Dyslipidemia in blood pressure control among adult hypertensive patients in Kiambu County Hospital Kenya

Introduction: Hypertension is one of the most common non-communicable diseases with about 40% global prevalence in adults and 46% in Africa. Dyslipidemia, among other factors may lead to poor blood pressure control in hypertensive patients. Dyslipidemia occurs when someone has abnormal levels of lipids in their blood However, the role of dyslipidemia in predicting hypertension has not received adequate attention. Objectives: This study aims to determine the relationship between dyslipidemia and blood pressure control among hypertensive patients in Kiambu County Hospital Kenya. Methods: This was a cross-sectional analytical study assessing independent association between blood pressure control and dyslipidemia in a cohort of 251 hypertensive patients in a hospital set up. Multiple logistic regression model was applied to determine factors associated with poor blood pressure control. Results: In total, 251 hypertensive patients, mean age 55.7 years, females-majority (80.9%) were considered in the study. The mean systolic blood pressure was 145.1±22.4mmHg and 87.4±13.0mmHg for diastolic blood pressure. Blood pressure was poorly controlled in 56.6% of the patients. High LDL levels was diagnosed in 82.1% of the patients, 23.1% low HDL levels, 31.9% high triglycerides and 59.8% high total cholesterol levels. Patients with poorly controlled hypertension (68.7%) recorded significantly higher mean total cholesterol (221.4 mg/dl) compared to193.4 mg/dl in the wellcontrolled group (mean 193.4 mg/dl), p0.05). Conclusion: Dyslipidemia was recorded in 68% of adult hypertensive patients and was significantly associated with development of of inadequate blood pressure control. Low density lipids ( LDL) was significantly higher in the poorly controlled group where 68.7% of the patients with high level of total cholesterol had poorly controlled blood pressure. Lifestyle modification, routine lipid profile testing among hypertensive patients, early treatment on high lipid level patients, change of lifestyle and use of statin were recommended for dyslipidemia treatment. Keyword: Hypertension, cardiovascular, blood pressure, diastolic, systolic,non-communicable,disease

Blood pressure parameters and the development of congestive heart failure among hypertensive patients at Kiambu County Hospital, Kenya

Introduction: Global incidence of heart failure is on increase. Heart failure has been shown to be on the increase with 1-3% admission rates globally and a 3-7% admission rate in the African hospitals. Hypertension (HTN) has been shown to play a pivotal role in the evolution and syndrome of heart failure where it is mostly non- ischemic in origin yet there are few studies on the association of the individual blood parameters and heart failure. Objective: The study assessed the individual blood pressure parameters as prognosticators of congestive heart failure (CHF) in hypertensive patients. Method: A retrospective study was carried out at Kiambu County Hospital, on 205 heart failure patients who met the Framingham Criteria. The parameters observed included the time of onset of CHF, systolic/ diastolic blood pressure, pulse pressure and their duration to the development of CHF. Multivariable cox proportional hazard regression models were used to determine the effects of individual blood pressure parameters relative to the onset of CHF. Results: Overall, 205 patients were eligible for the study. Median time to CHF was estimated to be 4 years (range: 1-18), median age of CHF development was 65.7 years with a 68.8% female preponderance. Pulse pressure of 55- 60 mm Hg (AHR: 2.21; 95%CI: 1.16-4.21), hypertension duration of 5-10 years (AHR: 0.14; 95%CI: 0.088-0.223) and over 10 years (AHR: 0.023; 95%CI: 0.010-0.050) were significantly associated with the development of CHF. Conclusion: Pulse pressure is a better prognosticator of CHF in hypertensive patients with a hazard ratio of 2.2 times more likely in patients with a pulse pressure of 55- 60 mmHg than those below 55mm Hg.

Patient related barriers to adequate blood pressure control among adult hypertensive patients seen at Kiambu County Hospital, Kenya

Introduction: Hypertension is a key precursor to cardiovascular and renal disease globally. According to WHO, Prevalence of hypertension was about 40 % globally in 2015 and 45% in Sub Saharan Africa in 2015. Despite much emphasis on treatment of the syndrome, the related blood pressure control remains poor or inadequate. Objective: The study sought to establish the patient related barriers to adequate blood pressure control among adult hypertensive patients in Kiambu Count Hospital in Kenya. Methods: A cross -sectional descriptive study method approach was used to examine sample of 330 patients selected through consecutive sampling technique in the medical outpatient chronic disease clinic. Multivariate logistic regression analysis was used to determine variables associated with inadequate or poorly controlled hypertension among adult patients. Results: Most of the patients were females (71.5%). However, the presence of inadequate blood pressure control was significantly higher among males (P-value= 0.009). Regularly taking of hypertension drugs for the last 6 months was significantly associated with adequate blood pressure control (p-value=0.033). The other barriers including single status, inadequate knowledge, employment and time duration since diagnosis of hypertension did not significantly affect blood pressure control status. Discussion: Males were 54% more likely to have inadequate blood pressure control compared to females (AOR=0.543; 95%CI=0.323-0.914). Patients with low adherence to treatment were 11% more likely to have inadequate blood pressure control than those with high adherence rate (AOR=1.093; 95%CI=0.224-5.332) though the association was not significant (p-value=0.912). Conclusion: Male gender was a major barrier to adequate blood pressure control. Patients who well adhered to treatment scheme for a duration of six months preceding the study had their blood pressure better controlled than those who did not. Male hypertensive patients need to be followed up to ensure they adhere to drug treatment in order to reduce the rates of inadequate blood pressure control and other related complications.

