Moi Teaching And Referral Hospital Research Articles

Burden of cancer in Kenya: types, infection-attributable and trends. A national referral hospital retrospective survey

Background:Cancer in Africa is an emerging health problem. In Kenya it ranks third as a cause of death after infectious and cardiovascular diseases. Nearly 31% of the total cancer burden in sub-Saharan Africa is attributable to infectious agents. Information on cancer burden is scanty in Kenya and this study aimed to provide comprehensive hospital based data to inform policies.Method:A cross-sectional retrospective survey was conducted at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH) from 2008 to 2012. Data was obtained from the patients files and the study was approved by the KNH/University of Nairobi and MTRH Ethics and Research Committees. Results: In KNH, the top five cancers were: cervical (62, 12.4%), breast (59, 11.8%), colorectal (31, 6.2%), chronic leukemia (27, 5.4%) and stomach cancer 26 (5.2%). Some 154 (30.8%) of these cancers were associated with infectious agents, while an estimated 138 (27.6%) were attributable to infections. Cancers of the cervix (62, 12.4%), stomach (26, 5.2%) and nasopharynx (17, 3.4%) were the commonest infection-associated cancers. In MTRH, the five common types of cancers were Kaposi’s sarcoma (93, 18.6%), breast (77, 15.4%), cervical (41, 8.2%), non-Hodgkin’s lymphoma (37, 7.4%) and colorectal, chronic leukemia and esophageal cancer all with 27 (5.4%). Some 241 (48.2%) of these cancers were associated with infectious agents, while an estimated 222 (44.4%) were attributable to infections. Kaposi’s sarcoma (93, 18.6%), cancer of the cervix (41, 8.2%) and non-Hodgkin’s lymphoma (37, 7.4%) were the commonest infection-associated cancers.Conclusion:Our results suggest that30.8% and 48.2% of the total cancer cases sampled in KNH and MTRH respectively were associated with infectious agents, while 27.6% and 44.4% were attributable to infections in the two hospitals respectively. Reducing the burden of infection-attributable cancers can translate to a reduction of the overall cancer burden.

Factors Influencing Post-Operative Pain Management Among Neonates at Moi Teaching and Referral Hospital, Kenya

Background: Neonatal post-operative pain management poses a unique challenge particularly with regard to assessing and treating the pain. In spite of the existence of empirical evidence on safety and effectiveness of neonatal postoperative pain management strategies, little is known about postoperative pain assessment and management practices in neonatal units in Kenya. In the Newborn Unit (NBU) at Moi Teaching and Referral Hospital (MTRH), neonatal assessment and treatment of neonatal postoperative pain is influenced by the knowledge base and personal decision of the health care provider. Objective: The objective of the study was to determine factors influencing postoperative pain management practices among neonates at MTRH, in Kenya in order to inform policy. Methods: This was a descriptive cross-sectional study design. The study was done at the newborn unit at MTRH, Eldoret. A semi –structured questionnaire and observation check-list was used to collect data. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0 program and presented in tables, graphs, frequencies and content analysis. Statistical techniques including logistic regression and correlation statistical procedures were employed in analysis. Results: Data from 45 health care providers were collected. The mean years of practice were 9 years, while the mean score for the assessment was 3.7. There was a negative correlation (r = - 0.058) between professional years of practice and assessment scores though it was not significant 0.703. There was a positive correlation between the intervention scores and professional years of practice (r = 0.028, p > 0.05) hence not significant. There was a positive correlation between the intervention scores and assessment scores (r = 0.546) and it was statistically significant p < 0.001. The mean score between doctors and the nurses differed and was slightly higher on assessment as compared to intervention. All health care providers cited that there were no written guidelines and pain assessment scale for use at NBU. Majority of the doctors and nurses had adequate knowledge on assessment of postoperative pain in neonates and the subsequent intervention to alleviate pain although none of them had attended any course on the same. Conclusion and Recommendations: From the study, there was lack of provision of objective tools to assess neonatal pain. Postoperative pain management was influenced by the knowledge base and personal decision of the health care provider. The study recommends the need for evidence-based guidelines for postoperative pain management at the newborn unit of MTRH. In addition, there is need for Continuing Professional Development for professional staff working at the newborn unit on the systematic assessment and management of postoperative pain in neonates.

