Medicine and Health Sciences Commons^™

Health-Related Quality Of Life Of Children With Gastroesophageal Reflux Disease After Nissen Fundoplication And Gastrostomy Tube Insertion, Felix Wafula Musibi

Theses & Dissertations

Background: Gastroesophageal reflux disease (GERD) negatively impacts the health-related quality of life (HRQoL). Nissen fundoplication is done when medical treatment fails. Goal of therapy is to eliminate symptoms and improve quality of life.

Justification: HRQoL is a key indicator that we can use to evaluate the impact of our interventions so that we can make evidence-based decisions and advice our patients appropriately based on the outcomes of these interventions.

Objectives: The primary objective was to assess the HRQoL of children with GERD after Nissen fundoplication alone or Nissen fundoplication and gastrostomy tube insertion.

Methods: Design- Observational …

The Prevalence Of Albuminuria In Children With Chronic Kidney Disease In Two Tertiary Hospitals In Nairobi, Kenya, Mercy Wambui Githumbi

Theses & Dissertations

Background: Chronic kidney disease (CKD) is a major health problem globally. In Africa, the burden in children remains unclear and is often reported as low. In developing countries, it is mainly due to secondary causes and nephrotic syndrome, while in the developed countries it is mainly due to congenital anomalies of kidney and urinary tract (CAKUT). The Kidney Disease: Improving Global Outcomes (KDIGO) defines CKD and utilises glomerular filtration rate (GFR) and albuminuria as an additional factor. Albuminuria is significant in prognostication of individuals with CKD as it is a marker of kidney damage. It is correlated with outcomes including …

Prevalence And Social Determinants Of Alcohol Use Disorders In Patients Attending Primary Care Clinics In Nairobi Kenya, Verah Kabwayi

Theses & Dissertations

No abstract provided.

Clinicians’ Perceptions Of Pediatric Assent For Invasive Bedside Procedures At Three Tertiary Referral Hospitals In Nairobi County, Kenya., Grace Petrine Oyito Omondi

Theses & Dissertations

Background: The medical profession is built on the foundation of morals and ethics guided by principles of beneficence, non- maleficence, autonomy and justice. In order for an individual to be sufficiently autonomous, the value of information is indispensable. The information allows the patient to make an informed decision concerning their healthcare. The patient then gives an informed consent or assent as is applicable to the pediatric population. Majority of the studies surrounding pediatric assent revolves around obtaining it for research. There is a paucity of literature in regards to pediatric assent for clinical treatment more so as regards clinicians’ …

The Utility Of An Initial Point-Of-Care Lactate In Predicting In-Hospital Mortality Among Adult Patients With Sepsis And Septic Shock At The Emergency Department Of A Tertiary Hospital In Nairobi, Gicheru B. Nyachira

Theses & Dissertations

Background: Sepsis is a leading cause of death and now a global health priority. Rapid identification, diagnosis and intervention can result in reduced in-hospital mortality. Elevated lactate has been shown to be a strong predictor of in-hospital mortality. However, the optimal cut-off has not been well defined. Identification of the optimal Point-of-Care (POC) lactate cut off that best predicts in-hospital mortality can therefore be used to rapidly risk stratify patients with suspected sepsis and septic shock presenting to the emergency department allowing for immediate intervention.

Objective: To determine the lactate cutoff from an initial Point-of-Care lactate result from a GEM …

Immunophenotypic Expression Profile Of Multiple Myeloma Cases At A Tertiary Hospital In Nairobi, Kenya, Isabella Chelagat Mengich

Theses & Dissertations

Background; Multiple myeloma (MM) is a heterogeneous disease with variable patient outcomes ranging from indolent to aggressive disease. GLOBOCAN data places Kenya amongst the top five African countries for MM incidence and MM-related mortality. Aberrant expression of CD56, CD117, Cyclin D1 and Ki-67 on neoplastic plasma cells has been demonstrated to be useful in disease prognostication. However, majority of the data on MM comes from western countries. The significance of expression of this markers is uncertain in our population. The aim of this study was to determine the immunophenotypic expression profile of CD56, CD117, Cyclin D1 and Ki-67 in a …

Compliance To Imaging Follow Up Recommendations Among Patients With Bi-Rads 3 Breast Lesions, Florence Thuita

