Medicine and Health Sciences Commons^™

Attrition In Surgical Residency Programmes: Causes And Effects, Mehwash Nadeem, M Shahrukh Effendi, Muhammad Hammad Ather

Section of Urology

Objective: To determine the rate and trend of attrition from a surgical residency programme and to identify the reasons for attrition.
Methods: A questionnaire-based survey was conducted at a university hospital. Separate questionnaires were designed for residents and programme directors (PDs). The residents who left the training voluntarily from one of the five surgical residency programmes (i.e., general surgery, orthopaedics, neurosurgery, otorhinolaryngology and urology) during the academic years 2005-2011 were identified from a departmental database. The residents who did not respond after three attempts at contact, or those who refused to participate, were excluded.
Results: During the last 6years, 106 …

Successes And Challenges Of Establishing A Cervical Cancer Screening And Treatment Program In Western Kenya, Kareem Khozaim, Elkanah Omenge, Astrid Christoffersen-Deb, Peter Itsura, John Oguda, Hellen Muliro, Jackline Ndiema, Grace Mwangi, Matthew Strother, Susan Cu-Uvin

Obstetrics and Gynaecology, East Africa

Objective: To describe the challenges and successes of integrating a public-sector cervical screening program into a large HIV care system in western Kenya.

Methods: The present study was a programmatic description and a retrospective chart review of data collected from a cervical screening program based on visual inspection with acetic acid (VIA) between June 2009 and October 2011.

Results: In total, 6787 women were screened: 1331 (19.6%) were VIA-positive, of whom 949 (71.3%) had HIV. Overall, 206 women underwent cryotherapy, 754 colposcopy, 143 loop electrical excision procedure (LEEP), and 27 hysterectomy. Among the colposcopy-guided biopsies, 27.9% had severe dysplasia and …

Surgical Site Infection Rates In Breast Cancer Surgery At A University Hospital In Nairobi, Kenya, Andrew Nyangau Nyaoncha

Master of Medicine in General Surgery

Back ground: Surgical site infections (SSI)following breast cancer surgery remain a significant cause of morbidity with the use of single dose pre-operative antibiotic prophylaxis. As a result the use of peri-operative antibiotics is common and unregulated, with no knowledge of the infection outcomes with their use. Objectives: To establish the SSI outcomes with the use of peri-operative antibiotic prophylaxis, evaluate the common risk factors for SSI development and assess for other important outcomes following breast cancer surgery. Methods: A prospective surveillance study for patients undergoing breast cancer surgery using the National Nosocomial Infections Surveillance (NNIS) system. Analysis: Analysis for the …

A Double-Blind Randomized Controlled Trial Comparing Effectiveness Of 0.2% Topical Nifedipine Versus 0.2% Topical Glyceryl Trinitrate In The Treatment Of Chronic Anal Fissure, Mark Michael Wekundah Siboe

Master of Medicine in General Surgery

Background: The medical management of chronic anal fissure varies among clinicians because no single treatment has yet approached an overall healing rate similar to lateral sphincterotomy. However, chemical sphincterotomy has the advantage of not carrying the presumed high risk of faecal incontinence. Glyceryl Trinitrate is commonly used in our practice with varied response. This study set out to evaluate the effectiveness of a locally compounded preparation of 0.2% topical Nifedipine in the treatment of chronic anal fissure and to compare the investigational product to 0.2% Glyceryl Trinitrate in overall healing rate and relieving pain. Design: Single centre, parallel, double-blind randomized …

Intimate Partner Violence And Pregnancy: A Systematic Review Of Interventions, An-Sofie Van Parys, Annelien Verhamme, Marleen Temmerman, Hans Verstraelen

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) around the time of pregnancy is a widespread global health problem with many negative consequences. Nevertheless, a lot remains unclear about which interventions are effective and might be adopted in the perinatal care context.

Objective: The objective is to provide a clear overview of the existing evidence on effectiveness of interventions for IPV around the time of pregnancy.