Cancer in Kenya: types and infection-attributable. Data from the adult population of two National referral hospitals (2008-2012)

Background: Cancer in Africa is an emerging health problem. In Kenya it ranks third as a cause of death after infectious and cardiovascular diseases. Nearly 31% of the total cancer burden in sub-Saharan Africa is attributable to infectious agents. Information on cancer burden is scanty in Kenya and this study aimed to provide comprehensive hospital based data to inform policies. Method: A cross-sectional retrospective survey was conducted at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH) from January 2008 to December 2012. Data was obtained from the patients files and the study was approved by the KNH/University of Nairobi and MTRH Ethics and Research Committees. Results: In KNH, the top five cancers were: cervical (62, 12.4%), breast (59, 11.8%), colorectal (31, 6.2%), chronic leukemia (27, 5.4%) and stomach cancer (26, 5.2%). Some 154 (30.8%) of these cancers were associated with infectious agents, while an estimated 138 (27.6%) were attributable to infections. Cancers of the cervix (62, 12.4%), stomach (26, 5.2%) and nasopharynx (17, 3.4%) were the commonest infection-associated cancers. In MTRH, the five common types of cancers were Kaposi’s sarcoma (93, 18.6%), breast (77, 15.4%), cervical (41, 8.2%), non-Hodgkin’s lymphoma (37, 7.4%) and colorectal, chronic leukemia and esophageal cancer all with 27 (5.4%). Some 241 (48.2%) of these cancers were associated with infectious agents, while an estimated 222 (44.4%) were attributable to infections. Kaposi’s sarcoma (93, 18.6%), cancer of the cervix (41, 8.2%) and non-Hodgkin’s lymphoma (37, 7.4%) were the commonest infection-associated cancers. Conclusion: Our results suggest that 30.8% and 48.2% of the total cancer cases sampled in KNH and MTRH respectively were associated with infectious agents, while 27.6% and 44.4% were attributable to infections in the two hospitals respectively. Reducing the burden of infection-attributable cancers can translate to a reduction of the overall cancer burden.

Case presentation: Mental health stigma and the effect on children in Kenya

As part of our professional development and interest in global health, we embarked on a three‐week journey to Eldoret, the fifth‐largest city in Kenya. During this time, we engaged in various teaching and learning opportunities, collaborating with mental health professionals at Moi Teaching and Referral Hospital (MTRH) and Shoe4Africa Children's Hospital through the Academic Model Providing Access to Healthcare (AMPATH) program. AMPATH is a partnership of organizations (including the Kenyan government, local teaching hospitals, Indiana University, Brown University, other North American medical schools, and the National Hospital Insurance Fund) that works closely to improve health care in Kenya, empower communities, and educate future clinicians, researchers, and health care workers. To raise awareness of global health and the need for future research and development, we will present a relevant clinical case along with a discussion of challenges for mental health treatment of children in Kenya.

Using Hospital-Based Cancer Registry Data to Inform Establishment of Population-Based Cancer Registries in Western Kenya

Background: Eldoret Cancer Registry (ECR) is both a population-based cancer registry (PBCR) and hospital-based cancer registry (HBCR) located in Uasin Gishu County, western region of Kenya. As HBCR, it collects data on cancer cases seen at the Moi Teaching and Referral Hospital (M.T.R.H.), which is the second largest public referral hospital in Kenya and has a robust cancer diagnosis, treatment facilities and medical specialists. The catchment population of MTRH is estimated at 24 million. Aim: The aim of this study is to determine the number of cancer patients seen at MTRH by county and determine which counties will benefit most from establishment of a PBCR, based on their high incidence. Methods: Case finding is an active process. The E.C.R seeks clearance to collect data from the various data sources within MTRH. Trained cancer registrars visit the units on a regular basis to abstract and update cancer data into CanReg5. Quality checks and analysis of data are mainly done using CanReg5. Results: 16 years of HBCR data were analyzed. Out 20,423 cancer cases, Uasin Gishu county registered 39%. Nandi, Bungoma, Kakamega and Trans-Nzoia counties each registered 8%, 7%, 6% and 6% respectively. E-Marakwet and Busia both had 4% while other counties had below 2% of cancers cases registered for the period of analysis. Conclusion: Notably, there were high numbers of cancer patients registered from counties bordering Uasin Gishu. There is a high likelihood that there are more cases in these areas for patients who did not make it to MTRH due to preference, distance, SES, traditional/cultural beliefs etc. Establishing PBCRs will ensure a more comprehensive capture and reporting of cancer incidence and therefore necessitate proper planning for cancer control programs in those areas to reduce cancer burden and improve services for cancer patients and their families.

