Pediatrics Commons^™

Incidence Of Peripheral Intravenous Cannula Complications And Associated Factors Among Paediatric Patients At A Tertiary-Care Referral Hospital, Vanessa Minsari Ogega

Master of Medicine in Paediatrics and Child Health

Introduction: Peripheral intravenous catheters (PIVCs) are widely used in clinical practice and are a major source of procedure-related pain in children. Their use is associated with complications including occlusion, dislodgement, infiltration, extravasation, phlebitis, and, rarely, bloodstream infections.

Objectives: To determine the incidence and risk factors associated with PIVC complications among paediatric patients aged 1 day to 18 years at Aga Khan University Hospital, Nairobi. The study also assessed the average survival time of PIVCs.

Methods: A prospective cohort study was conducted on 320 PIVCs among 192 children admitted between August and October 2024. Data collected included patient demographics, clinical characteristics, …

Perception And Experiences With Telemedicine Among Caregivers Of Children Requiring Outpatient Chronic Care, Maureen Wambui Kigara

Master of Medicine in Paediatrics and Child Health

Introduction Telemedicine is an expanding healthcare modality with potential to enhance access to paediatric specialist care, reduce healthcare costs, and minimize school and work disruptions. However, little is known about caregiver perceptions and experiences with telemedicine in low- and middle-income countries, especially in the context of chronic paediatric care.

Objectives This study explored how caregivers of children with chronic health conditions perceive and experience telemedicine, and what factors influence its adoption. The findings aim to inform the design of patient-centered paediatric telemedicine services.

Methodology A cross-sectional qualitative study was conducted at the Paediatric Specialist Clinics of Aga Khan University Hospital. …

Experiences And Attitudes Of Caregivers During Mealtimes In Children With Autism Spectrum Disorder At A Tertiary Facility In Kenya., Lynnette Muthoni Mwangi

Master of Medicine in Paediatrics and Child Health

Introduction: - ASD is a neurodevelopmental disorder characterized by deficits in social interactions and communication along with restrictive and repetitive behaviours affecting 1 in 100 children globally, with a higher prevalence in males. Despite the rising global statistics, there is limited information regarding the prevalence of ASD in Sub-Saharan Africa. Children with ASD often experience feeding challenges, which have been broadly categorized as food selectivity, food refusal, and disruptive mealtime behaviour, which poses challenges for caregivers during mealtime. While medical management of ASD receives considerable attention, less focus has been placed on the impact of ASD on caregivers and …

Child And Caregiver’ Perspective On Barriers To Asthma Management At A Tertiary Referral Hospital In Kenya, Joan Kwesigabo Ahimbisibwe

Master of Medicine in Paediatrics and Child Health

Background: Asthma is one of the most common chronic conditions in children, with significant morbidity and mortality, especially in Africa. Achieving adequate asthma control in children remains challenging due to gaps between standard recommended management strategies and treatment practices. This study explored barriers to asthma management as perceived by children and their caregivers in a private tertiary care setting in Kenya.

Methods: An exploratory phenomenological qualitative study was conducted at Aga Khan University Hospital (AKUH), Nairobi. Children aged 6–18 years with a confirmed diagnosis of asthma and their caregivers were recruited. Participants had been receiving treatment for at …

Demographic And Clinical Characteristics Of Venous Thromboembolism In Children, Deogracia Sindoiya Owende

Master of Medicine in Paediatrics and Child Health

Introduction: Venous thromboembolism in children is a cause of significant morbidity and mortality worldwide with an increasing annual incidence. The present study aimed to increase awareness as well as attempt to inform the management of paediatric venous thromboembolism in this setting.

Objective: To describe the demographic and clinical characteristics of venous thromboembolism in children aged one month to 18 years at two tertiary hospitals in Kenya.

