RANDOMISED DOUBLE BLIND STUDY TO COMPARE EFFECTIVENESS OF HONEY, SALBUTAMOL AND PLACEBO IN TREATMENT OF COUGH IN CHILDREN WITH COMMON COLD.

BACKGROUND: Acute upper respiratory infection is the most common childhood illness and presents with cough, coryza and fever. Available evidence suggests that cough medicines may be no more effective than honey-based cough remedies. OBJECTIVE: To compare effectiveness of honey, salbutamol and placebo in the treatment of cough in children with acute onset cough. DESIGN: Randomised control trial. SETTING: Aga Khan University Hospital Paediatric Casualty. SUBJECTS: Children between ages one to twelve years presenting with a common cold between December 2010 and February 2012 were enrolled. OUTCOME MEASURES: Frequency, severity and extent to which cough bothered and disturbed child and parental sleep were assessed at baseline and over the subsequent five days through telephone interview using a validated scoring tool. RESULTS: One hundred and forty five children were enrolled in the study (45- placebo, 57 -honey, 43 -salbutamol). Of the 145 children 51% were male. Honey significantly reduced the total mean symptom score by day three (p < 0.001). Total mean difference in scores between day zero to five demonstrated a significant difference of honey's efficacy over placebo (p < 0.002) however no difference was noted when compared to salbutamol (p < 0.478). Significant differences in both total as well as each individual symptom score was detected with honey consistently scoring the best whilst placebo and salbutamol scored the worst. In paired comparisons honey was superior to placebo but not salbutamol, whilst salbutamol was not superior to placebo. CONCLUSION: Honey was most effective in symptomatic relief of symptoms associated with the common cold whilst salbutamol or placebo offered no benefit.

Severe road traffic injuries in Kenya, quality of care and access.

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 was 15-49 years. First aid was availed to 16.0% of casualties. Unknown persons transported 76.5% of the injured. Police and ambulance vehicles transported 6.1% and 1.4%, respectively. 51.9% reached health facilities within 30 minutes of crash and medical care provided to 66.2% within one hour. 40.8% of recipient facilities were adequately prepared for RTI emergencies. CONCLUSIONS: Most RTI casualties were young and from poor backgrounds. Training of motorists and general public in first aid should be considered in RTI control initiatives. Availability of basic trauma care medical supplies in public health facilities was highly deficient.

Severe road traffic injuries in Kenya, quality of care and access

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; 15.6and 12.2were in public; faith-based and private hospitals; respectively. Peak age of the injured was 15-49 years. First aid was availed to 16.0of casualties. Unknown persons transported 76.5of the injured. Police and ambulance vehicles transported 6.1and 1.4; respectively. 51.9reached health facilities within 30 minutes of crash and medical care provided to 66.2within one hour. 40.8of recipient facilities were adequately prepared for RTI emergencies. Conclusions: Most RTI casualties were young and from poor backgrounds. Training of motorists and general public in first aid should be considered in RTI control initiatives. Availability of basic trauma care medical supplies in public health facilities was highly deficient

Oral hygiene practices and risk of oral leukoplakia.

OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. RECOMMENDATIONS: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Headache associated disability in medical students at the Kenyatta National Hospital, Nairobi.

OBJECTIVE: To study headache associated disability in a group of medical students at the Kenyatta National Hospital. STUDY DESIGN: Cross sectional survey. RESULTS: Between October 1994 and January 1995 we conducted a survey on headache characteristics on medical students at both the Kenya Medical Training Centre and the Medical School of the University of Nairobi. Six hundred and twenty-five (87%) of the 711 students surveyed admitted having had at least one episode of headache in the last six months. Using the International headache society (IHS) case criteria 314 students (50%) had tension type headache, 240 (38%) migraine headache and 71(12%) unclassified headache. Eighty-six percent of the students with headache had their working ability disturbed to various degrees. Eighty-five percent of the students reported that their social activities were interfered with by headache. Migraine headaches had the greatest impact on both the working and social activities at a p-value of 0.0005 and 0.0004 respectively. One hundred and forty-one students (23.6%) had missed at least one day of work or school in the last one-year as a direct result of the headache. There was an association between headache severity with working ability and social effect. There was no association between the days students missed work or classes with the severity of the headache. No gender difference was found in the headache associated disability. CONCLUSION: Headache is a prevalent condition with disability both in working and social activities.