Burden of cancer in Kenya: types, infection-attributable and trends. A national referral hospital retrospective survey.

Background: Cancer in Africa is an emerging health problem. In Kenya it ranks third as a cause of death after infectious and cardiovascular diseases. Approximately 15% of the global cancer burden is attributable to infectious agents, with higher percentages in developing countries. Therefore, this study aimed to provide comprehensive hospital based data to inform policies Method: A retrospective survey was conducted at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH) from 2008 to 2012. Data was obtained from the patients files using a pre-designed data collection form. The study was approved by the KNH/University of Nairobi and MTRH Ethics and Research Committees. Results: In KNH, the five most common cancers in females (n=300) were cervical 62 (20.7%), breast 59 (19.7%), ovarian 22 (7.3%), chronic leukemia 16 (5.3%), endometrial and gastric both with 15 (5%). In males (n=200) they were prostate 23 (11.5%), laryngeal 19 (9.5%), colorectal 17 (8.5%), esophageal 14 (7.0%) and nasopharyngeal carcinoma 12 (6%). The top infection-attributable cancers were: cervical 62 (12.4%), colorectal 31 (6.2%), gastric 26 (5.2%), prostate 23 (4.6%) and nasopharyngeal carcinoma 17 (3.4%). In contrast, in MTRH the five most common cancers in females (n=282) were breast cancer 74 (26.2%), cervical 41 (14.5%), Kaposi's sarcoma 38 (13.5%), non-Hodgkin's lymphoma 15(5.3%) and ovarian 14 (5%) while in males (n=218) they were Kaposi's sarcoma 55 (25.2%), non-Hodgkin's lymphoma 22 (10.1%), chronic leukemia 17 (7.8%), colorectal and esophageal cancers both with 16 (7.3%). The top infection-attributable cancers were: Kaposi's sarcoma 93 (18.6%), cervical 41 (8.2%), non-Hodgkin's lymphoma 37 (7.4%), colorectal 27 (5.4%) and liver cancer 16 (3.2%). Conclusion: This study presents a picture of the burden of cancer and infection-attributable cancer from two referral hospitals in Kenya. Reducing the burden of infection-attributable cancers can translate to a reduction of the overall cancer burden.

Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings

BackgroundWarfarin is a drug with narrow therapeutic index used in the management of thromboembolic disorders. Several factors affect its plasma concentrations with a resultant risk of toxicity. We examined the database of patients on warfarin therapy in order to establish the factors that affect the stability of INR and correlated them to clinical outcomes in resource limited settings.MethodsWe analysed retrospective data of patients admitted to adult medical wards at Moi Teaching and Referral Hospital (MTRH) in 2015. Inclusion criteria were patients with thromboembolic and related disorders and on warfarin treatment. Derived data included demographics, indications for warfarin use, co-prescribed drugs, co-morbidities, INR measurements, duration of hospital stay and clinical outcomes. Descriptive statistics were used to summarize the data. Pearson’s correlation coefficient was used to assess relationships between duration of hospitalization and number of INR tests. Regression splines were used to capture INR trends during the follow up period. Data was analysed using R v. 3.3.1.ResultsA total of 310 patients had thromboembolic disorders, out of which 63 met the study criteria.The median age was 48 years, while the mean number of INR measurements was once every four days. Majority of patients did not achieve stable INR values, with only two having consecutive INR values within therapeutic goal. Patients who died had high INR levels. The median duration of hospital stay was 9 days (IQR: 7.0, 16.5). There was a significant correlation between length of stay in hospital and the number of times that INR were measured (Corr = 0.667, p < 0.001). The two most common indications for warfarin were DVT (64.4%) and atrial fibrillation (24.7%). All the patients had one or more comorbid conditions except for 11 with DVT alone, with cardiovascular diseases and infections being the most frequent, and on concomitant medications, majority of which are known to interact with warfarin.ConclusionsIt was difficult to achieve stable INR under the prevailing conditions despite the frequent tests.The potential factors that may have contributed to the fluctuations include drug-drug interactions, frequency of INR tests, comorbidities and the short duration of hospital stay.

