Aga Khan University Hospital Nairobi Research Articles

Frequency of KRAS and BRAF mutations in colorectal carcinoma and their association with clinical-pathological characteristics in a tertiary hospital in Kenya.

Colorectal carcinoma is a leading cause of cancer morbidity and mortality globally. Its management includes the use of targeted therapy which require assessment for biomarkers to choose eligible patients. KRAS and BRAF mutations are biomarkers predictive of response to anti-EGFR therapy. This study aimed at determining the frequency of BRAF V600E and KRAS exon 2,3,4 mutations in colorectal carcinoma patients at the Aga Khan University Hospital Nairobi, Kenya. Study participants were patients who had colectomy for colorectal carcinoma. They were identified from the laboratory information system. The patients age, gender and tumor location were determined from the medical records. The histological diagnosis, pathological tumor and nodal stage were confirmed by examining hematoxylin and eosin-stained slides prepared from the colectomy specimen. DNA was extracted from the specimens using Qiagen QIAamp DNA FFPE Tissue Kit and PCR performed using EntroGen KRAS/BRAF mutation analysis kit following manufacturer's protocol. One hundred fourteen patients were enrolled. Colorectal carcinoma was significantly more common in males than females. The mean age at diagnosis was 58 years. Majority of the tumors were in the right colon, were of pathological tumor stage T3 and had nodal involvement. Forty six percent (46%) of the cases had KRAS mutations while 5.3% had BRAF V600E mutation. KRAS mutation was associated with a high pathological tumor stage and nodal involvement. Colorectal carcinoma in our patients is more common in males and tend to occur at a younger age. The patients tend to have a high tumor pathological stage and nodal involvement at diagnosis. The high frequency of KRAS exon 2,3,4 mutation and low frequency of BRAF V600E mutations is similar to what has been reported in literature.

E22 Experiences among parents caring for children with juvenile idiopathic arthritis at a tertiary referral hospital in Kenya

Abstract Background Juvenile idiopathic arthritis (JIA) is a highly morbid disease associated with significant rates of preventable permanent damage. The burden and distribution of JIA in African countries vary compared with data across the globe. High-income countries have shown a higher prevalence of JIA compared with low-income countries. Recent studies done in Zambia and Nigeria demonstrated contrasting results in the distributions of the subtypes of JIA within the African continent and those seen in Western countries. Most of these studies were quantitative in nature, looking at health related quality of life within this cohort of patients. Studies done looking at the parental experiences in caring for children for JIA have been reported in high income countries. No studies have been reported within our region to assess the impact of JIA has on parents/guardians caring for children suffering from JIA. Studies from high income countries have shown negative impacts on the social, emotional and financial well-being of guardians caring for children with JIA. We aim to look at impact JIA has on guardians caring for children affected within our context. A few studies in high income countries reported that parental experiences and perceptions play a big role in the long term wellbeing of the child. It still remains unknown the impact JIA might have within our population. Methods This will be a phenomenological type of qualitative study design. 18 potential participants (below 16 years) with a confirmed diagnosis of JIA will be purposively selected from the Kenya pediatric rheumatology registry database (KAPRI). Guardians of patients who meet the inclusion criteria will be scheduled for an introductory meeting on specific days of the week in line with their pediatric rheumatology appointment and in the presence of the primary investigator and the rheumatology consultant. Parental experiences will have been conceptualized using four major indicators: social experience, financial experiences, psychological experience, and medical and treatment-related experiences which impact their overall quality of life. These four concepts have been operationalized using various indicators which were retrieved from literature. The interview guide questionnaire was informed by the conceptual framework which was developed from extensive literature review findings on lived experiences of patients with various health conditions. The concepts in the framework will also serve as the pre-determined themes guiding the deductive thematic data analysis. We shall carry out a deductive thematic data analysis. Hence pre-determined themes extracted from the conceptual framework which was developed from extensive literature review findings on lived experiences of patients will be used in analyzing the data. At the same time, any other new emerging themes will be considered. The transcribed data will be analyzed using the Max for Qualitative Data Analysis (MAXQDA) software program version 2022. Results This project is in its preliminary data collection phase and enrolment of participants is ongoing at the Aga khan University Hospital Nairobi after approval by the Institutional Scientific and Ethical Review Committee (ISERC). Conclusions The results in this study will open avenues for further bigger studies to help promote patient centered care. The results in this study will depict the impact of JIA within our context, as studies done outside of Africa cannot be extrapolated because of the differences in social, economic, and cultural standards and capabilities of practice. Currently, the paucity of data from Africa makes it difficult to predict the burden and impact that JIA pauses on families. This study being a qualitative design, will give an in-depth view on the impact the disease has on the families compared with quantitative studies looking at the quality of life which scarce and despite their values, have limitations such as the inability to include social and cultural aspects and emotional aspects of children's lives and their families and the meaning of life.