Influence of cigarette filters on the risk of developing oral leukoplakia in a Kenyan population.

OBJECTIVE: To determine the influence of cigarette filters and the effect of smoking Kiraiku (home processed, hand rolled tobacco) on the risk of developing oral leukoplakia among cigarette smokers. DESIGN: Case control using population-based study groups in a Kenyan rural community. MATERIALS AND METHODS: 85 cases and 141 controls identified in a cross-section house-to-house screening of subjects aged 15 years and over and matched for sex, age (+/- 3 years) and cluster origin were compared for their use of filter and non-filter cigarettes as well as their history of smoking Kiraiku. RESULTS: The relative risk (RR) of oral leukoplakia was 9.1 (95% confidence intervals (CI) = 4.1-20.2) in smokers of filter cigarettes and 9.8 (95% CI = 2.3-47.0) in smokers of non-filter cigarettes. The RR in the latter compared to the former was 1.1 and was not statistically significant. Regarding the influence of smoking Kiraiku, the RR of this lesion was 29.3 in smokers of both Kiraiku and filter cigarettes and 17.3 in smokers of both Kiraiku and non-filter cigarettes. CONCLUSIONS: There was no statistically significant difference between the influence of filter and non-filter cigarettes on the risk of developing oral leukoplakia. The effect of Kiraiku on the risk of this lesion was stronger in filter than in non-filter cigarettes. However, the confounding effect of tobacco dose response parameters could not be ruled out.

Screening for urinary tract infection in children with cancer.

Neutropaenia and immunosuppression place children on treatment for malignancies at a high risk for infections. We undertook to determine the prevalence of urinary tract infection (UTI) in children on treatment for cancer at the Kenyatta National Teaching and Referral hospital. With the understanding that many laboratories in the rural areas of the country lack appropriate facilities for confirmation of UTI, it was also important to evaluate simple and inexpensive screening methods against a "gold standard" in this cross sectional study. One hundred and eighty six children between the ages of five and 14 years admitted in Kenyatta hospital with leukaemia or lymphoma were enrolled. Besides clinical evaluation, urinalysis and culture and sensitivity were performed on all the subjects. Urine culture was considered the "gold standard" for diagnosis for UTI. The prevalence of UTI was 8.1% (CI = 6.1, 10.1). Only five out of 15 patients were symptomatic. E. coli and klebsiella spp. were responsible for 93.4% of the infections. Presence of pyuria, defined as five or more pus cells per high power field, had a sensitivity of 80.0%, specificity of 97.1% and a positive predictive value of 70.6% while comparative values associated with a positive nitrite test were 60%, 97.7% and 96%. Other clinical and laboratory tests had low sensitivity. UTI is a relatively frequent infection in children on cancer treatment. Screening for pyuria is simple, inexpensive and an accurate method of diagnosing UTI in children on treatment for lymphohaematopoietic malignancies in situations where facilities for urine culture are unavailable.

X-ray diagnosable pneumonia in children with severe malnutrition at Kenyatta National Hospital.

OBJECTIVES: To estimate the prevalence of radiologically evident pneumonia among children with severe malnutrition and to evaluate the diagnostic utility of commonly used clinical indicators of pneumonia among children with severe malnutrition. METHODS: All children with severe malnutrition and admitted at the then Paediatric Observation Ward without congestive cardiac failure, severe anaemia, or severe dehydration, were clinically evaluated and a posteroanterior chest X-ray taken for each child. Pneumonia was diagnosed on the basis of radiological changes consistent with pneumonia as reported by an experienced radiologist. The performance of the various clinical parameters as diagnostic tests for pneumonia were also evaluated. SETTING: Kenyatta National Hospital, a tertiary level teaching institution for the University of Nairobi. RESULTS: One hundred and seven children comprising 68 males and 39 females were recruited into the study. Of these children, 38 had kwashiorkor, 40 had marasmus, while 29 had marasmic kwashiorkor. Radiological evidence of pneumonia was found in 58% of children with kwashiorkor, 75% with marasmic kwashiorkor, and 82% with marasmus. All the commonly used clinical parameters performed poorly as diagnostic tests for pneumonia among children with severe malnutrition. CONCLUSION: Prevalence of pneumonia was very high among children with severe malnutrition. Available clinical parameters, singly or in combination, are poor diagnostic tools for pneumonia in children with severe malnutrition. It is advisable to treat children with severe malnutrition as if they had pneumonia, even in the absence of suggestive clinical signs.