Methods: Following databases PubMed, Web of Science, CINAHL and the Cochrane Library were systematically searched and expanded by hand search. The search was limited to English peer-reviewed randomized controlled trials published from 2000 to 2013. This review …

Sexual And Gender-Based Violence In The European Asylum And Reception Sector: A Perpetuum Mobile?, Ines Keygnaert, Sonia F. Dias, Olivier Degomme, Walter Deville, Patricia Kennedy, Andras Kovats, Sara De Meyer, Nicole Vettenburg, Kristien Roelens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Refugees, asylum seekers and undocumented migrants are at risk of sexual and gender-based violence (SGBV) and subsequent ill-health in Europe; yet, European minimum reception standards do not address SGBV. Hence, this paper explores the nature of SGBV occurring in this sector and discusses determinants for ‘Desirable Prevention’.

Methods: Applying community-based participatory research, we conducted an SGBV knowledge, attitude and practice survey with residents and professionals in eight European countries. We conducted logistic regression using mixed models to analyse the data in R.

Results: Of the 562 respondents, 58.3% reported cases of direct (23.3%) or peer (76.6%) victimization. Our results …

Prevalence And Clinical Characteristics Of Venous Thromboembolism At The Aga Khan University Hospital, Nairobi, Felix Mutuma Riunga

Master of Medicine in Internal Medicine

Aim: To determine the prevalence of venous thromboembolism in patients presenting to the Aga Khan University Hospital, Radiology Department for lower limb compression ultrasonography with doppler and CT pulmonary angiography. In those found to have venous thromboembolism, the distribution of risk factors as described by Wells, the pattern of clinical presentation, the pattern of initial therapy, the length of hospital stay, major bleeding episodes and in hospital mortality were described. Design: Prospective survey Background: Venous Thromboembolism is a major cause of morbidity and mortality worldwide and its occurrence locally, as well as its clinical characteristics needs to be described in …

The Utility Of A Tablet Computer Device In Comparison To A Standard High Resolution Monitor For Reporting Ct Kub Images, Kenneth Kiriinya Ibeere

Master of Medicine in Imaging and Diagnostic Radiology

Background: The latest technological developments in the field of digital medical imaging have facilitated the transfer of the power and utility of the personal computer to mobile computing devices. One of these that have been used in diagnostic imaging is a tablet computer. Mobile tele-radiology using a tablet computer device is an apt extension of imaging services, for after-office-hours consultation. It is crucial to determine the diagnostic accuracy of these portable computer devices in order to determine safety for use in diagnostic image interpretation without compromising patient care. Objective: To find out the diagnostic accuracy of urolithiasis (urinary tract calculi) …

Prediction Of Breast Tumor Size By Ultrasound: A Comparison With Pathology, David Toyis Wanyonyi

Master of Medicine in Imaging and Diagnostic Radiology

Background: Tumor size is one of the most important prognostic factors in breast cancer and its accurate assessment is critical in planning appropriate treatment. Although histology is often regarded as the definitive way of establishing tumor size, radiological techniques, particularly ultrasonography, are usually relied upon to give an estimate of the tumor size for prognostication and treatment planning. Correlations between mammography, ultrasonography, magnetic resonance imaging (MRI) and pathology size have been performed in different populations with varying results however no prospective study has been done to establish the agreement between sonographic tumor size and histopathological tumor size in our population. …

The Prevalence Of Malaria And Assessment Of The Uptake Of Malaria Prevention Measures In Blood Donors In Two Regional Blood Transfusion Centres In Kenya, Valerie Magutu

Master of Medicine in Clinical Pathology

Transfusion transmitted malaria is one of the most common transfusion transmissible infections and is a threat to blood safety and malaria control in Sub-Saharan African countries where malaria is endemic. The majority of healthy adults living in malaria endemic areas have some degree of immunity to the disease and an asymptomatic low-level parasitaemia is known to exist in a subset of this population. Blood donors recruited from the population are screened using a donor-selection criteria that includes age, weight, self-declared well-being and measurement of vital signs but not history of recent malaria infection or treatment. The Kenya National Blood Transfusion …

Psychosocial Factors Associated With Exclusive Breastfeeding Among Pregnant Women On Follow Up In A Tertiary Maternity Hospital, Cornelia Akinyi Ochola