Stroke Mortality in Kenya’s Public Tertiary Hospitals: A Prospective Facility-Based Study

Background: Despite the increasing global burden of stroke, there are limited data on stroke from Kenya to guide in decision-making. Stroke occurrence in sub-Saharan Africa has been associated with poor health outcomes. This study sought to establish the stroke incidence density and mortality in Kenya’s leading public tertiary hospitals for purposes of informing clinical practice and policy. Methods: This is a prospective study conducted at Kenya’s leading referral hospitals, namely, Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH). Adult patients with confirmed cases of stroke were recruited from February 2015 to January 2016 and followed up for a minimum period of 1 year. The WHO 2006 Stroke STEPS instrument was used to collect data on incidence and mortality at days 10 and 28 and every 3 months for 24 months. The person-time of follow-up was computed from admission to death, loss to follow-up, or the end of the study. A survival regression analysis was done using the Cox proportional hazards model. Results: A total of 719 patients were recruited (KNH: n = 406 [56.5%]; MTRH: n = 313 [43.5%]). The mean age was 58.6 ± 18.7 years, and the male-to-female ratio was 1: 1.4. Ischemic stroke accounted for 56.1% of the stroke cases. The peak age for stroke was between 50 and 69 years, when 36.3% of the cases occurred. Mortality at day 10 and day 28 was 18.4 and 26.7%, respectively. The inpatient mortality rate was 21.6%. The stroke incidence density was 507 deaths per 1,000 person-years of follow-up. The mean survival time was significantly different between inpatients (13.9 months; 95% CI: 13.0–14.7) and outpatients (18.6 months; 95% CI: 17.2–19.9) (p < 0.001). A 1-year increase in age increased the hazard by 1.8%. Inpatients had a 3.9-fold increase in hazard compared to outpatients. Conclusions: Mortality due to stroke is high, with poor survival observed in the first year after stroke. The risk of death increases with increasing age and duration of hospital stay. There is need for attention to quality of care and long-term needs of stroke patients to mitigate the high mortality rates observed. Public health initiatives aimed at early screening and diagnosis should be enhanced. Further research is recommended to establish the true burden of stroke at the community level to inform appropriate mitigation measures.

Stroke distribution patterns and characteristics in Kenya's leading public health tertiary institutions: Kenyatta National Hospital and Moi Teaching and Referral Hospital.

SummaryBackgroundCardiovascular diseases are the second leading cause of morbidity and mortality in Kenya. However, there is limited clinico-epidemiological data on stroke to inform decision making. This study sought to establish stroke distribution patterns and characteristics in patients seeking care at Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH), with the ultimate aim of establishing the first national stroke registry in Kenya.MethodsThis was a prospective multicentre cohort study among stroke patients. The study used a modified World Health Organisation STEP-wise approach to stroke surveillance tool in collecting data on incidence, major risk factors and mortality rate. The Cochran’s Mantel–Haenszel chisquared test of conditional independence was used with p-value set at 0.05.ResultsA total of 691 patients with confirmed stroke were recruited [KNH 406 (males: 40.9%; females: 59.1%); MTRH 285 (males: 44.6%; females: 55.4%)] and followed over a 12-month period. Overall, ischaemic stroke accounted for 55.6% of the stroke cases, with women being the most affected (57.5%). Mortality rate at day 10 was 18.0% at KNH and 15.5% at MTRH, and higher in the haemorrhagic cases (20.3%). The most common vascular risk factors were hypertension at 77.3% (males: 75.7%; females: 78.5%), smoking at 16.1% (males: 26.6%; females: 8.3%) and diabetes at 14.9% (males: 15.7%; females: 14.4%). Ischaemic stroke was conditionally independent of gender after adjusting for age.ConclusionsTo our knowledge this is the first pilot demonstration establishing a stroke registry in sub-Saharan Africa and clearly establishes feasibility for this approach. It also has utility to both inform and potentially guide public policy and public health measures on stroke in Kenya. Important and unexpected observations included the preponderance of women affected by cerebrovascular disease and that cigarette smoking was the second most common risk factor. The latter, over time, will further impact on the clinico-epidemiological profile of cerebrovascular disease in Kenya.

