Medicine and Health Sciences Commons^™

Can Written Prompts Help Medical Residents To Accurately Monitor Their Own Communication Skills And Those Of Others?, Fleur Demeijer, Nelson Nyamu, A. B. H. De Bruin

Family Medicine, East Africa

In healthcare, effective communication in complex situations such as end of life conversa- tions is critical for delivering high quality care. Whether residents learn from communica- tion training with actors depends on whether they are able to select appropriate informa- tion or ‘predictive cues’ from that learning situation that accurately reflect their or their peers’ performance and whether they use those cues for ensuing judgement. This study aimed to explore whether prompts can help medical residents improving use of predic- tive cues and judgement of communication skills. First and third year Kenyan residents (N = 41) from 8 different specialties …

Development Of An Online Authentic Radiology Viewing And Reporting Platform To Test The Skills Of Radiology Trainees In Low- And Middle-Income Countries, Hubert Vesselle, Justy Antony Chiramal, Stephen Hawes, Eric Schulze, Tham Nguyen, Rose Ndumia, Sudhir Vinayak

Imaging & Diagnostic Radiology, East Africa

Background: Diagnostic radiology residents in low- and middle-income countries (LMICs) may have to provide significant contributions to the clinical workload before the completion of their residency training. Because of time constraints inherent to the delivery of acute care, some of the most clinically impactful diagnostic radiology errors arise from the use of Computed Tomography (CT) in the management of acutely ill patients. As a result, it is paramount to ensure that radiology trainees reach adequate skill levels prior to assuming independent on-call responsibilities. We partnered with the radiology residency program at the Aga Khan University Hospital in Nairobi (Kenya) to …

Centring Youth Mental Health Discourse On Low-Income And Middle-Income Countries, Kelly Rose-Clark, Mary Bitta, Evans-Lacko Sara, Jokinen Tahir, Mark Jordans, Moses Nyongesa, Abhijit Nadkarn, Praveetha Patalay, Indira Pradhan, Atif Rahman

Brain and Mind Institute

Commentwww.thelancet.com/psychiatry Vol 11 September 2024 671 The Lancet Psychiatry Commission on Youth Mental Health heralds a new field of research and practice with a focus on people aged 12–25 years.1 Patrick D McGorry and colleagues assert the global relevance of the field while acknowledging that much of its underpinning evidence comes from high-income countries (HICs). This distribution is problematic because 90% of children and adolescents live in low-income and middle-income countries (LMICs), which are under- represented academically and yet have the highest burden of mental ill health. Extrapolating findings from HICs to LMICs ignores crucial diversity in young people’s socioeconomic …

Leptomeningeal Carcinomatosis In A Young Patient With Colorectal Cancer: A Case Report, Zamanali Khakhar, Soraiya Manji, Rajiv Patel, Karishma Sharma, Sheila Waa, Sayed Karar

Internal Medicine, East Africa

Leptomeningeal carcinomatosis (LMC) is a rare and fatal complication associated with various solid tumors and hematological malignancies. It presents significant diagnostic challenges due to its nonspecific symptoms and complex clinical course. This case report details the presentation, diagnosis, and implications of LMC in a 33-year-old male with a history of colorectal cancer (CRC) and hemicolectomy. The patient presented with nonspecific symptoms of headache and dizziness. Cerebrospinal fluid cytology revealed the presence of malignant cells, leading to the diagnosis of LMC secondary to CRC. The elusive and multifaceted nature of this condition highlights the necessity for increased clinical awareness and extensive …

A Time-Stratified, Case–Crossover Study Of Heat Exposure And Perinatal Mortality From 16 Hospitals In Sub-Saharan Africa, Claudia Hanson, Jeroen De Bont, Kristi Sidney Annerstedt, Maria Del Rosario Alsina, Federica Nobile, Nathalie Roos, Peter Waiswa, Andrea Pembe, Jean-Paul Dossou, Hussein Kidanto

