Medicine and Health Sciences Commons^™

Utility Of Glasgow-Blatchford Scoring System In Identification Of Low Risk Patients With Upper Gastrointestinal Bleeding In Emergency Departments In Dar Es Salaam Hospitals, Tanzania, Selestin D. Mpiri

Theses & Dissertations

Background: Acute upper gastrointestinal bleeding (UGIB) remains a common cause of visits to the Emergency Department (ED). To stratify the risk of complications, rebleeding, need for clinical intervention, or death, several clinical scores are in use. Glasgow-Blatchford Score (GBS) is an excellent risk assessment tool and has shown to accurately identify patients with a low risk of death or requiring intervention. In urban Tanzania, there is a lack of standardized protocol and a well-validated risk assessment tool for analyzing patients presenting with UGIB symptoms. Good performance of GBS score and its use will help to reduce unnecessary emergency endoscopies …

Validation Of Kiswahili Version Of World Health Organization Quality Of Life-Hiv Bref Questionnaire Among People Living With Hiv/Aids In Tanzania., Nuru Abdallah Kondo

Theses & Dissertations

Background: WHO has developed an HIV specific quality of life tool (WHOQOLHIV-BREF) for assessing Quality of life of HIV positive individuals. This tool takes to account the different cultural variations that exist worldwide and hence enable assessment of the quality of life across different cultures/context. This tool has been validated in different cultures and is cross-culturally a promising tool. It is simple to use in routine clinics as it is self-administered. Despite its sound validity and reliability from several studies, the developers recommend it to be validated in different cultures to fully assess its psychometric properties before its adaptation.

Objectives: …

Barriers To Timely Disclosure Of Hiv Serostatus: A Qualitative Study At Care And Treatment Centres In Dar Es Salaam, Tanzania, Neelam Akber Ismail

Theses & Dissertations

Introduction: Disclosure of HIV status is important for HIV prevention and maintenance of health for People living with HIV (PLWHIV), their spouses and the community. Despite the benefits of disclosure, there are PLWHIV who delay in disclosing their status thus increasing the risk of transmission of the disease. Objective: This study aimed at determining the barriers to timely disclosure of HIV serostatus among HIV seropositive individuals in Dar es Salaam and what motivated them to disclose.

Methods: A qualitative descriptive study using in depth individual interviews was conducted. Ten participants attending the care and treatment centres took part. Qualitative content …

Discordance Between Breast Imaging And Histopathology Findings After Ultrasound Guided Core Needle Biopsy, Margaret Mutinda Mwania

Theses & Dissertations

Introduction: Breast cancer is the most prevalent cancer among women worldwide with an estimated global incidence of 11.6%. According to the GLOBOCAN factsheet, in 2018 breast cancer incidence in Kenya was 40.3 per 100,000. Early detection and diagnosis of breast cancer has been shown to reduce mortality and increase years of life gained. Breast lesion diagnosis is heavily based on imaging and pathology and typically findings are reported independent of one another. Correlation of imaging findings and pathology after biopsy is found to be of critical importance in detecting possible sampling error, concordance versus discordance, recommend appropriate management and thus …

The Needs At 48 Hours Of Immediate Family Members Of Patients Admitted To The Intensive Care Unit At The Aga Khan University Hospital, Nairobi, Maalim Fahad

Theses & Dissertations

Background: Family members of patients admitted to Intensive Care Unit (ICU) have been shown to have important needs. Inability of the critical personnel to interrelate appropriately with relatives of critically unwell patients, or to recognize or meet their needs, may lead to increased anxiety, misconception and distrust from relatives.

Aim: To determine the needs of immediate family members of adult patients admitted to ICU at 48 hours at the Aga Khan University Hospital, Nairobi.

Methods: This was a cross-sectional descriptive study. The Critical Care Family Needs Inventory questionnaire was employed to identify the needs of the immediate relatives …

Local Anaesthetic Wound Infusion Versus Thoracic Epidural Analgesia For Post-Operative Pain Control Following Elective Laparotomy: A Randomised Controlled Trial, Daniel Gathege Mwangi

Theses & Dissertations

Background: Post-operative pain control is an important pillar in enhanced recovery after surgery. There is a paucity of data that compares efficacy of pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients

Objective: To evaluate pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients.

