Pediatrics Commons^™

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

Paediatrics and Child Health, East Africa

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

Scientific Rationale For Study Design Of Community-Based Simplified Antibiotic Therapy Trials In Newborns And Young Infants With Clinically Diagnosed Severe Infections Or Fast Breathing In South Asia And Sub-Saharan Africa., Anita K. M. Zaidi, Abdullah H. Baqui, Shamim Ahmad Qazi, Rajiv Bahl, Samir Saha, Adejumoke I. Ayede, Ebunoluwa A. Adejuyigbe, Cyril Engmann, Fabian Esamai, Antoinette Kitoto Tshefu, Robinson D. Wammanda, Adegoke G. Falade, Adetanwa Odebiyi, Peter Gisore, Adrien Lokangaka Longombe, William N. Ogala, Shiyam Sundar Tikmani, A. S. M. Nawshad Uddin Ahmed, Steve Wall, Neal Brandes, Daniel E. Roth, Gary L. Darmstadt

Paediatrics and Child Health, East Africa

Background: Newborns and young infants suffer high rates of infections in South Asia and sub-Saharan Africa. Timely access to appropriate antibiotic therapy is essential for reducing mortality. In an effort to develop community case management guidelines for young infants, 0–59 days old, with clinically diagnosed severe infections, or with fast breathing, 4 trials of simplified antibiotic therapy delivered in primary care clinics (Pakistan, Democratic Republic of Congo, Kenya and Nigeria) or at home (Bangladesh and Nigeria) are being conducted.

Methods: This article describes the scientific rationale for these trials, which share major elements of trial design. All the trials are …

Effectiveness Of Sequential V. Standard Triple Therapy For Treatment Of Helicobacter Pylori Infection In Children In Nairobi, Kenya, Ahmed Laving, Rose Kamenwa, Shahin Sayed, Andrew Nyerere Kimang'a, Gunturu Revathi

Paediatrics and Child Health, East Africa

Background: Once the diagnosis of Helicobacter pylori is confirmed, treatment requires at least two antibiotics and an acid inhibitor for a minimum of seven days. Unfortunately, treatment failures are being frequently reported. Treatment regimens that include sequential administration of antibiotics with acid inhibitors have been developed to try and increase the rate of eradication.

Objective: To determine the effectiveness of a novel 10-day sequential therapy compared with the standard 10-day triple therapy for treatment of H. pylori infection in children.

Methods: A double-blinded, randomised, controlled trial was conducted. Children under the age of 16 years with recurrent abdominal pain associated …

Simplified Regimens For Management Of Neonates And Young Infants With Severe Infection When Hospital Admission Is Not Possible, Antoinette Tshef, Adrien Lokangaka, Cyril Engmann, Fabian Esamai, Peter Gisore, Adejumoke Idowu Ayede, Adegoke Gbadegesin Falade, Ebunoluwa A. Adejuyigbe, Chineme Henry Anyabolu, Robinson D. Wammanda, William N. Ogala, Lu Gram, Simon Cousens, Rajiv Bahl, Nigel Rollins, Sachiyo Yoshida, Shamim Ahmad Qazi

Paediatrics and Child Health, East Africa

Background: In resource-limited settings, most young infants with signs of severe infection do not receive the recommended inpatient treatment with intravenous broad spectrum antibiotics for 10 days or more because such treatment is not accessible, acceptable or affordable to families. This trial was initiated in the Democratic Republic of Congo, Kenya and Nigeria to assess the safety and efficacy of simplified treatment regimens for the young infants with signs of severe infection who cannot receive hospital care.

Methods: This is a randomized, open-label equivalence trial in which 3600 young infants with signs of clinical severe infection will be enrolled. The …

Nutritional Status Of Children Admitted For Diarrhoeal Diseases In A Referral Hospital In Western Kenya, I. Marete, J. Simba, Peter Gisore, C. Tenge, D. Bosire, A. Mwangi, F. Esamai

Paediatrics and Child Health, East Africa

Objectives: To determine the prevalence of malnutrition among children admitted with acute diarrhoea disease at Moi Teaching and Referral Hospital and to establish the effect of malnutrition on duration of hospital stay.

Design: Prospective observational study.

Setting: Paediatric wards of Moi Teaching and Referral Hospital, Eldoret, Kenya

Subjects: A total of 191 children aged 6 and 59 months admitted with acute diarrhoea disease, without chronic co-morbidities or visible severe malnutrition, were systematically enrolled into the study between November 2011 and March 2012.