Management of Multisystem Inflammatory Syndrome in Children (MIS-C) in resource limited settings: The Kenyan Experience

BackgroundSince the onset of the recent COVID-19 pandemic, there have been growing concerns regarding multisystem inflammatory syndrome in children (MIS-C). This study aims to describe the clinico-epidemiological profile and challenges in management of MIS-C in low-middle income countries by highlighting the Kenyan experience.MethodsA retrospective study at the Aga Khan University Hospital Nairobi, Avenue Hospital Kisumu and Kapsabet County Referral Hospital was undertaken to identify cases of MIS-C. A detailed chart review using the World Health Organization (WHO) data collection tool was adapted to incorporate information on socio-demographic details and treatment regimens.FindingsTwenty children with MIS-C were identified across the three facilities between August 1st 2020 and August 31st 2021. Seventy percent of the children were male (14 of 20). COVID-19 PCR testing was done for five children and only one was positive. The commonest clinical symptoms were fever (90%), tachycardia (80%), prolonged capillary refill (80%), oral mucosal changes (65%) and peripheral cutaneous inflammation (50%). Four children required admission into the critical care unit for ventilation support and inotropic support. Cardiac evaluation was available for six patients four of whom had myocardial dysfunction, three had valvulitis and one had pericarditis. Immunoglobulin therapy was availed to two children and systemic steroids provided for three children. There were no documented mortalities.InterpretationWe describe the first case series of MIS-C in East and Central Africa. Majority of suspected cases of MIS-C did not have access to timely COVID-19 testing and other appropriate evaluations which highlights the iniquity in access to diagnostics and treatment.

Clinicopathologic features of renal cell carcinomas seen at the Aga Khan University Hospital in Kenya.

Kidney cancer accounted for 1. 8% of global cancer deaths according to Globocan 2020 estimates, with most of these being renal cell carcinomas. Lower rates of renal cell carcinoma are reported for Africa and these are expected to change for a combination of reasons. The clinical and morphologic characteristics of renal cell carcinoma seen within Kenya have not been described before. This study aims to partially fill this gap. This was a cross-sectional descriptive study examining electronic histopathology reports from the Aga Khan University Hospital Nairobi Laboratory for the period January 2016 to May 2022. Sixty cases of renal cell carcinoma were identified. The mean age at diagnosis was 55.3 years. The most common histologic subtype diagnosed was clear cell renal cell carcinoma (41.7%), followed by papillary renal cell carcinoma and renal cell carcinoma not further specified (both 21.7%), and chromophobe renal cell carcinoma (11.7%). The most frequent specimen type was resection, followed by cores of renal masses. The mean tumor size was 8.5 cm. Sixty-seven percent of patients presented with Stage III and above. Renal masses were the commonest clinical indication for biopsy among the records reviewed. The male to female ratio, as well as the mean age at presentation were comparable to what is described in literature for other regions of the world. The proportions of the commonest histologic subtypes matched what is described in other parts of the world. Challenges in the identification of histologic subtypes included having a limited panel of antibodies for diagnosis and the lack of genetic molecular tests for histotyping. The spectrum of histologic subtypes of renal cell carcinoma seen at a tertiary referral hospital in Nairobi, Kenya was similar to that described in other parts of Africa and the globe. The age at presentation with renal cell carcinoma was consistent with what has been described in literature. Challenges were identified in the accurate histotyping of renal cell carcinoma due to constrained resources. Majority of cases diagnosed presented at advanced stage.

Late diagnosis of CHD and its associated factors in Kenya: an analytic cross-sectional study.