Disease patterns at the sick child clinic of Moi teaching and referral hospital, Kenya

Background: Moi Teaching and Referral Hospital (MTRH) serves a large population across the western part of Kenya, and has a sick child clinic which receives children 14 years and below. The study analyzed all cases that presented in 2014. Objective: To find out conditions presenting in the sick child clinic in MTRH. Methods: A retrospective study encompassing quantitative studies was used. All children 14 years and below presenting at the Sick child clinic in MTRH. The necessary information was recorded from the patients medical records seen in the hospital throughout 2014 using a structured questionnaire. The collcted data was cleaned and analyzed using STATA version 11. Results: A total of 29,307 children were seen at the clinic in 2014 and of those, 54.2% were male and 45.8% were female. Children aged five and below formed 67.7%. On average, about 2400 patients were seen monthly.There was an increase in patients admitted in March (9.9%) and July (9.5%). Of the conditions presenting, All other conditions’ (which included Febrile illness, Myalgia, Malnutrition) had the highest percentage at 41.1%. Other diseases of the respiratory system at 28.9% excluding pneumonia and tuberculosis. Among individual diseases, pneumonia was leading with 3.5% followed by diarrhea at 2.3%. Referrals formed about 14% of patients seen. About 20% were tested for HIV, of these only 1% were positive. Conclusion: Pneumonia was the single most prevalent disease followed by diarrhea.

The Predictive Role of Work Setting in the Development of Compassion Fatigue among Health Care Professionals in Moi Teaching and Referral Hospital, Kenya

Compassion fatigue is a condition unique to the human service occupations, characterized by a state of tension and preoccupation with the traumatized clients by re-experiencing traumatic events. With increased incidences of traumatic events both nationally and globally, the greater burden of care and after-care is usually borne by health care professionals. The objective of this study was to determine the predictive role of work setting in the development of compassion fatigue among health care professionals in Moi Teaching and Referral Hospital (MTRH) Eldoret, Kenya. The study was guided by Figley Model of Compassion Fatigue and adopted the Ex Post Facto research design. The target population was 76 doctors, 212 nurses and 33 counselors working in twelve units (grouped into more traumatizing and less traumatizing) offering specialized patient care services. A stratified simple random sampling technique was used to select a sample of 82 participants comprising of 19 Doctors, 54 Nurses and 9 Counselors. The independent variable was Years of Experience while Compassion Fatigue was the dependent variable. Data was collected using a demographic questionnaire, the “Professional Quality of Life Scale (ProQoL) version V”. Data was analyzed using analysis of variance (ANOVA) and t-tests. All the inferential statistics were tested at 0.05 level of significance and data presented in form of percentages, frequencies and means while graphic presentation was in form of graphs. The result showed a statistically significant association between work setting and compassion fatigue with a t of 6.266 and a p of <0.05 on the basis of which the hypothesis was therefore rejected. Based on the findings of this study, it is recommended that professional licensing bodies such as Kenya Medical Association, Kenya Counseling and Psychologist Association, Nursing Council of Kenya which license doctors, counselors and nurses respectively should include wellness and impairment of care providers in their respective curricular.

Selected Human Resources Factors as Determinants of Performance Management Framework Implementation in Kenya

The purpose of this paper is to examine human resource factors on implementation of performance management framework in Kenya and, specifically, at Moi Teaching and Referral Hospital (MTRH). The theory of planned behaviour and the Balanced Score Card Model were used to show how people are linked to the success of the organization. Questionnaires were 510 respondents through simple random and stratified sampling techniques out of which 505 (99%) subjects responded. SEMPATH model was test the hypotheses. Results of hypothesis testing indicate that employee attitude and leadership style have a significant relationship with implementation of performance management. The first model showed that leadership style was found not to likely affect implementation with other variable at the standardized regression measured .01 and was not significant at p&amp;gt; .05. A second model was therefore tested whereby leadership styles were conceptualized to influence attitude and in retrospect attitude affect implementation of performance management. The standardized regression between attitude and performance management directly was .41. The study established that leadership style influence attitude which, in turn, determines employee relationship with the implementation of performance management framework. It was therefore recommended that, to effectively manage the implementation of performance framework, an organization should put in place.