Centre of Excellence in Women and Child Health

Growing evidence suggests that extreme heat events affect both pregnant women and their infants, but few studies are available from sub-Saharan Africa. Using data from 138,015 singleton births in 16 hospitals in Benin, Malawi, Tanzania and Uganda, we investigated the association between extreme heat and early perinatal deaths, including antepartum and intrapartum stillbirths, and deaths within 24 h after birth using a time-stratified case–crossover design. We observed an association between an increase from the 75th to the 99th percentile in mean temperature 1 week (lag 0–6 d) before childbirth and perinatal mortality (odds ratio (OR) = 1.34 (95% confidence interval …

"I Just Assumed This Was Already Being Done": Canadian Patient Preferences For Enhanced Data Sharing For Precision Oncology, Samantha Pollard Pollard, Morgan Ehman, Anna Hermansen, Deirdre Weymann, Emanuel Krebs, Cheryl Ho, Howard J. Lim, Steven Jones, Yvonne Bombard, Tania M. Bubela

Office of the Provost

Purpose: In Canada, health data are siloed, slowing bioinnovation and evidence generation for personalized cancer care. Secured data-sharing platforms (SDSPs) can enable data analysis across silos through rapid concatenation across trial and real-world settings and timely researcher access. To motivate patient participation and trust in research, it is critical to ensure that SDSP design and oversight align with patients' values and address their concerns. We sought to qualitatively characterize patient preferences for the design of a pan-Canadian SDSP.
Methods: Between January 2022 and July 2023, we conducted pan-Canadian virtual focus groups with individuals who had a personal history of cancer. …

Inspire : Vol 7 Issue 8, Department Of Medicine

INSPIRE – Department of Medicine Archives

• Medicine at National and International Forums
• SESAM conference | Dr Faisal Ismail
• HIV Science and Community
• 34th ECCMID | Infectious Diseases Section
• Poster presentation | Cardiology
• Featured Faculty | Dr Sajid Hameed | Neurology Section
• Poem Section
• What Academics are reading this month?
• Upcoming Events

Lactoferrin And Lysozyme To Promote Nutritional, Clinical And Enteric Recovery: A Protocol For A Factorial, Blinded, Placebo-Controlled Randomised Trial Among Children With Diarrhoea And Malnutrition (The Boresha Afya Trial), Ruchi Tiwari, Kirkby Tickell, Emily Yoshioka, Joyce Otieno, Adeel Shah, Barbra Richardson, Lucia Keter, Maureen Okello, Churchil Nyabinda, Indi Trehan

Paediatrics and Child Health, East Africa

Introduction: Children with moderate or severe wasting are at particularly high risk of recurrent or persistent diarrhoea, nutritional deterioration and death following a diarrhoeal episode. Lactoferrin and lysozyme are nutritional supplements that may reduce the risk of recurrent diarrhoeal episodes and accelerate nutritional recovery by treating or preventing underlying enteric infections and/or improving enteric function.

Methods and analysis: In this factorial, blinded, placebo-controlled randomised trial, we aim to determine the efficacy of lactoferrin and lysozyme supplementation in decreasing diarrhoea incidence and improving nutritional recovery in Kenyan children convalescing from comorbid diarrhoea and wasting. Six hundred children aged 6–24 months with …

The Precise-Dyad Neurodevelopmental Substudy Protocol: Neurodevelopmental Risk In Children Of Mothers With Pregnancy Complications, Dorcas Magai, Jaya Chandna, Marie-Laure Volvert, Rachel Craik, Hawanatu Jah, Agnes Msoka, Amina Abubakar, Angela Koech, Grace Mwashigadi, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: Over 250 million children are not reaching their developmental potential globally. The impact of prenatal factors and their interplay with postnatal environmental factors on child neurodevelopment, is still unclear—particularly in low- and middle-income settings. This study aims to understand the impact of pregnancy complications as well as environmental, psychosocial, and biological predictors on neurodevelopmental trajectories. Open Peer Review Approval Status 1 2 version 2 (revision) 05 Aug 2024 view view version 1 09 Nov 2023 view view Kimford Meador, Stanford University School of Medicine, Palo Alto, CA,, USA 1. Page 1 of 21 Wellcome Open Research 2024, 8:508 Last …

