Medicine and Health Sciences Commons^™

A Comparison Of Caesarean Section Rates Before And After Introduction Of Free Maternity Services At Maragua Level Iv Hospital, Grace Rwamba

Master of Medicine in Family Medicine

Introduction: At population level, a caesarean section (CS) rate between 10 and 15 percent is considered optimal for maternal and infant health outcomes and a useful process indicator of quality of care. However, that there has been a worldwide increase of CS rates in the past three decades. Compared to vaginal birth, questions abide of appropriateness, balance of risk versus benefit and cost implications to the health care system. Introduction of free maternity services (FMS) in June 2013has been known to increase health facility deliveries. However it may affect the quality of care offered in these facilities due to a …

Factors Associated With Development Of Retinopathy Of Prematurity In Three Private Tertiary Hospitals In Kenya, Annette A. Metho

Master of Medicine in Paediatrics and Child Health

Introduction: Retinopathy of prematurity (ROP) is a condition that affects mainly premature infants. It’s characterized by abnormal retinal vascular growth which in its most severe form can result in blindness due to retinal detachment, and in less severe untreated forms, can result in marked visual impairment. Retinopathy of prematurity is one of the preventable causes of blindness. Research Question: What are the factors associated with development of retinopathy of prematurity in screened preterm infants in three private tertiary hospitals in Kenya? Study Objectives: This study aimed to identify factors associated with development of retinopathy of prematurity in screened preterm infants …

Determining The Level Of Agreement For Atherosclerotic Cardiovascular Disease Risk Stratification Between Coronary Artery Calcium Score And Traditional Cardiovascular Risk Models., Menge Kuria

Master of Medicine in Imaging and Diagnostic Radiology

Introduction: Estimating the risk of future cardiovascular (CV) events is an essential step in the management and prevention of cardiovascular diseases. Many cardiovascular risk tools are available such as the Framingham Risk Score (FRS), the American Heart Association/ American College of Cardiology (AHA/ACC) and the International Society of Hypertension and World Health Organization (ISH/WHO) risk charts. Regrettably, none of these tools has yet to be validated based on data from our Kenyan population. This study, therefore, sought to compare the accuracy of FRS and ACC/AHA in a Kenyan population. The risk estimates derived from the CV tools were correlated with …

Prevalence Of Metastatic Disease In Newly Diagnosed Breast Cancer Patients As Seen On Contrast Enhanced Computed Tomography Of The Chest, Abdomen And Pelvis At The Aga Khan University Hospital, Nairobi., Gregory Obala

Master of Medicine in Imaging and Diagnostic Radiology

Introduction: Breast cancer patients have traditionally been screened for occult metastases with abdominal ultrasound, chest radiography and bone scan although the use of modern tests with greateraccuracy such as computed tomography (CT), 2-[fluorine-18] fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) and Magnetic resonance (MR) imaging is on the increase. The use of contrast enhanced CT (CECT) in the staging of patients with newly diagnosed breast cancer has increased greatly in clinical practice in view of it being widely available and relatively cheapwhen compared to other modalities such as MRI and PET imaging. The clinical utility of routine staging CECT is yet …

Reference Intervals For Prothrombin Time And Activated Partial Thromboplastin Time Derived From Black African Blood Donors At A University Teaching Hospital In Nairobi, Kenya, Abubakar Abdillah

Master of Medicine in Clinical Pathology

Introduction: Prothrombin time (PT) and activated partial thromboplastin time (APTT) are important coagulation screening tests that give an insight into how well the extrinsic and intrinsic arms of the coagulation cascade are performing. For correct interpretation of laboratory results and avoidance of errors and misdiagnosis, population specific RIs are most appropriate. In a healthcare setting, it is up to the laboratory to establish RIs for use for the particular analytes that they run, or at least verify the RIs availed by the manufacturer of the reagents for a particular analyte. Objectives: This study aimed to establish reference intervals (RIs) for …

Two To Nine Year Review Of Breast Conservation Therapy (Bct) For Breast Carcinoma: Clinico-Pathological Features And Survival In A Single Centre In East Africa, George Orerah

