Family Medicine Commons^™

"I Can See Where This Is Taking Me": Medical Students' Perceptions Of Humanities Courses At Aga Khan University, Kenya, Catherine Gathu, Marthaclaire Zammit, Urvi Saboo, Robert Opoka

Family Medicine, East Africa

Background Humanities courses in medical training are increasingly recognized as essential for developing empathetic, reflective and socially responsive physicians. Although well-established globally, their integration into medical education in African contexts remains limited. In Kenya, humanities are often peripheral within curricula dominated by biomedical sciences and clinical medicine. Aga Khan University (AKU), Nairobi, has introduced a novel medical curriculum that embeds seven core humanities courses as central components of the initial phase of its MBChB program. This study explored students’ perceptions and lived experiences of these humanities courses.

Methods A retrospective descriptive study using an embedded mixed-methods design was conducted among …

Participant Recruitment, Baseline Characteristics And Burden Of Cardiometabolic Risk Markers Among Adults With Prediabetes In Kenya: Insights From The Fermented Foods And Prediabetes Study, Rosebella Iseme, Alex Muia, Jacob Shabani, Samuel Mucheru, Catherine Gathu, Eliphas Gitonga, Redempta Mutisya, Peter Kioko, Jalal Safipour, Cornelia Witthöft

Population Health, East Africa

Aims

Methods

Results …

Benefits, Challenges, And The Way Forward: Medical Specialists' Perception On Family Physician Integration In Healthcare System In Tanzania, Juvenalius Anselm, Roselyter Riang’A, Neelam Ismail, Davis Rubagumya, Jesca Munishi, Sumayyah Saudin, Lynn Moshi, Willbroad Kyejo, Nancy Matillya

Family Medicine, East Africa

Background Family medicine provides comprehensive care by integrating biomedical, behavioral, and social sciences. While established in some sub-Saharan countries, it remains new and unintegrated in Tanzania’s public health system. Its integration is vital for healthcare reform to enhance patient care and system quality.This study aimed to understand the perceptions of medical specialists regarding the integration of family physicians into the Tanzanian healthcare system.

Methods A descriptive qualitative study was conducted through in-depth interviews with ten medical specialists from Aga Khan Hospital and Muhimbili National Hospital in Dar es Salaam. Thematic analysis was employed in this study.

Results Integration of family …

Mental Wellbeing Of Family Caregivers Of People Living With Mental Illness In Kenya: Who Cares? A Cross-Sectional Study, Norah Obungu, Fleur Meijer, Stanley Luchters

Family Medicine, East Africa

Background Although about 60% of patients with chronic mental health disorders in sub-Saharan Africa live with their relatives, burden amongst family caregivers has not been studied much. The aim of this study was to evaluate the prevalence and factors associated with caregiver burden among family caregivers of patients with chronic mental illness attending two psychiatric care facilities in Nairobi, Kenya.

Methods A cross-sectional study was conducted among 284 systematically sampled participants who completed a socio-demographic questionnaire and the Zarit Burden Interview. Moderate to severe burden was defined as a ZBI score > 41. Independent associations were examined using bivariable and multivariable …

Perceptions Of Family Medicine Among First-Year Medical Students At Aga Khan University, Nairobi, Kenya, Catherine Gathu, Lucy Mwangi, Peter Kioko, Tatiana Elwes

Family Medicine, East Africa

Background: Family Medicine (FM) is vital in delivering comprehensive and continuous care essential for robust primary healthcare systems. However, it remains underappreciated in many settings, particularly in sub-Saharan Africa.

Aim: This study aimed to assess the perceptions of FM among first-year medical students at Aga Khan University (AKU), Kenya.

Setting: A cross-sectional survey was conducted between August 2024 and September 2024 among the first-year medical students at AKU. All were invited to participate via email.