Outcome Measures: Nutritional status based on WHO WHZ scores taken at admission and …

Commonly Cited Incentives In The Community Implementation Of The Emergency Maternal And Newborn Care Study In Western Kenya, Peter Gisore, B. Rono, J. Nekesa-Mangeni, C. Tenge, E. Shipala, H. Mabeya, D. Odhiambo, K. Otieno, S. Bucher, C. Makokha, E. Liechty, F. Esamai

Paediatrics and Child Health, East Africa

Background: Mortality of mothers and newborns is an important public health problem in low-income countries. In the rural setting, implementation of community based education and mobilization are strategies that have sought to reduce these mortalities. Frequently such approaches rely on volunteers within each community.

Objective: To assess the perceptions of the community volunteers in rural Kenya as they implemented the EmONC program and to identify the incentives that could result in their sustained engagement in the project.

Method: A community-based cross sectional survey was administered to all volunteers involved in the study. Data were collected using a self-administered supervision tool …

Treatment Of Fast Breathing In Neonates And Young Infants With Oral Amoxicillin Compared With Penicillin-Gentamicin Combination: Study Protocol For A Randomized, Open-Label Equivalence Trial, Antoinette Tshefu, Adrien Lokangaka, Cyril Engmann, Fabian Esamai, Peter Gisore, Adejumoke Idowu Ayed, Adegoke Gbadegesin Falade, Ebunoluwa A. Adejuyigbe, Chineme Henry Anyabolu, Robinson D. Wammanda, William N. Ogala, Lu Gram, Simon Cousens, Rajiv Bahl, Nigel Rollins, Sachiyo Yoshida, Shamim Ahmed Qaz

Paediatrics and Child Health, East Africa

Background: The World Health Organization recommends hospitalization and injectable antibiotic treatment for young infants (0–59 days old), who present with signs of possible serious bacterial infection. Fast breathing alone is not associated with a high mortality risk for young infants and has been treated with oral antibiotics in some settings. This trial was designed to examine the safety and efficacy of oral amoxicillin for young infants with fast breathing compared with that of an injectable penicillin–gentamicin combination. The study is currently being conducted in the Democratic Republic of Congo, Kenya and Nigeria

Methods/Design: This is a randomized, open-label equivalence trial. …

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

Paediatrics and Child Health, East Africa

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

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

Results: …

Nutritional Status Of Orphaned And Separated Children And Adolescents Living In Community And Institutional Environments In Uasin Gishu County, Kenya, Paula Braitstein, Samuel Ayaya, Winstone M. Nyandiko, Allan Kamanda, Julius Koech, Peter Gisore, Lukoye Atwoli, Rachel C. Vreeman, Corey Duefield, David O. Ayuku

Paediatrics and Child Health, East Africa

Objective: To describe the nutritional status of orphaned and separated children and adolescents (OSCA) living in households in the community (HH), on the street, and those in institutional environments in western Kenya. Methods: The study enrolled OSCA from 300 randomly selected households (HH), 19 Charitable Children’s Institutions(CCIs), and 100 street-involved children. Measures of malnutrition were standardized with Z-scores using World Health Organization criteria; Z-scores #-2 standard deviations (sd) were moderate-severe malnutrition. Data were analyzed using multivariable logistic regression adjusting for child age, sex, HIV status, whether the child had been hospitalized in theprevious year, time living with current guardian, and …

Patient Safety In Developing Countries: Retrospective Estimation Of Scale And Nature Of Harm To Patients In Hospital, R. M. Wilson, P. Michel, S. Olsen, R. W. Gibberd, C. Vincent, R. El-Assady, O. Rasslan, S. Qsous, William Macharia, A. Sahel, S. Whittaker, M. Abdo-Ali, M. Letaief, N. A. Ahmed, A. Abdellatif, I. Larizgoitia

Paediatrics and Child Health, East Africa

Objective: To assess the frequency and nature of adverse events to patients in selected hospitals in developing or transitional economies.

Design: Retrospective medical record review of hospital admissions during 2005 in eight countries.

Setting: Ministries of Health of Egypt, Jordan, Kenya, Morocco, Tunisia, Sudan, South Africa and Yemen; the World Health Organisation (WHO) Eastern Mediterranean and African Regions (EMRO and AFRO), and WHO Patient Safety.

Participants: Convenience sample of 26 hospitals from which 15 548 patient records were randomly sampled.

