Medicine and Health Sciences Commons^™

Screening Utility And Acceptability Of The Kiswahili-Pgals (Paediatric Gait, Arms, Legs, Spine) At A Tertiary Referral Hospital In Kenya-A Diagnostic Accuracy Study, Jacqueline Kawishe, Anthony Ngugi, Stanley Luchters, Helen Foster, Angela Migowa

Paediatrics and Child Health, East Africa

Background:Paediatric rheumatic diseases cause considerable disease burden to children and their families (Moorthy LN, Peterson MGE, Hassett AL, et al, Pediatric Rheumatology 8:20, 2010). Delayed diagnosis is a signifcant determinant of severity and mortality attributed to these conditions (Foster HE, Eltringham MS, Kay LJ, et al, Arthritis Care Res 57(6):921-7, 2007). pGALS is a simple clinical tool used to assess joints and identify musculoskeletal (MSK) conditions in school-going children to enable early referral to paediatric rheumatologists.

Objectives: This study aimed to translate and determine the diagnostic accuracy and acceptability of a Kiswahili version of the pGALS screening tool among …

Risk Factors For Seizure Recurrence After Initial Withdrawal Of Anti-Seizure Medications In Children With Epilepsy At Aga Khan University Hospital, Nairobi, Kenya, Nicholas Odero, Katherine Oyieke, Sanson Gwer, Pauline Samia

Paediatrics and Child Health, East Africa

Objectives: We sought to determine risk factors associated with seizure recurrence following initial withdrawal of anti-seizure medications (ASM) among children with epilepsy.

Methods: This was a retrospective observational study of children aged between 2 and 18 years with a diagnosis of epilepsy who underwent withdrawal of anti-seizure medication following remission of seizures. All eligible medical records between January 2011 and December 2019 were included. Demographic, clinical, imaging and electroencephalography data of all eligible patients were analyzed against seizure remission within 24 months after withdrawal of ASM, using appropriate parametric and non-parametric tests.

Results: A total of 49 …

Prevalence Of Non-Alcoholic Fatty Liver Disease In Overweight And Obese Children Seeking Ambulatory Healthcare In Nairobi, Kenya, Anne Njeri Mburu, Ahmed Laving, William Macharia, Joyce Sande

Paediatrics and Child Health, East Africa

Background While linked to obesity and associated with an increased cardiovascular morbidity, non-alcoholic fatty liver disease (NAFLD) is an often-asymptomatic cause of chronic liver disease in children. Early detection provides opportunity for interventions to curb progression. Childhood obesity is on the rise in low/middle-income countries, but cause-specific mortality data associated with liver disease are scanty. Establishing the prevalence of NAFLD in overweight and obese Kenyan children would guide in public health policies aimed at early screening and intervention.

Objectives To investigate prevalence of NAFLD in overweight and obese children aged 6–18 years using liver ultrasonography.

Methodology This was a cross-sectional …

Acute Kidney Injury In Hospitalized Children With Sickle Cell Anemia, Anthony Batte, Sahit Menon, John Ssenkusu, Sarah Kiguli, Robert Kalyesubula, Joseph Lubega, Edrisa Ibrahim Mutebi, Robert Opoka, Chandy John, Michelle Starr

Paediatrics and Child Health, East Africa

Background: Children with sickle cell anemia (SCA) are at increased risk of acute kidney injury (AKI) that may lead to death or chronic kidney disease. This study evaluated AKI prevalence and risk factors in children with SCA hospitalized with a vaso-occlusive crisis (VOC) in a low-resource setting. Further, we evaluated whether modifcations to the Kidney Disease: Improving Global Outcomes (KDIGO) defnition would infuence clinical outcomes of AKI in children with SCA hospitalized with a VOC.