Knowledge, attitudes and beliefs of primary caretakers towards sickle cell anaemia in children.

The objective of this study was to evaluate knowledge, attitudes and beliefs (KAB) that may influence health seeking behaviour of caretakers of children with sickle cell disease (SCD). A cross-sectional survey was undertaken at Nyanza provincial hospital in Kenya between March and September 1993 to identify socio-demographic and economic factors that may influence health seeking behaviour of primary caretakers of children with SCD. All caretakers accompanying children under the age of 18 years to the Sickle Cell Clinic were eligible. Guardians accompanying children to the clinic were interviewed using pretested questionnaires. An exploratory factor analysis method was used to categorise questionnaire items into domains (knowledge, attitude and belief) and to investigate for association between certain socio-demographic factors and KAB. Seventy five per cent of the 108 respondents interviewed were mothers and 16.7% fathers. Seventy eight percent knew SCD to be hereditary while 55% knew how the disease presents in childhood. Only 42% associated SCD with increased risk of infection. Many felt severe infections are largely preventable and that prevention would reduce their anxiety and illness related costs. In factor analysis, variables loaded almost exclusively on "Attitudes" and "Beliefs" factors. Only family size was found to influence caretaker attitudes (p = 0.0095) and beliefs (p = 0.0034). Education, monthly income, occupation and religion had no significant influence. The majority of caretakers had good knowledge and positive attitudes towards SCD in children. Interventions aimed at management of SCD or prevention of its sequelae would be well accepted. Factor analysis is recommended for statistical analysis of KAB data. The effect of family size on attitudes and behaviour needs further evaluation.

The effects of malaria control on nutritional status in infancy.

Both malaria and undernutrition are major causes of paediatric mortality and morbidity in sub-Saharan Africa. The introduction of insecticide-treated bed nets (ITBN) during a randomized controlled trial on the Kenyan coast significantly reduced severe, life-threatening malaria and all-cause childhood mortality. This paper describes the effects of the intervention upon the nutritional status of infants aged between 1 and 11 months of age. Seven hundred and eighty seven infants who slept under ITBN and 692 contemporaneous control infants, were seen during one of three cross-sectional surveys conducted during a one year period. Standardized weight-for-age and mid-upper arm circumference measures were significantly higher among infants who used ITBN compared with control infants. Whether these improvements in markers of nutritional status were a direct result of concomitant reductions in clinical malaria episodes remains uncertain. Never-the-less evidence suggests that even moderate increases in weight-for-age scores can significantly reduce the probability of mortality in childhood and ITBN may provide additional gains to child survival beyond their impressive effects upon malaria-specific events.

Migraine headaches in a group of medical students at the Kenyatta National Hospital, Nairobi.

A survey was carried out on 711 medical students from both the medical school and the Kenya Medical Training Centre on headaches using a closed ended questionnaire. Six hundred and twenty five (88%) of the students reported to have at least one episode of headache in the last six months. Two hundred and forty (33.8%) of these were classified as migraine using the International Headache Society case definition. Seventy (29%) had migraine with aura, the rest being migraine without aura. The mean age was 22.7 +/- 5 years with a male to female ratio of 1:1.3. The majority of the respondents (43%) had an average of two to three headache episodes per month. The major triggering factors for the headache were physical activities, emotional disturbance and studying, each occurring in 21% of the student respondents. It was reported by 43.6% of the respondents that there was a member of their nucleus family with a similar headache. Only 40% of the respondents had sought medical attention for their headache in the last one year. The main reason for not seeking medical services was self medication in 56% of those who did not attend medical services. Only 27 (11%) of the respondents were currently on medication which consisted of simple analgesics and antimalarials. There were only two students who were on specific drugs for migraine. The majority of the respondents continued to be inadequately treated despite the development of wide range of effective treatment.

Prevalence of persistent diarrhoea in children aged 3-36 months at the Kenyatta National Hospital, Nairobi, Kenya.