Main outcome measures: Two stage screening. Initial screening based on 18 explicit criteria. Records that screened positive were then reviewed …

A Qualitative Study Using Traditional Community Assemblies To Investigate Community Perspectives On Informed Consent And Research Participation In Western Kenya, Rachel Vreeman, Eunice Kamaara, Allan Kamanda, David Ayuku, Winstone Nyandiko, Lukoye Atwoli, Samuel Ayaya, Peter Gisore, Michael Scanlon, Paula Braitstein

Paediatrics and Child Health, East Africa

Background: International collaborators face challenges in the design and implementation of ethical biomedical research. Evaluating community understanding of research and processes like informed consent may enable researchers to better protect research participants in a particular setting; however, there exist few studies examining community perspectives in health research, particularly in resource-limited settings, or strategies for engaging the community in research processes. Our goal was to inform ethical research practice in a biomedical research setting in western Kenya and similar resource-limited settings.

Methods: We sought to use mabaraza, traditional East African community assemblies, in a qualitative study to understand community perspectives on …

Community Perspectives On Research Consent Involving Vulnerable Children In Western Kenya, Rachel Vreeman, Eunice Kamaara, Allan Kamanda, David Ayuku, Winstone Nyandiko, Lukoye Atwoli, Samuel Ayaya, Peter Gisore, Michael Scanlon, Paula Braitstein

Paediatrics and Child Health, East Africa

Involving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers,community leaders, and even community assemblies could participate in the consent process. Community members believed …

Perspective On Opportunities For Research And Interventions Provided By Community Based Health Information System Illustrated By The Potential Use Of Motivational Interviewing Intervention, Peter Gisore, F Were, D. Ayuku, D. Kaseje

Paediatrics and Child Health, East Africa

Background: With the growth of Community-Based Health Information (CBHIS) for decision making and service provision in the low income settings, innovative models of addressing Maternal and Newborn Health (MNH) morbidity and mortality are necessary. World Health Organization (WHO) estimates that five hundred thousand mothers and about three million newborns die each year in middle and low income countries.

Objectives: To stimulate interest in utilisation CBHIS for research and interventions, with an illustration of potential using on Motivational Interviewing intervention.

Data Source: Literature searched electronically, discussion with behavioural experts, health system researchers, and maternal and Newborn Health (MNH) experts, and book …

Community Based Weighing Of Newborns And Use Of Mobile Phones By Village Elders In Rural Settings In Kenya: A Decentralised Approach To Health Care Provision, Peter Gisore, Evelyn Shipala, Kevin Otieno, Betsy Rono, Irene Marete, Constance Tenge, Hillary Mabeya, Sherri Bucher, Janet Moore, Edward Liechty, Fabian Esamai

Paediatrics and Child Health, East Africa

Background: Identifying every pregnancy, regardless of home or health facility delivery, is crucial to accurately estimating maternal and neonatal mortality. Furthermore, obtaining birth weights and other anthropometric measurements in rural settings in resource limited countries is a difficult challenge. Unfortunately for the majority of infants born outside of a health care facility, pregnancies are often not recorded and birth weights are not accurately known. Data from the initial 6 months of the Maternal and Neonatal Health (MNH) Registry Study of the Global Network for Women and Children’s Health study area in Kenya revealed that up to 70% of newborns did …

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

Paediatrics and Child Health, East Africa

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

Risks To Early Childhood Health And Development In The Postconflict Transition Of Northern Uganda, Theresa A. Mcelroy, Stella Atim, Charles P. Larson, Robert Armstrong

Paediatrics and Child Health, East Africa

Research from numerous fields of science has documented the critical importance of nurturing environments in shaping young children’s future health and development. We studied the environments of early childhood (birth to 3 years) during postconflict, post displacement transition in northern Uganda. The aim was to better understand perceived needs and risks in order to recommend targeted policy and interventions. Methods. Applied ethnography (interview, focus group discussion, case study, observational methods, document review) in 3 sites over 1 year. Results. Transition was a prolonged and deeply challenging phase for families. Young children were exposed to a myriad of risk factors. Participants …

Survey Of “Northern” Child And Maternal Health Research Being Conducted In Canada, M. H. George, Robert Armstrong

Paediatrics and Child Health, East Africa

Objectives: The purpose of the study is to better understand the scope of research being conducted by Canadian paediatric and maternal health centres on the topic of maternal child health of northern populations. In addition, the results are intended to help assess the prospects for the creation of a research network dedicated to this topic.

Study design: Questionnaire study complemented with review of database.

