East African Medical Journal

Cultural, phenotypic and genotypic characteristics of autism spectrum disorder among people of African descent: A 10 year systematic review from 2013 to 2023

S. Ilovi — 2024-09-30

Objectives: This systematic review evaluated ASD studies conducted in Africa between 1st January 2013 and 31st July 2023.

Data Sources: Google scholar, Scopus and Medline were searched in August and September 2023

Study Selection and Extraction: Using PRISMA Guidelines, 35 studies were identified for review.

Data Synthesis: Culturally, Africans residing in all regions of the continent shared similar beliefs on the genesis of neurodevelopmental disorders; there was a strong belief in supernatural causes such as curses, God’s will and human maleficence. Traditional and spiritual interventions sought in tandem with conventional medicine with an aim of cure in some instances. Phenotypical presentation of ASD in African patients did not differ from those described globally. Those with severer phenotypes, attendant complications such as convulsive disorder and syndromic autism such as Down Syndrome were more likely to be diagnosed at an earlier age. Of the genotypic studies undertaken, only one utilized whole exome sequencing, with rest evaluating single or multiple candidate genes or cytogenetic analysis. ASD phenotype was associated with both known and novel and genetic variations and chromosomal aberrations.

Conclusion: ASD in Africans has similar phenotypic and genotypic features as compared to the rest of the world. Cultural beliefs on causation and prognosis of ASD have may have an adverse impact of health outcomes. Paucity of extensive genotypic and multi-omics data impairs adequate genotypic-phenotypic correlation of ASD among Africans.

Dysmenorrhea curtails effective academic engagements by female students - insights from a cross-sectional study at a Kenyan University

E. Kiprop — 2024-09-30

Objective: To assess the impact of dysmenorrhea on academic engagements and identify interventions that students seek to cope with dysmenorrhea.

Design: Descriptive cross-sectional study.

Participants: Female undergraduate students.

Main outcome measures: Prevalence of dysmenorrhea, missing classes, examinations, or inability to engage in social activities.

Results: The prevalence of dysmenorrhea was high (82.4%), and most participants (64.2%) experienced moderate and severe pain that lasted for up to 2 days with mood changes (70.3%), diarrhoea (50.5%), bloating (55%), and fatigue (58.9%) occurring frequently. Most participants were unable to engage in physical activities (72.3%), missed classes (61.9%) or had their academic performances affected by dysmenorrhoea. However, most (90%) participants never missed an exam due to dysmenorrhea. Additionally, almost half of participants increased doses of medications if symptoms of dysmenorrhea failed to subside.

Conclusion: We recommend health education and promotional measures to empower female students regarding menstrual health literacy and to sensitize the university community on the challenges experienced by female students and the support they need for optimum academic engagement.

Complications of male cultural circumcisions: A single site retrospective review in Eldoret, Kenya

S. Abdulhai — 2024-09-30

Background: Cultural male circumcision is a commonly performed procedure in Kenya as a rite of passage, often including cultural initiation activities in addition to the surgical procedure. These procedures are often performed out of medical facilities due to cultural requirements, and sometimes by untrained personnel in unsterile conditions resulting in serious complications. In recent years, there have been increased reports of devastating post-cultural circumcision complications both in the media and in our hospital in Western Kenya. This study describes our hospital’s experience with post-cultural circumcision related complications between 2014 and 2023.

Methods: A retrospective chart review of male patients who presented to Moi Teaching and Referral Hospital in Eldoret, Kenya from 2014 to 2023 with cultural circumcision-related complications was performed.

Results: A total of 129 patients presented between 2014 and 2023, 81% of which presented between 2022 and 2023. Mean age of admission was 16 years (range 6 to 27), and most presented between November and January each year. Complications included local and systemic infections, bleeding, and tetanus, as well as lower extremity wounds which were related to initiation activities after the circumcision. Mean hospital length of stay was 11.8 days and 14% of patients required ICU-level care. There were 11 mortalities between 2022 and 2023.

Conclusion: While male circumcision is generally considered a safe procedure, this study shows that male cultural circumcision in our region of Kenya can be associated with high morbidity and mortality and further studies are needed to understand the true scope of this problem.

Association between abnormal late third trimester cerebroplacental ratio and perinatal outcomes in appropriate for gestational age fetuses

M.K. Wabacha — 2024-09-30

Background: A significant proportion of adverse perinatal outcomes occurs in appropriately grown fetuses. There is therefore need for additional measures to screen for those fetuses at risk of hypoxia besides the estimated fetal weight and abdominal circumference.

Objectives: To determine the association between abnormal cerebro- placental ratio and adverse perinatal outcomes in appropriate for gestational age fetuses.