Methods: An 18-item questionnaire focused on three areas: perception and choice of medicine as a career, perception of FM and choice of FM as a …

Integrating Evidence Synthesis Into Doctoral Research: A Guide For Family Medicine And Primary Care, Klaus B. Von Pressentin, Jacob Shabani, Taryn Young

Family Medicine, East Africa

Given the increased complexity of healthcare needs, evidence-informed practices are needed, now more than ever. Combining the best available research evidence, the perspectives of patients and communities, and the voices of healthcare workers in guiding policy and practice is essential. All of us involved in providing and strengthening family medicine and primary care need to be good consumers (users) of research, and some will be good producers (doers) of research. In both using and doing research, a helpful starting point is evidence synthesis – a form of secondary research that collates primary research on the same research question. This short …

Factors Associated With Postpartum Depression Among Women Attending Postnatal Clinics In A Tertiary Care Hospital In Nairobi, Kenya, Cecilia Muthoni Njoga

Master of Medicine in Family Medicine

Background 

Postpartum depression (PPD) is a major mental health disorder affecting women during the postpartum period with a global prevalence of up to 17.22%. This prevalence has been shown to be higher in low and middle-income countries. In Kenya, about a fifth of women are affected. PPD can lead to poor infant growth and interference with maternal-child bonding. Additionally, women with PPD experience a lower quality of life and their children have an increased risk of developing and psychotic disorders later in life. Understanding the factors associated with PPD is crucial for early diagnosis and intervention. The study aimed to …

Factors Informing Referral Of Adult Patients To Palliative Care Services In A Tertiary Facility In Kenya: Physicians' Perspective, Donnah A. Opiyo

Master of Medicine in Family Medicine

Background The growing burden of chronic diseases underscores the urgent need for palliative care integration into healthcare systems worldwide. Despite its benefits, palliative care remains underutilized due to various barriers, including health system limitations, institutional challenges, infrastructure gaps, and individual provider factors. However, limited research has explored the specific factors influencing physicians' decisions to refer patients to palliative care. This study sought to fill that gap by examining the key determinants shaping referral practices in a tertiary facility in Kenya.

Design and Methods This exploratory qualitative study examined 22 physician specialists from five departments at Aga Khan University Hospital, Nairobi. …

Investment In Family Medicine To Improve Health Outcomes In Sub-Saharan Africa, Sunanda C. Ray, Mpundu Makasa, Innocent Besigye, Jacob Shabani, Martha Makwero

Family Medicine, East Africa

Family physicians (FPs), as educators, capacity builders and clinical governance leaders of primary care (PC) teams, work to make them more effective and responsive to the needs of their patients. Various strategies are required to raise the profile of Family Medicine (FM) to ensure stronger representation in health sector planning and policy development for advocacy on behalf of the communities they serve. An illustration is given of the need for FP leaders to become equal partners in the National Surgical, Obstetric and Anaesthesia Planning process to ensure safer surgery at district hospitals and to address unmet surgical needs. Integrating FM …

Evaluating The Effect Of Consumption Of Fermented Foods On Glycemic Control And Markers Of Cardiometabolic Risk Amongst Pre-Diabetic And Type 2 Diabetes Mellitus Adult Patients: A Systematic Review And Meta-Analysis, Alex Makau Muia

Master of Medicine in Family Medicine

Introduction 

Type 2 diabetes mellitus (T2DM) remains a major global health challenge, particularly in resource limited countries where conventional treatments are often inaccessible or unaffordable. While lifestyle interventions can reduce diabetes risk, their efficacy is moderate, highlighting the need for alternative strategies. Fermented foods (FFs), which are widely available and affordable, have been shown to improve glucose metabolism and may offer a promising adjunct in the prevention and management of T2DM and prediabetes.