Methods: A descriptive retrospective chart review of patients aged one month to 18 years diagnosed with venous thromboembolism between January 2014 and December 2022 in two tertiary hospitals in Kenya was …

Factors Associated With Clinically Significant Hyperbilirubinemia Among Abo-Incompatible Newborns At A Tertiary Care Hospital In Kenya., Wandera Ivy Mwenesi

Master of Medicine in Paediatrics and Child Health

Background: ABO incompatibility is one of the most common causes of immune-mediated neonatal jaundice. It occurs in approximately 20-25% of all pregnancies. Literature shows that 60- 80% of newborns will develop physiological jaundice within the first week of life. Globally, the incidence ranges from 10-41%. Early detection of newborns with ABO incompatibility-related jaundice can prevent the incidence of bilirubin-induced neurological dysfunction. Whereas there have been extensive published data on rhesus isoimmunization, very few studies have examined ABO incompatibility and isoimmunization. From the published literature, there has been no known study that has assessed risk factors for developing clinically significant jaundice …

Knowledge Attitudes And Priorities Regarding Antimicrobial Resistance And Antimicrobial Stewardship Among Clinic Administrators And Clinicians In Outpatient Medical Centres In Kenya: A Qualitative Study, Mary Wanjiru Kaniu

Master of Medicine in Paediatrics and Child Health

Introduction: Antimicrobial resistance is an important global health threat and it is estimated that by 2050 it will account for 10 million deaths globally. Low and middle income countries are disproportionately affected by the burden of antimicrobial resistance. One of the major causes of antimicrobial resistance is irrational and overuse of antibiotics. Understanding the knowledge, attitudes and priorities of healthcare workers and healthcare administrators on antimicrobial resistance and antimicrobial stewardship is pivotal in implementation of strategies to curb the spread of antimicrobial resistance. Methods: A qualitative study using in-depth semi-structured interviews was conducted among clinicians and clinic administrators in 12 …

Factors Influencing Uptake Of Human Papilloma Virus (Hpv) Vaccine Among Parents Of Adolescent Girls, Irene Nzisa Martin

Master of Medicine in Paediatrics and Child Health

Background: Cervical cancer is one of the most common preventable cancers causing morbidity and mortality in women especially in Sub-Saharan Africa. Three HPV vaccines have been approved for vaccination against HPV globally with Cervarix and Gardasil currently available in Kenya. Despite availability of free HPV vaccination and increased media campaigns the proportion of adolescent girls vaccinated against HPV remains low. Understanding the determinants of HPV vaccine uptake will inform strategies to improve the uptake at Aga Khan University Hospital, Nairobi. Objectives: The aim was to identify the factors influencing HPV vaccine uptake among parents of adolescent girls. The secondary objective …

Knowledge And Practice Of Pediatricians In Kenya Regarding Helicobacter Pylori Infection In Children., Aura Mwende Nzinga

Master of Medicine in Paediatrics and Child Health

Background: Helicobacter pylori is one of the most common chronic bacterial infections. It affects more than half of the world’s population and is frequently associated with peptic ulcer disease, gastric carcinoma and other extra gastrointestinal manifestations. Globally, one third of the children are infected with the highest burdens observed in low and middle income countries. In Kenya the prevalence stands at 87% among school going children and 50% in children under three years. Justification: Studies in high income countries suggest poor knowledge and practice amongst physicians with limited data from Africa. There exists conflicting information regarding the pathogenic role and …

Prevalence And Factors Associated With Undernutrition Among Children With Congenital Heart Disease At Three Tertiary Hospitals In Nairobi, Kenya., Shamsa Yahya

Master of Medicine in Paediatrics and Child Health

Background: Congenital heart disease (CHD) is the commonest birth defect. Children with CHD have a high burden of undernutrition and its consequences. Some of the factors that are associated with undernutrition in children with CHD include the type and complexity of the heart defect, associated pulmonary hypertension, late diagnosis, timing of surgical correction, low socioeconomic status, lack of adequate nutritional support, associated genetic conditions and the presence of other clinical comorbidities. Justification: Although these factors are well defined, they vary geographically in their distribution and extent to which they influence the level of undernutrition. This limits the extrapolation of findings …

Single Oral Or Single Intramuscular Dose Of Vitamin D In The Treatment Of Vitamin D Deficiency In Children At Aga Khan University Hospital, Nairobi: A Randomized Controlled Trial, Winfred Mwikali Ndaka

