Pediatrics Commons^™

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 …

Ceftriaxone Or Hiv Associated Angio-Oedema? Case Report, William Macharia, C. Mbaabu, L. Wachira, S.O.M. Muhudhia, G. Moniz

Paediatrics and Child Health, East Africa

Angio-oedema may be hereditary or acquired and is characterised by episodes of potentially life threatening localised tissue oedema and swelling resulting from deficiency of compliment pathway C1 esterase inhibitor. Acquired angio-oedema is about ten times less frequent than the hereditary type and has been associated with immune-deficiency disorders, malignancies and exposure to specific medications and food substances. We present a case of seven year old, human immune-deficiency virus positive girl, who developed gross swelling of the tongue and neck while on treatment for pneumococcal meningitis with ceftriaxone. Difficulties in arriving at a definitive diagnosis of angio-oedema in a resource poor …

A Systematic Review Of Existing National Priorities For Child Health Research In Sub-Saharan Africa, George Swingler, James Irlam, William Macharia, Felix Tietche, Martin Meremikwu

Paediatrics and Child Health, East Africa

Background: We systematically reviewed existing national child health research priorities in Sub-Saharan Africa, and the processes used to determine them.

Methods: Collaborators from a purposive sample of 20 WHO-AFRO Region countries, assisted by key informants from a range of governmental, non-governmental, research and funding organisations and universities, identified and located potentially eligible prioritisation documents. Included documents were those published between 1990 and 2002 from national or nationally accredited institutions describing national health research priorities for child health, alone or as part of a broader report in which children were a clearly identifiable group. Laboratory, clinical, public health and policy research …

Attitudes Of Developing World Physicians To Where Medical Research Is Performed And Reported, John Page, Richard F. Heller, Scott Kinlay, Lynette Lim, Wang Qian, Zheng Suping, Supornchai Kongpatanakul, Murtaza Akhtar, Salah Khedr, William Macharia

Paediatrics and Child Health, East Africa

Background: Little is known about the influence of the site of research or publication on the impact of the research findings on clinical practice, particularly in developing countries. The International Clinical Epidemiology Network (INCLEN) is dedicated to improving the quality of health research in the Developing World through institutional capacity building for evidence based medicine, and provided the opportunity to examine the likely impact of research location and journal location on physicians' practice in a number of the participating countries.

Methods: Physicians from secondary and tertiary hospitals in six cities located in China, Thailand, India, Egypt and Kenya were enrolled …

Morbidity And Outcome Of Low Birthweight Babies Of Adolescent Mothers At Kenyatta National Hospital, Nairobi, A. Wasunna, K. Mohammed

Paediatrics and Child Health, East Africa

Objective: To compare the morbidity and outcome of low birthweight babies (birthweight < 2000gm) of adolescent (age < 20 years) and older mothers.

Design: Cross sectional descriptive study.

Setting: The newborn Unit of the Kenyatta National Hospital. Main outcome measures: All babies weighing less than 2000gm at birth whose mothers consented to the study had their gestational age verified using the Dubowitz scoring system. They were then followed up by daily clinical assessment untill discharge, death or up to one month in the ward. The babies were divided into two groups according to their mother's age and then compared with respect to episodes of illness, duration of hospital stay, and overall …

Low Birthweight Babies: Socio-Demographic And Obstetric Characteristics Of Adolescent Mothers At Kenyatta National Hospital, Nairobi, A. Wasunna, K. Mohammed

Paediatrics and Child Health, East Africa

Objective: To compare some socio-demographic and obstetric factors between adolescent mothers (aged below 20 years) and older mothers of low birthweight (birthweight <2000gm) babies.

Design: Cross sectional descriptive study.

Setting: The Newborn Unit of the Kenyatta National Hospital.

Results: Sixty nine adolescent mothers and 73 older mothers were studied. Adolescent mothers were more likely to be unmarried (p 0.0001) have less formal education (p

Clinical Presentation And Treatment Outcome In Children With Nephroblastoma In Kenya, F.K. Abdallah, William Macharia

Paediatrics and Child Health, East Africa

Objective: To review the clinical presentation and management of children with nephroplastoma and the factors influencing the outcome at Kenyatta National Referral and Teaching Hospital (KNH).

Design: This was a retrospective case series study based on secondary data accumulated between 1990 and 1996.

Setting: The relevant data were extracted from records of all children aged 12 years and below, admitted for cancer at KNH, Nairobi.

Results: Out of 803 children with cancer, 71 (8.8% ) had histologically proven nephroblastoma. At presentation, 1.5% were in stage I, 13.2% stage II, 36.8% stage III, 41.2% stage IV and 7.4% stage V. Eighty …

Chrimcy: A Proposed Institute For Research On Reproduction, Development, And Mother, Child And Youth Health, Harvey Guyda, Robert Armstrong, Ken Milne, Alex Mackenzie, Victor Han, Robert Bortolussi, Elaine Orrbine

Paediatrics and Child Health, East Africa

The establishment of the Canadian Institutes of Health Research (CIHR) is one of the most significant and far-sighted plans to address the health of Canadians. The success of the CIHR will be determined by the degree to which Canada is able to provide focus and the resources to tackle the critical health issues affecting Canadians.

A Randomized Clinical Trial To Compare Selective Posterior Rhizotomy Plus Physiotherapy With Physiotherapy Alone In Children With Spastic Diplegic Cerebral Palsy, Paul Steinbok, Ann M. Reiner, Richard Beauchamp, Robert Armstrong, Douglas Cochrane

Paediatrics and Child Health, East Africa

A randomized controlled single-blind trial was performed to compare lumbo-sacral selective posterior rhizotomy (SPR) followed by intensive physiotherapy, with intensive physiotherapy alone in improving motor function in children with spastic diplegic cerebral palsy. Fifteen patients were randomly assigned to each treatment modality. Patients in the SPR group had rhizotomy within 1 month, followed by intensive outpatient physiotherapy for 9 months. Patients assigned to physiotherapy alone had identical intensive physiotherapy. There was a statistically significant and clinically important difference in improvement in motor function in favor of the SPR group, with a mean increase in total Gross Motor Function Measure (GMFM) …