Methods 

A systematic review and meta-analysis were conducted to assess the effects of fermented food consumption on glycemic control and cardiometabolic risk markers in adults with prediabetes …

The Prevalence And The Predictors Of Diabetes Distress In Patients With Type 2 Diabetes Attending Diabetes Clinics At A Tertiary Private Hospital In Nairobi, Kenya., Soulthy Azamkhan Mohamed

Master of Medicine in Family Medicine

Background Diabetes distress encompasses a spectrum of emotional and psychological challenges faced by individuals managing diabetes, including anxiety, stress, depression, frustration, and feelings of helplessness. This distress arises from the constant demands of monitoring blood sugar levels, managing medications, adhering to dietary restrictions, engaging in regular physical activity, and navigating potential complications. Social and emotional factors such as stigma, discrimination, and concerns about future health further contribute to this burden. Factors like fear of hypoglycemia, financial strain, fluctuating blood sugar levels, anxiety about complications, and impacts on personal relationships exacerbate diabetes distress. Left unaddressed, diabetes distress can lead to poor …

Can Written Prompts Help Medical Residents To Accurately Monitor Their Own Communication Skills And Those Of Others?, F. O. De Meijer, N. Nyamu, A. H. De Bruin

Family Medicine, East Africa

In healthcare, effective communication in complex situations such as end of life conversations is critical for delivering high quality care. Whether residents learn from communication training with actors depends on whether they are able to select appropriate information or ‘predictive cues’ from that learning situation that accurately reflect their or their peers’ performance and whether they use those cues for ensuing judgement. This study aimed to explore whether prompts can help medical residents improving use of predictive cues and judgement of communication skills. First and third year Kenyan residents (N = 41) from 8 different specialties were randomly assigned to …

Can Written Prompts Help Medical Residents To Accurately Monitor Their Own Communication Skills And Those Of Others?, Fleur Demeijer, Nelson Nyamu, A. B. H. De Bruin

Family Medicine, East Africa

In healthcare, effective communication in complex situations such as end of life conversa- tions is critical for delivering high quality care. Whether residents learn from communica- tion training with actors depends on whether they are able to select appropriate informa- tion or ‘predictive cues’ from that learning situation that accurately reflect their or their peers’ performance and whether they use those cues for ensuing judgement. This study aimed to explore whether prompts can help medical residents improving use of predic- tive cues and judgement of communication skills. First and third year Kenyan residents (N = 41) from 8 different specialties …

Sodium-Glucose Transport Protein 2 (Sglt2) Inhibitors And The Risk Of Pancreatitis: A Case Report, Zamanali Khakhar, Soraiya Manji, Ronakkumar Patel, Sayed Karar

Internal Medicine, East Africa

Acute pancreatitis is a condition seldom encountered with the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors. They are beneficial in the treatment of various conditions and offer great promise. Despite this, they are associated with several adverse effects, necessitating vigilance and further research. This case study reports a 69-year-old male with multiple comorbidities who presented with epigastric pain radiating to the back. Laboratory tests revealed elevated AST, ALT, GGT and lipase. The patient was diagnosed with acute pancreatitis secondary to the SGLT2 inhibitor therapy regimen. Cessation of dapagliflozin resulted in a complete resolution of symptoms. There is credible evidence to …

Reducing The Burden Of Diabetes Mellitus: Is It Achievable?, Rafay Iqbal, Raheel Ahmad, Aisha Ambreen

Department of Family Medicine

Diabetes mellitus is rapidly on the rise globally, particularly in low- and middle-income countries. Pakistan has emerged with the highest prevalence of diabetes by percentage according to recent estimates. Evidence is available for different strategies to reduce this burden. Screening high-risk individuals can reduce burden of undiagnosed diabetes and improve outcomes. Although prediabetes can progress to type 2 diabetes, it has the potential to regress to normoglycaemia as well. Interventions like lifestyle modifications and metformin in high-risk individuals can reduce the risk of progression to diabetes. Furthermore, there is a potential to reverse diabetes in some individuals in the early …

Primary Health Care And The Tanzania Comprehensive Cancer Project, Gijs Walraven, Harrison Chuwa, Alain Fourquet, Paschal Ruggajo

Internal Medicine, East Africa

No abstract provided.

