Kijabe, Kenya
Kijabe, Kenya

Time filter

Source Type

Riviello E.D.,Brigham and Women's Hospital | Letchford S.,AIC Kijabe Hospital | Achieng L.,AIC Kijabe Hospital | Newton M.W.,AIC Kijabe Hospital | Newton M.W.,Vanderbilt University
Critical Care Medicine | Year: 2011

Context: Critical care faces the same challenges as other aspects of healthcare in the developing world. However, critical care faces an additional challenge in that it has often been deemed too costly or complicated for resource-poor settings. This lack of prioritization is not justified. Hospital care for the sickest patients affects overall mortality, and public health interventions depend on community confidence in healthcare to ensure participation and adherence. Some of the most effective critical care interventions, including rapid fluid resuscitation, early antibiotics, and patient monitoring, are relatively inexpensive. Although cost-effectiveness studies on critical care in resource-poor settings have not been done, evidence from the surgical literature suggests that even resource-intensive interventions can be cost effective in comparison to immunizations and human immunodeficiency virus care. In the developing world, where many critically ill patients are younger and have fewer comorbidities, critical care presents a remarkable opportunity to provide significant incremental benefit, arguably much more so than in the developed world. ESSENTIAL CONSIDERATIONS:: Key areas of consideration in developing critical care in resource-poor settings include: Personnel and training, equipment and support services, ethics, and research. Strategies for training and retaining skilled labor include tying education to service commitment and developing protocols for even complex processes. Equipment and support services need to focus on technologies that are affordable and sustainable. Ethical decision making must be based on data when possible and on transparent articulated policies always. Research should be performed in resource-poor Asettings and focus on needs assessment, prognostication, and cost effectiveness. Future Directions: The development of critical care in resource-poor settings will rely on the stepwise introduction of service improvements, leveraging human resources through training, a focus on sustainable technology, ongoing analysis of cost effectiveness, and the sharing of context-specific best practices. Although prevention, public health, and disease-specific agendas dominate many current conversations in global health, this is nonetheless a time ripe for the development of critical care. Leaders in global health funding hope to improve quality and length of life. Critical care is an integral part of the continuum of care necessary to make that possible. Copyright © 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.


Nthumba P.M.,AIC Kijabe Hospital
World Journal of Surgery | Year: 2010

Background: Cutaneous malignancies are considered rare among Africans. Trauma, its sequelae, and other chronic non-healing wounds are known to predispose to malignant degeneration. Not much is known of the demographics of Marjolin's ulcers in sub-Saharan Africa. Methods: Pathology records on patients suspected to have Marjolin's ulcers submitted to the Pathology Department were extracted from a database of 75,124 specimens. A review of the English literature on Marjolin's ulcers from Nigeria, a sub-Saharan country, was also performed. Results: Of 210 specimens from suspected Marjolin's ulcers, 167 records had a histological diagnosis of malignancy, with a male to female ratio of 1:1.4, and a mean age of 48 years (range: 4-97 years). There were 163 (97.6%) squamous cell carcinomas, 3 (1.8%) sarcomas, and 1 (0.6%) malignant melanoma. Burn scars, chronic ulcers, osteomyelitis, and "other" ulcers constituted 82 (49%), 70 (42%), 9 (5.4%), and 6 (3.6%), respectively. Subjects in six sub-Saharan Marjolin's ulcer studies had a mean age between 36 and 42 years, with a mean latent period 16 years. Conclusions: Marjolin's ulcers in sub-Saharan African have a shorter latent period, and they occur in younger patients. Provision of early stable wound cover is essential for prevention of malignant degeneration of scars, while early appropriate intervention is crucial in the treatment of chronic ulcers. © 2010 Société Internationale de Chirurgie.


Nthumba P.M.,AIC Kijabe Hospital
Annals of Plastic Surgery | Year: 2013

The gold standard for mandibular defect reconstruction is the fibular free flap. Nevertheless, the pedicled osteomuscular dorsal scapular flap as a reconstructive tool offers promise for mandibular defect reconstruction and could be the first choice in certain circumstances. Its use in resource-limited settings offers an excellent solution to otherwise difficult reconstructive problems of the mandible.In 8 patients, mandibular defects resulting from the excision of benign tumors (6), trauma (1), and chronic osteomyelitis (1) were reconstructed using the pedicled osteomuscular dorsal scapular flap; these defects included the central segment of the mandible.The pedicled osteomuscular dorsal scapular flap is an excellent choice for mandibular reconstruction; it may serve as the primary choice in patients with vascular pathology that precludes free tissue transfer, as well as in resource-limited environments, as a secondary choice after a failed free flap reconstruction. Copyright © 2012 by Lippincott Williams & Wilkins.