Three hundred and eighty four children aged 3-36 months admitted to the Infectious Diseases Hospital (IDH) with diarrhoea were studied for persistent diarrhoea (PD), defined as diarrhoea lasting more than 14 days. To establish the duration of diarrhoea, the children were evaluated daily while in hospital and on days seven, fourteen, twenty one and twenty eight of the diarrhoea episode, if discharged. Of these children, 268 (69.8%) were less than 12 months. There was a slight male preponderance with a male to female ratio of 1.2:1. Twenty (5.4%) children presented with diarrhoea of more than 14 days at admission while of the 364 who presented with diarrhoea of less than 14 days at admission, 40 (11%) developed persistent diarrhoea, giving a total PD rate of 16.5%. The peak age for PD was nine months with no sex difference. Some possible risk factors for PD were identified as blood in stools, pneumonia, malnutrition, not breastfeeding, severe dehydration and antibiotic treatment. The total number of deaths in the study cases was 50, giving a case fatality rate of 13.6%. Of the children with PD, 19(31.7%) died. The children with PD were at a four times greater risk of dying (P<0.001, OR = 4.16). This study indicates that prevalence of PD among children admitted to IDH is high; and carries a high case fatality.

STD partner notification and referral in primary level health centers in Nairobi, Kenya.

BACKGROUND: Controlling sexually transmitted diseases requires that partners of patients with a sexually transmitted disease be notified and treated. However, many countries in the developing world lack the infrastructure and resources for effective partner referral. GOAL OF THIS STUDY: To provide information on rates of partner referral in primary-level health centers in Kenya, to identify characteristics of patients with sexually transmitted diseases who inform their partners about the need for treatment, and to evaluate the impact of a brief counseling intervention on rates of partner notification. STUDY DESIGN: Two-hundred-fifty-four patients presenting for treatment of a sexually transmitted disease were given 5 to 10 minutes of additional counseling on the importance of referring partners for sexually transmitted disease treatment. All patients who returned for follow-up 1 week later were interviewed to determine whether they had notified their sex partners. RESULTS: Sixty-eight percent of patients who returned for follow-up reported they had referred their partners for treatment of a sexually transmitted disease. The highest rates of partner notification occurred among women attending maternal child health/family planning clinics and married men and women attending general outpatient clinics. CONCLUSION: Strengthening and directing counseling toward women in maternal child health/family planning clinics and married men and women in general clinics may be an effective and inexpensive way to increase partner notification in the developing world.

PIP: In developing countries, patient referral is a more feasible means of notifying partners of sexually transmitted disease (STD) clients than the costly, labor-intensive provider referral approach. However, enhancement strategies such as education and counseling, contact cards, educational materials, follow-up, and monetary incentives may be necessary. To assess the impact of brief counseling on patient referral rates, a study was conducted at five primary health care centers in low-income areas of Nairobi, Kenya. All 254 STD patients who attended the clinic in a two-week period in 1992 were enrolled in the study. Subjects were given 5-10 minutes of counseling, asked to identify their sexual partners, and given a return appointment for the following week. Of the 93 patients who returned to the clinic and provided partner referral data, 63 (68%) reported they informed their partner of the need for STD treatment and 54 (58%) claimed that their partners had been treated. Multivariate analysis indicated that partner notification rates were highest for females, married individuals or those with regular partners, and maternal-child health/family planning clinic patients. Although 84% of unmarried men, 66% of unmarried women, and 47% of married men were infected by a casual sex partner, only 35% of those in the casual partner group attempted notification. Before the study, only 15% of partners presented to the clinics for treatment as a result of partner referral. This provides some evidence of the effectiveness of the counseling strategy, at least for married men and women, although more detailed guidelines on methods of partner notification are recommended.

Sexual behaviour in Kenya: implications for sexually transmitted disease transmission and control.

Sexual behaviour in Kenya in relation to STD transmission was investigated with a view to forming a basis for the more rational design of STD/HIV control interventions. Questionnaires were administered to a sample of 762 men and women attending eight health facilities in two urban centres. Equal numbers of STD patients (cases) and non-STD related clinic attenders (clinic controls) were selected, matched by gender and clinic. Another sample of 427 men and women was obtained from a random sampling of households in a slum area in Nairobi (community controls). Male STD patients who were unmarried, or married but living apart from their wives, reported a higher mean number of sex partners in the previous three months than did male clinic or community controls. Unmarried female STD patients reported a higher mean number of sex partners in the previous three months than did unmarried female clinic or community controls. Both male and female STD patients were more likely to report having been involved in commercial sex transactions in the previous three months than clinic or community controls. Considerable heterogeneity in sexual behaviour was apparent. In multivariate analysis, the most important predictor of STD acquisition for both men and women was the number of reported sex partners in the previous three months. In addition, for men only, marital status (unmarried, or married but living apart from their wives) and purchasing sex were significant predictors of being an STD patient. These data confirm the importance of commercial sex in STD transmission, and suggest that men play a bridging role between female sex workers and the general population of women.(ABSTRACT TRUNCATED AT 250 WORDS)

Health care-seeking behavior related to the transmission of sexually transmitted diseases in Kenya.