Methods: We prospectively enrolled 185 children from 2 – 18 years of age with SCA (Hemoglobin SS) hospitalized with a VOC at a tertiary hospital …

Blackwater Fever And Acute Kidney Injury In Children Hospitalized With An Acute Febrile Illness: Pathophysiology And Prognostic Significance, Andrea Conroy, Michael Hawkes, Aleksandra Leligdowicz, Ivan Mufumba, Michelle Starr, Kathleen Zhong, Sophie Namasopo, Robert Opoka, Chandy John, Kevin C. Kain

Paediatrics and Child Health, East Africa

Background: Acute kidney injury (AKI) and blackwater fever (BWF) are related but distinct renal complications of acute febrile illness in East Africa. The pathogenesis and prognostic signifcance of BWF and AKI are not well understood.

Methods: A prospective observational cohort study was conducted to evaluate the association between BWF and AKI in children hospitalized with an acute febrile illness. Secondary objectives were to examine the association of AKI and BWF with (i) host response biomarkers and (ii) mortality. AKI was defned using the Kidney Disease: Improving Global Outcomes criteria and BWF was based on parental report of tea-colored urine. Host …

Qualitative Exploration Of Feasibility And Acceptability Of The Modified Atkins Diet Therapy For Children With Drug Resistant Epilepsy In Kenya, Pauline Samia, Violet Naanyu, J. Helen Cross, Richard Idro, Paul Boon, Jo Wilmshurst, Stanley Luchters

Paediatrics and Child Health, East Africa

Purpose: Approximately one-third of children with epilepsy have clinical syndromes characterized by drug resistance. Modified Atkins dietary therapy (MADT) can reduce seizures and improve health out- comes for these children. This intervention is yet to be consistently offered as standard of care in sub- Saharan Africa.

Objectives: This study aimed to assess feasibility and acceptability of MADT for children with drug- resistant epilepsy and identify enabling strategies for implementation and adherence to the MADT. Methods: This qualitative inquiry utilized in-depth interviews with purposively selected caregivers and adolescent patients having used MADT for drug-resistant epilepsy. A qualified team consisting …

Clinical Characteristics Of Children With Epilepsy Managed At An Urban Hospital In Africa: A Retrospective Study, Pauline Samia, Arwen Barr, Subira B. Levi, Kirsten A. Donald, Jo M. Wilmshurst, Charles R. Newton

Paediatrics and Child Health, East Africa

Background: Most children with epilepsy reside in resource-limited regions such as sub-Saharan Africa, where the majority of studies have been conducted in rural areas with limited investigations. Medical records from children with epilepsy seen at an urban hospital in Kenya were examined to provide a comprehensive description of epilepsy in children from this hospital.
Methods: A retrospective observational study was conducted which involved reviewing medical records of 426 epilepsy patients (260 males and 166 females) aged 0 - 18 years, seen in Nairobi, Kenya between February 2011 and December 2014. Results: The most frequent age at presentation; documented in 29% …

Epilepsy Diagnosis And Management Of Children In Kenya: Review Of Current Literature, Pauline Samia, Jane Hassell, Jessica-Anne Hudson, Symon M. Kariuki, Charles R. Newton, Jo M. Wilmshurst

Paediatrics and Child Health, East Africa

Introduction: The growing impact of non-communicable diseases in low- to middle-income countries makes epilepsy a key research priority. We evaluated peer-reviewed published literature on childhood epilepsy specific to Kenya to identify knowledge gaps and inform future priorities.