Design: A randomised, single-blind, controlled clinical trial.

Setting: Aga Khan University Hospital, Nairobi, Kenya.

Population: Patients undergoing elective laparotomy.

Methods: Thirty eight patients scheduled for elective laparotomy were randomized into two equal groups to receive either continuous …

The Quality Of Life Of Patients With Early Breast Cancer And Their Partners One Year After Breast Conserving Surgery Versus Modified Radical Mastectomy: A Single Centre Five Year Review, Senoga Andrew

Theses & Dissertations

Background: Breast cancer accounts for the highest incidence rate (40.3/100000) and fourth highest mortality rate (17.8/100000) among cancers in Kenya. Forty percent of breast cancer cases in Kenya are early breast cancer and this is will increase with scaled up awareness campaigns and screening. Breast conserving surgery (BCS) followed by radiotherapy (BCT) and modified radical mastectomy (MRM) are the commonest forms of surgical techniques utilized in treatment of early breast cancer with similar overall survival and recurrence rates. These treatments impact variably on the quality of life of the patients and their spouses who are their immediate emotional and social …

Serum 25-Hydroxyvitamin D Levels In Children With Mild And Severe Atopic Asthma, Rhoda Ndinda Masaku

Theses & Dissertations

Background: Asthma is a chronic respiratory illness affecting an estimated 334 million people worldwide, including 14% of the total pediatric population. It results in significant morbidity, and therefore the etiologies and risk factors associated with asthma are of great interest. Serum 25- hydroxyvitamin D (25(OH)D) has substantial immunomodulatory effects on the innate immune system. It reduces the probability of viral respiratory infections and asthma exacerbations by potentiating the anti-inflammatory action of corticosteroids.

Objectives: This study was conducted to determine if there was a difference in serum 25-hydroxyvitamin D levels between children with mild and severe atopic asthma and explored the …

Referral Patterns Affecting Age At Orchidopexy For Undescended Testis At A Tertiary Hospital In Nairobi., Muthua Ken Njoroge

Theses & Dissertations

BACKGROUND: Undescended Testis is the most common urological congenital anomaly with significant burden of disease especially in our local context. Management relies on early diagnosis, in the perinatal period, and prompt referral to an appropriate surgical unit. Spontaneous descent, while possible, doesn’t occur beyond 6 months and thus surveillance should not proceed beyond this age. Current guidelines recommend surveillance up to 6 months, referral by 9 months and, most importantly, orchidopexy by 1 year of age. Despite these clear guidelines, achieving them has proven difficult globally with low rates of orchidopexy by 1 year. The most common cited cause has …

The Association Of Maternal Sociodemographic Factors With Stress In Pregnancy, Maheshwari Andhavarapu

Theses & Dissertations

Introduction: Antenatal stress has been linked to maternal morbidity and preterm birth (PTB). One of the pathophysiological processes leading to PTB is thought to be via activation of the hypothalamus-pituitary-adrenal axis resulting in cortisol production. Hair cortisol has recently been shown to be a stress marker in the pregnant and non-pregnant population. Some determinants of hair cortisol have also been studied but more research is needed in this area, especially in pregnancy. Understanding the risk factors of antenatal stress may guide institution of preventative or screening measures to reduce the risk of adverse birth outcomes. As the effect of stress …

Prevalence And Factors Associated To Incidental Prostate Carcinoma Among Patients Undergoing Turp For Benign Prostatic Enlargement., Isaac Herman Mawalla

Theses & Dissertations

Background: Prostate carcinoma carries higher morbidity and mortality when diagnosed late. Prostate cancer screening is paramount, however, there are no specific clinical signs for early-stage prostate cancer. As an independent variable, prostate-specific antigen is an established predictor of cancer. Incidental prostate cancer is detected by histological examination of resected biopsy tissue that had been previously diagnosed as benign. In the current PSA-use era the prevalence of incidental prostate cancer ranges from 1.4 to 13%. The prevalence in Tanzania as published by Gunda et al was 21.71%. This is alarmingly high. However, in his study, patients with high prostate-specific antigens were …

