Family Medicine Commons^™

Risk Factors And Outcomes Of Acute Kidney Injury Among Covid-19 Patients At A Tertiary Hospital In Kenya, Susan Cheruiyot

Master of Medicine in Family Medicine

Background: Corona Virus Disease 2019 (COVID-19), a novel infection caused by the SARS-Cov-2 virus, was declared a global pandemic on March 11, 2020. Three years later, 350,000 Kenyans had gotten the infection, with approximately 5,700 reported related deaths. Despite emerging research on the new virus, studies from the African continent on the impact of COVID-19 on the kidneys have been few. Early studies suggest that up to 75% of patients with COVID-19 have a derangement in their kidney function as evidenced by new onset proteinuria and hematuria. That said, the prevalence of acute kidney injury has varied greatly across populations, …

Monkeypox Outbreak In The Age Of Covid-19: A New Global Health Emergency, Rahim Hirani, Dawood Rashid, Joshua Lewis, Rasheed Hosein-Woodley, Ali Issani

Department of Emergency Medicine

No abstract provided.

Diagnostic Challenge Of Perimenopause Molar Pregnancy In A 52-Year-Old Lady: Case Report, Willbroad Kyejo, Davis Rubagumya, Gregory Ntiyakuze, Nancy Matillya, Munawar Kaguta, Miriam Mgonja, Lynn Moshi

Family Medicine, East Africa

Introduction and importance: Gestational trophoblastic disease is an uncommon group of pregnancy-related dis- orders, with a course of trophoblastic proliferation, including hydatidiform mole (Agha et al., 2020), invasive and metastatic mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelial trophoblastic tumor. Choriocarcinoma and trophoblastic tumor of the placenta are the most important tumors associated with pregnancy.

Case findings: A 52-year-old woman Para 2 Living 3, 3 years post-menopausal presented with prolong per vaginal bleeding for five weeks accompanied by lower abdominal pain. Diagnosis of gestational trophoblastic disease (choriocarcinoma type) was made by using beta HCG, radiology, and histology report. Patient underwent total …

Communication Skills Of General Practitioners In Nairobi, Kenya: A Descriptive Observational Study, Gulnaz Mohamoud, Robert Mash

Family Medicine, East Africa

Background High-quality primary care needs to be person-centred, and GPs must communicate effectively to ensure continuity and coordination of care. In Kenya, there is little knowledge about the quality of communication in consultations by GPs.

Aim To evaluate the quality of communication in consultations by GPs.

Design & setting Descriptive, observational study of 23 GP consultations in 13 private sector primary care facilities in Nairobi, Kenya.

Method One consultation with a randomly selected adult patient was recorded per GP, and 16 communication skills evaluated with the Stellenbosch University Observation Tool (SUOT). A total percentage score was calculated per consultation, and …

Clinical Skills Of General Practitioners In Nairobi, Kenya: A Cross-Sectional Study, Gulnaz Mohamoud, Robert Mash

Family Medicine, East Africa

Background: Quality service delivery in primary care requires motivated and competent health professionals. In the Kenyan private sector, GPs with no postgraduate training in family medicine offer primary care. There is a paucity of evidence on the ability of primary care providers to deliver comprehensive care and no such evidence is available for GPs practising in the private sector in Kenya.

Aim: To evaluate GPs’ training and experience in the skills required for comprehensive primary care.

Design and setting: A cross-sectional descriptive survey in 13 primary care clinics in the private sector of Nairobi, Kenya.

Method: A questionnaire, …

Facilitators And Barriers To Implementing A Community Rotation To The Internship Training In Kenya, Peter Mwanza Kioko

Master of Medicine in Family Medicine

Background: Primary care is increasingly being prioritized all over the world more so in developing countries in an effort geared towards achieving health equity. The availability of skilled human resources at the community level has been shown to improve health outcomes. However, doctor numbers remain low in sub-Saharan countries. Kenya’s policy on universal health coverage aims to enable access to essential health services by all its citizens by 2022. The introduction of community placements among undergraduate medical students has proven beneficial in understanding community health problems, the role of primary care in health as well as increasing the likelihood of …

Burden In Family Caregivers Of Patients With Chronic Mental Illness In Aga Khan University Hospital And Mathari National Referral Hospital, Nairobi, Kenya., Norah Atieno Obungu