Master of Medicine in Paediatrics and Child Health

Introduction: Exclusive breastfeeding during the first six months of life is the ideal form of infant feeding. Health benefits of exclusive breastfeeding to infant and mother are well documented in literature. Despite this, the rate of exclusive breastfeeding in the first six months of infants‘ life in Kenya remains low. National nutrition strategy for maternal, infant and young child has set its 2017 target for exclusive breastfeeding at 80% from 32%. To achieve this target, new strategies are needed to complement current exclusive breastfeeding initiatives. Application of theory of planned behaviour model was used to determine the psychosocial factors associated …

One Year Symptom Severity And Health-Related Quality Of Life Changes Among Patients Undergoing Uterine Fibroid Embolisation, Charles Muriuki Mariara

Master of Medicine in Obstetrics and Gynecology

Background: The main aim of treatment of symptomatic fibroids by various modalities including uterine fibroid embolisation is to alleviate symptoms and ultimately improve the quality of life. The efficacy of this modality of treatment in women with significant fibroid burden and large uterine volumes is not clear. Objective: To determine the change in symptom severity and health-related quality of life among patients who have undergone uterine fibroid embolisation for treatment of symptomatic uterine fibroids. Setting: Aga Khan University Hospital, Nairobi Methods: A prospective before and after study (observational) of patients undergoing uterine fibroid embolisation. Prior to embolisation, study participants underwent …

The Incidence Of Early Upper Extremity Disability After Axillary Surgery In Patients With Early Breast Cancer, Karen Mbaabu

Master of Medicine in General Surgery

Background: The treatment of early breast cancer includes surgical removal of the tumor as well as evaluation of the axillary lymph node status. Axillary lymph node surgery, both sentinel lymph node biopsy and axillary lymph node dissection, is associated with upper arm morbidity that has been relatively understudied. The impact of this upper arm limitation has a direct effect on the patients’ quality of life. Determining the degree to which our patients experience this disability will enable the breast cancer unit to develop a prospective surveillance rehabilitative program. Objectives: The objectives of the study were to determine the occurrence of …

Frequency Of Dentofacial Asymmetries: A Cross-Sectional Study On Orthodontic Patients, Nita Kumari Bhateja, Mubassar Fida, Attiya Shaikh

Section of Dental-Oral Maxillofacial Surgery

Background: Correction of orthodontic asymmetries is crucial to achieve functional occlusion, aesthetics and stability of post orthodontic treatment results. To date valid frequency data of dentofacial asymmetries in Pakistani orthodontic patients do not exist to document orthodontic treatment need. The objectives of this study were to determine frequency of dento-facial asymmetries, severity of dental asymmetries and to determine difference in frequency of dentofacial asymmetries in mixed and permanent dentition.
Methods: The sample of this cross-sectional study comprised of 280 patients (177 females and 103 males) with no history of previous orthodontic treatment having no craniofacial anomalies. Dento-facial asymmetries were assessed …

Typhoid Fever In Fiji: A Reversible Plague?, Corinne N. Thompson, Mike Kama, Shrish Acharya, Una Bera, John Clemens, John A. Crump, Aggie Dawainavesi, Gordon Dougan, W. John Edmunds, Kimberley Fox, Kylie Jenkins, M. Imran Khan, Josefa Koroivueta, Myron M. Levine, Laura B. Martin, Eric Nilles, Virginia E. Pitzer, Shalini Singh, Ratu Vereniki Raiwalu, Stephen Baker, Kim Mulholland

Centre of Excellence in Women and Child Health

Le pays des îles Fidji, avec une population d'environ 870 000 personnes, fait face à une charge croissante de plusieurs maladies transmissibles, y compris l'infection bactérienne de la fièvre typhoïde. Les données de surveillance indiquent que la fièvre typhoïde est devenue de plus en plus fréquente dans les zones rurales de Fidji et est plus fréquente chez les jeunes adultes. La transmission des organismes qui causent la fièvre typhoïde est facilitée par la contamination fécale des aliments ou de l'eau et peut être influencée par les pratiques comportementales locales dans les îles Fidji. Le Ministère fidjien de la Santé, avec …

Childhood Obesity In Asia: The Value Of Accurate Body Composition Methodology, Andrew P. Hills, Najat Mokhtar, Sharon Brownie, Nuala M. Byrne