The Burden Of Urinary Incontinence Among African Diabetic And Non-Diabetic Women Seeking Care At The Aga Khan University Hospital, Nairobi, Martin Kimemia Mbuthia

Theses & Dissertations

Introduction: Female urinary incontinence is a common and chronic condition with devastating psychosocial effects. It can occur at any age and is specifically more common in older women. It has a prevalence of up to 55% depending on the age-group and the target population studied. About 9% of adults globally have diabetes and a greater number live in LMICs. Diabetes is twice as prevalent in blacks and three to four times higher in South-Asian populations compared to Caucasian populations. In women with Type 2 DM, urinary incontinence is 30% to 70% more common than among women with normal glucose levels. …

Evaluation For Association Between Maternal Microbiota And Development Of Necrotizing Enterocolitis Or Gram-Negative Bacteremia In Preterm Infants, Mei Chi Quek

Theses & Dissertations

Background: Preterm birth is the leading cause of perinatal morbidity and mortality worldwide. There is a need for a better understanding of the correlation of vaginal microbiota with adverse preterm outcomes. Our study aimed to explore how the vaginal microbiota influences the outcome of the preterm infants, determine whether fecal microbiota in premature infants differs from that in term infants, and explore the microbiota pattern in preterm neonates who received multiple antibiotics.

Method: A prospective cohort design was used to enroll 33 women admitted in spontaneous labor between 25 to 36 weeks, and 33 controls matched for age and parity …

Long Term Health Related Quality Of Life Following Uterine Fibroid Embolization At Aga Khan University Hospital, Nairobi, Michael Muthoka Kioko

Theses & Dissertations

Background: Uterine Fibroid Embolization (UFE) is one of the effective options available for treatment of symptomatic uterine fibroids with documented improvement in the quality of life and reduction in symptoms. Most of the studies have demonstrated an improvement in the quality of life over a short to intermediate period. We carried out this study to assess the long-term quality of life following uterine fibroid embolization in a predominantly black population. There are no identified studies locally or in Africa addressing this issue whereas studies done elsewhere indicate a probable increased fibroid disease burden among black women.

Objectives: Our objectives in …

Effect Of Unmaskes On Delivering Difficult News Among Residents, Karishma Sharma

Theses & Dissertations

Background: Effective delivery of difficult news to patients and family has been shown to improve the physician-patient relationship, quality of care, and overall patient satisfaction. However, delivery of difficult news (DDN) remains a challenging task for even the most experienced providers. Little has been studied about delivery of difficult news by resident physicians in the sub-Saharan setting. We developed a 4-minute, easily accessible, graphic video using the mnemonic UNMASKES to help improve delivery of difficult news by resident physicians at our institution and their patients.

Objective: To determine the impact of a short training video called UNMASKES in helping resident …

The Clinicodemographic Profile Of Multiple Sclerosis At Aga Khan University Hospital (Nairobi), Imran Jamal

Theses & Dissertations

Background: Multiple sclerosis (MS) is the leading cause of nontraumatic disability in young adults and is the most common immune-mediated inflammatory demyelinating disease of the CNS. MS was initially considered to be rare in sub-Saharan Africa (SSA). However, there have been reports of rising trends of MS in regions with previously low prevalence.

Objective: The primary objective of this study was to describe the demographic and clinical characteristics of MS patients at AKUHN.

Methods: Medical records of patients with MS at the AKUHN were obtained using the ICD 10 code search at the medical records section of …

Burnout Among Medical Residents; Their Impressions Of Its Impact On Patient Care And Coping Mechanisms, Elizabeth Ochola

Theses & Dissertations

Introduction: Burnout is a syndrome that occurs as a result of chronic workplace stress that has not been successfully managed. This global definition is given by the International Classification of Diseases; 11th edition. The ICD-11 further characterizes burnout using three dimensions: Emotional exhaustion described as feelings of energy depletion or exhaustion; depersonalization described as; increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and low personal accomplishments seen as reduced professional efficacy. Burnout refers specifically to phenomena in the occupational context and is not applied to describe experiences in other areas of life. …

Profile Of Cardiac Arrhythmia In Acute Stroke Patients, Julius Stephen Nkhondeya Msukuya

Theses & Dissertations

Introduction: Cardiac arrhythmias are common and can be fatal in acute strokes, but they are often under-recognized. The presence of cardiac arrhythmia in acute stroke doubles the mortality.