Master of Medicine in Family Medicine

Introduction: In Africa, about 60% of patients with chronic mental health disorders live with their relatives. Family caregivers bear the responsibility of managing relatives with mental illness in the home environment, and this may result in psychopathology in the caregivers. Although extensively studied in the Western world, not much is known about the caregiver burden in Kenya. Objectives: The primary objective of the study was to find out the prevalence of caregiver burden among family caregivers of patients with chronic mental illness attending two psychiatric care facilities in Nairobi. The secondary objective was to determine the socio-demographic characteristics and correlates …

The Quality Of Primary Care Performance In Private Sector Facilities In Nairobi, Kenya: A Cross-Sectional Descriptive Survey, Gulnaz Mohamoud, Robert Mash

Family Medicine, East Africa

Background: Integrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is paucity of informa- tion on the performance of these key elements and such information is needed to improve service delivery. Therefore, the study aimed to evaluate the quality of primary care performance in private sector facilities in Nairobi, Kenya.

Methods: A cross-sectional descriptive study using an adapted Primary Care Assessment Tool for the Kenyan context …

Knowledge, Attitude And Beliefs Towards Polypharmacy Amongst Older People Attending Family Medicine Clinic (Fmc) At The Aga Khan University Hospital, Nairobi, Kenya (Akuhn)., Maureen Wanjiru Kamau

Master of Medicine in Family Medicine

Introduction: Life expectancy has increased over the last century amongst older individuals, and in particular, those 60 years and over. The World Health Organization estimates that the world's population of persons over 60 years will rise to 22 per cent by the year 2050. Ageing is associated with increasing disability, multiple chronic conditions, and an increase in the use of health services. Multiple chronic conditions associated with ageing are managed with different medications (polypharmacy) amongst the older population. Polypharmacy has numerous adverse effects including non-adherence, an increased risk of drug interactions with the various medications, reduced appetite, and risk of …

Adequacy Of Pain Management Among Advanced Cancer Patients With Solid Tumors Attending Palliative Care Centers In Dar Es Salaam, Judith Mwijage

Master of Medicine in Family Medicine

Background: Cancer pain is a universal undesirable symptom among cancer patients that if not addressed causes suffering and impedes quality of life of both the patients and their family. Observational studies available have shown increase in palliative care programs in Tanzania but there is dearth of information regarding the adequacy of pain control among patients with cancer after the initiation of these programs and improvement of the available interventions. Objectives: This study aimed to determine adequacy of pain management among advanced cancer patients with solid tumors as well as factors affecting adequate Cancer Related Pain management. Methods: We conducted a …

Chloroquine-Susceptible And -Resistant Plasmodium Falciparum Strains Survive High Chloroquine Concentrations By Becoming Dormant But Are Eliminated By Prolonged Exposure, Johan Ursing, Rasmus Johns, Berit Aydin-Schmidt, Carla Calçada, Poul-Erik Kofoed, Najia Karim Ghanchi, Maria Isabel Veiga, Lars Rombo

Department of Pathology and Laboratory Medicine

Background: Plasmodium falciparum strains that are resistant to standard-dose chloroquine can be treated by higher chloroquine concentrations maintained for a longer time in vivo.
Objectives: To determine the relative importance of chloroquine concentrations versus exposure time for elimination of chloroquine-susceptible and -resistant P. falciparum in vitro.
Methods: Chloroquine-susceptible (3D7) and -resistant (FCR3) strains were exposed in vitro to 1, 2, 4, 8, 16 or 32 times their respective 90% inhibitory chloroquine concentrations for 3, 5, 7 or 14 days and then followed until recrudescence, or not, by 42 days after the end of exposure.
Results: Exposure to chloroquine appeared to …

Variants Associated With Bedaquiline (Bdq) Resistance Identified In Rv0678 And Efflux Pump Genes In Mycobacterium Tuberculosis Isolates From Bdq Naïve Tb Patients In Pakistan, Dania Khalid Saeed, Sadia Shakoor, Safina Abdul Razzak, Zahra Hasan, Saba Faraz Sabzwari, Zahida Azizullah, Akber Kanji, Asghar Nasir, Samreen Shafiq, Najia Karim Ghanchi, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background: Mutations in the Rv0678, pepQ and atpE genes of Mycobacterium tuberculosis (MTB) have been reported to be associated with reduced antimycobacterial susceptibility to bedaquiline (BDQ). Resistance conferring mutations in treatment naïve MTB strains is likely to have implications for BDQ based new drug regimen that aim to shorten treatment duration. We therefore investigated the genetic basis of resistance to BDQ in MTB clinical isolates from BDQ naïve TB patients from Pakistan. In addition, mutations in genes associated with efflux pumps were investigated as an alternate mechanism of resistance.
Methods: Based on convenience sampling, we studied 48 MTB clinical isolates …