Master of Medicine in Paediatrics and Child Health

Background: Vitamin D deficiency is a global health concern and plays an important role in bone health and many chronic non-communicable diseases. Vitamin D deficiency in children is associated with short stature, underdevelopment, respiratory infections and many other features that increase the risk of childhood complications. The prevalence of vitamin D deficiency in Kenya among children is high. Treatment with daily oral vitamin D is associated with poor compliance. While a single high intramuscular dose vitamin D offers an alternative strategy, it is however, associated with injection site pain and its absorption is dependent on the patient’s peripheral circulation. Various …

Renal Angina Index As A Predictor Of Acute Kidney Injury In Critically Ill Children, Athul Shelly Kooliyath

Master of Medicine in Paediatrics and Child Health

Background: Acute kidney injury is associated with increased morbidity and mortality in hospitalized children. In the critically ill,DR WILLIAM M MACHARIA acute kidney injury (AKI) is prevalent and difficult to diagnose. Using conventional methods, AKI is often missed thus delaying the diagnosis up to 48 hours after initial injury. Though some biomarkers that identify AKI early have been identified, they may still be insufficient due to prohibitive costs. Renal angina index is used to identify ongoing renal injury. It is a product of the clinical state and the estimated glomerular filtration rate (eGFR) of a patient during admission to a …

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

Master of Medicine in Paediatrics and Child Health

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

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

Master of Medicine in Paediatrics and Child Health

Background: Gastroesophageal reflux disease (GERD) negatively impacts the health-related quality of life (HRQoL). Nissen fundoplication is done when medical treatment fails. Goal of therapy is to eliminate symptoms and improve quality of life. Justification: HRQoL is a key indicator that we can use to evaluate the impact of our interventions so that we can make evidence-based decisions and advice our patients appropriately based on the outcomes of these interventions. Objectives: The primary objective was to assess the HRQoL of children with GERD after Nissen fundoplication alone or Nissen fundoplication and gastrostomy tube insertion. Methods: Design- Observational retrospective cohort study. Setting- …

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

Master of Medicine in Paediatrics and Child Health

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

Parental Knowledge And Attitudes Towards Food Allergy, Namuli Jane Francis

Master of Medicine in Paediatrics and Child Health

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

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

Master of Medicine in Paediatrics and Child Health

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

Evaluation For Association Between Maternal Microbiota And Development Of Necrotizing Enterocolitis Or Gram-Negative Bacteremia In Preterm Infants, Mei Chi Quek

Master of Medicine in Paediatrics and Child Health

Background: Preterm birth is the leading cause of perinatal morbidity and mortality worldwide. There is a need for a better understanding of the correlation of vaginal microbiota with adverse preterm outcomes. Our study aimed to explore how the vaginal microbiota influences the outcome of the preterm infants, determine whether fecal microbiota in premature infants differs from that in term infants, and explore the microbiota pattern in preterm neonates who received multiple antibiotics. Method: A prospective cohort design was used to enroll 33 women admitted in spontaneous labor between 25 to 36 weeks, and 33 controls matched for age and parity …

Serum 25-Hydroxyvitamin D Levels In Children With Mild And Severe Atopic Asthma, Rhoda Ndinda Masaku

Master of Medicine in Paediatrics and Child Health

Background: Asthma is a chronic respiratory illness affecting an estimated 334 million people worldwide, including 14% of the total pediatric population. It results in significant morbidity, and therefore the etiologies and risk factors associated with asthma are of great interest. Serum 25- hydroxyvitamin D (25(OH)D) has substantial immunomodulatory effects on the innate immune system. It reduces the probability of viral respiratory infections and asthma exacerbations by potentiating the anti-inflammatory action of corticosteroids. Objectives: This study was conducted to determine if there was a difference in serum 25-hydroxyvitamin D levels between children with mild and severe atopic asthma and explored the …

Complementary Feeding Practices And Their Determinants In Infants And Young Children On Follow Up At A Private Tertiary Hospital In Nairobi, Catherine Muthoni

