Medical Specialties Commons^™

Child Road Traffic Crash Injuries At The Red Cross War Memorial Children’S Hospital In Cape Town South Africa In 1992, 2002 And 2012, Isaac Kihurani, Ashley Van Niekerk, Arjan Bastiaan Van As

Paediatrics and Child Health, East Africa

Road traffic crashes are a significant cause of the disease burden among children, with the highest mortality in low- and middle-income countries. This observational study explores such injuries in Cape Town, South Africa through an analysis of data for cases in 1992, 2002 and 2012 at the Red Cross War Memorial Children's Hospital, a referral paediatric hospital for children younger than 13 years. Descriptive and time trend analysis of demographic data as well as of the causes, severity and place of injury was conducted. Logistic regression and generalised linear models described factors influencing hospital admission. In the years 1992, 2002 …

Characterisation Of The Vaginal Microflora Of Human Immunodeficiency Virus (Hiv) Positive And Negative Women In A Sub-Urban Population Of Kenya, Teresa N. Kiama, Rita Verhelst, Paul M. Mbugua, Mario Vaneechoutte, Hans Verstraelen, Benson Estambale, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Lactobacilli predominate normal vaginal microflora and are important in maintenance of vaginal health. The current study set out to identify and compare culture isolates of vaginal microflora of human immunodeficiency virus (HIV) positive (HIV+ ) and HIV negative (HIV- ) women at different phases during menstrual cycle from a sub-urban population of Kenya. Seventy four (74) women, 41 HIV+ and 33 HIV- , followed up two consecutive menstrual cycles, had high vaginal swabs taken to prepare Gram stains for six visits and anaerobic cultures for four. All 751 isolates identified by t-DNA polymerase chain reaction (PCR) belong to 51 species. …

Identifying Factors Associated With The Uptake Of Prevention Of Mother To Child Hiv Transmission Programme In Tigray Region, Ethiopia: A Multilevel Modeling Approach, Wondwossen Lerebo, Steven Callens, Debra Jackson, Christina Zarowsky, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Prevention of mother to child HIV transmission (PMTCT) remains a challenge in low and middle-income countries. Determinants of utilization occur – and often interact - at both individual and community levels, but most studies do not address how determinants interact across levels. Multilevel models allow for the importance of both groups and individuals in understanding health outcomes and provide one way to link the traditionally distinct ecological- and individual-level studies. This study examined individual and community level determinants of mother and child receiving PMTCT services in Tigray region, Ethiopia.

Methods: A multistage probability sampling method was used for this …

Pediatric Cerebral Palsy In Africa: A Systematic Review, Kirsten A. Donald, Pauline Samia, Angelina Kakooza-Mwesige, David Bearden

Paediatrics and Child Health, East Africa

Cerebral palsy is a common neurologic problem in children and is reported as occurring in approximately 2-2.5 of 1000 live births globally. As is the case with many pediatric neurologic conditions, very little has been reported on this condition in the African context. Resource-limited settings such as those found across the continent are likely to result in a different spectrum of etiologies, prevalence, severity as well as management approaches. This review aims to establish what has been reported on this condition from the African continent so as to better define key clinical and research questions.

A History Of Abuse And Operative Delivery - Results From A European Multi-Country Cohort Study, Berit Schei, Mirjam Lukasse, Elsa Lena Ryding, Jacquelyn Campbell, Helle Karro, Hildur Kristjansdottir, Made Laanpere, Anne-Mette Schroll, Ann Tabor, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objective: The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult.

Design: The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as …

International Standards For Early Fetal Size And Pregnancy Dating Based On Ultrasound Measurement Of Crown–Rump Length In The First Trimester Of Pregnancy, A. T. Papageorghiou, S. H. Kennedy, L. J. Salomon, E. O. Ohuma, L. Cheikh Ismail, F. C. Barros, A. Lambert, Maria Carvalho, Y. A. Jaffer, E. Bertino, M. G. Gravett, D. G. Altman, M. Purwar, J. A. Noble, R. Pang, C. G. Victora, Z. A. Bhutta, J. Villar

Obstetrics and Gynaecology, East Africa

Objectives: There are no international standards for relating fetal crown–rump length (CRL) to gestational age (GA), and most existing charts have considerable methodological limitations. The INTERGROWTH-21^st Project aimed to produce the first international standards for early fetal size and ultrasound dating of pregnancy based on CRL measurement.