Theses & Dissertations

Background: The Breast Imaging Reporting and Data System 3 (BI-RADS 3) category is assigned to lesions which are deemed to be probably benign on breast imaging with a low likelihood of malignancy (≤2%). With regular imaging follow-up, this category is intended to reduce the rate of invasive biopsies while enabling early detection of breast cancer. However, imaging follow-up has been reported to be challenging to both radiologists and referring clinicians in terms of its appropriate use on the various imaging modalities and understanding management of the patients in this category. Furthermore, it has been reported to induce patient anxiety …

Efficacy Of Nerve Blocks On Immediate Post Caesarean Delivery Functionality, Dorothy Makena

Theses & Dissertations

Introduction; Caesarean section is becoming increasingly common and is one of the most performed procedures globally. It is a major surgery accompanied by moderate to severe pain. Pain impacts negatively on functionality of the mother in terms of daily activities like self-care, newborn care and mobility. A post caesarean section mother therefore requires effective and safe pain relief to improve functionality, for effective breastfeeding and to reduce the risk of venous thromboembolism. Abdominal plane nerve blocks have been studied widely in the recent past and have been shown to be effective as part of multimodal post caesarean analgesia. This study …

Survival Outcomes And Prognostic Factors Affecting Survival In Patients With Metastatic Breast Cancer, Mwongeli Matheka

Theses & Dissertations

Introduction: There is an increase in breast cancer in Africa with up to 77% of patients diagnosed with advanced disease. Late diagnosis, aggressive tumor biology and inadequate or incomplete treatments contribute to high mortality rates. However, there is little data on survival outcomes and prognostic factors affecting survival in patients with metastatic breast cancer (MBC) in Africa. The study objective was to establish the survival of patients with MBC at a single tertiary health facility and to outline the clinical and pathological characteristic of the patients and their relation to survival outcomes.

Methods: This was a retrospective descriptive study conducted …

Comparison Of Postoperative Pain Scores Following Bilateral Erector Spinae Versus Bilateral Transversus Abdominis Plane Blocks In Parturients Undergoing Elective Caesarean Delivery Under Spinal Anaesthesia At The Aga Khan University Hospital, Nairobi, Rawlings Thuranira

Theses & Dissertations

BACKGROUND: Good pain control following lower segment caesarean section (LSCS) is essential to facilitate early mobilization and to enable adequate care of the new-born by the mother. Inadequate analgesia after caesarean delivery has been associated with increased incidences of deep venous thrombosis, chronic pain, greater opioid use and postpartum depression. Peripheral or trunk nerve blocks have become popular as part of a multimodal approach, together with opioids and non-steroidal analgesics, in controlling post caesarean pain. While the transversus abdominis plane (TAP) block has emerged in recent years as the most widely performed block for post caesarean pain the novel erector …

Characterization Of Young Hypertensive Patients Aged Between 18 – 40 Years, Kelvin Orare Nyanchoka

Theses & Dissertations

Background: Hypertension is the world’s most significant risk factor for morbidity and mortality. Sub-Saharan Africa has the highest prevalence of hypertension worldwide. In Kenya, the estimated overall prevalence of hypertension is at 24.5%. Young adult hypertensive patients have a lower proportion of controlled blood pressure compared to older adults. Uncontrolled hypertension, irrespective of age, increases cardiovascular risk.

Methods: A total of 401 patients aged between 18 and 40 years were identified from the records department based on the ICD-10 codes for hypertension. Using their hospital identification numbers, files were sorted and analyzed including laboratory data on the hospital information management …

Sensitivity Of A Preanaesthesia Screening And Triage Tool In Identifying High Risk Patients: A Diagnostic Accuracy Study, Brian Kiplagat Misoi

Theses & Dissertations

Introduction; Preoperative evaluation and optimization is conducted to prepare a sound perioperative management plan and limit complications. The standard of assessment is by the anesthesiologist based on ASA recommendations, and can be conducted early in the PAC or on the operative day. Reviews in the PAC have been shown to allay anxiety and reduce day of surgery cancellation. While it is ideal for all patients to be evaluated preoperatively by the physician anesthesiologist in the PAC, there are very few anaesthesiologist's in low and middle income countries meaning this may be unachievable. This creates a demand for innovative ways to …