Scaling Up, Sustaining, And Enhancing School-Based Sexuality Education Programs In Resource-Constrained And Conservative Contexts: Replicable Lessons From Positive-Deviant Countries, Chandra Mouli, Michielsen Kristien, Gogoi Aparajita, Nair M, Ziauddin Mohammed, Hadi S, Ijaz A, Rubio Auriolesh, Marleen Temmerman

Centre of Excellence in Women and Child Health

Despite considerable efforts, progress in the implementationof sexuality education (SE) has been uneven. This study identi-fied six “positive-deviant” low- and middle-income countries,i.e., countries that had scaled up, sustained and enhancedtheir SE programs when many others—in similar social, cul-tural and economic circumstances—were not able to do so. Inother words, they were significantly and consistently moresuccessful than the norm. Countries were shortlisted using avalidated framework and were analyzed using three other vali-dated frameworks on political priority setting, scaling up, andstakeholder engagement. The study found that India, Pakistan,Nigeria, Senegal, Mexico, and Uruguay had scaled up (eithernationwide or in some states/provinces), sustained andenhanced their …

Covid-19 Lockdowns: A Catalyst For Rethinking Assessments In Skill-Based Nursing Courses, Zeenar Salim, Anil Khamis, Shanaz Cassum, Zohra Kurji, Pammla Petrucka

Book Chapters / Conference Papers

No abstract provided.

Child And Caregiver’ Perspective On Barriers To Asthma Management At A Tertiary Referral Hospital In Kenya, Joan Kwesigabo Ahimbisibwe

Master of Medicine in Paediatrics and Child Health

Background: Asthma is one of the most common chronic conditions in children, with significant morbidity and mortality, especially in Africa. Achieving adequate asthma control in children remains challenging due to gaps between standard recommended management strategies and treatment practices. This study explored barriers to asthma management as perceived by children and their caregivers in a private tertiary care setting in Kenya.

Methods: An exploratory phenomenological qualitative study was conducted at Aga Khan University Hospital (AKUH), Nairobi. Children aged 6–18 years with a confirmed diagnosis of asthma and their caregivers were recruited. Participants had been receiving treatment for at …

Effect Of Male Partners' Involvement And Support On Reproductive, Maternal And Child Health And Well-Being In East Africa: A Scoping Review, Richard Fletcher, Faye Forbes, Abel Fekadu Dadi, Getachew Mullu Kassa, Casey Regan, Anna Galle, Addisu Beyene, Rebecca Liackman, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background and Aims: East African countries have high rates of maternal and childmortality and morbidity. Studies have shown that the involvement of male partners inreproductive health can benefit maternal and child health (MCH). This scoping reviewaims to provide an overview of the evidence across East Africa that describes malepartner involvement and its effect on maternal, reproductive, and child well‐being.

Methods: Ten databases were searched to identify quantitative data on male'sinvolvement in East Africa. Studies reporting qualitative data, “intention to use” dataor only reporting on male partner's education or economic status were excluded.Studies were organized into five a priori categories: antenatal …

Health Professional Regulation And Provision Of Quality Health Services; Cross Sectional Analysis Of Private Health Care Providers In Wajir County, Kenya, Ali Ahmed Mohamed Qadar, Wanja Mwaura-Tenambergen, Eunice Muthoni, Luke Wahome Kinyua

Population Health, East Africa

Background: Health professional regulatory bodies oversee and enforce standards in healthcare to safeguard patient safety and prevent harm. However, international consistency in these regulations remains limited. The Kenya health sector relies on various bodies to enforce standards among professionals and institutions, albeit constrained by financial and human resources that hinder effective oversight. This study aimed to assess how regulatory practicessuch as licensing, training oversight, inspection of practice, and quality assurance mechanisms- affect the quality of healthcare provided by private providers.

