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Background: Oral squamous cell carcinoma (OSCC) is the sixth most common cancer in the world with several aetiological factors including inflammation having been associated with the disease. Inflammatory markers including interleukin 6(IL-6) and C-reactive protein (CRP), have been shown to be elevated in OSCC and wide geographical variations have been reported. Information about the association between CRP and OSCC in Kenya is scanty in the published literature and therefore this study aimed to determine the relationship between the disease and CRP in a Kenyan population. Objectives: To determine the relationship between C-reactive protein and Oral Squamous cell carcinoma in a Kenyan centre. Study design: This was a case control study Study participants: Cases were patients who presented to the Kenyatta National Hospital with OSCC while age and gender matched controls were patients in the same hospital who did not have the disease. Results: Of the 157 cases 61.8% and 38.2% were males and females respectively, with mean age of 58 Years (SD 13.2 years). The mean CRP levels were 10.55mg/l and 20.92mg/l for cases and controls respectively and this difference was significant (critical ratio 3.91, p<0.01). After setting up different cut-off points of 3mg/l, 5mg/l and 10mg/l patients with OSCC had a significant likelihood of having CRP levels of greater than 5mg/l (OR=19.98, 95% CI 6.65-60.05) Conclusion: This study reveals that patients with OSCC are more likely to have systemic inflammation resulting in production of C-reactive proteins. Assessment of CRP would be valuable in the management of this disease [ABSTRACT FROM AUTHOR]

Background: Oral squamous cell carcinoma is the sixth most common cancer in the world and despite advances in medical care the survival trends for OSCC have not significantly improved over the years. Information about the sociodemographic, clinical and pathological presentation of OSCC in Kenya is scanty in the published literature. In order to further understand the disease this study aimed to determine the sociodemographic and clinicopathological features of OSCC in a Kenyan hospital population. Objectives: To determine the sociodemographic and Clinicopathological features of Oral Squamous cell Carcinoma (OSCC) at a Kenyan Centre. Study design: This was a descriptive prospective study. Study participants: Patients who presented with oral squamous cell carcinoma at the Kenyatta National Hospital, Nairobi. Results: Out of the 157 cases 61.8% and 38.2% were males and females respectively. Mean age of 58 Years. Majority were of cases were farmers while most the controls were in the informal sector. Pain was the most common symptom among the cases with 68.15% complaining of moderate to severe pain. Palpable submandibular and cervical lymph nodes were more common among those with lymphadenopathy. The well differentiated histological type was prevalent. Tongue was the most common site among all cases although OSCC had a predilection buccal mucosa among females. Conclusion: This study reveals that OSCC is predominantly a disease of the older male, pain a major symptom and tongue the most common site. Well differentiated carcinoma was predominant. We recommend further studies to determine the prognostic value of these features in this population. [ABSTRACT FROM AUTHOR]

