East African Medical Journal

Dentists’ commitment-to-change following a professional development training on dental amalgam phase down: Barriers to implementation of restorative practice changes

2025-01-10T05:56:12+00:00

Objective: To evaluate dentists’ commitment to change towards dental amalgam phase down following implementation of an online continuous professional development training.

Design: Descriptive cross-sectional survey.

Setting: The 47 counties of Kenya.

Participants: Dentists registered to practice in Kenya

Interventions: Implementation of an online training programme on dental amalgam phase down.

Main outcome measures: Descriptive summaries of self-reported commitment to change statements, level of implementation of the committed changes and challenges experienced in implementation.

Results: Out of the 216 participants 147 (68.1%) indicated commitment to change (CTC) certain aspects of their practice, and all responses (100%) were aligned to dental amalgam phase down (DAPD). Overall, the total number of commitment statements were 434, mean 2.95 and range 1-6. The most committed intended change was “Use alternative restorative materials most of the time”. About a third 46 (31.3%) reported the status of implementation of the committed practice changes at three months. A total of 130 (30.0%) commitment reflections were submitted, the most frequent was “partially implemented” 66 (50.8%), whereas the least was “fully implemented” 31 (23.8%). Among those who committed to change, a majority 92 (62.6%) indicated challenges in implementation. Of these, 38 (41.3%) were hindered by inadequate funding, while a minority 4 (4.3%) faced lack of knowledge.

Conclusion: Majority of the participants committed to change aspects of their operative practice and all responses were aligned to DAPD. At three months, the most commitment reflection was partial implementation, while inadequate funding posed the greatest challenge to intended changes.

Environmental factors associated with diarrhoea prevalence among children under five years in Mathare informal settlement, Nairobi County

2025-01-10T06:04:17+00:00

Background: Diarrhea is the second leading cause of death globally among children under five. Nairobi County has reported 136,028 cases of diarrhearelated illnesses, with a large number occurring in informal settlements. This study assesses environmental factors associated with diarrhea prevalence among children under five in Nairobi’s Mathare informal settlement.
Methods: This cross-sectional study employed both quantitative and qualitative data collection methods. The study was conducted in 13 villages of Mathare, targeting 218 main caregivers. A multistage sampling approach was used, combining purposive, stratified, and simple random sampling. Descriptive statistics were used to analyze environmental factors.
Results: Among 173 caregivers surveyed, 88% were female, mostly aged 20-29 years. Nearly half (49%) had only primary education, and 95% earned 1,000 Kenyan shillings or less monthly, reflecting high poverty levels. Significant environmental factors associated with diarrhea included water sources, sanitation practices, and waste disposal. Households using tap water had a 2.97- fold higher risk of diarrhea compared to those relying on vendors. Poor waste disposal and lack of alternative water sources further exacerbated diarrhea incidence. Key informant interviews highlighted poor sanitation, overcrowding, and limited healthcare access as critical issues. Despite public health efforts, there is a need for improved infrastructure, healthcare services, and community health support.
Conclusion: To reduce diarrhea prevalence in informal settlements, health programs should focus on improving environmental conditions, particularly water supply and sanitation.

Knowledge, attitude and practice of medical doctors at Kenyatta National Hospital in Kenya towards oral diseases

2025-01-10T06:09:29+00:00

Objective: To assess medical doctors' knowledge, attitude and practice towards oral diseases.
Design: Descriptive cross-sectional study
Setting: Kenyatta National Hospital
Subjects: 80 medical doctors, including pre-interns, interns, medical officers, registrars, and consultants currently practising at the Kenyatta National Hospital, were recruited in the study.
Material and Methods: A convenience sampling technique was employed to obtain participants who completed structured self- administered questionnaires. Responses were analyzed using SPSS.
Results: A total of 80 doctors, 22 (28%) females and 58 (72%) males, were recruited in this study. The majority, 31/80 (38.75%), had been practising < 5 years. Regarding knowledge, 97.5% of the doctors knew there was a direct correlation between oral and systemic health, the primary source of oral health information being the internet. Regarding attitude, 90% responded positively towards all the parameters assessed, and 87.5% recognized that they have a role to play in their patients' oral health. Regarding practice, 73.75% of doctors had consulted a dentist on their patient's oral health, with an average referral rate of 1 patient/doctor/year. Only 6% of the doctors regularly visited a dentist.
Conclusion: Although most participants demonstrated basic knowledge of the aetiology of oral disease and the relationship between general and oral health, some gaps remain in the awareness and practice of oral health among medical practitioners. The potential for medical doctors as active players in oral health must be emphasized, and continuing medical education in oral health should be adequately provided.

Prevalence and health system determinants of uptake of three or more doses of sulphadoxine pyrimethamine for intermittent preventive treatment of malaria during pregnancy

2025-01-10T06:27:08+00:00

Background: Maternal anemia, low birth weight, intrauterine growth retardation and premature births are complications associated with malaria in pregnancy (MIP). In order to prevent malaria, Wold Health Organization (WHO) recommends at least three doses of Sulphadoxine Pyrimethamine (SP) for Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp-SP3+) during the antenatal period. This study aimed to determine the prevalence and the health system determinants of uptake of three or more doses (IPTp 3+) in Busia County, Kenya.