OBJECTIVES: The purpose of this study was to identify health-care seeking and related behaviors relevant to controlling sexually transmitted diseases in Kenya. METHODS: A total of 380 patients with sexually transmitted diseases (n = 189 men and 191 women) at eight public clinics were questioned about their health-care seeking and sexual behaviors. RESULTS: Women waited longer than men to attend study clinics and were more likely to continue to have sex while symptomatic. A large proportion of patients had sought treatment previously in both the public and private sectors without relief of symptoms, resulting in delays in presenting to study clinics. For women, being married and giving a recent history of selling sex were both independently associated with continuing to have sex while symptomatic. CONCLUSIONS: Reducing the transmission of sexually transmitted diseases in Kenya will require improved access, particularly for women, to effective health services, preferably at the point of first contact with the health system. It is also critical to encourage people to reduce sexual activity while symptomatic, seek treatment promptly, and increase condom use.

Influence of beta-blockade with beta-1-selectivity or intrinsic sympathomimetic activity on some metabolic responses to exercise.

Beta-blockers that are non-selective, beta-1-selective or possess intrinsic sympathomimetic activity (ISA) are thought to differ in their effects on serum potassium, glucose and lactate during exercise. In a randomized, double-blind, cross-over, placebo-controlled study, 21 healthy male volunteers took placebo, propranolol, pindolol and metoprolol on separate occasions. They were subsequently exercised using the same exercise protocol on each visit and serum levels of potassium, glucose and lactate determined before and after exercise. Only propranolol (non-selective beta-blocker with no ISA) was associated with significantly higher increases in serum potassium and glucose than placebo (p = 0.000). Increases in serum lactate levels with exercise were not significantly different between propranolol, pindolol (non selective blockers with ISA), metoprolol (beta-1-selective blocker with ISA) and placebo. Interference with metabolic responses to exercise associated with beta-blockade is modified by beta-1-selectivity and ISA amongst indigenous Kenyans.

Influence of beta-blockade with beta-1-selectivity or intrinsic sympathomimetic activity on some cardiorespiratory responses to exercise.

Possession of beta-1-selectivity and intrinsic sympathomimetic activity (ISA) by beta-adrenergic blocking drugs have been found to modify the effects of these drugs on heart rate, blood pressure and pulmonary airway resistance both at rest and during exercise. In a randomised, double-blind, cross-over, placebo-controlled trial, 21 healthy male volunteers took placebo, propranolol (non-selective with no ISA), metoprolol (beta-1-selective with no ISA) and pindolol (non-selective with ISA) on separate occasions prior to an exercise test using the same protocol each time. Heart rate, blood pressure and peak respiratory flow rate (PEFR) were measured before exercise and at exhaustion. No significant differences in percentage increase in heart rate after exercise were detected between placebo and all the three beta-blockers. All three drugs were associated with significantly lower percentage increases in systolic blood pressure with exercise compared to placebo; with metoprolol and propranolol causing lower increases than pindolol. The index of myocardial oxygen consumption, MVO2, was highest with pindolol. PEFR was reduced most by propranolol. Possession of beta-1-selectivity and ISA by beta-blocking drugs modifies their effects on cardio-respiratory responses to exercise amongst indigenous Kenyans.

Neurological complications of sickle cell anaemia at KNH: a five year retrospective study.

In a five year retrospective study of 360 patients with homozygous (SS) sickle cell disease, eighteen (5%) were found to have neurological complications. Their ages ranged from 7 months to 21 years with a mean of 11.1 +/- 6 years. Of those with neurological complications, twelve (67%) of the patients had cerebrovascular accident, six (33.3%) convulsions, three visual disturbance; one sensorineural deafness, one cerebellar degeneration and the last one confusion and hallucinations. Four of the patients had multiple neurological complications. There was only one patient with recurrence of neurological complications. Two patients were hypertransfused and up to the end of the study period none of them had any recurrence. The pattern of neurological complications are similar to that observed in other studies. However, in this study, there were fewer recurrences of neurological complications.