Pattern of epidemics monitoring data reporting among health facilities in Nairobi City County, Kenya

Background: Weekly epidemic monitoring data reporting was adopted in Kenya after the Ministry of Health embraced Integrated Disease Surveillance and Response (IDSR) strategy from WHO - Africa region to facilitate timely detection and response to disease outbreak. The government has a reporting target of 80% but this has not been achieved by many counties including Nairobi County. Under-reporting put counties at risk of untimely outbreak detection which can, in turn result in epidemic menace. There is no adequate data to explain under-reporting in Nairobi County. The aim of this study was to determine the factors associated with poor epidemic monitoring data reporting among health facilities in Nairobi County. Methods: This was a cross-sectional analytical study targeting 318 health facilities in Nairobi County, Kenya. A stratified sample of 169 health facilities was selected using simple random. Health facility records were checked for compliance to quarterly submission of reports. A self-administered questionnaire was administered to data focal persons in the health facility in order to understand background characteristics of the participants, data transmission methods at each health facility, adherence to policies, personnel and availability of data collections tools. Data was analyzed using SPSS version 17.0. Relationships among study variables were tested using Chi-square, (P < 0.05). Results: Complete reporting was recoded in a total of 47% of the health facilities within the period under review, 36% partial reporting and 17% had not reported at all. Complete reporting was higher in public facilities (74%) than in private facilities (40.8%). Non-reporting was similarly higher in private facilities (25%) particularly the clinics (33%). Among institution related factors, supervision, presence of data focal person in a health facility and data transmission methods were significantly associated with poor data reporting (P<0.001). Training and awareness of data reporting days were important individual factors which were significantly associated with poor reporting (P<0.001). Rapid response to disease outbreaks is important for control of the disease and its spread to other regions. However, with only 47% of the health facilities in Nairobi County complying with the data reporting requirements, the City is at risk of delayed response in case such outbreak occurred. There is need to streamline the system to realize, exceed and maintain the government epidemic monitoring data reporting target rate of 80%.

Perforated uterus

Early pregnancy failure is a major health problem worldwide which occurs in 15-20% of pregnancies. During evacuation, uterine perforation is a potential complication. Careful post-evacuation follow-up helps in early detection of perforation. Perforation often requires laparotomy or laparoscopy to repair the defect and evaluate for injury to adjacent organs. Our patient had pregnancy loss at 12 weeks and uterine perforation during a dilatation and curettage procedure. She had laparotomy, evacuation through the perforation site and uterine repair with good outcome.

Autism Society of Kenya

Autism Society of Kenya (ASK) is an NGO founded in Kenya in 2003 with the objectives to raise awareness about the existence of autism in the country, sensitize the communities and to lobby the Government of Kenya on issues about appropriate policies and acts regarding Autism Spectrum Disorder (ASD). Issues related to strategies were proposed to improve identification, diagnosis, management and support delivery for ASD affected individuals.

Autism Spectrum Disorder (ASD) in Kenya

In the commentary section of this issue, The Autism Society of Kenya (ASK) describes its role and objectives to sensitize and promote levels of awareness on Autism Spectrum Disorder (ASD) and to advocate for policies that would enhance the existing disease interventions. The syndrome is widely spread in Kenya but in the write up this is a neglected none communicable disease that is not well understood neither by the public health authority nor by the general community. Unlike malaria and other tropical infectious diseases, Autism Spectrum Disorder (ASD) is a worldwide health burden which is well understood and addressed in the developed world but there is no clear data in Africa