Methodology: A literature search utilizing the terms “epilepsy” OR “seizure” as exploded subject headings AND “Kenya” was conducted. Relevant databases were searched, generating 908 articles. After initial screening to remove duplications, irrelevant articles, and publications older than 15 years, 154 papers remained for full-article review, which identified 35 publications containing relevant information. Data were extracted from these reports on epidemiology, etiology, clinical features, …

Serum Procalcitonin Levels In Children With Clinical Syndromes For Targeting Antibiotic Use At An Emergency Department Of A Kenyan Hospital, Samuel Akech, Doris Kinuthia, William Macharia

Paediatrics and Child Health, East Africa

Serum procalcitonin (PCT) was measured in 228 children aged 1 month to 15 years at an emergency department of a hospital located in an area without local malaria transmission in children with suspected infections; 21% (49) children had a clinical syndrome for suspected bacterial infections (Syndrome+ve). In children with Syndrome+ve criteria, 27/49 (55.1%) had PCT ≥0.5 µg/l but only 59/179 (32.9%) of those Syndrome-ve had abnormal PCT, χ2 = 8.0, p = 0.005; positive likelihood ratio = 2.0 [95% confidence interval (CI) 1.2-3.3]; negative likelihood ratio = 0.8 (95% CI 0.7-1.0). In patients with pneumonia, 9/15 (60%) with severe pneumonia …

Children’S Oxygen Administration Strategies Trial (Coast): A Randomised Controlled Trial Of High Flow Versus Oxygen Versus Control In African Children With Severe Pneumonia, Kathryn Maitland, Sarah Kiguli, Robert Opoka, Peter Olupot-Olupot, Charles Engoru, Patricia Njuguna, Victor Bandika, Ayub Mpoya, Andrew Bush, Thomas Williams

Paediatrics and Child Health, East Africa

Background: In Africa, the clinical syndrome of pneumonia remains the leading cause of morbidity and mortality in children in the post-neonatal period. This represents a significant burden on in-patient services. The targeted use of oxygen and simple, non-invasive methods of respiratory support may be a highly cost-effective means of improving outcome, but the optimal oxygen saturation threshold that results in benefit and the best strategy for delivery are yet to be tested in adequately powered randomised controlled trials. There is, however, an accumulating literature about the harms of oxygen therapy across a range of acute and emergency situations that …

Children’S Oxygen Administration Strategies Trial (Coast): A Randomised Controlled Trial Of High Flow Versus Oxygen Versus Control In African Children With Severe Pneumonia., Kathryn Maitland, Sarah Kiguli, Robert Opoka, Peter Olupot-Olupot, Charles Engoru, Patricia Njuguna, Victor Bandika, Ayub Mpoya, Andrew Bush, Thomas Williams

Paediatrics and Child Health, East Africa

Background: In Africa, the clinical syndrome of pneumonia remains the leading cause of morbidity and mortality in children in the post-neonatal period. This represents a significant burden on in-patient services. The targeted use of oxygen and simple, non-invasive methods of respiratory support may be a highly cost-effective means of improving outcome, but the optimal oxygen saturation threshold that results in benefit and the best strategy for delivery are yet to be tested in adequately powered randomised controlled trials. There is, however, an accumulating literature about the harms of oxygen therapy across a range of acute and emergency situations that have …

Randomised Double Blind Study To Compare Effectiveness Of Honey, Salbutamol And Placebo In Treatment Of Cough In Children With Common Cold, Adil Waris, William Macharia, E. K. Njeru, F. Essajee

Paediatrics and Child Health, East Africa

Background: Acute upper respiratory infection is the most common childhood illness and presents with cough, coryza and fever. Available evidence suggests that cough medicines may be no more effective than honey-based cough remedies.

Objective: To compare effectiveness of honey, salbutamol and placebo in the treatment of cough in children with acute onset cough.

Design: Randomised control trial

Setting: Aga Khan University Hospital Paediatric Casualty

Subjects: Children between ages one to twelve years presenting with a common cold between December 2010 and February 2012 were enrolled.