Methods: Data were collected using a short questionnaire with qualitative and quantitative questions. Surveys were sent by email to members of two Canadian national paediatric groups, representing 17 organizations. Supplementary information was obtained through review of …

The Global Pediatrician: Is There Such A Person, Or Can There Be?, Robert Armstrong

Paediatrics and Child Health, East Africa

As pediatricians, our concern for the health of children and youth starts with our individual encounters with patients and their families and extends to the community in which they live and the broader systems of society that influence their health. This concept of a pediatrician is captured in one of the “bibles” of our profession and in the words of Richard Behrman when he defines pediatrics as being “concerned with the health of infants, children, and adolescents, their growth and development, and their opportunity to achieve full potential as adults.”¹ Health, growth and development, and opportunity as adults encompass …

Predictors Of Emotional Problems And Physical Aggression Among Children Of Hong Kong Chinese, Mainland Chinese And Filipino Immigrants To Canada, Morton Beiser, Hayley Hamilton, Joanna Anneke Rummens, Jacqueline Oxman-Martinez, Linda Ogilvie, Chuck Humphrey, Robert Armstrong

Paediatrics and Child Health, East Africa

Background and study aims: Data from the New Canadian Children and Youth Study (NCCYS), a national study of immigrant children and youth in Canada, are used to examine the mental health salience of putatively universal determinants, as well as of immigration-specific factors. Universal factors (UF) include age, gender, family and neighbourhood characteristics. Migration-specific (MS) factors include ethnic background, acculturative stress, prejudice, and the impact of region of resettlement within Canada.

Methods: In a sample of children from Hong Kong, the Philippines and Mainland China, the study examined the determinants of emotional problems (EP), and physical aggression (PA). A two-step regression …

Validation Of C-Reactive Protein In The Early Diagnosis Of Neonatal Sepsis In A Tertiary Care Hospital In Kenya., Rashim Kumar, Rachel Musoke, William Macharia, Gunturu Revathi

Paediatrics and Child Health, East Africa

Objective: To evaluate utility of C-reactive protein (CRP) in the early diagnosis of neonatal sepsis in a tertiary care Newborn Unit in Kenya.

Design: Cross-sectional study.

Setting: Newborn Unit, Kenyatta National Hospital.

Subjects: All neonates admitted to Newborn Unit, Kenyatta National Hospital during the study period with suspected sepsis based on specified clinical criteria.

Results: Of the 310 infants, there were 83 episodes of proven sepsis and 94 episodes of probable sepsis. Using the standard CRP cut-off value of 5 mg/dl, a sensitivity of 95.2% in proven sepsis and 98.9% for probable septic episodes were noted. In proven sepsis, a …

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

Paediatrics and Child Health, East Africa

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

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

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

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

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

Paediatrics and Child Health, East Africa

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

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

Design: Historical cohort study using medical records.

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

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

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

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

Severe Road Traffic Injuries In Kenya, Quality Of Care And Access, William Macharia, F. Muli-Musiime, V. Nantulya, Erastus K. Njeru

Paediatrics and Child Health, East Africa

Background: Road traffic injuries (RTI) are on increase in developing countries. Health care facilities are poorly equipped to provide the needed services.

Objective: Determine access and quality of care for RTI casualties in Kenya.

Design: Cross-sectional survey

Setting: 53 large and medium size private, faith-based and public hospitals.

Participants: In-patient road traffic crash casualties and health personnel in the selected hospitals were interviewed on availability of emergency care and resources. Onsite verification of status was undertaken.

Results: Out of 310 RTI casualties interviewed, 72.3%, 15.6% and 12.2% were in public, faith-based and private hospitals, respectively. Peak age of the injured …

Four-Country Surveillance Of Intestinal Intussusception And Diarrhoea In Children, Shally Awasthi, Girdhar Agarwal, Vikas Mishra, Vijay Laxmi Nag, Hesham Fathey El Sayed, Antonio Da Cunha, Alvaro Madeiro, Dipty Jain, William Macharia, James Ndung'u, Saumya Awasthi, Ashish Wakhlu

Paediatrics and Child Health, East Africa

Aim: Establishment of baseline epidemiology of intussusception in developing countries has become a necessity with the possibility of reintroduction of rotavirus vaccine. The current study assessed the seasonal trend in cases admitted with intussusceptions and dehydrating acute watery diarrhoea in children aged 2 months to 10 years.