Validity And Acceptability Of The Kiswahili-Paediatric Gait, Arms, Legs And Spine (Pgals) Screening Tool At A Tertiary Referral Hospital In Kenya, Jacqueline Evarist Kawishe

Theses & Dissertations

Background: A common reason implicated in the severity of presentation and mortality resulting from rheumatic conditions among children is the delayed presentation to a paediatric rheumatologist. Evidence suggests low-quality paediatric musculoskeletal clinical skills could be a cause for diagnostic delay and history suggestive of musculoskeletal disease alone has poor sensitivity in detecting paediatric rheumatic conditions. The paediatric gait, arms, legs, and spine (pGALS) musculoskeletal screening tool was developed to encourage early detection of paediatric rheumatic conditions. It has been validated and translated successfully in other countries. Kiswahili serves as a national language in several East African countries. Translating and …

Parental Knowledge And Attitudes Towards Food Allergy, Namuli Jane Francis

Theses & Dissertations

Background: Food allergy and other allergen-induced diseases are an increasing problem globally. This has been documented in studies done in Western countries as well as some parts of Africa. The prevalence of food allergy is highest during the first 2 years of life. For allergen-induced illness, avoidance of triggers and prevention of fatal reactions are the mainstay of treatment. Unnecessary withdrawal of suspected protein-rich foods at a time that is critical for children’s growth may lead to malnutrition and its related complications. This study aimed to understand the gaps in knowledge and misconceptions about food allergy among parents as …

Correlation Between Disease Severity And Health-Related Quality Of Life Among Patients With Fibromyalgia Syndrome, Janet Chebet Koros

Theses & Dissertations

Background: Fibromyalgia Syndrome is a rheumatic disorder characterized by chronic widespread musculoskeletal pain accompanied by fatigue, sleep, memory problems, and mood disturbances. Little is known about the characteristics of fibromyalgia patients in Kenya. Studies done elsewhere have shown that patients with fibromyalgia syndrome incur more healthcare costs, have a higher prevalence of comorbidities, have more workdays missed, have poor productivity, retire early, have impaired function, and lead a poorer quality of life.

Methods: This study was a prospective cross-sectional study that enrolled patients diagnosed with fibromyalgia syndrome attending the rheumatology clinic at the Aga Khan University Hospital Nairobi, …

Outcomes Of Cardiac Surgery At The Aga Khan University Hospital Nairobi – A One Year Review, Nelly Joseph Kahamba

Theses & Dissertations

Background: Cardiovascular diseases are the number one cause of death worldwide where an estimated 17.9 million people die yearly, according to WHO. Most of this disease burden lies in the low and middle-income countries. Management of cardiovascular diseases can be medical and/or surgical. Open heart surgery is one among the major surgeries performed worldwide. It is well established in high income countries where up to 200,000 cardiac surgeries can be performed yearly. In low-income countries particularly sub-Saharan Africa where most of the disease burden is, there are about 22 centres that cater to this growing need for cardiac surgery. There …

Bleeding Complications In Patients On New Oral Anticoagulants For Venous Thromboembolism In Kenya, Antonina Zebby Obayo

Theses & Dissertations

Background: The past five years have seen an increase in the use of new oral anticoagulants (NOACS) for treatment and prophylaxis against venous thromboembolism. These agents are as effective as warfarin, with much fewer bleeding complications. The incidence of bleeding complications in patients with venous thromboembolism on NOACS (New oral anticoagulants) has not been widely studied in Africa's contemporary practice. The purpose of this study is to determine the rates of major bleeding and clinically relevant non-major bleeding (CRNM) associated with new oral anticoagulant use in daily contemporary clinical practice.

Methods: A retrospective review of adult patients diagnosed with venous …

Prevalence Of Depression And Factors Associated With Depressive Symptoms Among Patients Diagnosed With Benign Prostatic Enlargement At Aga Khan University Hospital, Nairobi, Husni Abdalla

Theses & Dissertations

Background: There is a relationship between Benign Prostatic Enlargement (BPE) and Lower Urinary Tract Symptoms (LUTS). The persistence of LUTS can negatively affect the quality of living by interrupting daily activities. Depressive symptoms occur commonly in patients with BPE. Depression is a taboo subject in Africa, and Kenya is no exception. Depression at its worst can lead to suicide. Thus, it is of great importance to recognise the factors associated with depressive symptoms in patients with BPE and hence reinforce the need to assess depression in patients with BPE in our clinical practice.