Master of Medicine in Paediatrics and Child Health

Background: More than a third of all deaths in children under five years of age worldwide, are linked to maternal and child under-nutrition. Appropriate complementary feeding is one of the interventions with the greatest potential for reduction of nutrition-related diseases and mortalities, yet uptake of the recommended World Health Organisation (WHO) infant and young child feeding practices in Kenya remains low. Despite provision of nutrition education at Aga Khan University Hospital- Nairobi (AKUH-N), both growth faltering and over-weight trends have been observed, pointing to both under- and over-nutrition. Objectives: This study investigated caregivers' knowledge , attitude and practice (KAP) of …

Knowledge, Attitudes, Practices And Barriers In Use Of Evidence-Based Medicine Among Resident Physicians In Aga Khan University Hospital, Nairobi., Megha Unadkat

Master of Medicine in Paediatrics and Child Health

Background: Evidence based medicine (EBM) helps clinicians to integrate latest research evidence into their daily clinical practice. There is a need for all healthcare professions to adopt it in order to provide scientific, safe, efficient and most cost-effective care. Postgraduate residents are at the frontline of healthcare delivery and all medical institutions should strive to produce practitioners of EBM. Studies have shown that physicians are still struggling to adapt to this paradigm shift in the practice of medicine, especially in Sub Saharan Africa (SSA). However, very few studies have been done in SSA and none in East Africa to explore …

Factors Associated With Substance Use Among Adolescents Living With Hiv In Kenya, Wambui Kagucia

Master of Medicine in Paediatrics and Child Health

Background: Substance use is rife in our society and adolescents (10-19 years) do face this problem during this vulnerable period of growth and development. Use of substances is known to be associated with poor health choices and risky sexual behaviour. Since the advent of antiretroviral therapy (ART), significant progress has been made with reduced rates of mother to child transmission (MTCT) and a general downward global trend in acquired immunodeficiency disease (AIDS) related mortalities. However, human immunodeficiency virus (HIV)/AIDS is still a leading cause of mortality in adolescents living in Sub Saharan Africa, with an upward trend in new HIV …

Factors Associated With Development Of Retinopathy Of Prematurity In Three Private Tertiary Hospitals In Kenya, Annette A. Metho

Master of Medicine in Paediatrics and Child Health

Introduction: Retinopathy of prematurity (ROP) is a condition that affects mainly premature infants. It’s characterized by abnormal retinal vascular growth which in its most severe form can result in blindness due to retinal detachment, and in less severe untreated forms, can result in marked visual impairment. Retinopathy of prematurity is one of the preventable causes of blindness. Research Question: What are the factors associated with development of retinopathy of prematurity in screened preterm infants in three private tertiary hospitals in Kenya? Study Objectives: This study aimed to identify factors associated with development of retinopathy of prematurity in screened preterm infants …

Factors Associated With Late Diagnosis Of Congenital Heart Disease In Kenya, Mercy Chebet Ng’Eno-Owino

Master of Medicine in Paediatrics and Child Health

Introduction: Congenital heart disease (CHD) is the most common congenital anomaly (one-third of all congenital anomalies) with a global birth prevalence of 8/1,000 live births. About 30-50% of all CHD can be categorized as those that will result in death or long-term disability if surgery or catheter-based intervention is not done within one year (major CHD) or four weeks (critical CHD). Early diagnosis of CHD with subsequent prompt surgical/catheter-based interventions has been associated with better outcomes. In this study, late diagnosis of CHD is defined as cases of CHD diagnosed after the first year of life. Knowledge on presentations of …

Prevalence Of Cytotoxin Associated Gene-A Positive Strains In Children With Symptomatic H. Pylori Infection, Patricia Mumbi Muriithi

Master of Medicine in Paediatrics and Child Health

Introduction: Helicobacter pylori is a common bacterial infection in humans with early acquisition in childhood. It is adapted to the gastric environment and has been associated with chronic active gastritis, peptic ulcers, atrophic gastritis, gastric adenocarcinoma and mucosa associated lymphoid tissue (MALT) lymphoma. H. pylori strains bearing the Cytotoxin Associated Gene-A (CagA) gene have enhanced pathogenicity and have been strongly linked with increased risk for gastric carcinoma in adulthood. Objectives: The primary objective was to determine the prevalence of CagA positive strains in children with H. pylori infection. The secondary objectives were to compare CagA status and endoscopy findings and …