Abdominal Wall Endometriosis In Cesarean Scar: A Case Report, Willbroad Kyejo, Brenda Moshi, Euphraim Massanga, Gregory Ntiyakunze, Miriam Mgonja, Munawar Kaguta, Ernest Mdachi

Family Medicine, East Africa

Abdominal wall endometriosis refers to the presence of endometrial tissue within surgical scars, most commonly occurring following gynecological procedures such as cesarean sections. This case report presents a rare case of abdominal wall endometriosis in a cesarean scar. The patient, a 32-year-old woman with a history of two previous cesarean sections, presented with cyclic pain and swelling in the lower abdominal region. Physical examination revealed a tender, well-defined mass within the cesarean scar. Surgical excision of the mass was performed, and histopathological examination confirmed the presence of endometrial tissue. This case highlights the importance of considering abdominal wall endometriosis in …

Knowledge, Attitudes And Beliefs Toward Polypharmacy Among Older People Attending Family Medicine Clinic, Nairobi, Kenya, Maureen Kamau, Njeri Nyanja, Adelaide Lusambili, Jacob Shabani, Gulnaz Mohamoud

Family Medicine, East Africa

Background Life expectancy has increased over the last century among older people, particularly those aged over 60 years. Aging is associated with increased disability, multiple chronic conditions, and increased use of health services managed with polypharmacy. There are few studies on polypharmacy and aging in sub-Saharan Africa, and it is unclear what older people know and their attitudes toward polypharmacy. This paper presents findings from a study that aimed to understand older people’s knowledge, attitudes and beliefs about polypharmacy.

Methods A qualitative study using in-depth interviews of 15 patients aged 60 years and older who were taking more than five …

Metabolic Syndrome And Obesity Among Marginalised School-Going Adolescents In Karachi, Pakistan: A Cross-Sectional Study, Hina Sharif, Sana Sharif Sheikh, Tooba Seemi, Hira Naeem, Unab Khan, Shah Sumaya Jan

Department of Family Medicine

Background: Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors which increase the likelihood of developing type 2 diabetes and cardiovascular disease. This study aimed to determine the prevalence of MetS among adolescents living in slums aged 11-18 years in Karachi, Pakistan.
Methods: Data were collected from 689 adolescents attending five schools in two slum areas of Karachi, Korangi and Baldia, from February 2023 to March 2023. Measurements of weight, height, waist circumference, and blood pressure were obtained from the study participants. Blood samples were collected to assess fasting plasma glucose, High density lipoprotein HDL-cholesterol, and triglyceride levels as …

The Anthropometric Determinants Of Peak Expiratory Flow Rate Among Children In Dar Es Salaam, Tanzania, Willbroad Kyejo, Nancy Matillya, Neelam Ismail, Gloria Gachocha, Hajaj Salum, Rosebella Iseme, Mariam Noorani

Family Medicine, East Africa

Background: Peak expiratory flow rate (PEFR) is an important tool for assessing lung function, which can be affected by environmental and physical factors such as altitude, nutrition, genetics, age, height, and weight. Conducting a study to assess the correlation between peak expiratory flow rate and anthropometric measurements in Tanzanian schoolchildren is crucial to derive a population-specific prediction formula and further simplify respiratory health assessment.

Methods: This cross-sectional study was conducted in a single center private primary and secondary school in Dar es Salaam, Tanzania using data from an asthma screening camp. Variables of interest were height, weight, Body Mass Index …

Support, Networks, And Relationships: Findings From A Mixed-Methods Evaluation Of A Mentorship Programme For Early Career Women Researchers In Sexual And Reproductive Health And Rights, Muhammad Asim, Peter Muriuki Gatheru, Joy J. Chebet, Mehr G. Shah, Anna Thorson, Vanessa Brizuela