Objective: This study sought to …

Comparison Of Ajcc 7th Edition (Anatomic) Vs Ajcc 8th Edition (Prognostic) Staging Systems For Breast Cancer, Issack Mohamed Abdi

Theses & Dissertations

Background; Staging is key for the appropriate management of breast cancer. It is based upon the size of tumour, status of lymph nodes and the presence or absence of distant metastasis, to provide an overall estimate of tumour burden. In its latest (8th) edition, the American Joint Committee on Cancer (AJCC) made a radical change in staging, creating a new prognostic staging system for breast cancer by adding biological factors to the purely anatomical based staging system of the prior editions.

Study Objectives; This study aimed to retrospectively evaluate the changes in staging between the AJCC 7th (anatomic) and AJCC …

The Requirements Of Immunosuppressive Therapy And Clinical Features In Patients With Myasthenia Gravis Who Undergo Thymectomy Versus Non Thymectomy Management In East Africa, Nyawara Anthony Ochola

Theses & Dissertations

Background: Myasthenia gravis is an acquired autoimmune neuromuscular disease leading to fatigability of skeletal muscles. The thymus produces autoantibodies that target receptors to Acetylcholine or Muscle Specific Kinase. The resultant fatigability is generalized or limited to the ocular or bulbar muscles. Therapy has been targeted to reduce the autoimmune process by use of immunosuppressive agents or by thymectomy. In the African population, MG involves younger patients, more ocular involvement, is more aggressive and more resistance to immunosuppressive therapy.

Methods: We conducted a retrospective study between January 2009 and December 2019 at Aga Khan University Hospital, Nairobi. Medical records of patients …

Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise For The Assessment Of Fluid Responsiveness In Non-Intubated Spontaneously Breathing Septic Patients, Anne-Marie Githaiga

Theses & Dissertations

Background: Sepsis can cause deleterious organ deterioration due to deranged patient’s response to infection. Rapid fluid loading at diagnosis is part of standard treatment. While inadequate fluid administration may lead to tissue hypoperfusion and organ failure, excessive fluid administration may cause fluid overload and pulmonary oedema. Predictive tools of fluid responsiveness are therefore required to guide fluid resuscitation. The Passive Leg Raise (PLR) manoeuvre can predict fluid responsiveness in non-intubated patients with sepsis-induced hypotension but is challenging to perform in clinical practice. The Inferior Vena Cava Collapsibility Index (IVCCI) on the other hand is a non-invasive test that can be …

Uptake And Determinants Of Cervical Cancer Screening Among Health Care Workers In Aga Khan University Hospital, Nairobi Kenya., Doreen Moraa Osoro

Theses & Dissertations

Background: The cancer burden has been rising globally. The reported incidence of cervical cancer is 13.1 / 100,000 globally and 40 / 100,000 in Kenya. Up to 88% of all cervical cancer deaths have been reported in lower to middle-income countries. In comparison, developed countries had up to two to four times lower rates of cervical cancer incidence and mortality. The burden of cancers attributable to carcinogenic infections has potentially modifiable risk factors, for which prevention tools already exist. There is a gap in the implementation of evidence-based interventions including primary prevention with the HPV vaccine and secondary prevention with …

Assessment Of Palliative Care Needs In A Kenyan Intensive Care Unit Based On A Trigger-Based Model., Linda Atero Barasa

Theses & Dissertations

Background: Palliative care triggers have been used in the Intensive Care Unit (ICU) setting, usually in high-income countries, to identify patients who may benefit from palliative care consults. The utility and benefits of palliative care triggers in the ICU have not been previously studied in sub-Saharan Africa.

Objectives: The primary objective of this study was to estimate the prevalence of ICU admissions who meet the criteria for one or more palliative care triggers. The secondary objectives were to determine an association between palliative care consults and length of ICU stay, mortality, and time to formal change of goals of care …

Determining The Disability Status Of Adult Patients Post General Intensive Care Unit (Icu) Discharge At The Aga Khan University Hospital, Nairobi Using The World Health Organization Disability Assessment Schedule 2.0(Whodas)., Khadija Ahmed

Theses & Dissertations

Background: Critical care has evolved throughout the years since the polio outbreak when the first ICU was set up in the USA. There is an increasing number of survivors of critical illness. The survivors have been shown to have prolonged physical, cognitive, and psychological impairments. There is no current information on the status of this patient post-ICU in Africa.