Study Design: A retrospective cohort study was conducted. The association between cerebroplacental ratio below the 10th centile and composite adverse perinatal outcomes was sought. Multivariable logistic regression analysis was conducted to control for potential confounding variables.

Results: A total of 150 participants with appropriate for gestational age fetus between 36-38 weeks were assessed for cerebroplacental ratio. Of these 21(14%) had a cerebroplacental ratio below the 10th centile. The cumulative composite adverse perinatal outcomes were observed in 15 cases (10%). Of the 15 cases, only 2 (13%) had a cerebroplacental ratio below the 10th centile (p=1.000). No stillbirth, Apgar score < 7 at 5 minutes or NICU admission occurred. There was no difference in perinatal outcomes, maternal demographics, gestation at delivery, and mode of delivery in both groups. Overall, cerebroplacental ratio performed poorly as a predictor of adverse perinatal outcomes in AGA fetuses; aOR 1.08 (95% C.I: 0.25,7.43 p=0.99).

Conclusion: There was no association between abnormal cerebroplacental ratio and composite adverse perinatal outcomes in appropriate for gestational age fetuses and it is therefore not a useful index in the assessment of fetal wellness in this cohort.

Awareness of human papilloma virus among the residents Of Abduba Estate, Thika west sub-county, Kiambu County, Kenya

M.N. Wainaina — 2024-09-30

Background: Human papillomavirus (HPV) is of a great public health concern as it is a highly prevalent, sexually transmitted infection known to cause ill health and mortalities in the general public as it infects both men and women.
Objectives: The aim of the study was to evaluate the awareness of HPV and its associated factors.
Methodology: An analytical cross-sectional study using self-administered questionnaires among members of family of the 200 households in Abduba Estate, Kiambu County. Participants included all family members of both gender male/female of eighteen years and above selected using census mode of data collection. The primary outcome measure was HPV awareness.
Results: Majority of the respondents 156 (52%) were females while 144 (48%) were males. On the age distribution of the respondents, majority 146 (48.50%) were aged between 18 and 28 years and the least 32 (10.63%) were aged above 49 years. On marital status, majority 166 (55.33%) were married and the least 4 (1.33%) were widowed. Majority of the respondents 143 (47.67%) had low awareness, 119 (39.67%) had medium awareness and 38 (12.67%) had high awareness.
Conclusion: HPV awareness among the study population was very low. We recommend interventions in to increase knowledge about cervical cancer and HPV vaccines.

Patterns of Sacral Dysmorphism in Pelvic CT scans at a National Referral Hospital in Kenya

V.B. Nyang'au — 2024-09-30

Background: Sacral dysmorphism refers to morphological variations found in the first two sacral segments that limit the safe placement of percutaneous sacral iliac screws. The prevalence is documented in European, North American and some Asian populations. However, studies within the African population including Kenya are lacking.

Objective: The aim of the study was to describe the patterns of sacral dysmorphism in pelvic computerized tomography (CT) scans at a national referral hospital in Kenya.

Design: A cross-sectional study carried out at the Radiology Department, Kenyatta National Hospital of records from March 2020 to March 2021 involving the radiographic evaluation of 293 stored abdominal pelvic CT scans of patients.

Main Outcome Measure: Sacral dysmorphism was identified based on the sacral dysmorphism score >70 and the presence of any of the six morphological features of sacral dysmorphism.

Results: A sacral dysmorphism score of more than 70 was found to in 64% of the population. The prevalence of dysmorphic sacra (based on the presence of at least one qualitative feature) was 100%. The most prevalent feature of sacral dysmorphism was the lack of recession of the S1 segment (82%) followed by an unfused sacral segment (76%). Of note is that some qualitative features of sacral dysmorphism were protective against a high sacral dysmorphism score. There was no statistical significance of gender in sacral dysmorphism.

Conclusion: There is a high prevalence of sacral dysmorphism score in the Kenyan population; warranting a need for further studies in the African population.

Effectiveness of antimicrobial stewardship in a middle tier hospital – A quasi-experimental retrospective study

K.K. Irungu — 2024-09-30

Background: Antimicrobial Stewardship (AMS) is a framework that restricts antimicrobial use was introduced in our hospital in October 2019 and its effect had not been evaluated.

Objective: To determine the effect of AMS in Karatina Sub-County Hospital.

Methods: A quasi-experimental retrospective study looking at antimicrobia utilization before and after AMS implementation in a Sub- County hospital records department. Census sampling was done for; all inpatients on antibiotics; and for outpatients seen on dates of the specific months. Data were abstracted on: type of antibiotic, dose, frequency, indication, adherence to WHO-AWaRe categorization and prescriber cadre. Data were analyzed using R software.