Methods: The study targeted 108 healthcare providers from 36 private health facilities, primarily nurses and clinical officers. A sample of …

Assessment Of Ferritin And Lead Levels In Children Living In An Informal Urban Settlement In Kenya, Geoffrey Omuse, Daniel Maina, Maureene Ondayo, Stanley Onyango, Syama Sinuff, Alex Mugo, Pauline Samia, William Macharia

Pathology, East Africa

Background: Childhood lead exposure from recycling used lead-acid batteries (ULAB) in unregulated areas is a significant cause of lead toxicity, particularly in low and middle-income countries. This study aimed to assess the proportion of children with increased blood lead levels (BLLs) in an informal settlement where ULAB recycling occurs.

Methodology: This was a descriptive study conducted in Nairobi county, Kenya. Children aged 6 months to 7 years were recruited after obtaining written informed consent, completion of a questionnaire and collection of samples for complete blood count, ferritin, and lead analysis.

Results: Out of 215 children, 17 (8.0%) had BLLs ≥ …

Epilepsy Prevalence Studies And The Lingering Treatment Gap In Africa, Dilraj Sokhi, Pauline Samia

Internal Medicine, East Africa

No abstract provided.

Factors Associated With Non-Uptake Of Implantable Cardioverter-Defibrillator (Icd) Among Eligible Patients At A Tertiary Hospital In Kenya, Emmanuel Oluoch, Jasmit Shah, Jeilan Mohamed, Mohamed Varwani, Mzee Ngunga

Internal Medicine, East Africa

Background: Efficacy of Implantable Cardioverter-Defibrillator (ICD) implantation in both primary and secondary prevention of Sudden Cardiac Death (SCD) in at-risk population is well established. ICD implantation rates remain low particularly in Africa with a paucity of data regarding factors associated with non-uptake.

Objectives:The primary study objective was to determine the factors associated with non-uptake of ICD among heart failure (HF) patients with reduced ejection fraction (EF

Methods: This was a retrospective study among HF patients eligible for ICD implantation evaluated between 2018 to 2020. Comparison between ICD recipient and non-recipient categories was made to establish determinants of non-uptake.

Results: …

Access To Medicines For Parkinson's Disease In Kenya: A Qualitative Exploration, Natasha Fothergill-Misbah, Juzar Hooker, Judith Kwasa, Richard Walker

Internal Medicine, East Africa

Background: The accessibility of Parkinson’s disease medicines is limited across sub-Saharan Africa,which can have negative health, social and financial consequences for people with Parkinson’s disease andtheir families. However, there is a stark gap in the literature regarding the impact of poor access to medicineson individuals.

Objectives: The study objective was to understand the accessibility of Parkinson’s disease medicines in Kenyafrom the perspective of people with Parkinson’s disease, their caregivers and neurologists.MethodsMethods: In-depth qualitative interviews were conducted with 55 people with Parkinson’s disease, 23 caregiversand 8 neurologists to understand their experience regarding challenges with accessing Parkinson’s diseasemedicines and the health, social …

Enhancing Vaginal Delivery In Greece Through Educational And Behavioral Interventions Among Maternity Care Providers Regarding Labor Management: The Engage Stepped-Wedge Randomized Prospective Trial Protocol, Nikolaos Vrachnis, Nikolaos Antonakopoulos, Peter Von Dadelszen, Marianne Vidler, Georgios Maroudias, Jeffrey Bone, Ash Sandhu, Nikolaos Loukas, Laura Magee, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: There is an emerging need to systematically investigate the causes for the increased cesarean section rates in Greece and undertake interventions so as to substantially reduce its rates. To this end, the ability of the participating Greek obstetricians to follow evidence-based guidelines and respond to other educational and behavioral interventions while managing labor will be explored, along with barriers and enablers. Herein discussed is the protocol of a stepped-wedge designed intervention trial in Greek maternity units with the aforementioned goals in mind, named ENGAGE (ENhancinG vAGinal dElivery in Greece).