Objectives: This study aimed to determine the types of cardiac arrhythmia in acute stroke patients admitted in two urban hospitals in Dar es Salaam, The Aga Khan Hospital, Dar es Salaam and Muhimbili National Hospital. The secondary objectives were to determine the associations between the characteristic of stroke and cardiac arrhythmias as well as to determine the impact of cardiac arrhythmia on 30- days stroke outcomes.

Methods: This was a prospective longitudinal …

Neonatal Nurses' Perceptions Of Providing Palliative Care In The Neonatal Intensive Care Unit, Susan Di Nonno Chin

Theses & Dissertations

Although advances in neonatal medicine have greatly improved infant survival rates, there remains a significant number of infants admitted to the neonatal intensive care unit who will not survive. It is estimated that 50% of the 25,000 annual hospital pediatric deaths occur in the neonatal intensive care unit (NICU) (Conway-Oriel & Edlund, 2015). Despite widely supported guidelines endorsing neonatal palliative care (NPC), implementation has been sporadic and inconsistent (Kain & Wilkinson, 2013). Lack of palliative care protocols has been associated with negative impacts on infants, their families, and multidisciplinary team members. NICU nurses are uniquely positioned to influence end-of-life care …

Etiologies Of Lower Respiratory Tract Infections Among Adult Patients Presenting To A Tertiary Institution In Nairobi, Mary Achakolong

Theses & Dissertations

Background: Lower respiratory tract infections continue to contribute significantly to morbidity and mortality across all age groups globally. Viral pathogens in isolation or as co-infections are an important cause of pneumonia and associated with several life threatening syndromes that warrant appropriate and timely lifesaving diagnosis. Many viral respiratory infections demonstrate substantial regional and seasonal variations which are poorly understood. In addition, there are very few studies in sub-Saharan Africa that have examined the role of viruses as causes of community acquired pneumonia. The availability of molecular techniques such as multiplex PCR that are much more sensitive than traditional methods and …

Analysis Of Terminal Duct Lobular Unit Involution In Luminal, Her-2enriched And Triple Negative Breast Cancer Subtypes, Joseph Nyaguti Kiwinga

Theses & Dissertations

Introduction: The terminal duct lobular unit (TDLU) of the breast is the most common origin of most breast cancers (BC). With increasing age and menopause, physiologic involution of TDLU occurs with a reduction in both the number and size of the lobules. Reduced TDLU involution is associated with a higher mammographic breast density (MBD) which by itself is a strong breast cancer risk factor. Recent studies have shown that TDLU involution is associated with a reduced risk of breast cancer and involution also differs with molecular subtypes of BC.

Studies have shown that the etiology, pathogenesis and prognosis of the …

Outcomes Of Inpatients Hospitalized With Community Acquired Pneumonia, Jamila Nambafu

Theses & Dissertations

Background: The morbidity from lower respiratory tract infections has varied between age groups and from region to region. In sub-Saharan Africa, pneumonia remains the most frequent reason for adult hospitalization, with approximately 4 million episodes and about 200,000 deaths every year. Some of the attributable factors have been HIV pandemic, pulmonary tuberculosis, and poor socio-economic status.

Objective: The main objective was to determine the morbidity of community-acquired pneumonia in patients admitted to a tertiary hospital in Nairobi, Kenya, between May 2019, and March 2020. The results are anticipated to help in informing protocols for the evaluation and treatment …

Von Willebrand Disease Among Women Of African Descent Attending The Aga Khan University Hospital Nairobi, With Menorrhagia, Angela Nabutilu Munoko

Theses & Dissertations

Introduction: Von Willebrand Disease (VWD) is the most common heritable bleeding disorder with equal prevalence reported across the races. Women are more likely to present with excessive bleeding due to menstruation and child bearing. Studies have found that 5-24% of women presenting with menorrhagia have VWD.