'Pregnancy Has Its Advantages': The Voices of Street Connected Children and Youth in Eldoret, Kenya.

ObjectiveLittle is known about the reproductive health or family planning needs of street-connected children and youth in resource-constrained countries. The study objective was to describe how street-connected children and youth (SCCY) in Eldoret, Kenya, perceive pregnancy.MethodsThis qualitative study was conducted between August 2013 and February 2014. A total of 65 SCCY aged 11–24 years were purposively sampled from the three referral points: 1) A dedicated study clinic for vulnerable children and youth at Moi Teaching and Referral Hospital (MTRH); 2) Primary locations in which street children reside known as “bases/barracks”; and 3) Street youth community-based organizations. In-depth interviews and focus group discussions were audio recorded, transcribed, and translated into English. Content analysis was performed after thematic coding by 4 independent coders.ResultsThe majority of SCCY interviewed were male (69%) and sexually active (81.5%). None had gone beyond primary level of education. The strong desire for SCCY to go through conventional life experiences including marriage and child bearing was evident. Sub-themes around desired pregnancies included: sense of identity with other SCCY, sense of hope, male ego, lineage, source of income, and avoiding stigmatization. The desire for children was highly gendered with male SCCY more focused on their social status in the street community, while for females it was primarily for survival on the street. Female SCCY generally lacked agency around reproductive health issues and faced gender-based violence. Abortions (either assisted or self-induced), infanticide, and child abandonment were reported. Respondents described a lucrative market for babies born to SCCY and alleged that healthcare workers were known to abduct these babies following hospital deliveries.ConclusionOur findings indicate gender differences in the reasons why SCCY become pregnant and have children. We also noted gender inequalities in reproductive health decisions. SCCY friendly interventions that provide tailored reproductive health services are needed.

Prevalence and Anti-Microbial Susceptibility of Methicillin Resistant &amp;lt;i&amp;gt;Staphylococcus aureus&amp;lt;/i&amp;gt; at Moi Teaching and Referral Hospital Eldoret

Background: Methicillin-resistant Staphylococcus aureus (MRSA) are pathogens that have major negative impact in all aspects of patient care and are increasingly being recognized as troublesome pathogens in the community. The MRSA are multi-drug resistant bacteria responsible for higher morbidity, mortality and cost of treatment in the affected patients. Research on MRSA antimicrobial susceptibility and resistance in developing countries is limited; hence accurate burden is not certain. Objective: To determine the prevalence and susceptibility pattern of MRSA in S. aureus isolates from patients treated in various units at Moi Teaching and Referral Hospital. Study Design: Cross-sectional design was used to conduct the study. Methods and Materials: Staphylococcus aureus stored isolates from patients at various units at Moi Teaching and Referral Hospital (MTRH) were identified by laboratory conventional methods. Methicillin resistant Staphylococcus aureus was determined using cefoxitin and oxacillin, discs and confirmed by Penicillin Binding Protein (PBP2a’) latex agglutination test. Susceptibility testing was performed according to the Clinical Laboratory Standards Institute procedures. Control strains used were: ATCC 43300 for Methicillin resistant S. aureus (MRSA) strains and ATCC 29213 for methicillin susceptible S. aureus (MSSA) strains. Nine anti-microbials (Erythromycin, Gentamycin, Tetracycline, Vancomycin, Rifampin, Linezolid, Ciprofloxacin, Clindamycin and Fucidicacid) were used to test the anti-microbial susceptibility patterns. Control organisms were run along with the isolates for quality Assurance. The data was analyzed using STATA version 11. Categorical variables were summarized as frequencies and the corresponding percentages. Results were presented using tables and graphs. Results: A total of 107 isolates of S. aureus were obtained, of which 39 (37%) were MRSA. Most of the MRSA, 13 (33%) and 7 (17%), were found in pus and tracheal aspirate samples respectively. Majority of the MRSA isolates were from surgical wards and intensive care unit. The MRSA isolates were highly resistant to erythromycin (92%; 36/39) and tetracycline (92% 36/39) and moderately susceptible to linezolid (77% 30/39), Vancomycin (75% 29/39) and fucidic acid (67% 26/39). A total of 28 (74.4%) MRSA isolates were Clindamycin inducible resistant. Conclusions and Recommendations: This study showed that MRSA is a significant pathogen at MTRH. The MRSA were most detected in pus specimens and least in peritoneal aspirates. Routine Screening of S. aureus isolates for MRSA strains at MTRH is therefore imperative. Infection control measures should be put in place to reduce prevalence and prevent the spread of MRSA at MTRH.

