Cardiorespiratory fitness and physical activity in Luo, Kamba, and Maasai of rural Kenya.

BACKGROUND: Although habitual physical activity energy expenditure (PAEE) and cardio-respiratory fitness (CRF) are now well-established determinants of metabolic disease, there is scarcity of such data from Africa. The aim of this study was to describe objectively measured PAEE and CRF in different ethnic populations of rural Kenya. METHODS: A cross-sectional study was done among 1,099 rural Luo, Kamba, and Maasai of Kenya. Participants were 17-68 years old and 60.9% were women. Individual heart rate (HR) response to a submaximal steptest was used to assess CRF (estimated VO(2) max). Habitual PAEE was measured with combined accelerometry and HR monitoring, with individual calibration of HR using information from the step test. RESULTS: Men had higher PAEE than women (∼78 vs. ∼67 kJ day(-1) kg(-1) , respectively). CRF was similar in all three populations (∼38 and ∼43 mlO(2) ·kg(-1) min(-1) in women and men, respectively), while habitual PAEE measures were generally highest in the Maasai and Kamba. About 59% of time was spent sedentary (<1.5 METs), with Maasai women spending significantly less (55%). Both CRF and PAEE were lower in older compared to younger rural Kenyans, a difference which was most pronounced for PAEE in Maasai (-6.0 and -11.9 kJ day(-1) kg(-1) per 10-year age difference in women and men, respectively) and for CRF in Maasai men (-4.4 mlO(2) ·min(-1) kg(-1) per 10 years). Adjustment for hemoglobin did not materially change these associations. CONCLUSION: Physical activity levels among rural Kenyan adults are high, with highest levels observed in the Maasai and Kamba. The Kamba may be most resilient to age-related declines in physical activity.

HIV type 1 subtypes in circulation in northern Kenya.

The genetic subtypes of HIV-1 circulating in northern Kenya have not been characterized. Here we report the partial sequencing and analysis of samples collected in the years 2003 and 2004 from 72 HIV-1-positive patients in northern Kenya, which borders Ethiopia, Somalia, and Sudan. From the analysis of partial env sequences, it was determined that 50% were subtype A, 39% subtype C, and 11% subtype D. This shows that in the northern border region of Kenya subtypes A and C are the dominant HIV-1 subtypes in circulation. Ethiopia is dominated mainly by HIV-1 subtype C, which incidentally is the dominant subtype in the town of Moyale, which borders Ethiopia. These results show that cross-border movements play an important role in the circulation of subtypes in Northern Kenya.

Fluoride sorption characteristics of different grades of bone charcoal, based on batch tests.

Although bone charcoal (char) has been recommended for use in the de-fluoridation of drinking water in developing countries, parameters relating to fluoride (F) sorption characteristics by grade or type of bone char are unclear. Based on batch tests, the rate and capacity of F uptake were highest with black grade, followed by grey grade and lowest with white grade. Twenty-four-hour contact-time F sorption isotherms indicated saturation at capacities of 11.4 mg F per g of black grade, 2.4 mg F per g of grey grade, and less than 0.3 mg F per g of white grade bone char. Additional investigations showed that F-removal efficiency of black grade char decreased steadily with increasing F concentration. Its initial sorption kinetics were dependent on particle size, and the highest sorption rate was observed with particle sizes below 0.42 mm. For maximum sorption rate, the critical mixing time was between five and 15 min. The presence of chloride anions and elevated temperatures increased the rate of F uptake by black bone-char. The pH of distilled water following contact with bone char rose to 11.5 for white bone-char, 8.3 for grey bone-char, and 7.8 for black bone-char. The effects of processing temperature on the availability of intra- and extra-apatitic F-binding sites, levels of oxides of calcium and magnesium, and the carbon content were viewed as possible causes of observed variations. These findings suggest that the black grade of bone char was the most efficacious for use in partial de-fluoridation of drinking water.

Endemic fluorosis: an analysis of needs and possibilities based on case studies in Kenya.

