Survival of cervical cancer patients at Moi teaching and Referral Hospital, Eldoret in western Kenya.

BACKGROUND: Cervical cancer is a major health burden and the second most common cancer after breast cancer among women in Kenya. Worldwide cervical cancer constitutes 3.1% of all cancer cases. Mortality rates are greatest among the low-income countries because of lack of awareness, screening and early-detection programs and adequate treatment facilities. The main aim was to estimate survival and determine survival predictors of women with cervical cancer and limited resources in western Kenya. METHODS: Retrospective charts review of women diagnosed with cervical cancer and follow-up for two years from the date of the histologic diagnosis. The outcome of interest was death or survival at two years. Kaplan Meier estimates of survival, log-rank test and Cox proportional hazards regression were used in the survival analysis. RESULTS: One hundred and sixty-two (162) participants were included in the review. The median duration was 0.8 (interquartile range (IQR) 0.3, 1.6) years. The mean age at diagnosis was 50.6 years (SD12.5). The mean parity was 5.9 (SD 2.6). Fifty percent (50%) did not have health insurance. Twenty six percent (26%) used hormonal contraceptives, 25.9% were HIV positive and 70% of them were on anti-retroviral treatment. The participants were followed up for 152.6 person years. Of the 162 women in the study, 70 (43.2%) died giving an overall incidence rate (IR) of 45.9 deaths per 100 person years of follow up. The hazard ratios were better for the patients who survived (0.44 vs 0.88, p-value < 0.001), those who had medical insurance (0.70 vs 0.48, p-value = 0.007) and those with early stage at diagnosis (0.88 vs 0.39, p-value < 0.001). Participants who were diagnosed at late stage of the disease according to the International Federation of Gynecology and Obstetrics staging for cervical cancer (FIGO stage 2B-4B) had more than eight times increased hazard of death compared to those who were diagnosed at early stage (1-2A): Hazard Ratio: 8.01 (95% CI 3.65, 17.57). Similarly, those who underwent surgical management had 84% reduced hazard of mortality compared to those who were referred for other modes of care: HR: 0.16 (95% CI: 0.07, 0.38). CONCLUSION: Majority of the participants were diagnosed late after presenting with symptoms. The 1 and 2-year survival probability after diagnosis of cervical cancer was 57% AND 45% respectively. It is imperative that women present early since surgery gives better prognosis or better still screening of all women prioritized.

MALARIA PARASITAEMIA AMONG FEBRILE CHILDREN INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS IN THE CONTEXT OF PROPHYLACTIC COTRIMOXAZOLE AS STANDARD OF CARE: A CROSS- SECTIONAL SURVEY IN WESTERN KENYA.

OBJECTIVE: To document the prevalence of malaria parasitaemia among the HIV infected febrile children in a malaria endemic area. DESIGN: A cross-sectional study. SETTING: An ambulatory paediatric HIV clinic in Western Kenya, between November 2011 and December 2012. SUBJECTS: A total of 245 febrile HIV infected children aged less than 14 years attending the HIV clinic in the Webuye level IV hospital were included in the study. A systematic sampling method was used. MAIN OUTCOMES: A blood sample was taken for malaria parasite testing. Presence or absence of malaria parasites was documented. Clinical and socio-demographic characteristics of the participants were also recorded. RESULTS: A total of 245 participants were recruited mean age being 5.53 years. Malaria prevalence was 81.9%. Most participants (97%) were on cotrimoxazole prophylaxis. Some of the factors found to be positively associated with malaria parasitaemia were; male sex, care taker category (parent), WHO stage 3 and 4 of HIV disease, and a high absolute CD4 count. However, only the caretaker association was statistically significant. CONCLUSION: The frequency of malaria parasitaemia among febrile HIV infected children is still high regardless of the high cotrimoxazole prophylaxis uptake. It is also noted that there is a shift in the age group of fever among children toward the older age group. This implies that policies may need to be relooked at to include the older age group in the aggressive malaria prevention measures to avoid losing on the already made gains.

Nosocomial infections in developing countries: cost effective control and prevention.