Master of Medicine in General Surgery

Introduction: Breast conservation therapy compares to mastectomy in terms of overall survival and disease free survival. However it’s utilization in most parts of the sub-Sahara Africa is minimal with various factors cited: patient preference, provider preference and adverse effects of or limited access to radiation therapy. The aim of this study was to determine the clinico-pathological profile and outcomes of breast cancer patients treated with breast conservation therapy or mastectomy at a single referral centre. Methods: The Aga khan university hospital is one of the institutions in East Africa, where breast conservation therapy is practiced. We retrospectively analysed the details …

Effect Of Life Skills Building Education And Micronutrient Supplements Provided From Preconception Versus The Standard Of Care On Low Birth Weight Births Among Adolescent And Young Pakistani Women (15–24 Years): A Prospective, Population-Based Cluster-Randomized Trial, Jo-Anna B. Baxter, Yaqub Wasan, Sajid Bashir Soofi, Zamir Suhag, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Risk factors known to impact maternal and newborn nutrition and health can exist from adolescence. If an undernourished adolescent girl becomes pregnant, her own health and pregnancy are at an increased risk for adverse outcomes. Offering preconception carefrom adolescence could provide an opportunity for health and nutrition promotion to improve one's own well-being, as well as future pregnancy outcomes and the health of the next generation.
Methods: The Matiari emPowerment and Preconception Supplementation (MaPPS) Trial is a population-based two-arm, cluster-randomized, controlled trial of life skills building education and multiple micronutrient supplementation provided in a programmatic context to evaluate the …

Effect Of Life Skills Building Education And Micronutrient Supplements Provided From Preconception Versus The Standard Of Care On Low Birth Weight Births Among Adolescent And Young Pakistani Women (15–24 Years): A Prospective, Population-Based Cluster-Randomized Trial, Jo-Anna B. Baxter, Yaqub Wasan, Sajid Bashir Soofi, Zamir Suhag, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Risk factors known to impact maternal and newborn nutrition and health can exist from adolescence. If an undernourished adolescent girl becomes pregnant, her own health and pregnancy are at an increased risk for adverse outcomes. Offering preconception care from adolescence could provide an opportunity for health and nutrition promotion to improve one's own well-being, as well as future pregnancy outcomes and the health of the next generation.
Methods: The Matiari emPowerment and Preconception Supplementation (MaPPS) Trial is a population-based two-arm, cluster-randomized, controlled trial of life skills building education and multiple micronutrient supplementation provided in a programmatic context to evaluate …

Feasibility And Effect Of Life Skills Building Education And Multiple Micronutrient Supplements Versus The Standard Of Care On Anemia Among Non-Pregnant Adolescent And Young Pakistani Women (15-24 Years): A Prospective, Population-Based Cluster-Randomized Trial, Jo-Anna B. Baxter, Yaqub Wasan, Sajid Bashir Soofi, Zamir Suhag, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Adolescence is a critical period for physical and psychological growth and development, and vitamin and mineral requirements are correspondingly increased. Health and health behaviours correspond strongly from adolescence to adulthood. Developing a preconception care package for adolescent and young women in resource-limited settings could serve to empower them to make informed decisions about their nutrition, health, and well-being, as well as function as a platform for the delivery of basic nutrition-related interventions to address undernutrition.
Methods: In this population-based two-arm, cluster-randomized, controlled trial of life skills building education (provided bi-monthly) and multiple micronutrient supplementation (provided twice-weekly; UNIMMAP composition), we …

Difference In The Level Of Utilization And Determinants Of Preconception Care Among Pregnant Women In Aga Khan University Hospital And Maragua Level Four Hospital., Joan Okemo

Master of Medicine in Obstetrics and Gynecology

Background: Preconception care (PCC) is an important form of primary health care that aims to identify risks, offer patient education and evidence based interventions prior to conception in order to improve maternal and fetal short and long term health outcomes. Despite the benefits of PCC, the global levels of utilization are still low, more so in developing countries and in the rural settings. This study aimed to determine the difference in the level and determinants of PCC in both urban and rural settings in Kenya. Objectives: The primary objective of this study was to compare PCC among pregnant women in …

