East African Medical Journal

Evaluation of carbetocin and oxytocin for prevention of postpartum hemorrhage in women undergoing cesarean delivery at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya

G.K. Oyaro — 2024-12-04

Background: Postpartum hemorrhage (PPH) is the leading direct cause of maternal mortality and morbidity globally and locally. Use of uterotonics specifically oxytocin, for prevention of PPH in all births is recommended by the World Health Organization (WHO). Although oxytocin is readily and widely available at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) and is currently the preferred uterotonic for all births, there is paucity of data on its effectiveness.

Objective: To evaluate the effectiveness of oxytocin in the form of comparative study with its analogue, carbetocin for prevention of PPH in women undergoing cesarean delivery at JOOTRH.

Methods: This was a quasi-experimental trial with154 women, 77 in each arm recruited in the study. The intervention arm received 100mcg Carbetocin, the control arm received 10IU oxytocin. Variables of interest were use of additional uterotonics, estimated blood loss, and need for transfusion. Propensity score matching and binary logistic regression analysis were employed to assess the relationship between the study arm and variables of interest. Covariates with pvalue <0.05 were considered significant.

Results: Participants in the oxytocin group were 8 times more likely to receive additional uterotonics (OR=8.00, 95% CI 3.77,18.2, P-value<0.001). There was no statistically significant difference in blood loss (P-value 0.387) and need for transfusion (P-value 0.229).

Conclusion: Carbetocin was noted to be more effective in PPH prevention as its use was associated with reduced need for additional uterotonics. Recommendation: Carbetocin should be included as a first line agent in PPH prophylaxis in women undergoing cesarean delivery.

Chronic non-infectious lung conditions in adolescents living with HIV

E.A. Kegode — 2024-12-04

Background: The immune suppression and dysregulation in patients living with Human Immunodeficiency Virus (HIV) predisposes them to chronic noninfectious lung conditions.

Objective: To describe the chronic noninfectious lung conditions in adolescents living with HIV and associated factors.

Design: This was a retrospective study with convenient consecutive sampling.

Subjects: Children living with HIV (10 to 16 years) during the study period 1st April 2011 to 31st March 2019.

Setting: The study was done at Chris Hani Baragwanath Academic Hospital, South Africa at the Pediatrics pulmonology and HIV clinics.

Methods: The Database in the two clinics was screened and files retrieved. The information retrieved included; demographics, age at HIV diagnosis, duration on Anti-retroviral therapy, (ART) types of chronic noninfectious lung conditions, history of ever being treated for tuberculosis, anthropometric measures, ART regimens, viral loads and CD4 counts at diagnosis and at censure.

Results: Data was analyzed for 276 files. Females were 139 (50.4%). The median (interquartile range (IQR)) age at censure was 14 years (12-15 years). The majority of the participants were diagnosed with HIV at the age of 6 years (161 (58.2%)) (IQR 5-9). Bronchiectasis was the most common condition (n=113 (41%)), followed by Lymphoid interstitial pneumonia (LIP) (n=102 (37%)). A history of ever being treated for tuberculosis (n=140(50.7%)) was associated with multiple chronic noninfectious lung conditions (p=0.014).

Conclusion: Adolescents living with HIV in Johannesburg, South Africa had a high prevalence of chronic non-infectious pulmonary diseases such as bronchiectasis and tuberculosis disease was associated with multiple chronic lung conditions.

A study on the impact of chronic leg ulcers on the quality of life among patients from Nakuru, Kenya

P. Mugo — 2024-12-04

Background: Chronic-leg-ulcers (CLUs) have huge socioeconomic and psychosocial effects. Their impact on patients’ quality-of-life (QoL) from our community is unknown.
Methods: We conducted a cross-sectional study on patients with CLUs under our care. Data was collected with the Short-Form-36 (SF-36) tool. We included 55 patients.
Results: More than half of the study participants were male (52.7%). Nearly half (49.1%) were of the age group (41-60) years. A greater number of the ulcers were unilateral (78.2%) and lasted for 1-5 years (41.8%). The most prevalent risk factor for ulcers was venous disease (22%). The highest score was observed in the emotional-well-being domain (63.1%) while lowest score was for role-limitations due to physical-health (24.6%). Majority of patients had a mean QoL-score below population average.
Conclusion: Chronic-venous-ulcers lead to significantly lower QoL scores. These ulcers likely result from venous disease and trauma and to affect patients during their 4th-5th decades. The SF-36 tool may help to rationalize and design interventions for physical and mental wellbeing.