Burden of CHD in Africa is generally underestimated mainly due to significant under-reporting and early-related fetal and neonatal mortality. Determine the prevalence and factors associated with late diagnosis of CHD seen at three tertiary care hospitals in Kenya. A cross-sectional study on paediatric patients with CHDs, aged 0-18years, seen over a 5-year period, between January, 2011 and December, 2016. Aga Khan University Hospital Nairobi, Mater Hospital, and Kenyatta National Hospital. Patients were stratified into those diagnosed late (>1year of age) and those diagnosed early (<1year of age). Multiple logistic regression analysis was done to determine factors associated with late diagnosis. The study enrolled 411 patients, with equal gender distribution. Prevalence of late diagnosis (>1year of age) of CHD was 60.6% (95% CI 55.7-65.3). Median age at diagnosis was 15 (IQR 5-48) months. Presence of a cardiac murmur (OR = 0.87; 95% CI 0.72-0.92, p-value = 0.016) and level of parental education (OR = 4.99; 95% CI 2.25-11.40, p-value<0001) were associated with a decreased odds of late diagnosis. Other factors like cyanosis, an increase in the number of healthcare workers and healthcare facilities per 10,000 population showed some association with decreased odds of late diagnosis of CHD, but these were not statistically significant. Late diagnosis of CHD remains alarmingly high in our setting. Initiatives to enhance early detection and screening of CHD should be adopted to reduce related mortality and morbidity.

HIV stigma in Kenya: A family medicine led community orientated primary care approach.

The Kenyan Ministry of Health envisages that family physicians should play an important role in the implementation of community orientated primary care (COPC) in collaboration with the community health team. The Kenyan Community Health Strategy forms a solid basis for the implementation of the COPC model. Residents and faculty of the Family Medicine department at the Aga Khan University Hospital Nairobi collaborated with the Kaloleni sub-county of Kilifi County government near Mombasa in a five-step COPC process to better understand and act against the high prevalence of HIV stigma in the coastal region. Firstly, a deeper understanding of human immunodeficiency virus (HIV) stigma was acquired through community visits and work in the comprehensive care clinic. Secondly, a collaborative implementation team was formed to design a targeted and feasible intervention. In a participatory approach, a two-step intervention was employed, firstly sensitising healthcare workers and community health volunteers (CHVs) on the high prevalence of HIV stigma in their community and educating them on HIV-related issues. Secondly, the information was disseminated to the community through home visits by CHVs, health talks and the set-up of an HIV support group at the facility. This short report illustrates the important contribution of family physicians to implementation of COPC and capacity building of the primary healthcare team.

Self-reported knowledge, attitudes, practices and barriers in use of evidence-based medicine among resident physicians in Kenya: a mixed methods study

BackgroundEvidence based medicine (EBM) helps clinicians to integrate latest research evidence into their daily clinical practice. There is a need for all healthcare professions to adopt it in order to provide safe and most cost-effective care. Postgraduate doctors are at the frontline of healthcare delivery and all medical institutions should strive to produce practitioners of EBM. Studies have shown that physicians are still struggling to adapt to this paradigm shift in the practice of medicine but very few studies have been done in Sub Saharan Africa. This study explored the self-reported knowledge, attitudes, practices and barriers of evidence-based practice among resident physicians in a tertiary teaching hospital.MethodsA mixed methods cross-sectional study that used convergent parallel design was conducted. The quantitative arm was conducted among all residents enrolled in the Master of Medicine programme at Aga Khan University Hospital Nairobi (AKUHN). It included an online survey exploring self-reported knowledge, attitudes, practices and barriers of EBM among all residents. Simultaneously, semi-structured In-Depth Interviews were carried out among 18 purposefully selected residents in order to explore the same themes in more depth.ResultsOne hundred and one residents (99%) responded to the survey. The mean scores for self-reported knowledge, attitude and practice of EBM among residents were 73.88, 66.96 and 63.19% respectively, which were generally higher than in comparable studies. There was a significant association between year of residency and practice of EBM. The most common barriers faced by residents were lack of time, lack of EBM skills and patients’ unawareness about EBM.From the qualitative study, residents demonstrated good knowledge and support of EBM but practice remained relatively poor. Barriers to EBM were characterized by lack of motivation, time, skills and resources, patient overload and fear of challenging consultants.ConclusionThere was good understanding and support of EBM among residents at AKUHN, though challenges were experienced in regards to practice of EBM because of lack of time and skills. Therefore resources should be allocated towards integrating EBM into undergraduate medical curricula to cultivate critical thinking skills at an early stage before transition into residency.