Long-Term Outcomes And Factors Associated With Mortality Among Patients With Moderate To Severe Pulmonary Hypertension In Kenya, Abdulaziz Mansur Abeid

Master of Medicine in Internal Medicine

Background: Pulmonary hypertension (PH) is a condition that carries significant morbidity and mortality. Studies done in sub-Saharan Africa have reported poor short-term outcomes. However, data on long-term outcomes and prognostic factors are lacking. Objectives: This study sought to determine the one and two-year survival rates and prognostic factors associated with mortality in patients with moderate to severe PH. Methods: A retrospective review of moderate to severe PH patients [pulmonary artery systolic pressure (PASP), ≥45 mmHg] diagnosed at Aga Khan University Hospital, Nairobi from 2014 to 2017 was carried out. Demographic, clinical and in hospital outcome data were extracted from medical …

A Randomized Control Trial Of English-Speaking Advanced Cancer Patients At Akus Medical And Surgical Clinics And The Impact On Qol Of One Session Of Dignity Therapy, Miriam Gatehi-Muriithi

Master of Medicine in Internal Medicine

Background: Palliative care is a modality of treatment that addresses physical, psychological and spiritual symptoms. Dignity therapy, a form of psychotherapy, was developed by Professor Harvey Chochinov, MD in 2005. Methods: This was a randomized control trial of 144 patients (72 in each arm) randomized into group 1 (intervention arm) and group 2 (control arm). Baseline ESAS scores were determined in both arms following which group 1 received Dignity therapy while Group 2 received usual care only. Data collected was presented as Legacy documents to group 1 participants. Post intervention ESAS scores were obtained in both groups after 6 weeks. …

Physical And Psychological Violence Against Married Men In District Dir (Lower), Khyber Pukhtoonkhwa, Pakistan, Hizbullah Khan, Tazeen Saeed Ali, Aamir Abdullah, Shadbehr Shahid

School of Nursing & Midwifery

No abstract provided.

Comparison Of Xpert Mtb/Rif With Histology For The Detection Of Mycobacterium Tuberculosis In Formalin Fixed Paraffin Embedded Tissues At Aga Khan University Hospital, Nairobi, Njau Allan Njoroge

Master of Medicine in Anatomic Pathology

Background: Diagnosis of extrapulmonary tuberculosis (EPTB) continues to be a challenge due to the complexity of the causative organism and the wide array of pathologic features seen in this infection. A number of studies have shown polymerase chain reaction (PCR) for EPTB to be a feasible, sensitive and specific test for diagnosis of tuberculosis (TB) of which, the World Health Organisation (WHO) has given recommendations. As pertains EPTB, Xpert MTB/RIF may be used in place of conventional tests such as microscopy, histopathology and culture in lymph nodes and other tissues from patients suspected to have EPTB. It has been demonstrated …

Osteoporosis And Its Perspective In Pakistan: A Review Of Evidence And Issues For Addressing Fragility Fractures, Aysha Habib Khan, Lena Jafri, Sibtain Ahmed, Shahryar Noordin

Department of Pathology and Laboratory Medicine

Despite major advances in osteoporosis diagnosis and treatment, low rates of investigating and treating osteoporosis in patients with fragility fracture are reported in Pakistan. Cost of therapies, time and cost of resources for diagnosis, concerns about medications and lack of clarity regarding the onus of responsibility to undertake this care, are some of the barriers to osteoporosis identification and treatment. Data from our part of the world on osteoporosis as well as on fragility fractures is sparse. This review addresses the current screening and diagnostic strategies for osteoporosis and reviews the existing literature to highlight the issues prevalent in our …

Uterine Necrosis After Uterine Artery Embolization For Symptomatic Fibroids, Steve Mutiso, Felix Oindi, Nigel Hacking, Timona Obura

Obstetrics and Gynaecology, East Africa

Introduction: Uterine artery embolization (UAE) is a minimally invasive intervention that is used in the treatment of fibroids. UAE can lead to complications including postembolization syndrome, postprocedure pain, infection, endometrial atrophy leading to secondary amenorrhea, and uterine necrosis. Uterine necrosis afer UAE is very rare and hence poses a clinical dilemma for any clinician in its identifcation and management. We document a case of uterine necrosis afer UAE and conduct a literature review on its causation, clinical features, and management principles.