The decline in prevalence of dental caries in the western world is largely ascribed to the protective role of fluoride in water. However, in several Third World regions, its presence in excessive amounts has been detrimental to the health of resident communities due to the resulting endemic dental and skeletal fluorosis. As a prelude to introduction of preventive intervention among the affected communities, there is need to assess knowledge and perception, and affordable and effective possibilities. The results of such an assessment which was based on response of mothers from two affected communities showed that objectionable dental fluorosis was not viewed as a common health problem in the context of other more common diseases. A reawakening of interest and concern was evident when issues pertaining to oral health were addressed. Dental fluorosis was viewed as an important problem because of its unfavourable effects on an individual's personality by between 60.4 and 84.3% of the respondents. While 60% and over of the respondents attributed the problem to water, knowledge on perceived methods of prevention of fluorosis were significantly lower. Only 12% of respondents from a relatively higher income group were instituting relevant preventive strategies. Although defluoridation of water had been instituted in one area, problems relating to wrong choice of water for defluoridation to inadequate distribution of the defluoridated water were evident. Education of the communities on methods of reducing fluoride ingestion and the significance of the defluoridated water, rationalizing the distribution of defluoridated water, facilitating collection of rain water, protection of available low fluoride surface water from contamination with agro-chemicals and household defluoridation were recommended.(ABSTRACT TRUNCATED AT 250 WORDS)

Ameloblastoma after surgical removal of an impacted mandibular molar. A case report.

A case of an ameloblastoma diagnosed about 3 1/2 years after removal of an impacted mandibular 3rd molar is presented. The pre-operative radiographs, though poor in quality, showed an ill-defined radiolucency in relation to the tooth. This feature was not apparent to the examiners at the time of first presentation. Despite unfavourable working conditions in developing countries, a high level of suspicion should be maintained to avoid serious sequelae at a later stage.

Evaluation of physical-mechanical properties of 3 brands of plaster of Paris in the Kenyan market.

In this study, 3 brands of plaster of Paris that are available in the Kenyan Market for prosthetics and dental rehabilitation uses were subjected to physical-mechanical tests. The particles in two of the brands that had been imported were finer than a locally made plaster since less than 1.41% of their particles were larger than 150 microns compared to 15.2% in the local plaster. The range of their setting times was between 7.5 and 27.5 min. and was within the International Standards Organisation (ISO) recommendation. The water:power ratios required to produce plaster mixes of standard consistency for the locally made plaster was about 1.5 times of other brands. In compression, the mean 1-hour strength of local plaster was 2.5 MN/m2 (Mega Newtons per square metre) compared to 6.81 MN/m2 and 8.95 MN/m2 for the other brands. The differences between these strength values were highly significant (p less than 0.01). There were no significant differences in deformation of fracture for the 3 brands whose range was 1.32% to 1.71%. In order to obviate the need to import plaster, strict manufacturing techniques of locally made plaster are recommended.

Coping with embedded mandibular wisdom teeth in developing countries.

Despite low incidence of embedded mandibular wisdom teeth (third molars) among dental patients in developing countries (less than 100/1,000), the unfavourable patients:dentist ratios, the limited resources and low levels of public awareness render them an important problem to operators in these countries. Since the effectiveness with which they are removed largely depends on the age with respect to the stage of root formation, bone resilience and relationship with adjacent anatomical structures, and the dexterity of the operator, whenever possible, early removal is recommended. To minimise occurrence of non-operative complications that are costly to manage, primary health care workers have a vital role to play in raising levels of awareness and early referral for further evaluation. In view of the risks involved in the removal of these teeth and the small number of trained oral surgeons, continuing education to the dental practitioners, could improve their efficiency in the management of this condition.

The position of mandibular and mental foramina in Kenyan African mandibles.