Bacteriological Profile of Healthcare Workers and Patients’ Hands at Aga Khan University Hospital, Nairobi Outreach Centres

Background: Hand hygiene is the precursor to improved health standards among healthcare workers and patients seeking outpatient services. Unhygienic hands may escalate the transmission of multi-drug resistance bacteria that poses serious pathological manifestation to the vulnerable and susceptible patients. The study aims at establishing the possible pathogen and susceptibility pattern of Staphylococcus aureus carried on hands of healthcare provider and their patients.&#x0D; Methods: Cross sectional study design and random sampling of patients and convenient sampling of healthcare workers was carried out between May to August 2020 at Aga Khan University hospital Nairobi satellites. The participant’s hands palm and finger tips imprints were made on Blood agar during sample collection. The antimicrobial susceptibility pattern of Staphylococcus aureus was established using Vitek-2 automated system.&#x0D; Result: The study had 374 participants out of which 14% were colonized by possible pathogens. The overall Staphylococcus aureus hand carriage prevalence 6.9% (26/374) isolated from healthcare provider and patient at outpatient facility. The methicillin resistant staphylococcal in this study was 0.56% (2/374) showing resistance to both Oxacillin and Cefoxitin. Healthcare workers are prone to colonization with possible pathogens as compared to patient P-value .049. Staphylococcus aureus isolates were all resistant to penicillin.&#x0D; Conclusion: Hand hygiene mitigating measures in outpatient healthcare facilities should be sustained on the counts that 14% of possible pathogens in this study were isolated. Healthcare providers at the point of care in outpatient should strictly follow the hand hygiene protocols provided by WHO to curb the transmission of possible pathogenic bacteria.

Prevalence of vitamin D deficiency in exclusively breastfed infants at a tertiary healthcare facility in Nairobi, Kenya.

To determine the prevalence of vitamin D deficiency (VDD) in exclusively breastfed infants at the Aga Khan University Hospital Nairobi, Kenya (AKUHN). The relationships between 25-hydroxyvitamin D; 25OHD, parathyroid hormone (PTH), maternal vitamin D supplementation, and sunlight exposure were also determined. Blood from 98 infants was assayed for 25OHD, calcium, phosphate, and PTH. Socio-demographic and clinical characteristics were analyzed using descriptive statistics and inferential analysis (p < 0.05). The prevalence of VDD (25OHD <12 ng/mL), vitamin D insufficiency (VDI, 25OHD 12-20 ng/mL) and vitamin D sufficiency (VDS, 25OHD >20 ng/mL) was 11.2% (95% CI 8.0%-14.4%), 12.2% (95% CI 8.9%-15.5%), and 76.5% (95% CI 72.3%-80.8%) respectively. There was no difference in the mean age, head circumference, length, or weight of infants in VDD, VDI, and VDS groups. PTH was elevated when 25OHD was <12 ng/mL and normal when 25OHD was between 12-20 ng/mL. 25OHD and PTH were normal in infants whose mothers received vitamin D supplements. Infants who received <30 minutes/day of exposure to sunlight were 5 times more likely to have VDI than infants who received ≥30 minutes/day (p = 0.042). The prevalence of VDD in exclusively breastfed infants at AKUHN is low. The current national policy that recommends exclusive breastfeeding of infants in the first 6 months of life appears to be effective in staving off vitamin D deficiency but those infants with < 30 minutes sunlight exposure may benefit from low dose supplemental vitamin D during times of low sunlight exposure.

Staphylococcus aureus bacteremia at a referral medical center in Kenya: A retrospective review of cases from 2010 to 2018.

BackgroundMany studies have shown that Staphylococcus aureus is a leading cause of both community onset and hospital onset bloodstream infections. However, relatively little is known about the occurrence and outcome of S. aureus bacteremia in sub-Saharan Africa. A previous report indicated that S. aureus accounts for 16% of community onset and 6% of hospital onset bloodstream infections at Aga Khan University Hospital Nairobi (AKUHN). Data about the etiology of S. aureus bacteremia in sub-Saharan Africa will help optimize recognition and treatment. This study was performed in order to understand the etiologies and risk factors for S. aureus bacteremia in a sub-Saharan location.Materials and methodsA review of the electronic record of laboratory results from September 2010 through December 2018 identified 201 patients seen at AKUHN with S. aureus bacteremia. The source and/or focus of infection was identified and in-hospital mortality was determined. Cases with bacteremia after three days of hospitalization were considered hospital acquired. Community onset cases were divided into community acquired and health care associated.ResultsMost cases (71%; 143/201) were community onset, but only 41% (83/201) of these cases were community acquired. The most commonly identified foci of infection for community acquired bacteremia were musculoskeletal (25%; 21/83) and skin and soft tissue (24%; 20/83). The majority of health care associated (70%; 40/57) and hospital acquired cases (74%; 43/58) were associated with invasive vascular devices, with peripheral IVs being the most common for hospital acquired and dialysis catheters being the most common for health care associated infections. In-hospital mortality rates were 23% (19/83) for community acquired, 19% (11/57) for health care associated and 33% (19/58) for hospital acquired infections.ConclusionInvasive vascular devices were associated with a substantial portion of cases of S. aureus bacteremia and provide an important target for infection control efforts.