Case: A patient presented one month afer UAE with abdominal pain and abdominal vaginal discharge. Her work-up revealed features …

A Qualitative Exploration Ofdoctors And Nurses Experienceson The Management Of Tubercu-Losis And Hiv Co-Infection In Atuberculosis-Hiv High Burdencommunity In Northernkwazulu-Natal, South Africa, Mbuso Mabuza, Constance Shumba

School of Nursing & Midwifery, East Africa

South Africa is faced with a huge challenge of addressing the high burden of tuberculosis-human immune virus (TBHIV) co-infection, and this challenge is more pronounced in the province of KwaZulu-Natal which has one of the highest burdens of TB-HIV co-infection in the world. The study explored the experiences of doctors and nurses with regard to the management of tuberculosis and HIV coinfection in a TB-HIV high burden community in northern KwaZulu-Natal, South Africa. The particular focus was to provide insight and to inform policy and programme development for effective management of TB-HIV co-infection in the TB-HIV high burden community of …

Successful Use Of Balloon Tamponade In The Management Of Postpartum Hemorrhage In A Case Of Bicornuate Uterus, Erum Saleem, Ayesha Basharat

Department of Obstetrics & Gynaecology

Worldwide 50%–70% of all cases of maternal morbidity have been attributed to postpartum hemorrhage. This report discusses a case of bicornuate uterus in a term pregnancy. The delivery was by cesarean section, which was followed by massive postpartum hemorrhage, managed successfully with balloon tamponade. This is the second reported case of successful management of post partum hemorrhage in a bicornuate uterus with balloon tamponade. A 22-year-old primigravida at 39 weeks of gestational age presented with vaginal leaking of clear fluid. Cesarean section was done due to meconium stained liquor in early labor; with an incidental finding of bicornuate uterus followed …

Collaborative Task-Sharing To Enhance The Point-Of-Care Ultrasound (Pocus) Access Among Expectant Women In Kenya: The Role Of Midwife Sonographers, Sudhir Vinayak, Sharon Brownie

Imaging & Diagnostic Radiology, East Africa

Unrealized maternal and child health goals continue to challenge Kenya where adverse outcomes remain high and diagnostic services are limited. The acute shortage of doctors and radiographers requires alternate human resources for health (HRH) with the ability to identify risk factors in pregnancy through Point-Of-Care Ultrasound (POCUS). A specialist radiologist and ultrasonography team partnered with midwives to adopt interprofessional task sharing and capacity building. Faculty from the Radiology Department of our hospital designed and implemented the project which was carried out at three outreach health service centres. Designing and implementing a training model to skill midwife sonographers with the capacity …

International Scope Of Emergency Ultrasound: Barriers In Applying Ultrasound To Guide Central Line Placement By Providers In Nairobi, Kenya, Fareen Zaver, Keith Boniface, Benjamin Wachira, Grace Wanjiku, Hamid Shokoohi

Emergency Medicine, East Africa

Background: While ultrasound (US) use for internal jugular central venous catheter (CVC) placement is standard of care in North America, most developing countries have not adopted this practice. Previous surveys of North American physicians have identified lack of training and equipment availability as the most important barriers to the use of US.

Objective: We sought to identify perceived barriers to the use of US to guide CVC insertion in a resource-constrained environment.