Diagnostic Value Of Endoscopic Ultrasonography For Common Bile Duct Dilatation Without Identifiable Etiology Detected From Cross-Sectional Imaging, Nonthalee Pausawasdi, Penprapai Hongsrisuwan, Lubna Kamani, Kotchakon Maipang, Phunchai Charatcharoenwitthaya

Section of Gastroenterology

Background/aims: Endoscopic ultrasonography (EUS) is warranted when cross-sectional imaging demonstrates common bile duct (CBD) dilatation without identifiable causes. This study aimed to assess the diagnostic performance of EUS in CBD dilatation of unknown etiology.
Methods: Retrospective review of patients with dilated CBD without definite causes undergoing EUS between 2012 and 2017.
Results: A total of 131 patients were recruited. The mean age was 63.2±14.1 years. The most common manifestation was abnormal liver chemistry (85.5%). The mean CBD diameter was 12.2±4.1 mm. The area under the receiver operating characteristic curve (AUROC) of EUS-identified pathologies, including malignancy, choledocholithiasis, and benign biliary stricture …

Outcomes Of Surgical Tracheostomy On Mechanically Ventilated Covid-19 Patients Admitted To A Private Tertiary Hospital In Tanzania, Nadeem Kassam, Ally Zain, Sajida Panjwani, Kamran Hameed, Samina Somji, Hanifa Mbithe, Fatma Bakshi, Bonvetura Mtega, Gloria Kinasa, Blessing Mathew, Harrison Chuwa

Internal Medicine, East Africa

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in the number of patients necessitating prolonged mechanical ventilation. Data on patients with COVID-19 undergoing tracheostomy indicating timing and outcomes are very limited. Our study illustrates outcomes for surgical tracheotomies performed on COVID-19 patients in Tanzania.

Methods: This was a retrospective observational study conducted at the Aga Khan Hospital in Dar es Salaam, Tanzania.

Results: Nineteen patients with COVID-19 underwent surgical tracheotomy between 16 th March and 31st December 2021. All surgical tracheostomies were performed in the operating theatre. The average duration of intubation prior to tracheotomy …

Hypertension Pharmacological Treatment In Adults: A World Health Organization Guideline Executive Summary, Akram Al-Makki, Donald Dipette, Paul K. Whelton, M Hassan Murad, Reem A. Mustaf, Shrish Acharya, Hind Mamoun Beheiry, Beatriz Champagne, Kenneth Connell, Unab I. Khan

Department of Family Medicine

Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient's values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.

Effectiveness Of Simulation-Based Clinical Skills Training For Medical Students In Respiratory Medicine: A Pilot Study, Russell S. Martins, Saniya Sabzwari, Meesha Iqbal

Medical College Documents

Objective: To assess the effectiveness of high-fidelity simulation-based medical education (HF-SBME) in teaching and learning respiratory clinical examination in medical students.
Study design: Quasi-experimental pilot study.
Place and duration of study: The Aga Khan University, Karachi, from November 2018 to January 2020. Methodology: This study was conducted amongst third year medical students at the University. Students were assigned to intervention (IG) or control groups (CG). The IG underwent training for the respiratory clinical examination on a high-fidelity simulator mannequin, while the CG received the conventional practice session on standardised patients. Students were assessed on their respiratory clinical examination skills in …

Residency Training On The Frontlines Of The Covid-19 Pandemic - A Qualitative Study From Tanzania, Mariam Noorani, Hussein Manji, Elizabeth Mmari, Samina Somji, Nahida Z. Walli, Sherin Kassamali, Shabbir Adamjee, Nancy Matillya, Hanifa Mbithe, Aliasger Nagri, Neelam Ismail

Paediatrics and Child Health, East Africa

Introduction: the Coronavirus Disease 2019 pandemic has affected residency training globally. The aim of this study was to understand how the pandemic affected teaching and learning in residency programs in low resource settings where residents and faculty were working on the front line treating patients with the disease.

Methods: this qualitative study enrolled residents and faculty from the Aga Khan University in Tanzania who were providing front line care during the pandemic. Purposeful sampling was used and data was collected using focus group discussions and in-depth interviews between August and September 2020. Analysis was done using qualitative content analysis.