Prevalence of and factors associated with female sexual dysfunction among women using hormonal and non-hormonal contraception at the AGA Khan University Hospital Nairobi.

BackgroundFemale sexual function (FSD) is a complex phenomenon. It integrates all body systems and is influenced by a variety of factors. Contraceptives have shown to have variable effects on FSD. In Kenya, the majority of women use hormonal contraception with high rates of discontinuation of use, attributed to related side effects such as weight loss and loss of libido.AimTo determine the prevalence of and the factors affecting FSD among women using contraception in our setting.SettingThe study was carried out at the Aga Khan University Hospital, Nairobi, at various clinical sites.MethodsA cross-sectional study was conducted. Consecutive sampling of women of reproductive age using either hormonal or non-hormonal contraception was conducted. Two questionnaires were completed after obtaining informed consent. Independent associations of factors with the outcome variables were assessed using the chi-square test of association, and variables with a p < 0.25 were used in the multivariate analysis. Factors associated with FSD were determined using binary logistic regression.ResultsA total of 566 participants were included. The prevalence of FSD among those using hormonal and those using non-hormonal contraception was 51.5% and 29.6%, respectively (p < 0.0001). We found that the factors associated with FSD were presence of chronic illness and use of chronic medication, being self-employed or unemployed, alcohol intake and history of miscarriage(s).ConclusionThere was a high prevalence of and a strong association between hormonal contraception and FSD. More studies on this topic in different settings are recommended to investigate the effect of each type of hormonal method on FSD.

Third or more relapses of BPV associated with hyperuricaemia: A report of 8 cases with video presentation

I accessed my neurology clinic database between 1 January 2008 to 31 December 2018 situated at doctors plaza clinic at Aga Khan University Hospital Nairobi, all patients with Benign Positional Vertigo [BPV] and high uric acid level in the blood were collected. BPV was diagnosed with a positive Dix-Hallpike manoeuvre with all is its characteristics.. Each patient underwent Epleys manoeuvre and then was put allopurinol 300 orally once a day with confirmation three weeks later that uric acid levels had normalised. However due to poor compliance or fatigue some patients stopped treatment after few months and had relapses. All these patients had a high blood uric acid level, during relapses after stopping allopurinol for 5 to 8 months. Only those with 3 or more relapses were selected for this presentation. A total of eight patient's data were selected. There were seven Africans and one Asian with two females and six males. The mean age was 63 years. [Video presentation of three relapses with the repeat high associated uric acid level each time in ALL IN THE SAME PATIENT WILL BE SHOWN]. Benign positional vertigo associated with hyperuricaemia can present with many relapses in the SAME patient with high urate each time.

Outcomes in patients with acute coronary syndrome in a referral hospital in sub-Saharan Africa.

Coronary artery disease and its acute presentation are being increasingly recognised and treated in sub-Saharan Africa. It is just over a decade since the introduction of interventional cardiology for coronary artery disease in Kenya. Local and regional data, and indeed data from sub-Saharan Africa on long-term outcomes of acute coronary syndromes (ACS) are lacking. A retrospective review of all ACS admissions to the Aga Khan University Hospital, Nairobi (AKUHN) between January 2012 and December 2013 was carried out to obtain data on patient characteristics, treatment and in-patient outcomes. Patient interviews and a review of clinic records were conducted to determine long-term mortality rates and major adverse cardiovascular events. A total of 230 patients were included in the analysis; 101 had a diagnosis of ST-segment myocardial infarction (STEMI), 93 suffered a non-ST-segment myocardial infarction (NSTEMI), and 36 had unstable angina (UA). The mean age was 60.5 years with 81.7% being male. Delayed presentation (more than six hours after symptom onset) was common, accounting for 66.1% of patients. Coronary angiography was performed in 85.2% of the patients. In-hospital mortality rate was 7.8% [14.9% for STEMI and 2.3% for non-ST-segment ACS (NSTE-ACS, consisting of NSTEMI and UA)], and the mortality rates at 30 days and one year were 7.8 and 13.9%, respectively. Heart failure occurred in 40.4% of STEMI and 16.3% of NSTE-ACS patients. Re-admission rate due to recurrent myocardial infarction, stroke or bleeding at one year was 6.6%. In our series, the in-hospital, 30-day and one-year mortality rates following ACS remain high, particularly for STEMI patients. Delayed presentation to hospital following symptom onset is a major concern.