Epidemiology of acute Intestinal obstruction in Uasin Gishu County, Kenya

Background: Acute Intestinal Obstruction (AIO) is a common life threatening emergency in all general hospitals all over the world. This study provides a population based incidence of acute intestinal obstruction derived from hospital data within a period of seven years preceding the year of the study (2008/9). Inpatient records can provide a fairly accurate data on the incidence of acute intestinal obstruction since almost all the cases are admitted in hospitals. Objectives: This study aims at determining the incidence and other epidemiological characteristics of AIO in Uasin Gishu County based on the hospital records and the national population census. Methods: The study was conducted in twelve hospitals (six within Uasin Gishu County) and six from the surrounding counties. Patient records for seven years preceding the period of study (2008) were retrieved and demographic information of the disease and treatment outcome (mortality) were analyzed against the projected population for the seven year period covered by the study (2001-2007). The population projections (the denominators) were based on Kenya population census and housing survey, 1999. Results: There were 444 cases of AIO from Uasin Gishu County during the seven year period of the study (2001-2007). There were 319 males (71.8%) and 125 females (28.1%) (male/female ratio =2.6/1). The mean age was 31.4 years and the median age was 29 years. The population of Uasin Gishu County (1999 census) on which the population growth projections was based was 622,705. Mean annual incidence for the seven year period was 8.8 per 100,000 persons and this was significantly related to age and gender (p-values = 0.0001). Recovery (survival) rate was 93.5% and mortality (case fatality) rate was 6.5%. Mortality rate was not significantly related to age and gender (p-value>0.05). Conclusion: The observed annual incidence of acute intestinal obstruction in Uasin Gishu County was very low compared to available global data. Our findings could be a pointer to the general burden of AIO in Kenya (given the similarity of Uasin Gishu County and rest of the country in relation to demography, infrastructure and the state of health care services). The incidence increased exponentially with age. A prospective population based study on incidence could shed more light and confirm the low incidence found in this study.

Impact of devolution on the trends of paediatric malaria admissions and mortality in Homa-Bay County, Kenya

Background: Malaria is a leading cause of paediatric admissions, morbidity and mortality. Malaria burden is endemic in Homa Bay County in the Lake Region in Kenya. Low social-economic status in Homa Bay County enhances malaria transmission, morbidity and mortality. Paediatric malaria admission and mortality have recently increased in the lake region unlike the rest of Kenya. Literature review did not show studies interrogating health policy correlates of this malaria problem in the region. The policy of the recently devolvement of the government system in Kenya was to bring services closer to the people. Devolved government in which the county governments are now responsible for healthcare delivery may have unique challenges that may influence disease morbidity and mortality. Objective: The aim of this study was to investigate the impact of devolution on paediatric malaria admission and mortality trends in public health facilities in Homa Bay County. Methods: This was a retrospective quasi-experimental study in which paediatrics records of 36 months before and 36 months after the devolvement of government were retrieved and analyzed for malaria incidence and deaths. All records of paediatric malaria cases reported in all 164 public health facilities in Homa-Bay County were examined. Data from the sub-County was obtained from the electronic records at the County Hospital. Hard copy data from health facilities in eight sub-Counties was also inspected at the sub-County level. Analysis of the data was accomplished by use of the Interrupted Time Series (ITS). Permission to conduct the study was obtained from the appropriate authorities. Data coding system was used in order to ensure confidentiality. Results: From January 2013, deaths increased gradually until around the 33rd month when it rose abruptly to nearly 800 then declined to levels below 200 in the 34 th month, which was around the time of devolution. This was followed by a period of stability. Admissions had a similar trend. Conclusions: There was a slight raise in paediatric malaria admissions and in the number of deaths due to malaria morbidity in Homa Bay County after the devolvement of government system in Kenya a factor which could be attributed to teething challenges of devolution. More studies are necessary to assess progress towards universal access to good healthcare services post devolution.

Food safety knowledge, attitudes and practices among food handlers working in meat selling establishments in the City of Nairobi

Introduction: Food-borne diseases have been increasing in recent years with a greater impact on health and economies of developing countries. Good levels of knowledge towards food safety among food handlers and the effective practices in food handling are imperative in reducing such illnesses. Objective: The aim of the present study was to evaluate the level of knowledge, attitudes and practices in food safety among food handlers working in meat selling and processing points within Nairobi city. Methodology: A cross-sectional study was conducted in the City of Nairobi. Data were collected from 100 food handlers working in food establishments selling meat in the city using an interviewer administered questionnaire. Results: Majority of the participants were male (80.0%) and Christians (89.0%). The median (interquartile range (IQR)) age of the participants was 30.5 (26.0-38.0) years. The respondents demonstrated above average proficiency in the assessments involving Knowledge, Attitudes and Practices (KAP). The overall KAP scores were not associated with age, gender, level of education and marital status. On the other hand, respondents who had ever attended a food handling and/or food safety course had a statistically significantly higher KAP mean score than their counterparts who had never attended (respectively, 31.5±0.2 versus 30.3±0.3, p=0.003). Conclusion: The level of knowledge, attitude, and practice on food safety and food handling amongst the sampled food handlers were found to be favorable. Training, motivation and initiatives should be provided to encourage food handlers to sustain this positive trend in knowledge, attitude, and practices in food safety.