Effect of leadership styles on successful implementation of a performance management system

Although a well implemented performance management system (PMS) can have immense benefits, it has been reduced in many organisations to a mechanical, end of the year requirement for information. Consequently, in many organisations, PMSs are viewed with much trepidation and scepticism. It is therefore germane to understand factors that could cause PMS to be embraced and accepted by individuals in organisations. Effective leadership in the organisation could be critical in the successful implementation of performance management. However, empirical investigation of this relationship is lacking. The objectives of this study were: (1) To assess the effect of transactional and transformational leadership on the adoption of a performance management framework and (2) To assess the perceptions of various demographic groups in an organisation on the effects of leadership style on the implementation of a performance management system. The study was undertaken at Moi Teaching and Referral Hospital (MTRH), Kenya. An explanatory descriptive design was used. The target population for the study comprised all the 2,040 members of staff at the hospital. A stratified random sampling was used to select the 510 respondents. The study found that leadership style (transactional and transformational leadership) has a strong and positive influence on the implementation of performance management framework (B=0.677, SE = 0.027, p<0.0001; R 2 =0.72). Support for the relationship between leadership and PMS was found to be stronger amongst males, less educated and older employees. The study recommends that organisations should adopt more strategic leadership style if they are to successfully deliver the contiguous stages required in PMS. Keywords: Transactional Leadership, Transformational Leadership, performance management system

Effect of EMR implementation on clinic time, patient and staff satisfaction, and chart completeness in a resource-limited antenatal clinic in Kenya.

Electronic Medical Records (EMR) are thought to improve healthcare through a variety of means. However, the study of EMR implementation in resource-poor settings has been minimal. Moi Teaching and Referral Hospital (MTRH) is the second largest tertiary care centre in Kenya, hosting a busy antenatal clinic serving Eldoret and surrounding regions. The recent transition from written to electronic antenatal records at MTRH permits the opportunity to study whether this change improves quality of care, in terms of: TIME: Does the patient or healthcare worker spend the same amount of time at the encounter? SATISFACTION: Is the patient or healthcare worker more or less satisfied with the encounter? COMPLETENESS: Does the antenatal record do a better job of recording key information in the antenatal history? Our Objective wasto determine the effects of EMR implementation on an antenatal clinic in a resource-limited setting.

Dynamics, Impact, and Feasibility of Self-Monitoring of Blood Glucose in the Rural, Resource-Constrained Setting of Western Kenya

There has been considerable concern regarding the rapidly growing prevalence of diabetes, particularly in resource-rich settings as a result of the shift toward more sedentary lifestyles that occurs with calorie-rich diets (1). Although much of the global attention to diabetes has focused on resource-rich settings and emerging markets, the diabetes epidemic has also been expanding in resource-constrained settings such as sub-Saharan Africa (2). Estimates from the International Diabetes Federation suggest that the prevalence of diabetes is expected to increase by 98% in sub-Saharan Africa by 2030, in contrast to an expected 54% increase in the rest of the world (3). Furthermore, there is an alarmingly high mortality rate attributable to diabetes in sub-Saharan Africa compared with all other parts of the world, with 76.4% of diabetes-related deaths occurring in people <60 years of age (4). Despite these disturbing trends, there has been little effort to address this growing burden. Currently, most funding for international health care development focuses on communicable diseases, especially HIV and tuberculosis (5). However, the infrastructure that has been established to manage chronic infectious diseases such as HIV can be adapted to address many other chronic diseases, including diabetes (6–8). The Academic Model Providing Access to Healthcare (AMPATH) disease management program based in western Kenya has provided comprehensive HIV care for >140,000 HIV-infected patients throughout a catchment area of >3.5 million people. AMPATH is a partnership between Moi Teaching and Referral Hospital (MTRH) and Moi University College of Health Sciences in Eldoret, Kenya, and a consortium of North American universities led by Indiana University (Indianapolis, Ind.). Its goal is to deliver comprehensive health care at all levels of the health care system, in partnership with the Kenyan government (9,10). AMPATH’s chronic disease management (CDM) program was formed to address the growing …