Seroprevalence data at a private teaching hospital in Kenya: An examination of Toxoplasma gondii, cytomegalovirus, rubella, hepatitis A, and Entamoeba histolytica.

BackgroundRelevant seroprevalence data for endemic pathogens in a given region provide insight not only into a population’s susceptibility to acute infection or risk for reactivation disease but also into the potential need for policy initiatives aimed at reducing these risks. Data from sub-Saharan Africa are sparse and since Aga Khan University Hospital Nairobi is an internationally accredited hospital equipped with a laboratory electronic medical record system, analysis of pertinent local seroprevalence data has been made possible.MethodsWe have analyzed serology data from laboratory electronic records at a 300 bed tertiary private teaching hospital in Kenya for the dates, 2008 to 2017 for Toxoplasma gondii, cytomegalovirus, and rubella, which were used primarily for antenatal screening. We also analyzed the data from hepatitis A and amebiasis serologies, which were used primarily for diagnostic purposes.ResultsFor T. gondii, cytomegalovirus, and rubella, we used IgG serology to determine seroprevalence, finding rates of 32%, 86%, and 89%, respectively. There was no significant age-related difference in the 20 to 49 year old age range for any of these three pathogens. Of the Hepatitis A IgM tests that were ordered, 33% were positive with a peak positive rate of 70% in the five to nine year old age range. The seroprevalence of amebiasis was 4% and all cases of seropositivity were accompanied by compatible clinical illness (hepatic abscess).ConclusionsThese data provide insight into seroprevalence rates of selected pathogens that can be used to guide screening and diagnostic laboratory testing as well as private and public immunization practices.

Challenges of Building and Sustaining Radiation Therapy Capacity in Low-Resource Settings: A Case of the Breakdown of Cobalt 60 Teletherapy in Uganda and Lessons Learned

Background and context: The use of radiotherapy in developing countries is slowly gaining momentum but the gains are accompanied by some pitfalls. The breakdown of a teletherapy (cobalt 60) machine in Uganda is an example of the challenges to be considered while expanding access to treatment. It was a major test for the country and the Uganda Cancer Institute the agency of government responsible for provision of cancer services. It attracted a national and international outcry. This unprecedented response was based on the importance a seemingly old equipment in Kampala was playing in the entire region (Kenya, Tanzania, Rwanda, Burundi, Democratic Republic of Congo and southern Sudan). However, the manner in which the crisis was handled demonstrated clearly how to turn a misfortune into an opportunity given the many lessons learnt. Aim: In this paper we aim to highlight how the breakdown of the equipment triggered a major crisis and the response to the crisis resulting in the restoration of services within a reasonable time frame. We also want to show the long-term service modernization and expansion drive this has triggered within Uganda and the entire region. Strategy/Tactics: The restoration process comprised planning, decommissioning, renovation, security and safety systems, procurement of new machine, installation and commissioning. As this was ongoing there was the need for care provision for patient in need. Concurrently undertaken was public reassurance through building confidence and trust in the capacity for speedy restoration of services. Program/Policy process: All these steps were taken collaboratively within country, region and internationally. In the region there was support from the Aga Khan University Hospital Nairobi and internationally, technical support from the IAEA. Outcomes: Service has been fully restored, a new teletherapy cobalt machines installed and commissioned. The machine has modern capabilities compared with the previous. So far more than 200 patients have been treated. The numbers of patients are steadily increasing hence the government has embarked on modernization and expansion of the radiotherapy services in the country. What was learned: The breakdown of Uganda's radiotherapy machines has provided lessons that are important for handling health system operational crisis which may occur as we try to build complex delivery systems. It provided lessons that are important in the drive for expansion of radiotherapy services in developing countries. In particular that benefit of investments in modern equipment transcends national boundaries. Secondly how to limit potential impact of major crisis through regional and international collaboration. Further that the needs of patients is central in crisis management. Finally need to consider pooling infrastructure investments in tackling NCD's such as the East Africa's centre of excellence for skills and tertiary education project of the East African community.

