East African Medical Journal

Antiplasmodial activity of Justicia betonica, Vernonia dumicola and Rotheca myricoides

2025-02-25T13:03:43+00:00

Background: Malaria, a disease caused by Plasmodium species, is a major cause of human sickness and death worldwide, more so in the tropics. The parasites have developed resistance to antiplasmodial drugs, and this has been a challenge in control and treatment of the disease through chemotherapy. Hence, there is a need for a continuous search for alternative antiplasmodial agents. The use of plants to treat malaria and other ailments has been there since time immemorial. The plants: Justicia betonica, Vernonia dumicola and Rotheca myricoides are among the many that are used traditionally to treat malaria. Despite this use, their antiplasmodial activity has neither been scientifically confirmed nor evaluated.

Objective: This study determined the antiplasmodial activity of aqueous extracts of J. betonica aerial parts and leaves of V. dumicola and R. myricoides. Also, qualitative phytochemistry was analyzed.

Materials and methods: In vitro antiplasmodial activity was done using the D6 strain of Plasmodium falciparum. Phytochemistry was screened following standard protocols

Results: The aqueous extract of R. myricoides leaves had the highest chemosuppression with an IC₅₀ value of 1.32±0.03μg/ml while the lowest chemosuppression was in the combined aqueous extract of J. betonica aerial parts and leaves of V. dumicola. This recorded an IC₅₀ value of 11.03±1.18μg/ml. Besides, all the extract contained tannins, anthraquinones and phenols

Conclusion: All the extract possesses antiplasmodial efficacy which could be credited to the classes of phytochemicals observed. The plants analyzed in this study are recommended for developing antimalarial agents.

Clinicopathological features of urinary bladder cancer managed at a tertiary hospital in Western Kenya

2025-02-25T13:06:57+00:00

Background: Urinary bladder cancer is the ninth leading cause of morbidity and mortality globally, necessitating characterization of clinical and pathological features for early detection and improved management.

Objective: To profile and document the clinicopathological features of urinary bladder cancer at Moi Teaching and Referral Hospital (MTRH).

Materials and methods: A prospective assessment of patients diagnosed with urinary bladder cancer. Patient characteristics and associated causal factors obtained from full clinical evaluation and review of clinical records. Tumour characterization was based on examination and review of radiological imaging and histopathology findings and documented in structured questionnaires. Descriptive statistics and tests of association used Fisher’s exact tests for socio-demographic characteristics, causal factors, histological type, and Tumor, Node, Metastasis (TNM) stage of bladder cancer.

Results: Forty-five patients aged between 21 to 85 (mean: 61.84 ± 14.46) years with urinary bladder cancer were evaluated. Males were 68.9% and painless hematuria was most common symptom. Exposure to agrochemicals (60%) and cigarettes smoking (mean pack years = 9.43 ±6.198) in 31%. Clinical staging showed 71.1% with T1, while 6.7% had metastatic disease. 55.6% had TNM stage I, while 91.1% had low-grade tumors. Transitional cell carcinoma (51.1%) was the most common histological type. Agrochemicals exposure was associated with low-grade tumors (p=0.013), TNM clinical stage I (p=0.021), and adenocarcinoma (p=0.029).

Conclusions: Urinary bladder cancer affected males over 60 years old with a history of smoking and agrochemical exposure. Majority presented with classical symptoms of early disease and low-grade tumors. History of exposure to agrochemicals was a significant risk factor.

Comparison of single dose and extended dose antibiotics for prevention of surgical site infections in elective cesarean section at a tertiary hospital in Western Kenya: A randomized control trial

2025-02-25T13:15:22+00:00

Background: Cesarean sections (CS) account for most recorded cases of surgical site infections (SSI), occurring in one-third to two-thirds of operated patients in low-income nations. It is not clear from previous studies whether there exists any significant difference in prevention of SSI when single dose prophylaxis is used compared to extended dose antibiotics.

Objective: To evaluate differences in occurrence of SSI among women undergoing elective CS when single dose antibiotics is used for prophylaxis compared to extended antibiotics.