Analysis of 79 adult African mandibles indicated that 64.6% of the mandibular foramina were located below the level of the posterior extension of the occlusal plane while 30.7% were located along this plane. 56.1% of the mental foramina were located below the second premolar while 31.1% were between the second premolar and first molar. The remainder were located between the premolars. The mental foramen opened posterosuperiorly in 72.5% of the surfaces. Multiple mental foramina were found on 4.5% of the mandibles. While emphasising the importance of palpation prior to administration of mental nerve block, these observations suggest that in case of uneffective mandibular nerve block, for a significant proportion of Kenyan Bantus, attempts to place the anaesthetic solution slightly below the occlusal plane be considered.

Mandibular fractures: an appraisal of the weak regions.

There is no uniformity in the role of different aetiologic factors in mandibular fractures in different cities of the world. Cultural and socioeconomic factors appear to have important contribution to the aetiologies. The condyle and the angle-body regions are most commonly fractured. There is no obvious relationship between aetiology and the site of fracture. Structural considerations suggest that differences between dentate (open section structure) and non dentate (closed section structure) regions are important determinants of fracture sites. Some modifications of standard teaching materials are recommended.

Fluoride and abrasive content in commonly used dentifrices on the Kenyan market.

About one decade ago, a heated debate on the appropriateness of fluoride dentifrices in Kenya culminated in the introduction of no-fluoride brands. Analysis of dentifrices that were available on the market in 1989/1990 confirmed two distinctly different categories, the fluoride and the low or no-fluoride types. Among the former, the mean ionic fluoride concentration ranged between 0.4 and 1.36 mg/g while the total fluoride concentration ranged between 1.15 and 114.68 mg/g. The low or no-fluoride dentifrices had less than 0.03 mg/g ionic fluoride and less than 2.14 mg/g total fluoride. The mean abrasive (powder) content ranged between 26.5 g% and 78.5 g%. The gel categories had markedly lower powder values than the pastes. The ash values of the powders ranged between 15.8 g% and 85 g% and did not have an obvious relationship with the powder content. Despite the obvious risk of increasing exposure to excessive fluoride among children, presently, the situation has reverted to the pre-debate time. Given the ubiquitous nature of ingestable fluoride in the region, provision of guidelines and guidance on the sale of dentifrices by the government and consumer organisations, and increased accountability of the manufacturers are recommended.

Biocidal effects and residual glutaraldehyde in cellulosic and synthetic polymers.

The amount of leachable glutaraldehyde from medical grade Cuprophan 150PM (cellulose based) and AN69S (a copolymer of acrylonitrile and sodium methallyl sulphonate) membranes, and polyproprene plates following 72 hr immersion in 2% alkaline glutaraldehyde was determined. After rinsing the materials for 30 minutes in distilled water at 37 degrees C, the mean concentration of leachable glutaraldehyde from Cuprophan 150 PM (8. 60 +/- 0.55 micrograms/g) was significantly greater than that from AN69S membrane (6.50 +/- 0.60 micrograms/g), (p < 0.01). The mean leachable glutaraldehyde from plates was 0.30 +/- 0.15 microgram/g. There was a significant decrease in the mean leachable glutaraldehyde from AN69S (5.35 +/- 0.25 micrograms/g) after second immersion (p < 0.05). The concentration of leachable glutaraldehyde in the plates and Cuprophan 150PM remained relatively unchanged. Absence of growth following infusion of 2% alkaline glutaraldehyde into blood contaminated miniature dialyzers containing high microbial loads of selected bioindicator organisms (S. aureus, P. aeruginosa, B. subtilis (Var globigii) spores, M. gordonae, A. niger spores and attenuated polio virus) demonstrated its effectiveness under environmental conditions that were conducive to high resistance. These findings indicate that 2% alkaline glutaraldehyde is readily washed from the three polymer materials that were studied and its accumulation following repeated exposure was not evident. Its application in pre-sterilization treatment of heavily contaminated invasive polymer based devices seemed feasible.

Fluoride binding capacity of bone charcoal and its effects on selected micro-organisms.