Background: Road Traffic Accidents (RTAs) are a major cause of Severe Head Injuries (SHI) among Kenyan citizens of productive age comprising 14.3% of adult Intensive Care Unit/High Dependency Unit ICU/HDU admissions. Severe injuries are managed in a Critical Care Unit (CCU) for specialized supportive care. Objectives: To determine the specialized supportive care for patients with road traffic injuries (RTI's) and identify the challenges experienced by health care workers managing the patients in CCU. Design: A one-year retrospective cohort study. Setting: Critical Care Unit at Kenyatta National Hospital-(CCU-KNH) Subjects: Patients admitted to CCU-KNH with Road Traffic Injuries (RTI's) in 2013 and managers for Anaesthesiologists, Nurses, Physiotherapists and Nutritionists. Results: The specialized supportive services offered to RTA patients included radiological services; Computerized Axial Tomography (CT Scan) (95.8 %); XRay services (78.9%); Abdominal Ultra-Sound (5.6%); Laboratory services; Full hemogram (FHG) (81.7 %), Grouping and Cross-Matching (GXM)(29.6%), Urea and Electrolytes (77.5%), Coagulation profile (1.4%) and Arterial Blood Gas Analysis (ABGs) (87.3%), Physiotherapy (97.2%), Nursing care and Nutritional support. Challenges were reported as inadequate resources, poor staffing, lack of multidisciplinary teamwork, delayed admission, lack of specialized training, long stay patients and complications among patients. Electrolyte imbalances, infections, shock and arrhythmias were significantly associated with mortality among the patients, P<0.05. Conclusion: Specialized supportive care for RTA patients was provided though at varied levels. Addressing the challenges of care can improve health outcomes of patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence and predictors of hospital acquired catheter associated urinary tract infections among catheterized patients admitted at Kenyatta National Hospital Critical Care Unit Study Design: Prospective Cohort Study Setting: Kenyatta National Hospital Critical Care Unit Subjects: the study population was two hundred and thirty-eight patients admitted in the critical care unit between January 2019 and January 2020 and were put on urinary catheter Main Outcome Measures: Incidence of hospital acquired urinary tract infection, patient level and hospital level risk factors associated with catheter associated urinary tract infections. Results: the incidence density of hospital acquired catheter associated urinary tract infection was 32 per 1000 Catheter-days in the critical care unit. The cumulative incidence was 28.7%. Patients having other comorbidities had a higher risk to acquire catheter associated urinary tract infection; risk ratio of 1.669. Failure to observe aseptic techniques during emptying of the urine bag had a higher risk to acquire catheter associated urinary tract infection; risk ratio of 3.392. Failure to secure the urinary catheter on the patient's thigh had a higher risk to acquire catheter associated urinary tract infection; risk ratio of 1.836. Conclusion: the incidence of intensive care acquired catheter associated urinary tract infection at the critical care unit is relatively high compared to other jurisdictions. The risk factors associated with the high incidence of the urinary tract infection are comorbidities, failure to observe aseptic techniques during emptying of the urine bag and failure to secure the urinary catheter on the patient's thigh. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of early intermittent Kangaroo Mother Care (KMC) in improving neonatal weight gain and length of stay in stable Low-Birthweight (LBW) infants Design: A multi-site quasi-experimental study. The intervention group was early intermittent KMC while the control group was conventional neonatal care. Setting: Newborn units in 3 hospitals in Kenya from July 2016 to June 2017. Participants: Stable LBW infants (N=343 (171 KMC infants and 172 control infants)) born weighing ≤2000 grams and their mothers. Interventions: KMC infants received early (≤72 hours after birth) intermittent KMC for a cumulative period of 8 hours a day and were placed in incubators when not on KMC. The control infants received standard neonatal care. Main outcome measures: Neonatal weight gain and length of stay Results: Intervention infants had a significantly higher mean weight gain during the neonatal period (709.5g vs 471.5g, p<0.0001) than controls. Secondary level maternal education, toilet access, delivery complications and at least 3 meals a day during pregnancy were associated with better neonatal weight gain (p<0.05). Higher birthweight was associated with lower neonatal weight gain (p<0.001). The intervention shortened length of stay (7.1 days vs. 17.4 days, p<0.0001). Higher birthweight was associated with shorter length of stay (p=0.001). A pregnancy history of 1 or more pregnancy loss with 1 or more live births was associated with longer length of stay (p=0.027). Conclusion: Early intermittent KMC was effective in improving neonatal weight gain and reducing length of stay in stable LBW infants. [ABSTRACT FROM AUTHOR]

Background: W. ugandensis is widely used by herbalist due to its therapeutic properties with observation studies suggesting it can manage asthma. This research sought to find out the anti-asthmatic effects of W ugandensis using BALB/c mouse model for asthma. Methodology: Percent protection to developing airway resistance by measure of Pre-Convulsion Time (PCT), efficacy in reduction of inflammatory cells count and Nitric Oxide levels in BALF were assessed. Animals were induced with asthma and challenged with methacholine one hour after final OVA inhalation to determine baseline PCT. Intervention was done with (500mg/kg, 250mk/kg, negative control (NS), positive (budesonide) then challenged with methacholine 72 hours after final OVA inhalation, PCT taken was compared to the baseline PCT and percent protection calculated. Hemocytometer was used to determine total inflammatory cell count and four- part differential counts of 200 cells per slide performed for differential cell count. NO level was determined using Griess reagent protocol. Results: PCT was not significantly different across all groups before intervention (p>0.05). Percent inhibition for 500mg/kg of W. ugandensis was 88.02±1.72b was not significantly different from positive control 82.03±1.29b. Negative control recorded highest total cell count (619.67±15.50a) most being eosinophils (494.33±12.01) and decreased significantly following interventions p<0.05. NO was highest in negative control (494.33±12.01a) and decreased significantly with interventions, positive control (0.082±0.003d), 250mg/kg (0.114±0.00c) and 500mg/kg (-0.013±0.003d) p<0.05. Conclusion: Results attested that W. ugandensis stem bark extract has antiasthmatic effects though there is need for further validation of anti-asthmatic potent molecules to augment the findings. [ABSTRACT FROM AUTHOR]

