and depressive symptoms among university students in Karachi, Pakistan in the context of the pandemic COVID-19.
Method: This web-based cross-sectional study was conducted among …

Addition Of Mental Health To The Lady Health Worker Curriculum In Pakistan: Now Or Never, Fauziah Rabbani, Samina Akhtar, Javeria Nafis, Shahid Khan, Sameen Siddiqi, Zul Merali

Brain and Mind Institute

The technical advisory group of the World Health Organization (Geneva, Switzerland) has suggested person-centered and community-based mental health services in response to the long-term and far-reaching mental health impacts of the COVID-19 pandemic. Task shifting is a pragmatic approach to tackle the mental health treatment gap in low- and middle-income countries. Pakistan is dismally resourced to address the mental health challenges. Pakistan’s government has established a lady health worker’s program (LHW-P) which can be effectively utilized to provide some basic mental health services at community doorsteps. However, lady health workers’ current curriculum does not include mental health as a subject. …

Pharmacy Newsletter : April 2023, Pharmacy Department

Department of Pharmacy Archives

• Changes in Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report
• TOX-TOK: Sulfonylurea Overdose
• Difference Between Parenteral Iron Products
• Drug-Drug Interactions Impacting the Treatment of HIV-TB Co-Infection
• Conversion Between Different Corticosteroid Preparations
• Use of Analgesics in Adult Patients with Cirrhosis

Pediatric Malaria With Respiratory Distress: Prognostic Significance Of Point-Of-Care Lactate, Catherine Mitran, Robert Opoka, Andrea Conroy, Sophie Namasopo, Kevin Kain, Michael Hawkes

Paediatrics and Child Health, East Africa

Respiratory distress (RD) in pediatric malaria portends a grave prognosis. Lactic acidosis is a biomarker of severe disease. We investigated whether lactate, measured at admission using a handheld device among children hospitalized with malaria and RD, was predictive of subsequent mortality. We performed a pooled analysis of Ugandan children under five years of age hospitalized with malaria and RD from three past studies. In total, 1324 children with malaria and RD (median age 1.4 years, 46% female) from 21 health facilities were included. Median lactate level at admission was 4.6 mmol/L (IQR 2.6–8.5) and 586 patients (44%) had hyperlactatemia (lactate …

Acute Necrotizing Encephalopathy In An Infant: A Case Report, Elisamia Ngowi, Zeenat Juneja, Jacqueline Gabone, Maria Bulimba, Mohamedraza Ebrahim, Yaser Abdallah

Paediatrics and Child Health, East Africa

Background: Acute necrotizing encephalopathy is a rare, severe neurological condition, characterized by symmetrical necrotic brain lesions affecting the thalamus, cerebral white matter, brain stem, and cerebellum. Diagnosis relies on characteristic clinical and radiological features.

Methodology: We describe a 10-month-old female infant presenting with multiple seizures following a brief febrile upper respiratory illness.

Findings: MRI of the brain showed bilateral symmetrical abnormal signal intensities involving both thalami and caudate nucleus, consistent with ANE. Management of ANE is symptom-related but high-dose steroids and IVIG have been used.

Conclusion: This case highlights the importance of recognizing ANE beyond its …