School of Nursing & Midwifery, East Africa

Childhood obesity, a significant global public health problem, affects an increasing number of low- and middle-income countries, including in Asia. The obesity epidemic has been fuelled by the rapid nutrition and physical activity transition with the availability of more energy-dense nutrient-poor foods and lifestyles of many children dominated by physical inactivity. During the growing years the pace and quality of grow this best quantified by a combination of anthropometric and body composition measures. However, where normative data are available, this has typically been collected on Caucasian children. To better define and characterise overweight and obesity in Asian children, and to …

A Single Competency-Based Education And Training And Competency-Based Career Framework For The Australian Health Workforce: Discussing The Potential Value Add, Sharon Brownie, Janelle Thomas

School of Nursing & Midwifery, East Africa

This brief discusses the policy implications of a research study commissioned by Health Workforce Australia (HWA) within its health workforce innovation and reform work program. The project explored conceptually complex and operationally problematic concepts related to developing a whole-of-workforce competency-based education and training and competency-based career framework for the Australian health workforce and culminated with the production of three reports published by HWA. The project raised important queries as to whether such a concept is desirable, feasible or implementable – in short what is the potential value add and is it achievable? In setting the scene for discussion, the foundation …

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 …

Prevalence Of Significant Liver Fibrosis In Patients With Hiv Monoinfection Compared To Those With Hiv-Hepatitis B Coinfection As Assessed By Shear Wave Elastography, Samuel Nguku

Master of Medicine in Imaging and Diagnostic Radiology

Background: Liver disease is an emerging management problem in human immunodeficiency virus (HIV) infected patients. The incidence of chronic Hepatitis B infection, which accelerates the progression of chronic liver disease and development of liver fibrosis, is ten times higher in patients with HIV than the general population. Staging of liver fibrosis provides essential information in management of these patients. Objective: To determine the prevalence of significant liver fibrosis in patients with HIV mono-infection versus those with HIV-HBV co-infection as assessed with shear wave elastography (SWE). Methods: This was a cross-sectional study whereby HIV infected patients attending the HIV clinic at …

Gender Differences In Self-Esteem In Young Adolescents Of Karachi, Shelina Bhamani, Sabeen Jamil, Falak Zehra Mohsin

Department of Obstetrics & Gynaecology

The purpose of this research was to explore the self-esteem trends in adolescents of Karachi, Pakistan with regard to gender differences. The insights from previous literature helped to form the hypothesis that there will be a significant gender difference on the self-esteem of adolescents variable. There were a total 224 (96 male and 126 female) adolescents chosen for this study and the Multidimensional Self-Esteem Scale: a 36 item and a 3 Likert response scale was adapted for this study with the consent of the author. The data analysis revealed that there is a significant gender difference on the variable of …

Responding To Health Care Complexity: Suggestions For Integrated And Interprofessional Workplace Learning, Pim Kuipers, Carolyn Ehrlich, Sharon Brownie

School of Nursing & Midwifery, East Africa

This report highlights complexity in health care and the relevance of integrated and interprofessional care and learning. It is proposed that appropriate workforce training in response to complexity should be contextually relevant and workplace integrated, and should focus on building interprofessional capability for reflective practice and critical thinking. This training should be interprofessional and foster systems thinking. It is suggested that the World Health Organization's International Classification of Functioning, Disability and Health (ICF) is a useful integrating framework.

Coverage And Quality Of Antenatal Care Provided At Primary Health Care Facilities In The ‘Punjab’ Province Of ‘Pakistan’, Muhammad Ashraf Majrooh, Seema Hasnain, Javaid Akram, Arif Siddiqui,, Zahid Memon

Centre of Excellence in Women and Child Health

Background: Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In ‘Pakistan’ antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to ‘Divisions’ and ‘Districts’. By population ‘Punjab’ is the largest province of Pakistan having …

Are Physicians More Technical In Their Approach And Less Humane? A Call For Reconsideration, Waris Qidwai

Department of Family Medicine

No abstract provided.