Methods: In a prospective surveillance study, teaching and research hospital sites in India (Lucknow and Nagpur), Brazil (Fortazela), Egypt (Ismailia) and Kenya (Nairobi) established a surveillance where a network of hospitals with surgical facilities catered to a reference population of about 1-2 million for reporting of intussusception. One large hospital per site also …

Characteristics Of Hiv-Infected Children Seen In Western Kenya, W Nyandiko, A. Mwangi, S. O. Ayaya, E. C. Nabakwe, C. N. Tenge, R. C. Vreeman, Peter Gisore

Paediatrics and Child Health, East Africa

Objectives: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya.

Design: A retrospective descriptive study.

Setting: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya.

Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya.

Interventions: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART).

Main outcome measures: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive …

Clinico-Pathologic Characteristics And Treatment Outcomes In Children With Neuroblastoma At The Kenyatta National Hospital, Nairobi., Grace Kitonyi, William Macharia, Otieno Walter Mwanda, R. Pamnani

Paediatrics and Child Health, East Africa

Objective: To determine clinical-pathologic characteristics, treatment modalities and treatment outcomes of children diagnosed with neuroblastoma.

Design: Cross- sectional descriptive study based on secondary data from patient records.

Setting: Records department of Kenyatta National Hospital (KNH), a tertiary teaching and referral hospital based in Nairobi.

Subjects: Children aged 15 years and below, admitted with the diagnosis of neuroblastoma, between January 1997 and December 2005.

Main outcome measures: Presenting clinical features, diagnostic modalities including laboratory and imaging data, treatment modalities, response to treatment and patient survival.

Results: Twenty six patients were eligible for the study; 13 males and 13 females giving a …

Seroprevalence Of Varicella Zoster Antibodies Among Children With Malnutrition, Malignancies And Hiv Infection, Bashir Admani, William Macharia, F. Were

Paediatrics and Child Health, East Africa

Objective: To determine the seroprevalence of varicella zoster in paediatric patients at a high risk of developing complications.

Design: A cross-sectional study.

Setting: Paediatric general wards at Kenyatta National Hospital.

Subjects: Children with malignancies, severe malnutrition and were HIV positive.

Interventions: The sample size was calculated at 147 subjects. Venous samples were tested for varicella zoster virus (VZV) antibodies using enzyme immunosorbent assay (ELISA) technique at Kenya Medical Research Institute (KEMRI) laboratories, The data were anaIysed using the SPSS software and presented in form of tables and graphs. The prevalence of VZV antibodies was determined and 95% confidence interval computed. …

Waiting For Child Developmental And Rehabilitation Services: An Overview Of Issues And Needs, Anton R. Miller, Robert Armstrong, Louise C. Mâsse, Anne F. Klassen, Jane Shen, Maureen E. O’Donnell

Paediatrics and Child Health, East Africa

Concern about the length of time that children, young people, and families may have to wait to access assessment, diagnostic, interventional, therapeutic, and supportive child developmental and rehabilitation (CDR) services is widespread, but adequate data collection and research on this issue remain limited. We review key concepts and issues relevant to waiting for CDR services from the published literature, a national workshop devoted to this topic, and international experience. We conclude that gaps in data, evidence, and consensus challenge our ability to address the issue of waiting for CDR services in a systematic way. A program of research coupled with …

Focus On The Profession: Academic And Clinical Departments, Robert Armstrong

Paediatrics and Child Health, East Africa

The departments within the Faculty of Medicine at UBC play a central role in achieving the goals of the expanded medical school, and the goals of the broader health care system. Four strategies are needed for success: make professionalism the tie that binds the Faculty of Medicine and the health authorities; engage clinical and academic de­partments as key drivers of professionalism; ensure knowledge development and continuous learning are recognized as central to professionalism; challenge government to focus on supporting professionalism.

Outcome For Hospitalized Road Trauma Patients At A Tertiary Hospital In Kenya, Hassan Saidi, William Macharia, John Ating'a

Paediatrics and Child Health, East Africa

Background: The developing world continues to experience a disproportionate burden of injury. About one half of injury deaths are due to motor vehicle collisions. Road traffic fatalities per 10,000 vehicles are ten to 20 times higher in Africa compared to Europe.

Patients and Methods: 233 patients were consecutively analyzed. Injury acuity was determined by calculating Injury Severity Scores (ISS) for each patient. Information on the care and treatment outcome was obtained from patient interviews, case notes and discharge summaries. Data analysis was performed using the SPSS version 10.0 statistical software.

Results: Injury accounted for 48.8% of all emergency hospitalizations into …