Methods: Urban areas in eight geographically diverse countries that met strict eligibility criteria were selected for the prospective, population-based recruitment, between 9 + 0 and 13 + 6 weeks' gestation, of healthy well-nourished women with singleton pregnancies at low risk of fetal growth impairment. GA was calculated on the basis of a …

Rwandan Young People’S Perceptions On Sexuality And Relationships: Results From A Qualitative Study Using The ‘Mailbox Technique’, Kristien Michielsen, Pieter Remes, John Rugabo, Ronan Van Rossem, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

This study aimed to gain more insight into young Rwandans’ perceptions on sex and relationships, which is essential for formulating effective sexual and reproductive health (SRH) promotion interventions. Using a ‘mailbox technique’, this paper studies the spontaneous thoughts of Rwandan young people on sexuality. Mailboxes were installed in five secondary schools in the Bugesera district and students were invited to write about their ideas, secrets, wishes, desires and fears on sexuality and relationships. Of the 186 letters collected, 154 addressed SRH topics. The letters were analysed in NVivo 9 using a theoretical model on vulnerability. Two stereotypical sexual interactions co-exist: …

Sexual Violence And Sub-Saharan Migrants In Morocco: A Community-Based Participatory Assessment Using Respondent Driven Sampling, Ines Keygnaert, Abdessamad Dialmy, Altay Manço, Jeroen Keygnaert, Nicole Vettenburg, Kristien Roelens, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: The European Union contracted Morocco to regulate migration from so-called “transit migrants” from Morocco to Europe via the European Neighbourhood Policy. Yet, international organisations signal that human, asylum and refugee rights are not upheld in Morocco and that many sub-Saharan migrants suffer from ill-health and violence. Hence, our study aimed at 1) investigating the nature of violence that sub-Saharan migrants experience around and in Morocco, 2) assessing which determinants they perceive as decisive and 3) formulating prevention recommendations.

Methods: Applying Community-Based Participatory Research, we trained twelve sub-Saharan migrants as Community Researchers to conduct in-depth interviews with peers, using Respondent …

Knowledge, Attitudes And Practices Of Parents Regarding Antibiotic Use In Children, Saad Siddiqui, Mubeen Sultan Cheema, Romana Ayub, Noreen Shah, Ameer Hamza, Sheraz Hussain, Muhammad Hamza Khan, Syed Musa Raza

Department of Radiology

Background: Emerging resistance to antimicrobial chemotherapy is becoming a challenge for medicine in recent times. Un-prescribed use of antibiotics is a major contributor to development of this problem. In Pakistan access to antibiotics remains unchecked and hence results in it are over use. The aim of this study was to assess knowledge of parents regarding use of antibiotics, its associated problems, their source of information and their expectations from Paediatricians for prescription of anti-biotics.Methods: This is a questionnaire based cross sectional study conducted in Hayatabad town, District Peshawar. Parents who were consenting, had children aged between 0-16 years, and were …

Toward The Development Of The International Classification Of Functioning Core Sets For Children With Cerebral Palsy: A Global Expert Survey, Veronica Schiariti, Louise C. Masse, Alarcos Cieza, Anne F. Klassen, Karen Sauve, Robert Armstrong, Maureen O’Donnell

Paediatrics and Child Health, East Africa

The goal of the International Classification of Functioning is to standardize the classification of health and function of children around the world. To facilitate the application of this classification, International Classification of Functioning-based tools like the "Core Sets" are being developed. We conducted an international survey of professional experts to identify the most relevant areas of functioning in children with cerebral palsy. The questionnaire covered each component of the classification. In total, 193 professionals completed the survey (response rate 78%). Overall, 9706 answers were linked to the classification (pediatric version) by 2 professionals. From the experts' perspective, movement-related areas and …

Immunization Manual For Medical And Nursing Students ''Hepatitis B Disease'', Rose Kamenwa

Paediatrics and Child Health, East Africa

Approximately 350 – 400 million people worldwide are chronically infected with the hepatitis B virus (HBV ), and approximately 1 million die annually of HBV -related disease. The worldwide prevalence of hepatitis B virus ranges from 0.1% to 20%). This wide range is largely due to differences in age at the time of infection. Following acute HBV infection, the risk of developing chronic infection varies inversely with age: 90% for perinatal infection, 25–35% for infection at age 1–5 years and less than 10% for adults. About 45% of the world population live in areas where chronic HBV is highly endemic …