Results: …

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

Master of Medicine in Family Medicine

Introduction: In Kenya, studies have been conducted at community levels aiming at understanding the determinants of Alcohol-Use and heavy episodic drinking which may include healthy people. However, limited studies have been done to find out social determinants of alcohol use disorders in patients at private primary care clinics in Nairobi County. The study aimed to find out the prevalence and social determinants of alcohol use disorders in patients attending primary care clinics in Nairobi. Methods: A cross-sectional survey design was used and 389 respondents purposefully recruited into the study. Data was collected using a self-administered questionnaire adapted from the alcohol …

Application Of The Ultra-Poverty Graduation Model In Understanding Community Health Volunteers’ Preferences For Socio-Economic Empowerment Strategies To Enhance Retention: A Qualitative Study In Kilifi, Kenya, Njeri Nyanja, Nelson Nyamu, Lucy Nyaga, Sophie Chabeda, Adelaide Lusambili, Marleen Temmerman, Michaela Mantel, Anthony Ngugi

Family Medicine, East Africa

Background: A significant shortage of healthcare workforce exists globally. To achieve Universal Healthcare cover- age, governments need to enhance their community-based health programmes. Community health volunteers (CHVs) are essential personnel in achieving this objective. However, their ability to earn a livelihood is compromised by the voluntary nature of their work; hence, the high attrition rates from community-based health programmes. There is an urgent need to support CHVs become economically self-reliant. We report here on the application of the Ultra-Poverty Graduation (UPG) Model to map CHVs’ preferences for socio-economic empowerment strategies that could enhance their retention in a rural area …

Barriers To Timely Disclosure Of Hiv Serostatus: A Qualitative Study At Care And Treatment Centers In Dar Es Salaam, Tanzania, Neelam Ismail, Nancy Matillya, Riaz Ratansi, Columba Mbekenga

Family Medicine, East Africa

Introduction: Disclosure of Human Immunodeficiency Virus (HIV) status is important to prevent the spread of HIV and maintain the health of people living with HIV, their spouses, and the community. Despite the benefits of disclosure, many people living with HIV delay disclosing their status to those close to them thereby increasing the risk for disease transmission. This study aimed to determine the barriers to timely disclosure of HIV serostatus for people living with HIV in Dar es Salaam, Tanzania, and identify what motivated disclosure.

Methods: A qualitative descriptive study using in-depth individual interviews was conducted with10 participants attending …

The Relation Of Abo Blood Group To The Severity Of Coronavirus Disease: A Cross-Sectional Study From A Tertiary Care Hospital In Karachi, Fazal Ur Rehman, Syed Furrukh Omair, Fatima Memon, Bakhtawar J. Rind, Danish Ahmed Memon, Syed Ahsan Ali, Bilal Ahmed, Naureen Ali

Section of Internal Medicine

Background: Blood groups are considered to have an impact on the occurrence and severity of coronavirus disease. While among Chinese and Caucasian, blood group O individuals were less and group A were more likely to have severe disease and mortality, data on South Asians aren’t available.
Objective: This study aimed to find out the association of disease severity with blood group among coronavirus disease 2019 (COVID-19) patients.
Materials and methodology: Data were collected on a predesigned questionnaire containing details of patient demographics, medical comorbidities, clinical presentation, and laboratory parameters. Multiple logistic regression was used to determine the association of the …

Characteristics Of Patients Presenting With Covid-19 From Balochistan Province And Lessons Learnt, Abida Munir Badini, Aurangzeb Badini, Naeem M. Mengal, Kashmira Nanji

Department of Family Medicine

Objective: With the spread of COVID-19 in Pakistan, Balochistan province with its unique problems of lowest literacy rates in the country, limited resources and a flail health care system is reporting an increasing number of cases of COVID-19. This study discusses the epidemiological and clinical characteristics of COVID-19 patients from the Balochistan province.
Study design: Situation report Place and Duration of Study: The study was conducted in Balochistan province of Pakistan. The completion date for the study was April 30, 2020.
Methodology: The data was retrieved from the daily situation report from the Health Department, Government of Balochistan. Descriptive statistics …

Online Assessment In Undergraduate Medical Education: Challenges And Solutions From A Lmic University, Syeda Sadia Fatima, Romana Idrees, Kauser Jabeen, Saniya Sabzwari, Sadaf Khan