Bird P.,AIC Kijabe Hospital
Breast | Year: 2016

This is an personal reflection on the challenges of managing advanced breast cancer in a resource-poor setting, focussing on financial constraints, unavailability of treatment options, and the personal cost to patient and surgeon. © 2016 Elsevier Ltd


Nthumba P.M.,AIC Kijabe Hospital
Journal of Oral and Maxillofacial Surgery | Year: 2012

Purpose: The supraclavicular skin is thin and pliable; it closely resembles that of the neck and facial skin, making it the perfect source of tissue for neck and orofacial reconstructions. The author sought to provide a concise compilation of the use of the supraclavicular artery flap, including surgical landmarks, modifications, uses, common complications, and anomalies, and experience with the use of the flap in a sub-Saharan African country. Materials and Methods: A literature search was performed on the Internet and PubMed for anatomic and clinical studies/reports in the English language on the supraclavicular artery flap with a minimum of 10 subjects and sufficient data on postoperative complications. Results: Five anatomic studies (2 of which included clinical cases) and 12 clinical series qualified for inclusion. These articles included 146 flaps from 73 cadaveric studies and 376 supraclavicular flaps in patients (including a series of 22 flaps by the present author). The supraclavicular artery was present in 99% of anatomic dissections and was a branch of the transverse cervical artery in 91% of anatomic dissections. Safe margins for elevation of the supraclavicular artery flap were delimited anteriorly by the clavicle, posteriorly by the superior border of the trapezius, and distally by the insertion of the deltoid muscle. Common flap complications included tip and partial flap necroses. The flap was used successfully in nononcologic and oncologic reconstructions, even with concurrent neck dissection. Conclusions: The pedicled supraclavicular fasciocutaneous flap is emerging as a versatile reconstructive tool for the neck and orofacial regions. It is an excellent option, especially in resource-poor environments and in patients in whom free flaps may be technically difficult. Anatomic and clinical studies have shown it to be consistently reliable, with excellent color matching for the face and neck regions, and have established reliable surgical landmarks, modifications, uses, common complications, and anomalies. © 2012 American Association of Oral and Maxillofacial Surgeons.


Adam M.B.,AIC Kijabe Hospital
American Journal of Tropical Medicine and Hygiene | Year: 2014

We measured the effectiveness of a human immunodeficiency virus (HIV) prevention program developed in Kenya and carried out among university students. A total of 182 student volunteers were randomized into an intervention group who received a 32-hour training course as HIV prevention peer educators and a control group who received no training. Repeated measures assessed HIV-related attitudes, intentions, knowledge, and behaviors four times over six months. Data were analyzed by using linear mixed models to compare the rate of change on 13 dependent variables that examined sexual risk behavior. Based on multi-level models, the slope coefficients for four variables showed reliable change in the hoped for direction: abstinence from oral, vaginal, or anal sex in the last two months, condom attitudes, HIV testing, and refusal skill. The intervention demonstrated evidence of non-zero slope coefficients in the hoped for direction on 12 of 13 dependent variables. The intervention reduced sexual risk behavior. Copyright © 2014 by The American Society of Tropical Medicine and Hygiene.


Nthumba P.M.,AIC Kijabe Hospital
World Journal of Surgical Oncology | Year: 2012

Background: In the head and neck region, osteosarcoma is the most common primary malignant bone tumor, representing 23% of total head and neck malignancies. Osteosarcomas of the jaws are nevertheless rare lesions, representing only 2 to 10% of all osteosarcomas. This report reviews a single-center histopathology experience with craniofacial osteosarcomas, and reports the management of unusually large synchronous mandibular and maxillary osteosarcomas in a patient.Patients and methods: A search of the hospital pathology database for specimens with a histological diagnosis of osteosarcomas submitted between July 1992 and May 2011 was made. A chart review of a patient with large synchronous maxillary and mandibular osteosarcomas was performed, and is reported.Case presentation: A 21-year-old African man with large maxillary and mandibular tumors under palliative care presented with increasing difficulties with eating, speech, and breathing. Surgical debulking was performed, with histology confirming synchronous osteosarcomas of the mandible and maxilla. The patient is well after one year, with no evidence of recurrence, having undergone no further treatment.Conclusion: Osteosarcomas of the jaw remain enigmatic, and a number of difficulties related to their diagnosis and treatment are yet to be resolved. True synchronous multicentric osteosarcomas of the jaws are extremely rare but, like other osteosarcomas of the jaws, have a favorable outcome, and palliative resection of such lesions, though challenging, can therefore lead to an enormously improved quality of life and self-image, and may even offer the opportunity for cure. © 2012 Nthumba; licensee BioMed Central Ltd.