Outcome measures: Frequency, severity and extent to which cough bothered and disturbed child and parental …

Better Drug Therapy For The Children Of Africa: Current Impediments To Success And Potential Strategies For Improvement, Stuart M. Macleod, Janet K. Finch, William Macharia, Gabriel M. Anabwani

Paediatrics and Child Health, East Africa

A commentary is presented on the urgent need for a comprehensive effort to improve the practice of pediatric therapeutics in Africa. A call for action is addressed to a variety of practitioners internationally, many of whom possess skills that could be fruitfully applied to the improvement of health outcomes for African children. Successful engagement with the many challenges requires the complementary effort of researchers in basic and clinical pharmacology and toxicology, nurses, pharmacists, physicians, clinical pharmacologists, clinical pharmacists, and political leaders and civil servants. While a comprehensive or systematic review of the relevant literature has not been attempted, the authors …

Disclosure Of Hiv Status To Children In Resource-Limited Settings: A Systematic Review, Rachel C. Vreeman, Anna Maria Gramelspacher, Peter Gisore, Michael L. Scanlon, Winstone M. Nyandiko

Paediatrics and Child Health, East Africa

Introduction: Informing children of their own HIV status is an important aspect of long-term disease management, yet there is little evidence of how and when this type of disclosure takes place in resource-limited settings and its impact.

Methods: MEDLINE, EMBASE and Cochrane Databases were searched for the terms hiv AND disclos* AND (child* OR adolesc*). We reviewed 934 article citations and the references of relevant articles to find articles describing disclosure to children and adolescents in resource-limited settings. Data were extracted regarding prevalence of disclosure, factors influencing disclosure, process of disclosure and impact of disclosure on children and caregivers.

Results: …

Influence Of Perceived Racial Discrimination On Health And Behaviour Of Immigrant Children In British Columbia, Anne George, Cherylynn Bassani, Robert Armstrong

Paediatrics and Child Health, East Africa

This study examines the influence of perceived discrimination on the health and behaviour of ethnic minority immigrant children in British Columbia, Canada. Using data from the New Canadian Children and Youth Study, we examine perceived discrimination experienced by the parent, family, and cultural group in Canada to test the influence of micro-, meso-, and macrolevels of discrimination on children. Families from 6 ethnic backgrounds participated in the study. Parents’ perceptions of the child’s health and six behavioral scales (hyperactivity, prosocial behaviour, emotional problems, aggression, indirect aggression, and a general combined behaviour scale) were examined as outcome variables. After controlling for …

Short Term Clinical Outcome Of Children With Rotavirus Infection At Kenyatta National Hospital, Nairobi, Bonface Osano, Rose Kamenwa, D. Wamalwa, J. K. Wang'ombe

Paediatrics and Child Health, East Africa

Background: Rotavirus infection is the single most common cause of acute gastroenteritis in children under five years of age. Rotavirus gastroenteritis has a high morbidity and mortality in children in Kenya.

Objectives: To determine the short term clinical outcome for children admitted to Kenyatta National Hospital with rotavirus gastroenteritis and the correlates of poor outcome.

Design: Short longitudinal survey. Setting: Kenyatta National Hospital from February to May 2008.

Subjects: Five hundred children were screened using a rapid antigen detection kit and ELISA. Results: Of the 191 children who tested positive for rotavirus in stool; 172 children were recruited into the …

Outcome And Haemato-Toxicity Of Two Chemotherapy Regimens For Childhood Non-Hodgkin's Lymphoma In A Kenyan Hospital, William Macharia

Paediatrics and Child Health, East Africa

Background: Effectiveness and toxicity of childhood cancer treatments have never been evaluated in Kenya since introduction of structured care in the early seventies.

Objective:To evaluate effectiveness and toxicity of two treatment protocols for Non- Hodgkin’s lymphoma (NHL).

Design: Historical cohort study using medical records.

Setting: Kenyatta National Hospital, a tertiary care and medical teaching hospital.

Subjects: Children ≤ 15 years with diagnosis of non-Hodgkin’s Lymphoma.

Main outcome measures: Primary outcomes were median survival, event free survival and toxicity.

Results: Out of 101 records, only 26 (25.7%) met inclusion criteria. Baseline characteristics were similar in the two treatment arms. …