Methods: This was an unblinded randomized control study carried out at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). A total of 150 women between 18 to 49 years of age who underwent elective CS and received either single dose of ceftriaxone or extended dose of ceftriaxone and metronidazole. Follow up for 28 days for evidence of SSIs on days 1, 2, 14 and 28 after surgery was done. The data collected was summarized using frequency counts and percentages. Inferential analysis employed were Pearson’s Chi-square test of independence and binary logistics regression analysis. Covariates with p-value < 0.05 were considered significant.

Results: The two groups were comparable in sociodemographic characteristics. A total of 3 (2%) respondents developed SSI, 2 (1.3%) from the single dose arm and 1(0.7%) from the extended dose arm. This difference was not statistically significant (P value 0.567 CI 0.044 – 5.559; OR 0.493)

Conclusion: Single dose antibiotic is as effective as extended dose of antibiotics in prevention of surgical site infection in women undergoing elective cesarean section at JOOTRH.

Factors influencing malnutrition among children aged 6-59 months in Kamukunji Sub-County, Nairobi County, Kenya

2025-02-25T13:18:14+00:00

Background: Malnutrition in children, which can take the form of stunting, wasting, or underweight, affects a child’s growth, morbidity, mortality, cognitive development, health, and survival. Despite the various strategies and policies by government and partners, malnutrition remains a challenge in Kenya.

Objectives: To assess the determinants of malnutrition among children aged 6-59months in Kamukunji sub-county, Nairobi County.

Design: A cross-sectional study design was adopted. A Semi-Structured interviewer administered questionnaires were used to interview 260 caregivers with children aged 6-59 months. Data was collected on anthropometry measurements, socio-demographic and economic characteristics, maternal and child characteristics influencing wasting, underweight and stunting.

Setting: The study was done in Kamukunji Sub-County.

Subjects: The study population included children aged 6-59 months in Kamukunji Sub County and their care givers.

Main Outcome: The dependent variable were the three forms of malnutrition defined as underweight, wasting and stunting.

Results: Wasting prevalence was at 4.8%, underweight prevalence was 12.3% and stunting prevalence was 28.8%. Mothers with medium household income of above Ksh 20,000 experienced more underweight children compared to mothers who had a low household income of below Ksh 10,000 (95% CI: 1.901-9.930). Households with more than 3 children experienced more underweight children compared to households with less than 3 children (95% CI: 1.830-7.543). Children weighing between 2.1-3.0 experienced less underweight, wasting and stunting compared to children weighing between 0.0-1.0(95% CI: 0.075-0.584, 0.010-0.829,0.074-0.553g respectively).

Conclusion: Child weight, age of the child, household income and number of children have a significant effect on the nutrition status of children.

Knowledge and attitudes of medical professionals towards the post-covid syndrome: A cross-cultural study

2025-02-25T13:22:22+00:00

Objectives: To investigate and compare the knowledge and attitudes of medical professionals in Berlin, Germany, and Nairobi, Kenya, towards Post-COVID syndrome.

Design: Descriptive, cross-sectional study.

Study setting: Kenyatta National Hospital (KNH) in Nairobi, Kenya, and Charité University Hospital (Charité) in Berlin, Germany.

Study participants: 90 medical professionals, including doctors and medical students.

Methods: Data collection was facilitated via an online survey hosted on the SoSci server, encompassing demographics, PCS knowledge, and attitude. Descriptive statistics were used for analysis employing SPSS.

Results: The study involved 90 participants, equally split between Berlin, Germany, and Nairobi, Kenya. Majority were below 30 years and medical students. 81.1% were aware of Post-COVID Syndrome (PCS), with a higher awareness among German participants (97.7%) compared to Kenyan participants (66.7%). The most commonly used source of information was social media and colleagues. The most common PCS symptoms recognized were fatigue, shortness of breath, and memory problems. Most participants agreed that PCS patients should be treated by specialists and that awareness of PCS among healthcare workers is important. Overall, the majority of participants displayed a good understanding of PCS and its management.