Results: For the outpatient 243 (45.7%) prescriptions did not fulfil AWaRe categorization in the pre-AMS period reducing to 127 (37.8%) in the post AMS period p<0.05. Prescriptions with antibiotics reduced from 70.4% to 35.7% and prescriptions written by interns from 40.9% to 15.7%. For the inpatient, initially 78 (22.3%) prescriptions did not fulfil AWaRe categorization, but this reduced to 76 (19.9%). Prescriptions with antibiotics were reduced from 47.6% to 40.8% and specialist prescriptions increased from 0.7% to 11.9%. Defined daily doses of antibiotics cumulatively increased between the two periods in both departments but reduced for amoxicillin, cefixime, cefuroxime, doxycycline and ceftriaxone.

Conclusion: There was statistically significant reduction in antibiotic use after the institution of AMS.

Sonographic findings of carotid artery disease in adults with hypertension as a risk of stroke. A cross-section study in a Tertiary Hospital in Tanzania East Africa

S. J. Rweyemamu — 2024-09-30

Background: Systemic arterial hypertension is a major risk factor for atherosclerosis, leading to conditions like carotid artery stenosis and ischemic stroke. Extracranial ultrasonography is recommended for the initial assessment of patients with hypertension to detect carotid artery disease. This study aimed to assess sonographic findings of carotid artery disease in adults with hypertension at a Cardiovascular Hospital in Tanzania, East Africa.

Methods and materials: A 7-month cross-sectional hospital-based study was conducted at JKCI on adult patients with hypertension who gave consent. Demographic and clinical histories were recorded, and SPSS version 20 was used for analysis. Sonographic findings of carotid artery disease and associated factors were presented using descriptive analysis. Proportions between independent variables were compared using Pearson Chi-square or Fisher’s exact tests. Statistical significance was considered at a P value of less than 0.05.

Results: 104 patients were included in the study, and their average age was 62. Most patients (38.46%) were aged between 51-60 and above; females accounted for 74.04% of the participants. The primary risk factors observed were overweight (50.96%) and diabetes (26.92%). Carotid Doppler ultrasound showed that 53.85% of the patients had intima-media thickness, and 30.77% had plaque. These changes were significantly associated with age (p value= <0.05), hypertension, and dyslipidemia (p value= <0.05).

Conclusion: At the age of 50 or older, high dyslipidemia is associated with intima-media plaque/stenosis

Predictors of TB treatment failure among pulmonary patients attending Public Health Facilities Nairobi County, Kenya

F.M. Mwanzui — 2024-09-30

Background: Tuberculosis (TB) is one of the infectious diseases of public health concern globally. Kenya is ranked 15th among the 22 high TB burden countries worldwide. TB Treatment failure is one of the threats to the control of TB.

Aim/Goal: To determine affordable predictors of TB treatment failure in a resource limited setting to inform policy in designing public health interventions that are best suited to the country’s needs.

Objective(s): To determine the predictors of treatment failure among patients with sputum smear positive pulmonary TB.

Design: Data was abstracted and summarized from both patients and their medical records, focusing on socio-demographic, behavioral, and clinical exposure data.

Setting: Data was collected from 4 Sub-counties, a total of 21 public health facilities with high case load of pulmonary TB were reached.

Subjects: Utilizing an unmatched case-control design, the study enrolled 81 patients diagnosed with TB treatment failure (cases) and 162 patients who were declared cured after completing their anti-TB treatment (controls).

Main Outcome Measures: The factors significantly associated with treatment failure in this study encompassed prior exposure to first-line anti- Tuberculosis drugs, positive sputum smear at 2 months of treatment, and suboptimal adherence to anti-TB treatment.

Results and Conclusion: These findings contribute valuable insights into the identification of simple predictors of TB treatment failure such as utilizing sputum microscopy testing at 2 months of treatment to detect individuals at risk and strengthen the implementation of DOT and TB treatment failure contact tracing protocols.

Ectodermal dysplasia: A Case Report

H.W. Githaiga — 2024-09-30

Ectodermal dysplasia (ED) is a rare group of hereditary disorders caused by defects in the embryonic ectoderm and its derived tissues; primarily the skin, hair, nails, sweat glands, and teeth. ED has an incidence rate of about 7 cases occurring in every 100000 live births. These defects can affect the development of two or more of these tissues. This report is a discussion of a nine-month-old boy, who presented with hypotrichosis, nail dysplasia, unexplained persistent fever, and failure to thrive; features characteristic of Ectodermal Dysplasia.