Objectives: To measure the disability status of adult patients post general Intensive Care Unit (ICU) Discharge Using WHODAS 2.0.To determine the factors associated with the degree of disability.

Methodology: This was a cross-sectional analytical study. Patients admitted to AKUHN ICU, were …

The Effectiveness Of Digital Health Interventions For Weight Loss In Postpartum Women: A Systematic Review And Meta-Analysis, Logan Rabuogi

Theses & Dissertations

Objectives: This systematic review and meta-analysis aimed (1) to determine the effectiveness of digital health intervention (DHI) components on weight loss in postpartum women, (2) to determine the effect of DHIs on body mass index and (3) to determine the attrition rates within DHIs.

Methods: Electronic searches were conducted on PubMed (MEDLINE), Cochrane Library, Google Scholar, and Web of Science from inception to 22nd April 2020. Studies included were; (1) randomized controlled trials (RCT), quasi-experimental trials, and controlled before-after studies (2) of weight loss interventions delivered by either website, Internet, email, computer, Apps, SMS, phone call, or video player (3) …

Radiographic Patterns Of Different Aetiologies Of Community Acquired Pneumonia In Patients Presenting To Aga Khan University, Hanika Ajaykumar Patel

Theses & Dissertations

Background: Community-acquired pneumonia (CAP) is a major cause of significant morbidity and mortality globally. The spectrum of causative organisms of CAP varies markedly with region as well as with the immune status of the patient. Chest radiography remains an important initial imaging modality in the diagnostic work-up of patients with CAP. Although previous studies have highlighted major trends and radiographic patterns of various causative organisms of CAP, there is a paucity of recent literature within Sub-Saharan Africa on these various radiographic patterns.

Objective: The primary objective of this study was to identify the association between the radiographic patterns of different …

Planned Delivery At 37 Weeks Gestation Versus Expectant Management For Non-Severe Chronic Hypertension, A Systematic Review., Jackson Njuguna

Theses & Dissertations

Background: Chronic hypertension is independently associated with an increased incidence of adverse maternal and perinatal outcomes. Delayed delivery carries maternal risks, while early delivery increases fetal risk, so appropriate timing is important. The optimal timing of delivery for women with this condition has not been adequately addressed by the available literature.

Objective: To review the literature that assesses the benefits and risks of a policy of planned delivery versus expectant management in pregnant women with non-severe chronic hypertension at 37 weeks gestation. Our primary outcomes were composite maternal outcome (super-imposed pre-eclampsia, placental abruption, maternal admission to intensive care unit and …

Association Of Helicobacter Pylori Caga And Vaca Genotypes With Gastric Adenocarcinoma In Kenya, Priscilla Waithira Njenga

Theses & Dissertations

Background: Helicobacter pylori infects approximately half of the world’s population. The main virulence factors, CagA and VacA, are associated with chronic gastritis and cancer. Notable geographic and temporal variations in the prevalence and genotypes of H. pylori in relation to gastric pathologies have been observed, however, their significance and trends in African populations is scantly described. The aim of this study was to investigate the association of H. pylori and its respective CagA and VacA genotypes with gastric adenocarcinoma and to describe the trends of H. pylori genotypes over the last 8 years (2012-2019).

Materials and Methods: A total of …

Prevalence And Severity Of Malnutrition In People Living With Hiv On Chronic Haemodialysis In Dar Es Salaam., Hanifa Mbithe

Theses & Dissertations

BACKGROUND: Human immunodeficiency virus is still a global burden more so in sub-Saharan Africa. Chronic kidney disease and end-stage renal disease are important comorbid conditions that are prevalent in HIV-infected individuals. Patients who are HIV positive and on hemodialysis have triple risk factors for development of malnutrition (i.e. Human immunodeficiency virus, chronic kidney disease, and haemodialysis). Malnutrition greatly impacts these patient’s morbidity and mortality and thus the great need to address this gap which will improve their prognosis.

OBJECTIVE: The objective of the study was to assess the prevalence and severity of malnutrition in people living with HIV on chronic …