Leadership In Healthcare Is A Neglected Issue: A Call For Action, Waris Qidwai

Department of Family Medicine

Healthcare and medical profession stands at crossroads today. Unprecedented technological advances as a result of ongoing scientific research has revolutionized healthcare around the world. Despite these developments, we are still faced with a huge burden of communicable diseases, an ever rising burden of noncommunicable diseases, coupled with an increasing load of mental health diseases and accidents in healthcare. There are several reasons for our failure to address healthcare issues of our populations, including a desperate need to revamp existing medical and health care related curriculum. In addition to considering curriculum change, perhaps single most needed change we need to address …

Multiple Mini-Interviews (Mmi) And Semistructured Interviews For The Selection Of Family Medicine Residents: A Comparative Analysis, Marie Andrades, Seema Bhanji, Samreen Kausar, Fouad Majeed, Sheilla Pinjani

Department of Family Medicine

Background. Family Medicine Residency Program at the Aga Khan University has applicants for the residency position in excess of the positions offered resulting in formulation of certain selection criteria. The objective of this study was to compare MMI versus semistructured interviews for assessing noncognitive domains in the selection of residents. The secondary objectives were to determine perceptions of the interviewers and candidates for the acceptability and feasibility of MMI as a selection tool.
Methods: The candidates underwent semistructured interviews along with MMI and identical attributes were tested in both. The attributes tested were safe doctor, communication skills, professionalism, problem …

Using Management Information System To Evaluate Quality Of Care At Tertiary Care Hospital’S Stroke Centre, Abdul Malik, A. Zafar, F. S. Khan

Pakistan Journal of Neurological Sciences (PJNS)

To find out the average length of stay, the rate of I/V catheter cellulites, the rate of bed sores among patients in stroke centre and determine the mortality rates. Methodology: This is a descriptive study, carried out at a tertiary care hospital over the period of six months. Data was analyzed by SPSS version 15.0. Result: Total numbers of patients were 36 from January 1 to June 30, 2007 at Stroke Center Liaquat National Hospital. The mean length of stay was 8.17 ±5.81 days. Patients had cellulitis (intravenous) 97.2%, only 2.8% of patients did not develop. The rate of bed …

A Need To Climb High To Integration Ladder, Nazish Fatima, Syed Muhammad Faizan Ul Haque

Department for Educational Development

No abstract provided.

Late Presentation Of Posterior Urethral Valves, Imran Khan Jalbani, Syed Raziuddin Biyabani

Department of Surgery Docs

ABSTRACT Presence of posterior urethral valves (PUV) is the most common cause of urinary tract obstruction in the male neonate. Late presentation occurs in 10% of cases. We present a case of PUVs in an adult male who presented with history of obstructive lower urinary tract symptoms and hematuria. On evaluation, he was found to have raised serum creatinine level. A voiding cystourethrogram (VCUG) could not be completely performed because of narrowing in the posterior urethra. A rigid urethrocystoscopy was performed at which he was found to have type-I posterior urethral valve which were fulgurated. A repeat uroflowmetry revealed maximum …

Ovarian Sex Cord Stromal Tumours In Children And Young Girls - A More Than Two Decade Clinicopathological Experience In A Developing Country, Pakistan, Saroona Haroon, Romana Idrees, Aleena Zia, Aisha Memon, Saira Fatima, Naila Kayani

Department of Pathology and Laboratory Medicine

Background: Ovarian sex-cord stromal tumours (SCST) are rare, and relatively infrequent in children. These have to be distinguished from more common germ cell tumors in children and also from benign epithelial neoplasms.
Objectives: The purpose of our study was to report the clinical and pathological findings in young patients with these tumours in our population.
Material and Methods: The present observational cross-sectional study included all subjects SCST, in Aga Khan University Hospital Histopathology Laboratory, Karachi, Pakistan, from January 1992 till July 2013.
Results: Of the total of 513 SCSTs presented during the study period, 39 fulfilled inclusion criteria and were …

Environmental And Occupational Factors Associated With Chronic Myeloid Leukemia: A Case-Control Study, R. Kasmani, N.A. Othieno-Abinya, M.T. Singh Riyat, G.W. Kiarie, Peter Wanzala

Pathology, East Africa

Background: The relationship between chronic myeloid leukemia (CML) and a broad range of exposures to occupational and environmental factors known to cause leukemia in general is limited. CML is by and large incurable and treatment is just palliative and life prolonging, with high case fatality rate, even in the best centers. Furthermore treatment is very expensive. Identification of leukemogenic factors is therefore important if this can lead to simple public health interventions.

Objective: The objective was to determine key environmental and occupational exposure factors that may be associated with CML.

Methods: This was a case-control study involving CML …