Methods: Twenty-two selected maternity units in Greece will participate in …

Cancer Care Terminology In African Languages, Hannah Simba, Miriam Mutebi, Moses Galukande, Yahya Mahamat-Saleh, Elom Aglago, Adamu Addissie, Lidya Genene Abebe, Justina Onwuka

General Surgery, East Africa

Importance: Effective communication between patients and health care teams is essential in the health care setting for delivering optimal cancer care and increasing cancer awareness. While the significance of communication in health care is widely acknowledged, the topic is largely understudied within African settings.

Objective: To assess how the medical language of cancer and oncology translates into African languages and what these translations mean within their cultural context.

Design, etting, and participants: In this multinational survey study in Africa, health professionals, community health workers, researchers, and scientists involved in cancer care and research and traditional healers were invited to participate …

Outcomes Of Different Steroid Dosing Regimens In Critical Covid-19 Pneumonia At A Kenyan Hospital: A Retrospective Cohort Study, John Odhiambo, Jasmit Shah, Nancy Kunyiha, Felix Riunga, Charles Makasa

Internal Medicine, East Africa

Background: Among therapeutic options for severe and critical COVID- 19 infection, dexamethasone six milligrams once daily for ten days has demonstrated mortality benefit and is guideline recommended at this dose. In practice, variable doses of steroids have been used, especially in critical care settings. Our study aimed to determine the pattern of steroid dosing and outcomes in terms of critical care mortality, occurrence of dysglycaemias, and occurrence of superadded infections in patients with critical COVID-19.

Methods: A retrospective cohort study was carried out on all eligible patients admitted to the Aga Khan University Hospital, Nairobi, with critical COVID-19 between 1st …

Estimation Of The Optimal Radiotherapy Utilization Rate For Childhood Neuroblastoma, Azumi Fukushima, Varsha Hande, Katherine Wakeham, Michael Barton, Mohamed Zaghloul, Daniel Moreira, Nickhill Bhakta, Kathy Pritchard-Jones, Bilal Mazhar Qureshi, Michael Sullivan

Haematology and Oncology, East Africa

Background and purpose: The optimal utilization rate of radiotherapy (oRUR) serves as a benchmark for assessing service demand and improving access to cancer care. While it is estimated that approximately 50 % of adult cancer patients require external beam radiotherapy during their treatment, there is a scarcity of data regarding the optimal use of radiotherapy in pediatric cancer. In this study, we adopted an established method and developed a model to estimate the oRUR in childhood neuroblastoma.

Materials and methods: We developed a decision tree model to calculate the oRUR using indications for radiotherapy and corresponding epidemiological data collected through …

A Case For Increasing Taxes On Cigarettes, Vapes And Oral Nicotine Pouches, Ken, Cyprian Mostert, Olalekan Ayo-Yusuf, Manasi Kumar, Andrew Aballa, Willie Njoroge, Edna Bosire, Linda Khakali, John Thomi, Lukoye Atwoli, Zul Merali

Population Health, East Africa

No abstract provided.

Relationships Between Trauma Types And Psychotic Symptoms: A Network Analysis Of Patients With Psychotic Disorders In A Large, Multi-Country Study In East Africa, Anne Stevenson, Supriya Misra, Engida Girma, Adela-Maria Isvoranu, Dickens Akena, Melkam Alemayehu, Lukoye Atwoli, Bizu Gelaye, Stella Gichuru, Symon Kariuki

Internal Medicine, East Africa

Background: The link between trauma exposure and psychotic disorders is well-established. Further, specific types of trauma may be associated with specific psychotic symptoms. Network analysis is an approach that can advance our understanding of the associations across trauma types and psychotic symptoms. Methods: We conducted a network analysis with data from 16,628 adult participants (mean age [standard deviation] = 36.3 years [11.5]; 55.8% males) with psychotic disorders in East Africa recruited between 2018 and 2023. We used the Life Events Checklist and the Mini International Neuropsychiatric Interview to determine whether specific trauma types experienced over the life course and specific …