Methods: A facility-based cross-sectional study conducted at Busia County Referral Hospital between June and July 2023. Mothers’ in the Maternity Unit with term deliveries were consecutively sampled. Data on health system factors was collected using interviewer administered semi-structured questionnaires and interview guides. The statistical significance of health system factors affecting IPTp-SP3+ was dertemined using the odds ratio (OR) and adjusted OR.

Results: The prevalence of IPTp-SP 3+ uptake was 43.0%. Health system factors significantly associated with IPTp-SP 3+ uptake were facility being too far (aOR = 0.575, 95% CI: 0.351-0.941, p = 0.028) and waiting time being too long (aOR = 0.606, 95% CI: 0.385-0.955, p = 0.031).

Conclusion: Prevalence of uptake of IPTp 3+ is still low, with less than half of the pregnant mothers complying. The County and National Ministries of Health should make a concerted effort to ensure availability and affordability of SP drugs and also ensure access to and customer satisfaction at the healthcare facilities.

Prevalence of Vitamin D insufficiency/deficiency among children with cerebral palsy at Kenyatta National Hospital

2025-01-10T06:52:57+00:00

Background: It is estimated that 50% of both children and adults have insufficient/deficient levels of vitamin D. Children with cerebral palsy are at a higher risk of vitamin D deficiency due to their comorbidities.

Objective: This study aimed to determine the prevalence of vitamin D insufficiency/deficiency among children with cerebral palsy aged 1-18 years attending services at the Kenyatta National Hospital, the proportion of children receiving Vitamin D supplements and the association of antiepileptic drugs and sunlight exposure with Vitamin D levels.

Methodology: A hospital based cross sectional study of children with known diagnosis of cerebral palsy at KNH were recruited consecutively. Data on sociodemographic factors, history of antiepileptic drug use, vitamin D supplementation and sun exposure was collected. Blood samples were collected for analysis.

Results: Eighty (80) cerebral palsy patients median age (IQR) 42 (21 to 72) months old were recruited. Twenty-six (32%, 95%CI 22 to 44%) had Vitamin D deficiency, with Vitamin D levels median (IQR) of 14.3 (8.52 to 18.2) ng/mI. Twenty-three (29% 95%CI 19 to 40%) had insufficient Vitamin D with Vitamin D calcitriol median (IQR) of 26.8 (22.8 to 27.7) ng/mI. There was a significant association between sun exposure(>1hour) and Vitamin D levels. (p<0.001) (aRR 0.43 (95%CI 0.22–0.83)) and none between age, gender, use of antiepileptic drugs, nutritional status, gross motor functional classification scale (GMFCS) and Vitamin D levels.

Conclusion: The prevalence of Vitamin D insufficiency/deficiency was high at 61%. Daily sunlight exposure of <1 hour had a significant association with Vitamin D levels.

Recommendation: Early detection and management of vitamin D deficiency is recommended for children with Cerebral Palsy in order to improve their health status.

Root Amputation; a viable alternative to tooth extraction: A case series

2025-01-10T07:05:48+00:00

Background: Increased desire of patients to maintain their dentition, supported by advance in dentistry have led to treatment of teeth that once would have been extracted. To retain such teeth in whole or part, combined restorative, endodontic and periodontal treatments may be required. The terminology tooth resection refers to the excision and removal of any segment of the tooth or a root with or without its accompanying crown portion. Root amputation, hemisection, radisection and bisection are among the various tooth resection procedures described in literature. Root amputation is a procedure that involves the surgical removal of one or more roots of a multirooted tooth while other roots are retained. The Involved root (or roots) is usually separated at the junction of the root and the crown. Indications for root amputation include; untreatable roots with separated instruments, perforations, extensive caries, resorption, root fractures, calcifications and periodontal disease with associated severe bone loss.

Objective: To illustrate the clinical management of teeth with insurmountable impediments by root amputation procedures.

Design: This is a case series, illustrating the clinical management of four cases, where root amputation procedures were performed to salvage teeth that would have otherwise been extracted.

Conclusion: This case series presents four cases of root amputation procedures carried out on maxillary first molars with insurmountable impediments in either of the buccal roots. The untreatable roots were amputated salvaging the remaining portion of the strategically important teeth.

Self-care practices among adult patients newly diagnosed with type 2 diabetes mellitus in selected level five hospitals in Kenya

2025-01-10T07:23:13+00:00

Background: Self-care practices refers to patient’s real-life application of the knowledge acquired on diabetes management. In Kenya, the prevalence of diabetes related complications has been on the rise and this has been linked to poor self-care practices.

Objective: To determine the self-care practices among adult patients newly diagnosed with Type 2 Diabetes Mellitus (T2DM).