Detection of Obstetrics Early Warning Signs among Midwives at Aga Khan University Hospital Nairobi, Kenya

Detection of Obstetrics Early Warning Signs among Midwives at Aga Khan University Hospital Nairobi, Kenya

Abstract A12: Ethnic differences in the clinical and pathological characteristics of breast cancer among Kenyan women

Abstract Background: Breast cancer is the most common female malignancy worldwide. The effect of race and ethnicity on breast cancer has been the subject of much investigation. However, there are no published data from specific regions of sub-Saharan Africa with regards to the ethnic distribution of breast cancer and its subtypes. Objective: To investigate the differences in clinical and pathological characteristics of breast cancer in three major ethno-cultural groupings (Bantus, Nilotes and Cushites) in Kenya. Methods: A nationwide prospective study involving 15 public, faith-based and private institutions, which recruited patients with pathologically confirmed breast cancer between March 2012 and May 2015, was conducted. Relevant socio-demographic, clinical, reproductive and known breast cancer risk factor data were collected using a standardized questionnaire. Central pathology review and immunohistochemistry of all breast cancer tissue were done at Aga Khan University Hospital Nairobi. Proportions, chi-square tests, and logistic regression were used in the analysis of data. Results: Among the 867 female study participants with malignant breast tumor, 675 (77.8%) were Bantus, 148 (17.0%) were Nilotes, 20 (2.4%) were Cushites, and 24 (2.8%) were patients of mixed ethnicity. Bantus were more likely than the other three ethnic groups to fall within the 40-49 year age group (32 vs 19, 15, and 25% respectively, p=0.002), more likely to have at most secondary education (27.6 vs 17.6, 0, and 16.7%, p=0.0003), and more likely to be farmers (33.9 vs 19.6, 0.0, and 16.7%, p&amp;lt;0.0001). The majority of the study population overall was overweight or obese. When limited to Bantus and Nilotes only, Bantus were significantly more likely to be overweight than Nilotes (42.0 vs 29.9%, p=0.04). After adjusting for age, Nilotes seemed more likely to present with larger tumors and less likely to present with lymph node metastasis (OR: 0.39, 95% CI: 0.24-0.65), extra nodal extension (OR: 0.42, 95% CI: 0.23-0.75), and lymphovascular invasion (OR: 0.67, 95% CI: 0.47-0.97). The data suggest that Nilotes may be less likely to have ER positive cancers and more likely to have HER2+ cancers, though these associations were not statistically significant. Conclusion: The differences observed for some of the clinical and pathologic features of Breast Cancer among the three distinct ethnic groups in Kenya could be multifactorial and attributable to socio economic indicators, lifestyle factors and probable genetic variations. The association of specific measurements and biomarkers of obesity from Breast cancer patients among the ethnic Kenyan population and the association of serum estradiol concentrations with ethnicity and breast cancer subtypes are areas of future research. Further research to explore the BC incidence among the ethnic groups may provide insight into yet unexplored risk factors and etiology of breast cancer. Citation Format: Shahin Sayed, Zahir Moloo, Ronald Wasike, Asim Jamal, Peter Bird, Maya Palakal, Gretchen Gierach, Dhiren Govender, Mansoor Saleh. Ethnic differences in the clinical and pathological characteristics of breast cancer among Kenyan women [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr A12.

Urolithiasis analysis in a multiethnic population at a tertiary hospital in Nairobi, Kenya

BackgroundUrolithiasis is a global problem whose incidence is reported to be on the rise across the world. Previously, urolithiasis was reported as being rare among the indigenous African population but recent data suggest otherwise. This study reviewed the demographic and clinical characteristics of patients with urolithiasis seen at the Aga Khan University hospital Nairobi (AKUHN) as well as the chemical composition of the stones and the modalities of therapy used.MethodsThis was a retrospective study which utilized patients’ clinical and laboratory records from 2013 to 2014. Sixty-seven symptomatic patients with confirmed urolithiasis formed the study. This study aimed to describe the clinical characteristics of patients, modalities of treatment as well as the chemical composition of renal stones from patients diagnosed and managed for urolithiasis during a duration spanning 17 months. Wet chemistry was utilized for analyzing the chemical composition of the urinary calculi. Data on age, sex, symptoms, radiological investigations done, location of the calculi, chemical composition of calculi and therapeutic procedures instituted were extracted and analyzed.ResultsAges ranged from 3 to 87 years with a median of 42; males were the majority (79%) and the commonest presenting symptoms were flank pain (91%) and dysuria (19%). The majority of the stones were located in the ureters (46%) and at the pelvi-ureteric junction (25%). A statistically significant difference in frequency of lodgment at the pelvi-ureteric site between males and females was noted. However, the number of female patients in this study was small and studies with larger numbers of female participants are required to confirm this observation. All stones contained calcium and oxalate, often as the only constituents (72%). In the remainder of the stones, other constituents such bicarbonate, ammonium, phosphorous, magnesium, uric acid and cystine occurred in varying combinations with calcium oxalate. Laser lithotripsy was the most performed therapeutic procedure (77.6%).ConclusionsMales formed the majority of patient with urolithiasis. Overall, most of the calculi were located in the ureters except in women where the pelviureteric location was commoner. Stones containing calcium oxalate only were predominant across the age groups and in both sexes. Lithotripsy was the commonest mode of management.