Inspire : Vol 7 Issue 7, Department Of Medicine

INSPIRE – Department of Medicine Archives

• Message from the Chair
• Medicine at National and International Forums
• Question Development Retreat
• Cardiology team achieves Platinum Performance Award!
• Facebook live session
• Dr Javaid A Khan takes Charge!
• Featured Faculty: Dr. M Uzair Rauf
• What Academics Are Reading This Month?
• Upcoming event

Ocular Gene Transfer In The Spotlight: Implications Of Newspaper Content For Clinical Communications, Shelly Benjaminy, Tania M. Bubela

Office of the Provost

Background: Ocular gene transfer clinical trials are raising hopes for blindness treatments and attracting media attention. News media provide an accessible health information source for patients and the public, but are often criticized for overemphasizing benefits and underplaying risks of novel biomedical interventions. Overly optimistic portrayals of unproven interventions may influence public and patient expectations; the latter may cause patients to downplay risks and over-emphasize benefits, with implications for informed consent for clinical trials. We analyze the news media communications landscape about ocular gene transfer and make recommendations for improving communications between clinicians and potential trial participants in light of …

E-Gaming: An Active Learning Pedagogy For Engaging Learners In A Private University In Karachi, Pakistan, Laila Akber Cassum, Syeda Sadia Fatima

School of Nursing & Midwifery

There is a radical shift in teaching and learning pedagogies to engage the learners in healthcare profession. It was a tough challenge for Pakistani educators of an esteemed university to motivate and assess the learners for concept absorption and critical reasoning using creative approaches. Teaching and learning styles have changed fundamentally from conventional teacher centred to inquiry-based student-centred approach. Classroom teaching in recognised nursing and medical institutes in Pakistan have transformed to blended and entirely online methodologies with the integration of diverse active learning strategies. The educators grapple to engage the millennials and to encounter this, gaming technological platform was …

Stress And Its Associated Factors In Mothers With Preterm Infants In A Private Tertiary Care Hospital Of Karachi, Pakistan, Salima Akbar, Yasmin Parpio, Sumia Andleeb Abbasi, Tazeen S. Ali

Journal of Asian Midwives (JAM)

Background: Preterm births are the leading cause of death worldwide. Preterm births not only have devastating effects on the newborn, but they also have psychological effects on the mothers. Identifying stress related to preterm births, and the factors associated with the stress among mothers with preterm infants is of great importance, for providing sound care to the newborns and their mothers. The aim of this protocol paper outlines an extensive approach to assess the level of stress and its associated factors among mothers with preterm infants.
Methods: An analytical cross sectional study design will be used to achieve the study …

Exploring Maternal Perspectives On Human Milk Banks In Pakistan And Identifying Barriers And Enablers For Establishment, Hina Baba Jan, Naghma Rizvi, Kiran Mubeen, Marina Baig

Journal of Asian Midwives (JAM)

Background: Low-and middle-income countries including Pakistan still have low breastfeeding rates and infant feeding remains a concern. Human milk banks (HMBs) play a crucial role in neonatal and infant health by providing safe, pasteurized donor human milk to infants who do not have access to their mother's own milk, particularly preterm and low-birth-weight infants. The perception regarding the concept and use of HMBs has yet to be explored in several contexts, especially in the low-and middle-income countries including Pakistan.
Aim: To explore the perceptions of mothers regarding human milk banks in Pakistan, focusing on the barriers and enablers to …

Assessing Association Between Socio-Demographic Variables And Contraceptive Usage In Married Men Residing In Korangi District, Karachi, Pakistan, Fahmida Khawaja, Gloria Noble Khan, Alia Nasir, Kiran Khowaja

Journal of Asian Midwives (JAM)

Background: Population growth remains an alarming concern for Pakistan as it not only exhausts scarce resources but further impedes socioeconomic development. One potential solution is to advance modern Family Planning (FP), which in the Pakistani context requires specific and rigorous attention towards male contraception in conjunction with female family planning usage. This study aims to determine the association between socio demographic factors and contraceptive use in married men of squatter settlement of Korangi Karachi.
Methods and Materials: A cross-sectional study was carried out from March, 2017 to June 2017, using a non-probability convenience sampling technique to select married men …