Department of Biological & Biomedical Sciences

Background and objectives: The Covid-19 pandemic has caused large-scale disruption in almost all educational programs across the world. Planning and rapid implementation of assessment through an online format presents the next set of novel challenges that must be addressed by academic administrations across the globe.
Methods: This cross-sectional study was conducted between March to August 2020 at the Aga Khan University Medical College. Two hundred medical students of year 1 and 2 participated in the study. We describe the planning, processes, and outcomes of online assessments using video communication platforms conducted at a private university in Pakistan. Standardized protocols were …

Applying A Mixed-Method Approach To Improve On-The-Job Learning And Job Satisfaction In A Cohort Of Interns At A University Hospital, Amna Subhan Butt, Muhammad Shahzad Shamim, M Asghar Ali, Farah Naz Qamar, Irum Qamar Khan, Swaleha Tariq, Syeda Amrah Hashmi, Quratulain Hafeez, Muhammed Tariq

Section of Gastroenterology

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern's work-based learning and satisfaction in a university hospital setting.
Methods: Using Kern's six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome …

Clinical Presentations Associated With Adverse Outcomes Among Patients Admitted With Dengue At A Tertiary Hospital In Dar Es Salaam., Nakiganda John Mkasa

Master of Medicine in Family Medicine

Introduction Dengue is one of the most important mosquito viral borne infections caused by four viral serotypes (DENV 1-4). In 2019 WHO named dengue as among the top ten global threats due to an increase in the number of cases worldwide. Tanzania is among the countries in Africa with multiple outbreaks; 2010, 2013-2014, and 2019. Dengue has variable clinical presentations ranging from nonspecific such as fever, joint pain, and fatigue to more serious such as hemorrhage and shock. Dengue can result in adverse outcomes such as ICU admissions and prolonged hospital stays. Clinical presentations associated with adverse outcomes have been …

Reflections Of An Earliest Established Screening And Testing Facility For Covid-19 In The Largest Metropolis, Pakistan, Fatima Kanwal, Karishma Kanhya Lal, Asra Qureshi

Department of Family Medicine

As the world struggles to deal with the COVID-19 pandemic, this article talks about the experience and findings of the first COVID-19 screening facility in a tertiary care hospital in Karachi, Pakistan. Department of Family Medicine at Aga Khan University (AKU) took initiative where COVID-19 screening of stable patients first began in a dedicated area. Since testing kits were limited and community spread had not started, nurses would screen every walk-in patient based on the presence of fever, cough, travel history and exposure to COVID-19 positive patient in the last 14 days, and advise swab testing if indicated. Out of …

Child Maltreatment And Neglect In The United Arab Emirates And Relationship With Low Self-Esteem And Symptoms Of Depression, Syed M. Shah, Gul Nowshad, Fatima Al Dhaheri, Mariam H. Al-Shamsi, Alfan M. Al-Ketbi, Alaa Galadari, Priyam Joshi, Heba Bendak, Michal Grivna, Danilo Arnone

Department of Family Medicine

Objectives: To our knowledge, this study is the first in the United Arab Emirates (UAE) to investigate the prevalence of child maltreatment in relation to depressive symptoms and self-esteem.
Study design: Exposure to physical maltreatment, emotional abuse and neglect was evaluated in 518 adolescents (86% response rate) randomly selected from schools in Al Ain in the Emirate of Abu Dhabi. The Rosenberg self-esteem scale and the Beck Depression Inventory were used to measure self-esteem and depressive symptoms by using multivariate logistic regression analyses.
Results: The mean age of study participants was 14.3 years. Emotional abuse was the most frequent form …

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

Master of Medicine in Family Medicine

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 determine the …

Implementation And Evaluation Of Employee Health And Wellness Program Using Re-Aim Framework, Unab I. Khan, Asra Qureshi, Karishma Lal, Shehreen Ali, Arshnoor Barkatalia, Shamim Nayani

Department of Family Medicine

Purpose: To describe the design, implementation, and evaluation of an employer-sponsored health screening program [Employee Health and Wellness Program (EHWP)] in an academic healthcare system in Pakistan.
Design/methodology/approach: One-year after implementation, we use the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to evaluate and report participant- and organizational-level indicators of success.
Findings: Of 5286 invited employees, 4523 (86%) completed blood work and 1809 (34%) completed health risk assessment (Reach). Of the 915 (51%) who required referrals, 3% were referred for new diagnoses of diabetes, hepatitis C or severe anemia; 63% for elevated 10- year risk of cardiometabolic diseases (cardiovascular …

Need For Clinical Guidelines For Management Of Osteoporosis And Way Forward For Pakistan, Aysha Habib Khan, Manju Chandran

Department of Pathology and Laboratory Medicine

No abstract provided.