Women of African descent are under-represented in studies carried out on Von Willebrand disease and lower prevalence has been reported in this population. VWD has variable penetrance and racial differences in genetic mutations may influence presentation and disease severity. It was predicted that the standardization of the study conditions (case definition of menorrhagia, use …

Breast Cancer Recurrence Rate In Patients Treated For Early Breast Cancer, Cecilia Munguti

Theses & Dissertations

Background: Breast cancer, the leading cause of cancer in Kenya among women, has a prevalence of 57.1 per 100,000 women and an annual mortality of 3.7 per 100,000. Early breast cancer is curable, but has a residual risk of recurrence of 10.4% in the first 5 years. Fifty percent of the recurrences occur after the first 5 years after diagnosis. Recurrent breast cancer is associated with poorer prognosis and higher mortality rates.

Objectives: The primary objective was to determine the breast cancer recurrence rates for women managed for DCIS and early breast cancer at Aga Khan University Hospital. Secondary objectives …

Occult Hepatitis B Virus Infection In A Cohort Of Hiv Infected Antiretroviral Therapy Naïve Adults, Adil Suleiman Salyani

Theses & Dissertations

Background: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are endemic to sub-Saharan Africa (SSA) with co-infection being common. Infection with HIV is a risk factor for occult hepatitis B virus infection (OBI), defined as presence of HBV deoxyribonucleic acid (DNA) in the absence of hepatitis B surface antigen (HBsAg). Occult hepatitis B virus infection is further classified based on HBV DNA level as true (/mL) or false (≥200 IU/mL). Presence of OBI is associated with development of liver cirrhosis and hepatocellular carcinoma (HCC).

Objectives: The primary outcome was to determine the prevalence of OBI in anti-retroviral therapy …

Perceptions Of Surgeons On Surgical Antibiotic Prophylaxis Use At Aga Khan Hospital, Dar Es Salaam., Elizabeth Elibariki Mmari

Theses & Dissertations

Introduction: Surgical site infections are a major cause of morbidity and mortality among operated patients. The use of antibiotic prophylaxis in prevention and reduction of incidence of surgical site infection is widespread. In spite of the accessibility of universal and national guidelines for surgical prophylaxis, recent studies surveying the present routine of prophylaxis have demonstrated overutilization of a wide range antibacterial medications for a single patient. Few studies have shown qualitatively factors influencing this, and perceptions of surgeons on surgical antibiotic prophylaxis use. Unfortunately, none of these studies have been done in Tanzania.

Objective: To describe the perceptions of surgeons …

Cyto-Histological Correlation Of Thyroid Cytology And Associated Adverse Surgical Outcomes At Aga Khan University Hospital, Nairobi., Moses Barasa

Theses & Dissertations

Background: Solitary thyroid nodules are commonly encountered endocrine disorders in surgical practice. Fine Needle Aspiration Cytology (FNAC) is a minimally invasive, accurate and cost-effective diagnostic tool that provides basis for surgical decisions-making in thyroid lesions management. Thus, it’s imperative that such a test should have high diagnostic accuracy in order to avoid under or over-treatment arising from false negative or positive results respectively. Studies from the African region, compared to the developed world have reported higher thyroid cyto-histologic discrepancy.

Objective: To determine the diagnostic accuracy and adverse surgical outcome of discrepant thyroid cytology.

Methods: Retrospective cross-sectional analytical study conducted at …

Timing And Factors That Contribute To The Decision Making Process On The Mode Of Delivery After One Previous Casearean Section., Sylvia Nyanyu Mruttu

Theses & Dissertations

Background: The rates of caesarean sections have continued to rise despite public and professional concern. This has continually increased the proportion of the obstetric population with a history of previous caesarean delivery. These women may be offered either elective repeat caesarean section (ERCS) or planned vaginal birth after caesarean delivery (VBAC). This study aimed to identify the timing, level of knowledge and factors that influence the decision-making.

Objectives: The primary objective was to elicit the factors that contribute to women to choose VBAC or ERCS. The secondary objectives were to determine the timing of this decision, measure the level of …