Prevalence Of Non-Alcoholic Fatty Liver Disease In Overweight And Obese Children Seeking Ambulatory Health Services In Nairobi, Anne Njeri Mburu

Master of Medicine in Paediatrics and Child Health

Introduction: Non-alcoholic fatty liver disease is often an asymptomatic condition one of the leading causes of chronic liver disease and is associated with an increase in cardiovascular morbidity. Being overweight or obese has been positively linked to non-alcoholic fatty liver disease in children. There is evidence to show that when detected early, non-alcoholic fatty liver disease is reversible primarily upon institution of lifestyle changes targeted at weight reduction. Establishing the prevalence of non-alcoholic fatty liver disease in overweight and obese Kenyan children would serve as a benchmark for long term monitoring of associated morbidity and guide in public health policies …

Prevalence Of Bladder Dysfunction In Children With Primary Nocturnal Enuresis Presenting To The Hospital, Nikita Pravin Jethwa

Master of Medicine in Paediatrics and Child Health

Introduction: Bladder dysfunction is thought to be a common cause of nocturnal enuresis. It can either be overactive, underactive or dysfunctional. Currently, there is a paucity of data on what proportions of children with nocturnal enuresis have bladder dysfunction. Studies have shown the prevalence of bladder dysfunction to be as high as 77-94.5% (28), and children with bladder dysfunction have poor response to treatment. There are currently no protocols for investigating and managing children with nocturnal enuresis. The decision for bladder ultrasound is usually made by the primary physician, and at times after the child has been on treatment for …

Diagnostic Utility Of Who Defined Sepsis Syndromic Criteria With Procalcitonin In Identification Of Sepsis In Children With Suspected Infections, Samuel Owuor Akech

Master of Medicine in Paediatrics and Child Health

Title: Diagnostic Utility of WHO Defined Sepsis syndromic Criteria with Procalcitonin in Identification of Sepsis in Children with Suspected Infections Background: Bacterial infections are a major cause of morbidity and mortality in children but accurate and timely diagnosis remains a challenge to the frontline clinicians. Cultures of sterile bodily specimens are considered the gold standard but are insensitive and results are delayed. Procalcitonin (PCT) has recently emerged as a biomarker with high sensitivity and specificity making it superior to culture based techniques performed in non-ideal circumstances which prevail in resource poor settings. This study investigated the diagnostic utility World Health …

Caregivers’ Knowledge, Perceptions And Home Management Practices Of Fever In Children Under The Age Of Five Years Presenting With Acute Febrile Illnesses, Katherine Oyieke

Master of Medicine in Paediatrics and Child Health

Background: Fever in children is one of the most common clinical symptoms and a frequent cause of caregiver concern. It is a normal body response to a variety of conditions, the most common of which is infection. Many childhood illnesses are accompanied by fever, which is often treated at home prior to presentation at a health facility. Nearly every child will develop a febrile episode at some point in life. The challenge for caregivers is to know when to be concerned and how to manage such episodes appropriately when they occur. Caregiver knowledge and perceptions regarding fever are an important …

Prevalence Of Vitamin D Deficiency In Exclusively Breastfed Infants At The Aga Khan University Hospital, Nairobi, Nusrat. A. Said

Master of Medicine in Paediatrics and Child Health

Introduction: Vitamin D deficiency in infants is a recognized cause of rickets. In the last few years, evidence has emerged of its association with lower respiratory tract infections, food allergy, type 1 diabetes, schizophrenia and various other extra skeletal health effects. Exclusively breastfed infants are especially vulnerable to vitamin D deficiency due to their dependence on previous trans-placental transfer of vitamin D from the mother, dietary vitamin D from breast milk and cutaneous synthesis of vitamin D on exposure to sunlight. The worldwide epidemic of Vitamin D deficiency in pregnancy and the low content of vitamin D in breast milk …