Methods: Prior to an US-guided CVC placement training course conducted at the Aga Khan University Hospital in Nairobi, Kenya, physicians were asked to complete a survey to determine …

Intermittent Fetal Heart Rate Monitoring Using A Fetoscope Or Hand Held Doppler In Rural Tanzania: A Randomized Controlled Trial, Paschal Francis Mdoe, Hege L. Ersdal, Estomih R. Mduma, Jeffrey M. Perlman, Robert Moshiro, Peter T. Wangwe, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Background: Neonatal mortality is a global challenge, with an estimated 1.3 million intrapartum stillbirths in 2015. The majority of these were found in low resource settings with limited options to intrapartum fetal heart monitoring devices. This trial compared frequency of abnormal fetal heart rate (FHR) detection and adverse perinatal outcomes (i.e. fresh stillbirths, 24-h neonatal deaths, admission to neonatal care unit) among women intermittently assessed by Doppler or fetoscope in a rural low-resource setting.

Methods: This was an open-label randomized controlled trial conducted at Haydom Lutheran Hospital from March 2013 through August 2015. Inclusion criteria were; women in labor, …

Fifteen Years Experience Of Managing Penetrating Extra-Peritoneal Rectal Injuries, Tanzeela Gala, Noman Shahzad, Ahmed Ibrahim Edhi, Fareed Ahmed Shaikh, Hasnain Zafar

Section of General Surgery

Background: Although civilian injuries are generally less severe, they nevertheless remain a challenging problem for the surgeons. In isolated rectal injury patients, though proximal diversion, pre-sacral drainage, distal rectal wash-out and wound debridement are the various surgical options employed in various combinations, the optimum strategy especially for civilian injuries remains unknown. We reviewed our experience of managing penetrating extra peritoneal rectal injuries.
Methods: We conducted a Retrospective review of Adult patients with penetrating extra-peritoneal rectal injuries. Follow-up information of at least one month was needed for early post-operative complications.
Results: A total number of fifteen patients met …

Integration Of Mental Health Into Primary Healthcare: Perceptions Of Stakeholders In Pakistan, Syed S. Hussain, Murad M. Khan Dr., Raisa B. Gul, Nargis Asad

Department of Psychiatry

Background: In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC).
Objectives: This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan.
Methods: A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the …

Intimate Partner Violence, Forced First Sex And Adverse Pregnancy Outcomes In A Sample Of Zimbabwean Women Accessing Maternal And Child Health Care, Simukai Shamu, Stephen Munjanja, Christina Zarowsky, Patience Shamu, Marleen Temmerman, Naeemah Abrahams

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) remains a serious problem with a wide range of health consequences including poor maternal and newborn health outcomes. We assessed the relationship between IPV, forced first sex (FFS) and maternal and newborn health outcomes.

Methods: A cross sectional study was conducted with 2042 women aged 15–49 years attending postnatal care at six clinics in Harare, Zimbabwe, 2011. Women were interviewed on IPV while maternal and newborn health data were abstracted from clinic records. We conducted logistic regression models to assess the relationship between forced first sex (FFS), IPV (lifetime, in the last 12 months and …

Does Courtesy Bias Affect How Clients Report On Objective And Subjective Measures Of Family Planning Service Quality? A Comparison Between Facility- And Home-Based Interviews, Waqas Hameed, Muhammad Ishaque, Xaher Gul, Junaid-Ur-Rehman Siddiqui, Sharmeen Hussain, Wajahat Hussain, Aftab Ahmed, Asma Balal

Community Health Sciences

Purpose: Despite a general understanding that exit interviews being conducted at service providers' facilities may influence clients' responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients' perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews.
Methods: A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels - nongovernmental organization (NGO) clinics, social franchise (SF) centers, and outreach camps. The survey took place from December 2015 to January …

Sensitivity And Specificity Of Ct Scan In Small Bowel Obstruction Among Children, Huma Faiz Haleopota, Muhammad Arif Mateen Khan, Noman Shahzad

Section of Paediatric Surgery

Objective: To determine the sensitivity and specificity of computed tomography scan for diagnosing small bowel obstruction among children.
Methods: The retrospective diagnostic test accuracy study was carried out at the Aga Khan University Hospital, Karachi, and comprised data of all patients aged 2-16 years who presented with clinical features of small bowel obstruction and underwent computed tomography scan of abdomen from January 2001 to December 2015Data was analyzed using SPSS19.
Results: Of the 98 subjects, 65(66.0%) were males and 33(34.0%) were females. Overall mean age of the patients was 7.67±4.33 years and mean duration of symptoms was 2.84±1.17 days. …