Conclusion: This study uncovers diverse knowledge and attitudes among medical professionals regarding PCS. It highlights demographic variations, awareness discrepancies, and regional distinctions. Standardized education and regional-specific strategies are crucial for effective PCS management. Future research should focus on addressing these knowledge gaps to enhance patient care.

Prevalence and risk factors of Plasmodium falciparum and Dengue virus infections among children below 5 years with acute febrile illnesses in Kisumu and Busia Counties

2025-02-25T13:26:56+00:00

Objective: To determine the risk factors and proportions of the emerging malaria and Dengue virus due to the climate changes in Western Kenya.

Design: Prospective mixed method cohort study that primarily collected data from febrile ill children.

Setting: All the levels; 2, 3 and 4 public health facilities in Bunyala Sub-County in Busia and Kisumu Central Sub-County in Kisumu County.

Participants: Under 5 years old children presenting with febrile illness.

Main outcome measures: Risk factors linked with malaria and Dengue virus disease burden among children due to the changing climate calls for an increased mosquito borne disease surveillance and patient care.

Results: A total of 1,004 study children were screened. Prevalence of Plasmodium falciparum, Dengue virus and co-infection were 21.4%, 8.9% and 7.5%, respectively. Overall disease prevalence was 37.8%. Gender was found to be a significant risk factor at p = 0.006 (OR = 0.52, 95% CI: 0.33, 0.83). Residential equally influenced the risk (OR = 1.22, 95% CI: 0.60, 2.50), same as having stagnant water at workplace (OR = 3.79, 95% CI: 1.17, 13.3). The time of experiencing mosquito bites also was found to be a risk factor (OR = 2.13, 95% CI: 1.29, 3.54).

Conclusion: Malaria control efforts remain essential, yet there are minimal arbovirus control measures despite the emerging climate change favoring fecundity. Level of diagnostic capacity, awareness and exposure risks trail behind that of malaria. The inclusion of routine arbovirus screening is necessary to facilitate early detection and appropriate patient care and disease surveillance.

Prevalence of malaria among in-patient and out-patient febrile children aged five years and below at Banadir Hospital, Somalia

2025-02-25T13:31:10+00:00

Objective: To determine the prevalence of malaria and associated factors among febrile children aged five years and below at Banadir Hospital, Somalia.

Materials and Methods: A cross-sectional study examined 246 children aged five and below using systematic random sampling. Malaria infection was diagnosed by microscopy of thin blood films. Binary logistic regression assessed associations between confirmed malaria and various predictors.

Results: The study found the highest malaria prevalence in children under 12 months at 35.7%, which dropped to 15.2% in children aged 12-24 months. Prevalence increased to 31.4% in children aged 25-36 months, 32.0% in those aged 37-48 months, and peaked at 38.1% in children aged 49-60 months. After controlling for other factors, children's age, caregivers' knowledge of headache as a malaria symptom, and the use of preventative measures were significantly associated with malaria infection. Children aged 12-24 months were 18% less likely to have malaria than those under 12 months (AOR=0.82; 95% CI: 0.65-0.94). Caregivers' awareness of headache as a symptom reduced the likelihood of malaria infection by 44% (AOR=0.56; 95% CI: 0.42-0.89). Children whose caregivers used indoor residual spraying (IRS) had a 22% lower likelihood of infection compared to those using insecticide-treated nets (ITNs) (AOR=0.78; 95% CI: 0.61-0.92).

Conclusion: Key risk factors include child's age, caregivers' symptom knowledge, and preventive measures used. Health administrators should create educational programs to raise awareness of malaria symptoms and prevention and increase access to insecticide-treated nets and other malaria control tools, especially for children under five.

Undergraduate medical student attrition at Maseno University School of Medicine

2025-02-25T13:33:56+00:00

Background: Admission into medical schools is highly competitive. Despite having lower attrition rates than other university programmes, medical school attrition varies from as low as 3.8% to as high as 80%. Student attrition has several causes and affects the students and other parties.