Community Health Sciences

Low research output among women researchers in health research has been linked to inadequate mentorship opportunities for early career women researchers and particularly in sexual and reproductive health and rights (SRHR) field. Mentorship has been recognized as a contributor to strengthening research capacity and as beneficial for both mentors and mentees. Women researchers oftentimes experience negative impacts of organizational and structural gender inequities related to formal and informal mentoring. In 2020, the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction at WHO launched a mentorship programme for early career SRHR women researchers from low- and …

The Pattern Of Admission, Clinical Characteristics, And Outcomes Among Patients Admitted To The Intensive Care Unit Of A Tertiary Hospital In Tanzania: A 5-Year Retrospective Review, Nadeem Kassam, Philip Adebayo, Iris Martin Matei, Eric Aghan, Samina Somji, Samwel Paul Kadelya, Yasson Abha, Frank Elton Swai, Mangaro Mabusi, Kamran Hamid

Internal Medicine, East Africa

Introduction: Despite the implementation of complex interventions, ICU mortality remains high and more so in developing countries. The demand for critical care in Sub-Saharan Africa is more than ever before as the region experiences a double burden of rising rates of non-communicable diseases (NCD) in the background battle of combating infectious diseases. Limited studies in Tanzania have reported varying factors associated with markedly high rates of ICU mortality. Investigating the burden of ICU care remains crucial in providing insights into the effectiveness and challenges of critical care delivery.

Material and Methods: A single-center retrospective study that reviewed records of all …

Outpatient Management Of Urinary Tract Infections By Medical Officers In Nairobi, Kenya: Lack Of Benefit From Audit And Feedback On Adherence To Treatment Guidelines, Florence Mbatia, James Orwa, Mary B. Adam, Gulnaz Mohamoud, Rodney Adam

Family Medicine, East Africa

Introduction: Acute uncomplicated urinary tract infections are common in outpatient settings but are not treated optimally. Few studies of the outpatient use of antibiotics for specifc diagnoses have been done in sub-Saharan Africa, so little is known about the prescribing patterns of medical ofcers in the region.

Methods: Aga Khan University has 16 outpatient clinics throughout the Nairobi metro area with a medical ofcer specifcally assigned to that clinic. A baseline assessment of evaluation and treatment of suspected UTI was performed from medical records in these clinics. Then the medical ofcer from each of the 16 clinics was recruited from …

Dorsal Pancreas Agenesis, An Incidental Finding During Acute Appendicitis Diagnosis; A Case Report, Willbroad Kyejo, Ally Zain Ismail, Sajida Panjwani, Nancy Matillya, Ahmed Jusabani, Adil Datoo, Pilly Ally

Family Medicine, East Africa

Introduction and importance: Dorsal pancreas agenesis is a rare congenital anomaly characterized by the absence or severe underdevelopment of the dorsal pancreatic bud. We report a case of a man who presented with features of appendicitis only to the incidentally discovery of dorsal pancreas agenesis during the diagnosis of acute appendicitis. We describe our experience on radiological diagnostic formulation and work up.

Case presentation: We present the case of a 45-year-old male patient who presented to the emergency department with symptoms and signs suggestive of acute appendicitis. A computed tomography scan and laboratory investigations confirmed the diagnosis of appendicitis. Incidentally, …

Role Of Hospital Leadership In Pandemic Preparedness: Experience At A Tertiary Hospital In Kenya During The Covid-19 Pandemic, Lucy Mwangi, William Macharia, Benjamin Wachira, Jemimah Kimeu, Boniface Mativa, Lukoye Atwoli

Paediatrics and Child Health, East Africa

Introduction: Pandemic preparedness refers to being ready for, responding to and recovering from public health crises, and is integral for health security. Hospital leadership is a critical building block of an effective healthcare system, providing policy, accountability and stewardship in a health crisis.