Reference intervals for thyroid stimulating hormone and free thyroxine derived from neonates undergoing routine screening for congenital hypothyroidism at a university teaching hospital in Nairobi, Kenya: a cross sectional study.

BackgroundIn order to accurately interpret neonatal thyroid function tests (TFTs), it is necessary to have population specific reference intervals (RIs) as there is significant variation across different populations possibly due to genetic, environmental or analytical issues. Despite the importance of RIs, globally there are very few publications on RIs for neonatal TFTs primarily due to ethical and technical issues surrounding recruitment of neonates for a prospective study. To the best of our knowledge, this is the first report from Africa on neonatal RIs for TFTs.MethodsWe used hospital based data largely derived from neonates attending the wellness clinic at the Aga Khan University Hospital Nairobi (AKUHN) where screening for congenital hypothyroidism is routinely done. Specifically we derived age and gender stratified RIs for free thyroxine (fT4) and thyroid stimulating hormone (TSH) which had been analyzed on a Roche e601 analyzer from 2011 to 2013. Determination of reference intervals was done using a non-parametric method.ResultsA total of 1639 and 1329 non duplicate TSH and fT4 values respectively were used to derive RIs. There was a decline in TSH and fT4 levels with increase in age. Compared to the Roche RIs, the derived RIs for TSH in neonates aged 0–6 days and those aged 7–30 days had lower upper limits and narrower RIs. The fT4 lower limits for neonates less than 7 days and those aged 7–30 days were higher than those proposed by Roche. There was a significant difference in TSH RIs between male and female neonates aged less than 15 days. No gender differences were seen for all other age stratifications for both TSH and fT4. Appropriate age and gender specific RIs were subsequently determined.ConclusionThe AKUHN derived RIs for fT4 and TSH revealed similar age related trends to what has been published. However, the differences seen in upper and lower limits across different age stratifications when compared to the Roche RIs highlight the need for population specific RIs for TFTs especially when setting up a screening programme for congenital hypothyroidism. We subsequently recommend the adoption of the derived RIs by the AKUHN laboratory and hope that the RIs obtained can serve as a reference for the African population.

Spectrum of Microbial Diseases and Resistance Patterns at a Private Teaching Hospital in Kenya: Implications for Clinical Practice.

BackgroundAccurate local prevalence of microbial diseases and microbial resistance data are vital for optimal treatment of patients. However, there are few reports of these data from developing countries, especially from sub-Saharan Africa. The status of Aga Khan University Hospital Nairobi as an internationally accredited hospital and a laboratory with an electronic medical record system has made it possible to analyze local prevalence and antimicrobial susceptibility data and compare it with other published data.MethodsWe have analyzed the spectrum of microbial agents and resistance patterns seen at a 300 bed tertiary private teaching hospital in Kenya using microbial identity and susceptibility data captured in hospital and laboratory electronic records between 2010 and 2014.ResultsFor blood isolates, we used culture collection within the first three days of hospitalization as a surrogate for community onset, and within that group, Escherichia coli was the most common, followed by Staphylococcus aureus. In contrast, Candida spp. and Klebsiella pneumoniae were the most common hospital onset causes of bloodstream infection. Antimicrobial resistance rates for the most commonly isolated Gram negative organisms was higher than many recent reports from Europe and North America. In contrast, Gram positive resistance rates were quite low, with 94% of S. aureus being susceptible to oxacillin and only rare isolates of vancomycin-resistant enterococci.ConclusionsThe current report demonstrates high rates of antimicrobial resistance in Gram negative organisms, even in outpatients with urinary tract infections. On the other hand, rates of resistance in Gram positive organisms, notably S. aureus, are remarkably low. A better understanding of the reasons for these trends may contribute to ongoing efforts to combat antimicrobial resistance globally.