Background: While vaccination currently averts an estimated 2-3 million deaths every year an estimated 21.8 million infants worldwide are still missing out on basic vaccines. In Kwale County, particularly Msambweni Sub County, vaccination coverage among under five children is 77% compared with recommended of 80% for rural and 90% urban. Objective: To determine factors influencing vaccination coverage among children aged two to five years in Msambweni Sub-County, Kwale County, Kenya. Study Design: A descriptive cross-sectional study Study Setting: Four wards of Msambweni Sub-County, Kwale County, Kenya Study Subjects/participants: A total of 399 households were selected using Probability Proportional to Size sampling in the 4 wards. Systematic sampling technique was employed, and 11 health workers were interviewed, within the Wards. Data was collected using structured questionnaires through door to door visits. Observation checklist was used to supplement data. Results: Fully/complete vaccination coverage was 63.7% while specific antigen were as follows: BCG - 87%, Pentavalent 1 -82%, Pentavalent 2 - 82.5%, and Pentavalent 3 -80% and measles- 65.6%. Mothers/caregivers who rated vaccination not very importance were OR=0.64(95% CI 0.43 to 0.97) P=0.037, while mothers /caregivers age was significantly associate with unimmunized where OR=0.39(95% CI 0.18 to 0.65) P=0.001. Conclusion: The proportion of fully vaccination children was far below the WHO's target of 80% however, measles coverage remains low. Knowledge on the importance of vaccination, numbers of living children, side effect of vaccine and mothers /caregivers age were significant associated with vaccination coverage. Therefore, interventions need to focus on these factors to improve vaccination coverage in future. [ABSTRACT FROM AUTHOR]

To improve estimates of C. burnetii epidemiology in Kenya, a survey was undertaken in small ruminants in Baringo County, where acute cases of Q fever in humans had been reported in 2014. From 140 household herds selected, 508 (60.5%) goats and 332 (39.5%) sheep were included and an indirect ELISA assay for C. burnetii IgG antibodies performed. In addition, epidemiological information at both herd and animal level was collected. Generalized mixed-effects multivariable logistic model using herd as the random effect was used to determine variables correlated to the outcome. Overall seroprevalence was 20.5% (95% CI: 17.8%, 23.3%). Goats had 26.0% (95% CI: 22.2%, 30.0%) compared to sheep 12.2% (95% CI: 8.7%, 16.0%). Nomadic pastoralism, goats and older animals (>1 year) were associated with greater risk of C. burnetii seropositivity ( P = ≤0.05). Heterogeneity in C. burnetii seropositivity was observed across the sublocations ( P = 0.028). Evidence of C. burnetii exposure in small ruminants revealed poses a potential risk of exposure to the people living in close proximity to the animals. We recommended integrated animal-human surveillance and socio-economic studies for C. burnetii, to aid our understanding of the risk of transmission between the animals and humans, and in the design of prevention and control strategies for the disease in the region. [ABSTRACT FROM AUTHOR]

Background: Over 80% of blindness in Kenya is due to curable or preventable causes and 7.5 m Kenyans currently need eye services. Embedding sociodemographic data collection into screening programmes could help identify the groups facing systematic barriers to care. We aimed to determine the sociodemographic characteristics that were associated with access among patients diagnosed with an eye problem and referred for treatment in the Vision Impact Programme, currently operating in Meru County., Method: We used an embedded, pragmatic, cross-sectional design. A list of sociodemographic questions was developed with input from key stakeholders. The final question set included the following domains: age, gender, religion, marital status, disability, education, occupation, income, housing, assets, and health insurance. These were integrated into an app that is used to screen, refer, and check-in (register) participants within a major eye screening programme. We gathered data from 4,240 people who screened positive and were referred to their local outreach treatment clinic. We used logistic regression to identify which groups were facing the greatest barriers to accessing care., Results: A quarter of those screened between April - July 2023 were found to have an eye problem and were referred, however only 46% of these people were able to access care. In our fully adjusted model, at the 0.05 level there were no statistically significant differences in the odds of attendance within the domains of disability, health insurance, housing, income, or religion. Strong evidence (p < 0.001) was found of an association between access and age, gender, and occupation; with males, younger adults, and those working in sales, services and manual jobs the least likely to receive care., Conclusions: Access to essential eye services is low and unequal in Meru, with less than a third of those aged 18-44 receiving the care they need. Future work should explore the specific barriers faced by this group., (© 2024. The Author(s).)