Materials and Methods: Descriptive cross-sectional design was adopted. A total of 124 patients newly diagnosed with T2DM were randomly recruited from the selected hospitals. Data was collected using a questionnaire modified from the Diabetes Self-Management Questionnaire (DSMQ). Descriptive analysis was done to generate frequencies while chi-square was used to assess association between variables (p≤ 0.05 at 95% CI).

Results: Of 124 respondents, 70 (56.5%) were females with most 35 (28.2%) belonging to the age group between 60-69 years. Regarding the duration of T2DM since diagnosis, 45 (36.3%) reported that they were diagnosed at least four months ago. Poor self-care practices were noted in 69 (55.6%) of the respondents, with the mean and standard deviation being 4.92 (±1.10), mean score ranging from 0 to 10. However, there was no significant association between self-care practices and respondents’ characteristics.

Conclusion and Recommendation: Self-care practices among the respondents was poor, hence the need for clinicians to conduct a needs assessment among patients newly diagnosed with T2DM in order to identify gaps in their self-care. This will also help in developing evidenced based diabetes education materials.

Knowledge and uptake of cervical cancer screening among women in Kiambu Sub-County, Kiambu, Kenya

2025-01-10T07:51:51+00:00

Background: In Kenya, cervical cancer accounts for 12% of all cancer cases and is also the leading cause of cancer deaths. However, evidence on uptake and knowledge levels is limited. It is against this background that this study was carried out.

Objective: The study sought to assess knowledge and uptake of cervical cancer screening among women aged 15-54 years in Kiambu sub-County.

Design: Analytical cross-sectional study.

Setting: Kiambu sub-County in Kiambu Kenya.

Subjects: Women aged 15-54 years residing in Kiambu sub-County.

Main outcome measures: Age, knowledge, uptake, screening and associated factors.

Materials and Methods: An in-person administered questionnaire was used for data collection. Data was analyzed using STATA software to generate descriptive and inferential statistics. Binary logistic regression was used for all bivariable and multivariable analyses to identify factors associated with knowledge on cervical cancer and screening.

Results: 391 women participated in the study. Uptake of cervical cancer screening was 101 (25.8%). The majority 315 (80.56%) of the study participants had good knowledge on cervical cancer and screening. Those who had a tertiary level of education (AOR 0.45; 95% CI 0.25-0.81; p=0.01), and being a Muslim (AOR 0.13; 95% 0.02-0.84; p=0.03) were significantly associated with knowledge on cervical cancer and screening.

Conclusion: Generally, uptake of cervical cancer screening among women in Kiambu sub-County was low. The knowledge levels on cervical cancer screening were generally good. The factors associated with knowledge on cervical cancer screening included tertiary level of education and being a Muslim.

Knowledge, attitudes, and practices towards COVID-19 vaccination among secondary school students in Kajiado County, Kenya: A cross-sectional study

2025-01-10T08:10:51+00:00

Objective: The study investigated the level of knowledge, attitudes, and practices (KAP) towards COVID-19 vaccination among secondary school students in Kenya and identify significant differences in KAP between students from day and boarding schools.

Methods: A descriptive cross-sectional survey conducted among 246 secondary school students in Kajiado North Sub-County, Kenya. Students were selected from five schools using proportionate random sampling. Data were collected through face-to-face interviews using a structured questionnaire, with descriptive statistics and chi-square tests for analysis.

Results: 95% of students possessed high level of knowledge about COVID-19 vaccination. Our analysis revealed a statistically non-significant difference in vaccine knowledge between students from day secondary schools and those from boarding secondary schools (χ2=0.025, p=0.874). Attitudes towards vaccination were generally positive among students. However, we identified a significant difference in attitudes towards COVID-19 vaccine between students from day and boarding schools (χ2=10.72, p=0.001), highlighting a variance in perception based on type of schooling. 95% of the students exhibited supportive and proactive behavior towards COVID-19 vaccination. We did not find any statistically significant difference in practices towards COVID-19 vaccination between students from day and boarding schools (χ2 = 0.209, p = 0.648).

Conclusion: Our study demonstrates a high level of knowledge, positive attitudes, and proactive practices towards COVID-19 vaccination among secondary school students in Kenya, irrespective of school type. The recommendations were: sustain high vaccine knowledge in future, vaccination programs should incorporate regular updates and educational sessions. Ministry of Education and schools should develop vaccination campaign programs involving students and parents, especially in boarding schools.

Severe nail dystrophy due to Norwegian scabies in a pediatric patient living with Human Immunodeficiency Virus (HIV): A case report

2025-01-10T08:37:09+00:00

Background: Norwegian scabies is a rare presentation of scabies that can involve the nails. Severe nail dystrophy is an unusual presentation in neglected persons living with HIV.
Case report: We present a case of Norwegian scabies in a pediatric patient living with HIV. The patient presented with generalized crusted and thickened skin lesions. The nails were elongated dystrophic with subungual hyperkeratosis. This was treated successfully with urea cream, ivermectin tablets and benzyl benzoate emulsion.
Conclusion: Severe nail dystrophy is a rare presentation of Norwegian scabies in neglected patients. This can be treated adequately with topical urea and scabicides