Objectives: The objectives of this study were to determine the attrition rates of students who graduated from Maseno University School of Medicine, and the perceptions of ongoing students on the causes and effects of student attrition in the school.

Methodology: The study employed a cross-sectional mixed-methods design with quantitative data from a review of student data for six graduated cohorts, analysed using the R programme, as incidence and attrition rates, displayed using Kaplan-Meier curves. Qualitative data from focused group discussions with ongoing students which were recorded, transcribed, and analysed using Microsoft Excel.

Results: The mean student attrition rate at the school was 25%, with a statistically significant increase between subsequent graduating cohorts (p= 0.0004), direct entry students had a higher attrition than self-sponsored students (p= 0.0016). The students perceived academic difficulty, economic reasons and lack of social support as the top causes of attrition. The most significant effect of attrition was on the mental health of the affected student.

Conclusion: Student attrition rates at Maseno University School of Medicine is higher than the global average, with common causes being academic grounds, financial constraints and lack of social support. To reduce attrition rates at MSU we propose a review of the financial support system and enhancing of counselling and mental health services.

Usefulness of neonatal pulse oximetry in early detection of cyanotic congenital heart disease at the Moi Teaching And Referral Hospital, Eldoret, Kenya

2025-02-25T13:39:16+00:00

Objective: To determine the usefulness of neonatal pulse oximetry in early detection of cyanotic congenital heart disease at the maternity and newborn unit of the Moi Teaching and Referral Hospital, Eldoret, Kenya.

Setting: Moi Teaching and Referral Hospital, Eldoret, Kenya, from July 2023 to November 2023.

Study Design: Hospital based cross sectional study.

Subjects: Five hundred and fifty-six newborns at the Moi Teaching and Referral Hospital.

Interventions: Eligible study participants had their socio-demographic and clinical characteristics taken and recorded. They then underwent pulse oximetry screening and were grouped as either screen positive or screen negative. All participants screened were subjected to gold standard echocardiography imaging study and were grouped as either disease present or disease absent for cyanotic congenital heart disease. Data was analyzed using STATA version 16.

Main outcome measure: Sensitivity, specificity and the predictive values of neonatal pulse oximetry in detection of cyanotic congenital heart disease.

Results: Out of the 556 newborns screened, a test positive rate of 0.72% (4) was established with a true positive rate of 0.18% (1)

All newborns who screened negative (552) did not have cyanotic congenital heart disease. The sensitivity, specificity, negative predictive value and positive predictive value were 100%, 99.5%, 100% and 25% respectively.

Conclusion: Neonatal pulse oximetry has high sensitivity, specificity and negative Predictive value for early detection of cyanotic congenital heart disease.

Tocilizumab as a therapeutic option for rheumatoid arthritis patients with interstitial lung disease: Case report

2025-02-25T13:42:51+00:00

Rheumatoid arthritis (RA) is a chronic inflammatory, autoimmune disease with significant extra-articular manifestations in the heart, lungs, and kidneys. It can cause interstitial lung disease (ILD) due to synthetic immunosuppressants and biologic agents. However, there is conflicting evidence about the link between RA and lung conditions, with recent research focusing on lung involvement in RA, specifically interstitial lung disease (ILD).

A 63-year-old female with severe early RA developed subacute ILD despite methotrexate treatment, causing cough, dyspnea, and bilateral basal crackles and was on oxygen at home.

Tocilizumab, a humanized monoclonal antibody targeting the Interleukin 6 (IL-6) receptor, was introduced as a treatment option for RA due to its efficacy and ability to mitigate profibrotic effects without the need for methotrexate. After three months, the patient's clinical state improved significantly, with cough and dyspnea symptoms subsiding and bilateral basal crackles resolved, and over a one-year follow-up, the patient's RA disease activity decreased. She also stopped using oxygen. This indicates tocilizumab is a safe and effective therapy for controlling RA in ILD patients without aggravating pulmonary problems.