Introduction: prostate cancer is categorized as the most common cancer in males in 2020 in Kenya at 21.9%. The major challenge with prostate cancer in Low and Middle-Income Countries is the presentation of patients with advanced disease. The rate of prostate cancer screening is low across African countries which has been associated with low knowledge and fatalistic beliefs. The study aimed to assess the effectiveness of community-based health education on prostate cancer fatalism., Methods: the study design was quasi-experimental. The study was conducted in Kiambu County in the Gatundu North and Kiambu sub-counties in Kenya. A total of 288 men were selected per arm of the study using stratified random sampling. Data were collected using a structured questionnaire at baseline and post-intervention. The intervention was health education through home visits by a Community Health Worker., Results: in the study, fatalism was associated with prostate cancer screening (P<0.05). There was a significant decrease in prostate cancer fatalism for the attributes of pessimism, pre-determination, and death inevitability in the intervention arm post-intervention. In contrast, in the control arm, there was no significant decrease. Post-intervention, the proportion of respondents with a high perception of fatalism decreased from 51% to 23.6% (P<0.05) in the intervention arm. In contrast, in the control arm, there was no significant decrease., Conclusion: prostate cancer fatalism significantly influenced prostate cancer screening. Community-based health education significantly reduced pessimism, death inevitability, and pre-destination beliefs about prostate cancer. Tailored culturally relevant health education is an effective strategy to address fatalistic beliefs., Competing Interests: The authors declare no competing interests., (Copyright: Ruth Gathoni Mbugua et al.)

Increased iron loss may reduce the effectiveness of iron supplementation. The objective of this study was to determine if daily oral iron supplementation increases iron loss, measured using a stable isotope of iron ( 58 Fe). We enrolled and dewormed 24 iron-depleted Kenyan children, 24-27 months of age, whose body iron was enriched and equilibrated with 58 Fe given at least 1 year earlier. Over 3 months of supplementation (6 mg iron/kg body weight [BW]/day), mean (±SD) iron absorption was 1.10 (±0.28) mg/day. During supplementation, 0.55 (±0.36) mg iron/day was lost, equal to half of the amount of absorbed iron. Supplementation did not increase faecal haem/porphyrin or biomarkers of enterocyte damage and gut or systemic inflammation. Using individual patient data, we examined iron dose, absorption and loss among all available long-term iron isotopic studies of supplementation. Expressed in terms of body weight, daily iron loss was correlated significantly with iron absorption (Pearson's r = 0.66 [95% confidence interval 0.48-0.78]) but not with iron dose (r = 0.16 [95% CI -0.10-0.40]). The results of this study indicate that iron loss is increased with daily oral iron supplementation and may blunt the efficacy of iron supplements in children. This study was registered at ClinicalTrials.gov as NCT04721964., (© 2024 British Society for Haematology and John Wiley & Sons Ltd.)

Anemia is a significant public health problem among children worldwide. The etiology of anemia is multifactorial but iron deficiency (ID) is the most common cause of anemia in low- and middle-income countries. ID and anemia in infancy can impair growth and cognitive development. The aim of this study was to determine the prevalence and predictors of anemia among six-week-old infants in Kwale County, Kenya. This cross-sectional study included 424 mother-infant pairs. Structured questionnaires were administered to the mothers to obtain information on socio-demographic variables, maternal characteristics and birth information. Anthropometric data was collected for each child. A heel prick was done to measure hemoglobin and zinc protoporphyrin concentration levels. Chi-square test, bivariate and multivariate regression analyses were done to determine factors associated with anemia. The prevalence of ID, anemia and IDA was 60.4% (95%CI: 55.9-65.2), 21.0% (95%CI: 17.5-25.2) and 15.8% (95%CI: 12.7-19.7) respectively. Bivariate analysis showed that the risk of anemia was significantly higher among male infants (odds ratio (OR) = 2.20 (95%CI: 1.33-3.63), p = 0.002), iron deficient infants (OR = 2.35 (95%CI: 1.39-3.99), p = 0.001) and infants from Msambweni Sub-County (OR = 2.80 (95%CI: 1.40-4.62), p<0.001). Multivariate analysis revealed that odds of anemia were significantly higher in infants born to mothers who did not use iron supplements during pregnancy (adjusted odds ratio (aOR) = 74.01 (95%CI: 2.45-2238.21), p = 0.013 and significantly lower in infants born to mothers with parity ≥ 4 (aOR = 0.05 ((95%CI: 0.00-0.77), p = 0.024). In six-week-old infants in rural Kenya, anemia prevalence was 21.0% with ID accounting for 75.3% of anemia cases. Given the physical and cognitive impairments associated with ID and anemia in early infancy, it may be prudent to re-evaluate the current Kenyan pediatric protocols to include anemia screening and potential treatment of infants less than 6-months of age., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mwakishalua et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)