Water is a major source of fluoride ions in areas where skeletal and dental fluorosis are endemic. We investigated the capacity of bone char to remove fluoride from water and its effects on selected bio-indicator organisms. Under static and dynamic conditions, the capacity of bone char was in the order of 2.5 mg of fluoride per g of bone char. Bone charcoal did not appear to support growth of yeast and S. aureus. E. coli and S. faecalis counts in the filtrate decreased with time but there was substantive growth in the bone charcoal.

Incidence and pattern of oesophageal perforations in Kenyatta National Hospital.

A retrospective study of 42 patients with perforations of the oesophagus during the period 1981-1987 indicated that 57.1% of the perforations were iatrogenic. Diseases of the oesophagus and in contiguous structures and foreign bodies in the oesophagus caused perforations in 31% of the cases. Perforations in 35.7% of the patients were located in the middle third of the oesophagus. The lower and upper thirds were affected in 31% of the patients in each site. The presenting physical signs included tachycardia (78.6%), fever (76.2%) and dyspnoea (59.5%). The main accompanying symptoms were chest pain and coughs in 100% and in 50% of the patients respectively. Radiographic findings showed hydropneumothorax in 40.5% of the cases and consolidation in 38.1% of the patients. Oesophagoscopy was positive in 78% of cases tested while thoracocentesis was positive in all cases that were tested.

Replacement therapy utilising autotransplanted wisdom teeth.

Loss of 1st and 2nd molars among adolescents due to dental caries is not uncommon in developing countries. Whilst their replacement is indicated, conventional methods of treatment, namely, bridging and dentures are in most cases inaccessible because of prohibitive cost. Given that it is in the same age group that diagnosis of unfavourably embedded wisdom teeth becomes feasible, autotransplantation of the latter to replace the unsalvageable 1st and 2nd molars could be an alternative treatment. Available literature suggests a success rate of over 82% based on follow-up studies of over ten years. Observations at the Dental School Clinic of the University of Nairobi, Kenya, indicate that the time it takes the transplant to 'take' and assume its functional position is 4 to 8 weeks and 2.5 to 3.5 months respectively. Since the method is relatively straightforward, we are of the view that training undergraduates and practising dental surgeons in this technique should enhance utilisation of otherwise "useless" teeth to replace the lost 1st and 2nd molars in occlusal rehabilitation.

Prevalence of oral mucosal lesions in a Kenyan population with special reference to oral leukoplakia.

The prevalence of oral leukoplakia and related lesions in a Kenyan rural population was determined in a systematic house to house survey of individuals aged 15 years and above. Among the 803 individuals examined, the following prevalence of lesions was observed: leukoedema (26%), melanosis (12.7%), leukoplakia (10.6%), palatal keratosis (6.4%), frictional keratosis (5.5%), pre-leukoplakia (4.1%), borderline leukoplakia (2.4%), cheek/lip biting (1.3%), and snuff dippers lesion (0.4%). 48.6% of the subjects had at least one of these lesions. Statistically significant preponderance was demonstrated for oralleukoplakia, palatalkeratosis, leukoedema and frictional keratosis among males and melanosis among females. With regard to clinical classification of oral leukoplakia, the prevalence was 10% for homogeneous and 0.6% for nonhomogeneous lesions. On the basis of aetiological classification; the prevalence was 8.3% for tobacco associated and 2.2% for idiopathic leukoplakia. 22.5% of leukoplakia lesions biopsied had evidence of epithelial dysplasia. In view of the premalignant potential of oral leukoplakia, our findings suggest a need for greater attention towards prevention and control of this lesion in the study community.

Orofacial lesions as indicators of HIV/AIDS among dental patients in Kenya.

