Aga Khan University Hospital Nairobi Research Articles

A report from the first regional pain medicine symposia in East, Central and Southern African region. (ECSA-R)-"The Rhino Model in Pain Education in Africa".

The 1st Regional pain medicine symposia were held between the 14th and 18th of November 2011 in 3 cities (Nairobi, Mombasa and Dar-es-salaam), across 2 countries, Kenya and Tanzania. It was funded by the International Association for the Study of Pain (IASP), through the IASP developing country education grant for 2011 and The Aga Khan University Hospital Nairobi (AKUHN). It was organized by faculty from the Pain Management Unit (PMU) AKUHN. The Pain medicine educators were from PMU, AKUHN and from Specialists in Pain International Network (SPIN). The aims of the symposia were to introduce the Rhino model concept, the theoretical and clinical concepts of pain medicine, as well as create awareness and stimulate an interest in pain medicine education and pain research in ECSA region. At each of the 3 different locations, the same topics and workshops were presented by the speakers, thus ensuring uniformity of the message delivered.

Validating Customer Loyalty Model Using Structural Equation Modelling in a Kenyan Hospital

In healthcare services, customer satisfaction measurement is increasingly gaining emphasis due to researchers’ and clinicians’ desire which is to get outcomes that reflect varying unique patient perceptions. Ultimately, the main aim of every patient is to have their disease or health problem alleviated. These parameters alienate healthcare service from other service contexts. The study sought to assess quality levels and examine drivers of patients’ loyalty in Aga Khan University Hospital, Nairobi (AKUHN) in Kenya. Semi-structured questionnaire was used to collect data through face-to-face interviews. The contextual measures mainly used in social, business and education fields were adopted and customized to fit healthcare environment. The 251 respondents were randomly selected and were proportional to the cluster of the services they sought. The causal relationship between service quality and customer loyalty as mediated by customer satisfaction and trust was analyzed using structural equation modeling. The model converged with good fit statistics. Both trust and customer satisfaction exhibited significantly strong mediating effects between quality of service and patients’ loyalty. This implies that customer satisfaction and trust are key parameters in explaining the strength of the significant relationship between quality of service and customer loyalty.

Measurement of Improvement Achieved by Participation in International Laboratory Accreditation in Sub-Saharan Africa

As part of the ISO 15189:2007 accreditation process, the Aga Khan University Hospital Nairobi laboratory became the first internationally accredited hospital laboratory in sub-Saharan Africa outside South Africa in 2011 through the South Africa National Accreditation System. Seven preanalytic, 10 analytic, eight postanalytic, and five administrative performance parameters were monitored from 2009 to 2012 to measure the impact of the accreditation process. Most measures in all four categories showed substantial improvement. The seven preanalytic measures all showed major improvement-between a quarter and a half sigma. Real but less dramatic improvement appeared in analytic and postanalytic measures, but greater than one sigma decrease in analytic "procedure violations" and a three-quarter sigma decrease in excessive turnaround time were noted in these categories. Administrative improvements included dramatic decreases in misdirected and missing reports and complaints. This study demonstrates the correlation of the accreditation process with improvement in quality measures in a low-resource region.

Prevalence of Panton Valentine Leukocidin in Carriage and Infective Strains of <i>Staphylococcus aureus</i> at a Referral Hospital in Kenya

Panton valentine leukocidin (PVL) is a pore forming exotoxin that is expressed by some Staphylococcus aureus (S. aureus) strains and is thought to add to its virulence. The prevalence of PVL in carriage and disease causing strains varies considerably from region to region. This study compared the prevalence of the PVL gene in S. aureus isolates obtained from healthcare workers and from patients seen at the Aga Khan University Hospital Nairobi (AKUHN). S. aureus isolates obtained from healthcare workers and patients attended to at AKUHN between July 2010 and March 2011 were used for this study. Forty five S. aureus isolates from healthcare workers and 63 from clinical specimens obtained from 59 patients were analysed for the PVL gene. The prevalence of PVL in isolates from healthcare workers was 24.4% compared to 39.7% in the isolates causing infection (P = 0.098). PVL prevalence was 58.8% in S. aureus isolates obtained from skin and soft tissue infections (SSIs) compared to 25.0% in carriage isolates (P = 0.002, OR 4.29). Prevalence in isolates from invasive infections was 11.1%. Patients with PVL positive S. aureus were younger than those with PVL negative isolates (P = 0.082). The high prevalence of PVL is comparable with that reported in other African countries. The significance of the high prevalence of PVL in S.aureus isolates carried by health care workers at AKUHN is unclear at the moment. PVL prevalence is significantly higher in S. aureus isolates causing SSIs compared to carriage and invasive isolates.