Hypertension, structural heart changes and associated factors among police officers in Dar-Es-Salaam barracks, a cross-sectional observational study in firearms East Africa Tanzania

S.J. Rweyemamu — 2024-12-04

Background: Hypertension affects about one billion people globally (26% of adults). Uncontrolled hypertension leads to target organs damage and contributes to 7.1 million premature deaths worldwide. The study aimed to determine the burden of hypertension; structural heart disease/ associated factors among Police Officers.

Methodology: A cross-sectional study was conducted in Dar es Salaam among 360 police officers from six police stations. The participants gave their consent for the study. Demographic, clinical, and 2D M-mode echocardiographic information was collected through structured questionnaires. The data was analysed using the Statistical Package for the Social Sciences (SPSS) version 20. Regression analyses were also performed, and statistical significance was considered at a p-value of ≤ 0.05.

Results: Out of 360 participants, 262 (73%) were males and 114 (31%) were middle-aged. Police prevalence of hypertension was 209 (58%.). Diabetes Mellitus was documented in 19 (5.4%) while overweight/obesity in 124 (34.7%). Structural heart changes were observed in 51 (66.2%) of those who had echocardiography. Structural heart disease was statistically significantly associated with higher systolic blood pressure (p-value <0.001), diastolic blood pressure (p-value<0.001), and diabetes mellitus (p- value=0.044) in a multivariate analysis.

Conclusion: There was a high prevalence of hypertension and hypertensive heart (58%) disease among the police officers studied. Hypertensive heart disease was statistically significantly associated with hypertension and diabetes mellitus.

Cardio-metabolic health in relation to handgrip strength and walking speed in overweight South African women

N.E. Brooks — 2024-12-04

Background: There is increasing concern with rising levels of obesity in lowand middle–income-countries due to the association between cardio-metabolic abnormalities, obesity and accompanying poor physical health.

Objective: This study aimed to investigate the independent associations between cardio-metabolic parameters (plasma glucose, insulin sensitivity, blood pressure, lipid profile), handgrip strength (HS) and walking speed (WS) in overweight and obese black South African (SA) peri-urban women adjusting for confounders.

Participants/setting: Sixty-five black SA women participated.

Main outcome measurements/design: Information from fasting blood samples, blood pressure, anthropometrics, HS and six-minute walk test were gathered, age and body mass index (BMI)-adjusted linear regression models assessed the associations between physical performance (HS, WS) and cardio-metabolic indices.

Results: Mean age 36.8 (23-66) years and mean BMI 34.0 (25.0-51.4) kg · m^-2 . A high proportion of participants were insulin resistant (67%), had dyslipidemia (84%) and hypertension (46%). The ratio between fasting serum insulin and HS was significant (eB=0.39, p<0.041), and the ratio between QUICKI and HS was borderline significant (eB=1.14, p=0.057), none of the ratio estimates between WS and the cardio-metabolic parameters were statistically significant.

Conclusions: Cardio-metabolic health parameters are weakly associated with HS, but not with WS in overweight and obese African women.

Individual factors associated with post-partum depression among post-natal women in selected clinics in Kiambu County, Kenya

M.M. Mugambi — 2024-12-04

Background: Postpartum Depression (PPD) is a global concern with an estimate of between 10 - 20% prevalence. This is a health condition that many women develop after birth which is characterized by feelings of tiredness, sadness, worry, severe mood swings, feelings of suicide among others. The aim was to determine prevalence of PPD among women attending selected post-natal clinics as well as individual factors associated with PPD among these women.

Methods: The study used a mixed method cross-sectional design with simple random sampling technique. Data was collected using Edinburgh Postnatal Depression Scale and questionnaires. Descriptive statistics was used to describe the basic characteristics of a data while, the chi square test, logistic regression were used to examine the interactions between the variables, at the significant level of p-value of 0.05 and thematic analysis to analyze qualitative data.

Results: Out of the 404 questionnaires that were issued, 321 were duly filled. There was a significant relationship (p<0.05) between PPD and the following psychosocial factors: whether the mother was suffering from any chronic disease, type of chronic disease, support after delivery, spousal support, feeling after birth and social group support with a p-value of p<0.05.

Conclusion: Women's mode of delivery, antenatal clinic attendance, complications during childbirth, expected gender of the baby and pregnancy type are all obstetric factors significantly (p<0.05) associated with post-partum depression.

The effects of advanced prostate cancer management on health service care providers in western Kenya region

P. Musau — 2024-12-04

Background: The management of advanced prostatic cancer patients in hospitals are known to impact on the patient as well as the core health care services providers, and patient’s relatives. This study was purposed to examine for the effects and put forward suggestions to ameliorate the negative impacts.

Objective: To establish the effects of advanced prostate cancer management outcome on the involved health care service providers.

Design: Cross-sectional study with in-depth interviews of core healthcare service providers.