Despite an estimated prevalence of 3-5% of HIV infection in Kenya, little has been reported on the occurrence of oral lesions amongst the afflicted individuals. We report ten cases who presented with orofacial lesions and subsequent serological evaluation confirmed them seropositive. In the light of the numerous problems facing clinical staff in less developed countries, these findings underscore the significance of clinical identification of more probable HIV patients on the basis of orofacial signs. Continuing education with respect to HIV infection through wider dissemination of information on orofacial signs to clinical staff especially in the context of invasive care and containment of infection are recommended.

Assessment of blood compatibility of haemodialysis membranes using a miniature flat sheet dialyser.

Available pre-clinical techniques of assessing severity of untoward reaction by blood following contact with haemodialysis membranes do not account for the effects of dialysate and flow characteristics in the observed blood changes. A miniature flat sheet dialyser that considered these effects was prepared and tested in both in-vitro and ex-vivo circuits. Changes in platelets and leucocytes in heparinised human blood in-vitro tests did not distinguish regenerated cellulose (Cuprophan 150PM) membrane from a synthetic membrane, a copolymer of acrylonitrile and sodium methyl sulphonate (AN69S). Ex-vivo tests using rats showed more marked leucocyte (41.3%) and platelet (43.1%) depletion by Cuprophan 150PM than AN69S after 90 minutes of dialysis. Leucocyte and platelet loss due to AN69S were 26.9% and 13.4% respectively. In addition, Cuprophan 150PM membranes exhibited high affinity for leucocytes and platelets in both in-vitro and ex-vivo tests compared to AN69S membranes which were primarily covered with erythrocytes. Application of simulated in-use techniques in preclinical evaluation of blood compatibility membranes that are used in extra-corporeal treatment are recommended.

Focal epithelial hyperplasia (Heck's disease) in three Kenyan girls: case reports.

We report the first three patients diagnosed with focal epithelial hyperplasia (Heck's disease) in Kenya. Clinically they presented as focal or diffuse papillomatous lesions in the oral mucosa. Histopathological features rule out other similar lesions inter alia multiple fibro-epithelial and viral warts.

Symptoms in health personnel exposed to disinfectants.

BACKGROUND: While the biocidal efficacy of disinfectants available for use in health facilities has been widely investigated, little attention has been paid to their potential side effects to users. OBJECTIVE: To describe the occurrence of symptoms attributable to occupational exposure to disinfectants with emphasis on gluteraldehyde. DESIGN: Exploratory cross-sectional study. SETTING: Kenyan health facilities. SUBJECTS: One hundred and fifteen members of various health cadres. RESULTS: All the respondents reported using disinfectants. Glutaraldehyde-based preparations, either alone or alongside other agents (excluding hypochlorite), were used by 52.2% of the respondents. Hypochlorite-based preparations, either alone or alongside other agents, were used by 18.3%, while cetrimide preparations and ethanol alongside other agents were used by 13% of the respondents. More than sixty two per cent of the respondents had suffered one or more symptoms during the use of these disinfectants. Among the users of glutaraldehyde preparations, the most common symptoms reported were sneezing (38.3%), headache (31.7%), watering of eyes (25%), skin rash (10%) and chronic cough (8.3%). Among users of hypochlorite and cetrimide preparations, the most commonly reported symptoms were sneezing, headaches and watering of eyes. CONCLUSIONS: Our findings suggest possible occupation-related adverse reactions that may be attributed to the use of disinfectants. Awareness of these potential hazards needs to be increased among users and efforts made to introduce techniques to minimise exposure to liquid and vapourised disinfectants. Further studies involving larger sample sizes, are necessary to unequivocally apportion the various symptoms to specific disinfecting agents.

Occurrence and characteristics of mandibular fractures in Nairobi, Kenya.

Analysis of 355 cases with fractures of the mandible indicated that 74.9% of the cases were due to interpersonal violence and 13.8% were caused by road traffic accidents. The men to women ratio was 8.4:1 and 75.5% of the fracture cases had single fractures while 24.5% had multiple fractures. In cases with a single fracture, the most commonly involved mandibular site was the body (42.2%). The angle of mandible was most frequently fractured (50.5%) in cases with multiple fractures.