Unexpected absence of meticillin-resistant Staphylococcus aureus nasal carriage by healthcare workers in a tertiary hospital in Kenya

Healthcare workers (HCWs) are a major reservoir of meticillin-resistant Staphylococcus aureus (MRSA). A cross-sectional study was conducted between July and December 2010 to determine the prevalence of nasal carriage of MRSA at the Aga Khan University Hospital Nairobi. Nasal swabs were taken from 246 randomly selected HCWs. MRSA was identified using both phenotypic and genotypic methods. The prevalence of MRSA carriage was 0% [95% confidence interval (CI): 0-1.5%] whereas that of meticillin-susceptible Staphylococcus aureus was 18.3% (95% CI: 14.0-23.6%). Given the absence of MRSA in our hospital, screening HCWs should be limited to an outbreak setting.

Laparoscopic management of uterine perforation: report of three cases

We present three cases of uterine perforation which were managed laparoscopically at the Aga Khan University Hospital Nairobi, between January and December 2008. Our objective was to determine the outcomes of uterine perforations and to create awareness on the availability of the laparoscopic management at such complications and to recommend the procedure as a suitable option to laparotomy.

HisBreast cancer Molecular subtypes and their clinicopathological characteristics amongst patients at the Aga Khan University hospital (Nairobi)

Introduction Breast cancer is a heterogeneous disease with varying clinical outcomes in histologically similar tumors. Micro arrays gene profiling has identified several breast cancer subtypes which include luminal A, Luminal B, Basal, and Her2 subtype. These subtypes show variable prognosis and response to therapy. Objectives To determine the proportion of the various subtypes at Aga Khan University hospital and describe their clinical and pathological characteristics. Study Design & setting Cross sectional study of all breast cancer specimens received in the pathology department of the Aga Khan university Hospital Nairobi between November 2007 and November 2008. Methods 101 cases of breast cancer were analysed using immunohistochemical surrogates to identify the subtypes. The subtype definition was; Luminal A ( Estrogen receptor(Er) or Progesterone receptor(Pr) positive Her2 negative), Luminal B ( Er, Pr, and Her2 positive), Her 2 sub type (Her2 positive, Er and Pr negative), and basal (Er, Pr,and Her2 negative Cytokeratin 5/6 (Ck5/6) and or Her1 positive). Cases not falling into any category were unclassified. Other clinical pathological characteristics including age, race, menopause status, tumor size, grade and stage were determined in each sub type. Results Luminal A was the most common, 42%, followed by basal, Her2, and luminal B at 23%, 21%, and 4% respectively. 10% of the cases were unclassified. There was no significant difference between the sub types with regard to age, menopause, tumor size and stage. There was a significant difference with regards to grade with the Her2 and basal subtypes having a higher grade. Conclusion The molecular sub types of breast cancer exist in our population. The prevalence of the basal subtype is higher than that seen in studies amongst Caucasians while the prevalence of Luminal A is lower.

External quality assurance of breast cancer pathologic reporting in Kenya

e11586 Background: Eighty percent of women diagnosed with breast cancer (BC) in East Africa present with advanced disease; current literature suggests a preponderance of triple negative/basal like breast cancer in this subset of African women. These studies are limited by their retrospective nature, small numbers, and unclear quality of pathologic specimen reporting. The objective of this study is to provide external quality assurance (EQA), quality control, and validation of hormone receptor and Her2 status of breast cancer specimens from Kenya. Methods: 108 retrospectively identified BC tumour blocks from the Aga Khan University Hospital (Nairobi, Kenya) during 2006–2008 will undergo repeat pathologic assessment for estrogen receptor (ER), progesterone receptor (PR), and Her2 status at Sunnybrook Health Sciences Center (Toronto, Canada).Currently at the Aga Khan University Pathology Lab, ER,PR and Her2 testing is performed manually once every two weeks using Heat Induced Antigen Retrieval and Dako reagents including the ENVISION detection system. Parallel controls of known tissue reactivity are also run; however there is currently no formal EQA. Results: Results will be used to identify areas of improvement in specimen handling and pathology reporting. Conclusions: Standardized and accurate pathologic assessment of BC specimens in East Africa is essential for establishing centres of excellence in Kenya and the wider East African region for hormone receptor and Her2 neu analysis. Results would contribute to understanding the prevalence of triple negative disease in East Africa, lead to improved treatment recommendations and patient outcomes, and serve as a foundation for prospective studies in East Africa. No significant financial relationships to disclose.