Setting: County Referral Hospitals of the 8 counties in western Kenya region.

Subjects: Fifty-six healthcare service providers involved in the management of prostate cancer patients in the region.

Results: The respondents’ ages ranged between 27 years and 59 years with a mean ±standard deviation of 40.1 ± 7.7 years. Majority of the patients (92.9%) presented with advanced disease. Major treatment options offered were palliative care and symptoms control. The stated effects on the healthcare providers included disappointment with the management processes, limited options of care, low morale, and poor job satisfaction. The suggested ways to improve the care were focused on cancer health support, improved human resources, and infrastructural quality for dedicated services.

Conclusion: Advanced prostate cancer management in the Western region of Kenya was limited to palliative care and symptoms control. The health care service providers were negatively impacted by the poor outcome of management and the suggestions were to improve human and infrastructural support for better outcomes.

Perspectives of diabetes patients in improving diabetes care in Ghana: a nationwide quantitative descriptive study

E. Yorke — 2024-12-04

Background: Past and recent publications suggest that significant patient-related challenges in the management of diabetes patients remain, especially, in subSaharan Africa.

Objectives: We set out to obtain patients’ perspectives on the challenges they face in the management of their condition as well as suggestions to improve these identified gaps.

Design: This was a cross-sectional descriptive study.

Setting: Public and private health facilities across all 16 administrative regions of Ghana

Participants: Diabetes patients

Methodology: Patients’ perspectives on various aspects of their management and possible solutions on perceived gaps were sought using a structured pre-tested questionnaire. Data were analysed using STATA version 16.1. P-value <.05 was set as significant.

Results: Between 71.7%-85.6% (n=104-124) of the 145 respondents reported that the availability of specialist doctors, diabetes educators, ophthalmic nurses, ophthalmologists, dieticians, and glucose monitoring devices were below average; with podiatrists/foot care specialists only available in a few facilities. Respondents generally reported that availability of laboratory services needed for their care, human insulins, oral diabetes medications (except Sodium Glucose Transporter-2) was either good or excellent. Overwhelming majority of the patients used NHIS to finance their diabetes-related healthcare costs, whilst nearly 50% also pay-out-of-pocket to supplement healthcare and deemed this as expensive. Averagely, more than 95% (n=138) of the patients surveyed either agree, strongly agree or extremely agree to improving personnel, support services, laboratory investigations and access to affordable medications to enhance comprehensive diabetes care.

Conclusion: Diabetes patients across the country continue experience significant challenges relating to their care. Cross-sector collaboration to improve identified challenges is urgently needed.

The influence of the internet on self-medication practices among non-medical egerton university students in Nakuru City, Nakuru County, Kenya

F. Getankwa — 2024-12-04

Background: This study aimed to determine the influence of the internet on selfmedication practices among non-medical university students.

Design: A cross-sectional study design was used and data was collected through an e-questionnaire from a total 218 participants.

Setting: Egerton University, Nakuru City Campus.

Participants: The study utilized 218 participants, constituting non-medical
students in Egerton University Nakuru City Campus.

Main Outcome Measures: The percentage of individuals who relied on the internet for self-medication.

Results: The study found that the majority (89.9%, n=218) of the participants used the internet to access health information. Google was the most popular source of information with 198 individuals (96.6%) selecting this source, followed by social media platforms, such as Twitter selected by 17 participants (8.3%), Facebook, 6 individuals (2.9%), and Instagram, 6 individuals (2.9%). The choice to self-medicate
was influenced by symptom severity, familiarity to the drug, and the cost of the drug. The most common symptoms for which the participants self-medicated include cough by 139 participants (63.8%), headache by 170 individuals (78.4%), and sore throat by 100 individuals (45.9%). Analgesics were noted as the most commonly used self-medication drugs by 154 individuals (70.6%), followed by antibiotics by 42 participants (19.3%) and antihistamines by 26 participants (11.9%).

Conclusion: The study's findings suggest a need to improve health education and policy in the region. Educational programs will help increase awareness about the importance of consulting with healthcare professionals and the risks of relying solely on internet-based information for medical advice.

Management of elevated blood pressure and cholesterol in a nonagenarian with ischemic stroke and atrial fibrillation: A case report

A. F. Charles — 2024-12-04

This case report details the management of a 94-year-old male with a complex medical history including ischemic stroke secondary to atrial fibrillation (AF), recently hospitalized for coronary artery disease (CAD), and presenting with left arm swelling. The diagnosis was left arm artery thrombosis and arterial calcification. Management included the adjustment of baseline medications (aspirin, statin and calcium channel blockers) and the addition of telmisartan and rivaroxaban. A significant improvement in clinical parameters was observed at a 16-week follow-up.