Objectives and methods: We aimed to describe the leadership and governance structures put in place at the Aga Khan University Hospital, Nairobi, a private not-forprofit tertiary healthcare facility, following the COVID-19 pandemic. We reviewed over 200 hospital documents archived in the COVID-19 repository including those received from the Kenya Ministry of Health, emails, memos, bulletins, meeting minutes, …

Factors Associated With Depressive Symptoms In Patients With Benign Prostatic Enlargement, Husni Abdalla, Jasmit Shah, Tabitha A.N. Nyanja, Jacob Shabani

Family Medicine, East Africa

Background: Depression is a common condition that may lead to suicide at its worst. It is considered one of the primary causes of morbidity globally. Among the urological causes of depression is benign prostatic enlargement (BPE).

Aim: To determine the prevalence and factors associated with depressive symptoms among BPE patients.

Setting: This study was conducted in the Urology and Family Medicine Clinic at the Aga Khan University Hospital, Nairobi and Urology clinic at the Aga Khan Hospital Mombasa.

Methods: The study was a cross-sectional design recruiting 308 males above the age of 40. Patient Health Questionnaire-9 …

The Distribution Of Cardiovascular Risk Factors And The Association With Cadre Amongst Healthcare Workers At A Tertiary University Hospital In Nairobi City, Kenya, Emma Andrea Khabure

Master of Medicine in Family Medicine

Introduction: According to the World Health Organization (WHO), non-communicable diseases such as stroke, contribute to about 70% of the top ten causes of mortality in the world. The growing burden of Cardiovascular (CVD) risk factors has also been noted to affect the health workforce. According to the Ministry of Health in Kenya employing the WHO STEPS survey, 27% of Kenyans are either overweight or obese. Few studies have been done in Kenya to highlight the prevalence and impact of cardiovascular risk factors amongst healthcare workers. The variety of findings and paucity of data bring about the need to evaluate this …

Barriers Of Iucd Uptake Among Sexually Active Nulliparous University Students In Dar Es Salaam Tanzania, Fatma Shaib Mohamed

Master of Medicine in Family Medicine

Background Family planning contributes an important role in prevention of unintended pregnancy, unsafe abortion, maternal and child mortality. One of the methods used is an IUCD that help in preventing unintended pregnancy. Un intended pregnancy is a public he alth concern worldwide among younger women, resulting into unsafe abortion. Preventing unintended pregnancies in youth is crucial yet challenging. Few studies have addressed the problem of the low utilization of IUCD among university students. This group is overwhelmed with physiological, social, and economic issues in relation to reproductive health especially on family planning accessibility and use. Gap of knowledge and skills …

Experiences Of Diverse Health Care Workers’ Providing Maternal Care During The Covid-19 Pandemic: A Qualitative Study At Five Hospitals In Dar Es Salaam, Tanzania., Fatma Zahran

Master of Family Medicine

Background There are drastic changes in patient care with respect to maternity due to the COVID-19 pandemic with negative impact to health care workers. With Interruption of everyday basic services, arose the need to redistribute the scanty health care workers across health care facilities in sub-Saharan Africa. Its effects and involvement on maternity practice in Sub-Saharan Africa are nevertheless to be analyzed. This study aims to explore the likely ramifications for obstetrics and gynecologic practice in Tanzania. At present there are limited studies looking at impacts of COVID-19 in sub-Saharan Africa and Tanzania. No study has been carried out to …

Trends Of Intra-Facility Births Outcomes Before And During Covid-19 Era In Dar Es Salaam, Tanzania, Willbroad Kyejo

Master of Medicine in Family Medicine

Background While substantial progress had been made in reducing maternal deaths, there was a risk that the COVID-19 pandemic might have reversed the progress made in maternal and newborn health in the last two decades. As such, maternal and newborn outcomes had been a topic of interest during the pandemic. Objectives This study aimed to compare the number of childbirths as an indicator of maternal health service utilization and to assess maternal and newborn outcomes before COVID-19 (2011-2019) and during the COVID-19 pandemic (2020/2021) in 22 health facilities in Dar es Salaam. Methodology A retrospective cohort study was conducted at …