Expression Of Androgen Receptor And Cancer Stem Cell Markers (Cd44 +/Cd24 - And Aldh1 +): Prognostic Implications In Invasive Breast Cancer, Nazia Riaz, Romana Idress, Sadia Habib, Iqbal Azam Syed, El Nasir Lalani

Section of General Surgery

Background: Androgen receptor (AR) has emerged as a significant prognostic marker in early breast cancer (BCa). Association of AR with cancer stem cell (CSC) markers in BCa is unknown. Aim of the present study was to evaluate the immunohistochemical expression of AR, CD44, CD24 and ALDH1 in a cohort of Pakistani patients diagnosed with invasive BCa and to correlate the expression with 5- year disease free survival.
Patients and methods: We evaluated immunohistochemical expression AR, CD44, CD24 and ALDH1 in formalin fixed paraffin embedded archival blocks of 166 cases of primary invasive BCa (stage I-III) and correlated the expression with …

Descriptive Epidemiology Of Karachi Road Traffic Crash Mortality In 2015, Rashid Jooma, Masood Ali Shaikh

Section of Neurosurgery

The Karachi city's Road Traffic Injury Research and Prevention Center (RTIRPC), collects Road Traffic Crash (RTC) data on injuries and fatalities from three major public and private hospitals' emergency departments. In the year 2015, 1021 deaths were recorded; with 871 (85.3%) deaths in males. Cumulatively, 286 (28.0%) deaths were recorded in the 21-30year age group, and for 198 (19.4%) RTC fatal victims, the primary vehicle involved was motorbike. Highest number of fatalities were recorded in the month of January i.e. 153 (15.0%), while the lowest number was recorded for June, with 47 (4.6%) fatalities. RTIRPC is a unique surveillance system …

Association Between A Single Nucleotide Polymorphism In Neuregulin-1 And Schizophrenia In Pakistani Patients, Haider Ali Naqvi, Shafqat Huma, Hira Waseem, Kashaf Aqeel Zaidi, Hina Saeed Zuberi, Syed Hani Abidi

Department of Biological & Biomedical Sciences

Objective: To determine the association of single-nucleotide polymorphism8nrg433E1006 in the neuregulin-1 gene associated with schizophrenia.
Methods: This case-control study was conducted at the Fountain House, Lahore, and the psychiatric clinics at the Aga Khan University, Karachi, from 2010 to 2013.The total genomic deoxyribonucleic acid was isolated and single-nucleotide polymorphism8nrg433E1006 was screened by nested polymerase chain reaction followed by sequencing. These sequences, from patients and controls, were aligned with the human neuregulin-1-glial growth factor 2 gene sequence, which served as a reference sequence. The single nucleotide polymorphism genetic algorithm was characterised at position 433 in the neuregulin-1 gene by …

A Care Bundle Including Antenatal Corticosteroids Reduces Preterm Infant Mortality In Tanzania A Low Resource Country, Augustine Massawe, Hussein Kidanto, Robert Moshiro, Edna Majaliwa, Flora Chacha, Aisa Shayo, Paschal Mdoe, Prisca Ringia, Mary Azayo, Georgina Msemo

Faculty of Health Sciences, East Africa

Background Preterm neonatal mortality (NM) has remained high and unchanged for many years in Tanzania, a resource-limited country. Major causes of mortality include birth asphyxia, respiratory insufficiency and infections. Antenatal corticosteroids (ACS) have been shown to significantly reduce mortality in developed countries. There is inconsistent use of ACS in Tanzania.

Objective To determine whether implementation of a care bundle that includes ACS, maternal antibiotics (MA), neonatal antibiotics (NA) and avoidance of moderate hypothermia (temperature < 36°C) targeting infants of estimated gestational age (EGA) 28 to 34 6/7 weeks would reduce NM (< 7 days) by 35%.

Methods A Pre (September 2014 to May 2015) and Post (June 2015 to June 2017) Implementation strategy was used and introduced at three University-affiliated and one …