Models Of Care For Orphaned And Separated Children And Upholding Children's Rights: Cross-Sectional Evidence From Western Kenya, Lonnie Embleton, David Ayuku, Allan Kamanda, Lukoye Atwoli, Samuel Ayaya, Rachel Vreeman, Winstone Nyandiko, Peter Gisore, Julius Koech, Paula Braitstein

Paediatrics and Child Health, East Africa

Background: Sub-Saharan Africa is home to approximately 55 million orphaned children. The growing orphan crisis has overwhelmed many communities and has weakened the ability of extended families to meet traditional care-taking expectations. Other models of care and support have emerged in sub-Saharan Africa to address the growing orphan crisis, yet there is a lack of information on these models available in the literature. We applied a human rights framework using the United Nations Convention on the Rights of the Child to understand what extent children's basic human rights were being upheld in institutional vs. community- or family-based care settings in …

Association Between Parity And Rubella Seropositivity Among Older Reproductive-Age Women, Ibtisam Salim Awadh

Master of Medicine in Obstetrics and Gynecology

Background: Rubella virus when it infects a non-pregnant adult or child usually causes a mild febrile rash illness. However, infection in the first 12 weeks of pregnancy causes miscarriages, stillbirths or foetal anomalies known as congenital rubella syndrome (CRS). Factors associated with rubella immunity include age and parity. No studies have been done to isolate the association of parity independent of age. Objectives: To determine the seroprevalence of rubella IgG antibodies among nulliparous and multiparous women of the same age-group attending various clinics in Aga Khan University Hospital, Nairobi, Design: A cross-sectional study of women attending a tertiary hospital, Nairobi, …

Heart Valve Surgery: Euroscore Vs. Euroscore Ii Vs. Society Of Thoracic Surgeons Score, Muhammad Sharoz Rabbani, Irfan Qadir, Yasir Ahmed, Marrium Gul, Hasanat Sharif

Section of Cardiothoracic Surgery

Background: This is a validation study comparing the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II with the previous additive (AES) and logistic EuroSCORE (LES) and the Society of Thoracic Surgeons' (STS) risk prediction algorithm, for patients undergoing valve replacement with or without bypass in Pakistan.PATIENTS AND Methods: Clinical data of 576 patients undergoing valve replacement surgery between 2006 and 2013 were retrospectively collected and individual expected risks of death were calculated by all four risk prediction algorithms. Performance of these risk algorithms was evaluated in terms of discrimination and calibration.Results: There were 28 deaths (4.8%) among 576 patients, …

Neurosurgery Literature Highlights & Psychiatry Literature Highlights, Muhammad Waqas Shaiq, Muhammad Shahzad Shamim

Pakistan Journal of Neurological Sciences (PJNS)

Today, a great challenge of our profession is to envision how we will deliver exemplary neurosurgical care in the future. To accomplish this requires anticipating how economic, political, and societal influences will affect our ability to provide the highest quality of patient care in an arena that will look increasingly different from today's world of medicine. Already, our profession is battling a relentless assault as numerous sectors implement change that impacts us and our community every day. Surviving this requires an effective strategy that will involve significant cultural change.

Functional And Clinical Outcome Of Ileal (Studer) Neo-Bladder Reconstruction: Single Centre Experience From Pakistan, Syed M. Nazim, Muhammad Hammad Ather, Farhat Abbas

Section of Urology

Objective: To determine the medium and long-term outcome of orthotopic continent urinary diversion with ileal (Studer) neo-bladder following radical cystectomy. Study Design: Case series.
Place and Duration of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1998 to September 2010.
Methodology: Thirty eight patients underwent radical cystectomy for invasive bladder tumor with ileal neo-bladder (Studer type) reconstruction. Peri-operative and late complications, functional outcome of neo-bladder, urinary continence, metabolic and upper urinary tract status and overall survival were evaluated in all patients.
Results: A total of 29 patients (23 males and 6 females) with mean age of …

Lifelong Learning: Established Concepts And Evolving Values, Jamsheer J Jehangir Talati Professor

Section of Urology

Objective: To summarise the concepts critical for understanding the content and value of lifelong learning (LL).
Methods: Ideas generated by personal experience were combined with those of philosophers, social scientists, educational institutions, governments and UNESCO, to facilitate an understanding of the importance of the basic concepts of LL.
Results: Autopoietic, continuous, self-determined, informal, vicarious, biographical, lifelong reflexive learning, from and for society, when supported by self-chosen formal courses, can build capacities and portable skills that allow useful responses to challenges and society’s new structures of governance. The need for LL is driven by challenges. LL flows continuously in pursuit of …

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 …