Initiation to street life: a qualitative examination of the physical, social, and psychological practices in becoming an accepted member of the street youth community in Western Kenya.

BackgroundThe objective of this study was to describe the physical, social, and psychological initiation practices of street connected children and youths, in Eldoret, western Kenya.MethodsThis qualitative study was conducted from August 2013 to February 2014. A total of 65 SCCY aged 11–24 years were purposively sampled from the three referral points: 1) A dedicated study clinic for vulnerable children and youth at Moi Teaching and Referral Hospital (MTRH); 2) Primary locations in which street children reside “bases/barracks”; 3) Street youth community-based organizations. In-depth interviews and focus group discussions were used to collect data. All data were audio recorded, transcribed, translated to English, and a content analysis performed.ResultsThe overall median age was 18 years (IQR 14–20.5 years) and 69.2 % of participants were male. None had gone beyond primary level of education. The majority (81.5 %) reported to be sexually active. The street community had well-defined structures and rules that were protective of members and ensured survival on the streets. To be fully accepted children had to go through an initiation ritual that had important gender differences. Common rituals between males and females included interrogation, smearing of black soot, and payment of tax. Ritual practices unique to boys were physical abuse, theft of personal possessions, volatile substance use, being forced to eat garbage, and sodomy among the physically weak. Rituals unique to girls were being forced to ‘become a wife or sexual partner’, rape, and gang rape. Physical and psychological abuse during initiation was normalized and there were no clear mechanisms of dealing with these forms of abuse.ConclusionThere were important gender differences in the initiation practices of SCCY. Normalization of physical and psychological abuse during initiation contributes to the high health risks faced by these SCCY. Appropriate interventions need to be developed in collaboration with SCCY.

PATTERN OF ANORECTAL MALFORMATIONS AND EARLY OUTCOMES OF MANAGEMENT AT MOI TEACHING AND REFERRAL HOSPITAL ELDORET-KENYA.

Objectives: To describe the anatomical sub-types of Anorectal malformations, their management and the early outcome at Moi Teaching and Referral Hospital (MTRH) over a 16 month period. Design: A prospective study. MTRH, in the neonatal Unit and paediatric surgical wards for theinitial capture of patients and initial follow up. The Paediatric Surgical out-patient clinic was used for the subsequent follow ups. All infants diagnosed with ARM (Anorectal malformations) at MTRH from November 2011 to April 2013. Sub-types of the Anorectal malformations, coexisting abnormalities morbidity and mortality rates. There were 42 participants including 24 (57%) males and 18 (43%) females. Neonates presented at an average age of 4 ± 3, three days and older children presented on average age of 152 ± 118, three days. There were 30 (71%) neonates and 12 (29%) older infants. In males, the predominant sub-type was imperforate anus without a fistula found in ten participants (42% of males). In females, the predominant sub-type was recto-vestibular fistula found in 14 participants (78% of females). Mortality occurred in 13 (31%) participants among them ten (24%) had coexisting abnormalities. The main causes of morbidity were: colostomy complications in four (9.5%); wound,infections in one (5%); and wound dehiscence in one (5%). Patients with Anorectal malformations presented late at MTRH. The diagnosis at birth was missed in babies born at home as well as those delivered in health institutions.

Abandonment of childhood cancer treatment in Western Kenya

BackgroundThe most important reason for childhood cancer treatment failure in low-income countries is treatment abandonment.ObjectiveThe aim of this study was to explore reasons for childhood cancer treatment abandonment and assess...