OBJECTIVES: To review the efficient and cost-effective preventive, control and surveillance measures that could be employed against nosocomial infections in developing countries. DATA SOURCES: Literature search on compact disk-read only memory (CD-ROM), Medline and Internet, using the key words: nosocomial infection, prevention and control, use of antibiotics and use of computers. Some articles were manually reviewed. STUDY SELECTION: Relevant studies or articles on nosocomial infections in developing and developed countries were included in the review. DATA EXTRACTION: From individual studies or articles. DATA SYNTHESIS: Information on nosocomial infections from developing and developed countries with some emphasis on Kenya is synchronized under the headings; introduction, historical background of nosocomial infections. Current situation of nosocomial infections and predisposing factors, nosocomial infections and antimicrobial resistance, consequences of nosocomial infections, hospital infection control programme and use of computers in nosocomial infection surveillance, and the cost benefit of infection prevention and control programme. CONCLUSION: Nosocomial infections may be contained more effectively by having an infection prevention and control programme. Computer-assisted epidemiological surveillance appears to be the most important aspect of monitoring infection control programmes, and to identify changes in risk factors that can increase the infection rate. Even minimally, effective infection control programmes are cost-effective. For the war against nosocomial infections to be won, the whole exercise should be handled as a global project with significant inputs from developing countries.

Combating cholera epidemics by targeting reservoirs of infection and transmission routes: a review.

OBJECTIVES: To determine the parameters which can be investigated for prevention and effective control of cholera. DATA SOURCES: Literature search on compact disk-read only memory (CD-ROM), medline and internet, using the key words: cholera outbreaks, and cholera transmission. A few reviews were manually reviewed. STUDY SELECTION: Relevant studies or articles on cholera outbreaks and transmission worldwide, with special reference to Kenya is included in the review. DATA EXTRACTION: From individual study or articles. DATA SYNTHESIS: Information on cholera epidemics worldwide and in Kenya is synchronized under the headings; Introduction, History and predisposing factors, Current situation, Bioecology and transmission patterns, and, Use of molecular epidemiological and geographic information system (GIS) techniques in mapping out the bioecology, reservoirs and transmission routes of cholera. CONCLUSION: Cholera can be prevented and controlled more effectively at environment level. This requires a multi-disciplinary approach including poverty alleviation.

Rectal dihydroartemisinin versus intravenous quinine in the treatment of severe malaria: a randomised clinical trial.

OBJECTIVE: To compare the clinical efficacy and safety of rectal dihydroartemisinin (DATM--Cotecxin) and intravenous quinine in the treatment of severe malaria in children and adults. SETTING: Moi Teaching and Referral Hospital, Eldoret, Kenya between July and November 1998. PATIENTS: A total of sixty seven patients aged two to sixty years with severe malaria were studied. DESIGN: This was an open randomised comparative clinical trial. OUTCOME MEASURES: These were parasite clearance time, fever clearance time, efficacy and the side effect profile of the two drugs. RESULTS: The two groups were comparable on admission on the clinical and laboratory parameters. The parasite clearance time was shorter in the rectal DATM group than quinine group. There was no statistical difference on the fever clearance time and cure rates in the two groups. The adverse reaction profile was better with rectal DATM than with quinine, tinnitus observed more in the quinine group. CONCLUSION: Rectal DATM is faster in parasite clearance than quinine and is a safe and convenient alternative to quinine in the treatment of severe malaria.

Childhood immunisation in Bungoma County, Kenya, from 2008 to 2011: need for improved uptake.

Uptake of immunisations in children aged 1-2 years in Bungoma County, Kenya, was determined as part of the 6-monthly Health and Demographic Surveillance System surveys. A total of 2699 children were assessed between 2008 and 2011. During this time period, full immunisation declined significantly from 84% to 58%, and measles vaccine declined uptake from 89% to 60% (P < 0.001). Each year there was a significant fall-off for the third doses of the oral polio and pentavalent vaccines (P < 0.001). These findings are of concern, as low immunisation coverage may lead to vaccine-preventable disease outbreaks. Further investigations into the reasons for declining immunisation trends are required.

La couverture vaccinale des enfants de âgés de 1 à 2 ans dans la conté de Bungoma au Kenya a été déterminée dans le cadre d'un enquête du Système de surveillance sanitaire et démographique. Au total 2699 enfants ont été évalués de 2008 à 2011. Au cours de cette période, le taux de vaccination complète a diminué de façon significative, de 84% à 58%, et celui de la vaccination contre la rougeole de 89% à 60% (P < 0,001). Chaque année, on a constaté une chute de l'administration de la 3e dose du vaccin polio oral et du vaccin pentavalent (P < 0,001). Ces résultats sont préoccupants car cette faible couverture vaccinale pourrait conduire à des épidémies de maladies évitables. Il est nécessaire de faire d'autres investigations à la recherche des causes de ce déclin de la vaccination.

La vacunación de los niños de 1 a 2 años de edad en el condado de Bungoma, en Kenia, se investigó como parte de las encuestas semestrales del Sistema de Vigilancia Sanitaria y Demográfica. Se evaluaron 2699 niños del 2008 al 2011. Durante este período se observó una disminución considerable de la administración de un esquema completo de vacunación, de 84% a 58%, y la aplicación de la vacuna antisarampionosa disminuyó de 89% a 60% (P < 0,001). En cada año, se redujo de manera notable la administración de la tercera dosis de la vacuna antipoliomielítica oral y la vacuna pentavalente (P < 0,001). Estas observaciones son fuente de preocupación, pues una baja cobertura de vacunación puede dar origen a brotes epidémicos de enfermedades prevenibles. Se justifica la realización de nuevas investigaciones que aclaren las razones de esta tendencia decreciente de las vacunaciones.

Webuye Health and Demographic Surveillance Systems Baseline Survey of Soil-Transmitted Helminths and Intestinal Protozoa among Children up to Five Years.

Background. The intestinal parasitic infections (IPIs) are globally endemic, and they constitute the greatest cause of illness and disease worldwide. Transmission of IPIs occurs as a result of inadequate sanitation, inaccessibility to potable water, and poor living conditions. Objectives. To determine a baseline prevalence of IPIs among children of five years and below at Webuye Health and Demographic Surveillance (HDSS) area in western Kenya. Methods. Cross-sectional survey was used to collect data. Direct saline and formal-ether-sedimentation techniques were used to process the specimens. Descriptive and inferential statistics such as Chi-square statistics were used to analyze the data. Results. A prevalence of 52.3% (417/797) was obtained with the male child slightly more infected than the female (53.5% versus 51%), but this was not significant (χ (2) = 0.482, P > 0.05). Giardia lamblia and Entamoeba histolytica were the most common pathogenic IPIs with a prevalence of 26.1% (208/797) and 11.2% (89/797), respectively. Soil-transmitted helminths (STHs) were less common with a prevalence of 4.8% (38/797), 3.8% (30/797), and 0.13% (1/797) for Ascaris lumbricoides, hookworms, and Trichuris trichiura, respectively. Conclusions. Giardia lamblia and E. histolytica were the most prevalent pathogenic intestinal protozoa, while STHs were less common. Community-based health promotion techniques are recommended for controlling these parasites.

A randomized open label clinical trial to compare the efficacy and safety of intravenous quinine followed by oral malarone vs. intravenous quinine followed by oral quinine in the treatment of severe malaria.

The treatment of patients with severe malaria in sub-Saharan Africa has become a challenge to clinicians due to poor compliance to quinine and the increasing multidrug resistance to antimalarials by the P. falciparum parasite. The aim of this study was to compare the efficacy and safety profile of two truncated antimalarial regimens of intravenous quinine followed by oral Malarone (Malarone arm) with intravenous quinine followed by oral quinine (quinine arm) in the treatment of severe P. falciparum malaria. The outcome measures were parasite clearance time, fever clearance time, efficacy, and adverse events profile. Consecutive patients aged 1-60 years, with a diagnosis of severe malaria with positive blood smears for P. falciparum parasites and admitted to the Moi Teaching and Referral Hospital were randomized into the two study arms. Of the 360 patients studied 167 and 193 cases were randomized into the Malarone and quinine arms, respectively. Of the five (1.4 per cent) patients who died, three came from the quinine arm. The frequency of adverse reactions was higher in the oral quinine group (31.6 per cent) than in the Malarone group (25.7 per cent). The mean parasite clearance time was 120 h and 108 h for the quinine and Malarone arms of the study, respectively, and the mean fever clearance times were 84 h and 72 h for the quinine and Malarone arms, respectively (p=0.1). Truncated therapeutic regimen using malarone after intravenous quinine is safer and as effective as conventional intravenous quinine followed by oral quinine in the treatment of severe malaria. The P. falciparum recrudescence rate was lower with the use of Malarone than for quinine.