Nthumba P.M.,AIC Kijabe Hospital
World Journal of Surgical Oncology | Year: 2010

Background: Due to improved care, more and more children born with spina bifida in rural Kenya are surviving into adulthood. This improved survival has led to significant challenges in their lifestyles, especially the need to ensure pressure ulcer prevention and treatment. Malignant degeneration of pressure ulcers in spina bifida patients is very rare. The author describes the clinical presentation of two pressure ulcer carcinomas that are at variance from classical descriptions.Materials and methods: An internet/Medline/PubMed search of English literature for theories on Marjolin's ulcer evolution and prognostic features of Marjolin's ulcers was performed.A chart review of two young adults with spina bifida who had presented to the author's hospital between 2004 and August 2010 with chronic pressure ulcers found to be Marjolin's ulcers on histo-pathological examination was performed, and the clinical features are reported.Results: The two ulcers appeared clinically benign: one was a deep ulcer, while the other was shallow; both had normal, benign-appearing edges, and a foul smelling discharge. The two ulcers were surrounded by induration and multiple communicating sinuses, with no evidence of chronic osteomyelitis. The internet search revealed a total of nine theories on Marjolin's ulcer development, as well as seven clinical and four histological prognostic features.Discussion: The multifactorial theory, a coalescence of a number of proposed theories, best explains the evolution of Marjolin's ulcers. Poor prognostic features include pressure ulcer carcinomas, lesions and location in the lower limbs/trunks, all present in the two patients making their prognosis dim: this is despite the surgical margins being clear of tumor. Benign appearance, induration and presence of multiple communicating sinuses are features that have not been previously described as presenting features of pressure ulcers carcinomas.Conclusion: There is need for spina bifida patients and their guardians/caretakers to receive a close follow-up throughout life; health education focused on pressure ulcer prevention as well as early treatment of pressure ulcers when they occur, will avert the development of Marjolin's ulcers, and save lives. © 2010 Nthumba; licensee BioMed Central Ltd.


Nthumba P.M.,AIC Kijabe Hospital
World Journal of Surgery | Year: 2010

Background: Most reconstructive surgery in Sub-Saharan Africa is provided by numerous noncoordinated individuals and organizations, in multiple short trips, or "surgical blitzes." Because many such groups do not train local surgeons, these communities have become dependent on unsustainable systems. By providing much-needed care to otherwise neglected areas, the blitzes offer an easy solution to what would otherwise be the source of a significant headache to local governments. Methods: The collection of data and other material in this highly ambiguous and fluid field is nearly impossible, as scientific papers on the results of poor surgical treatment, especially in the realm of humanitarian medicine, do not exist: The author has had to rely on personal experience and community interaction to reach the views and conclusions articulated in this article. Results: Although not the rule, blitz surgeries have poorer outcomes than in-hospital procedures, primarily because of inadequate preoperative and postoperative care. Conclusions: Although the value of blitz surgery in meeting some of the surgical needs of otherwise neglected communities is undeniable, the author seeks to provoke a sober reexamination of these efforts vis-à-vis the long-term sustainability of such programs, with the objective of harnessing strengths that would see the evolution of a new reconstructive surgical service tailor-made for Africa-affordable and sustainable yet able to deliver quality surgical care to the remotest villages. Otherwise, these humanitarian efforts' will continue to be 'drops in the ocean, meeting the needs of a few in the community but resulting in no long-term gains. © 2009 Société Internationale de Chirurgie.


Nthumba P.M.,AIC Kijabe Hospital
Burns | Year: 2016

Objective Burns are important preventable causes of morbidity and mortality, with a disproportionate incidence in sub-Saharan Africa. The management of these injuries in sub-Saharan Africa is a challenge because of multiple other competing problems such as infectious diseases (HIV/AIDS, tuberculosis and malaria), terrorist acts and political instability. There is little investment in preventive measures, pre-hospital, in-hospital and post-discharge care of burns, resulting in high numbers of burns, high morbidity and mortality. Lack of data that can be used in legislation and policy formulation is a major hindrance in highlighting the problem of burns in this sub-region. Methods An online search of publications on burns from sub-Saharan countries was performed. Results A total of 54 publications with 32,862 patients from 14 countries qualified for inclusion in the study. The average age was 15.3 years. Children aged 10 years and below represented over 80% of the burn patient population. Males constituted 55% of those who suffered burns. Scalds were the commonest cause of thermal injuries, accounting for 59% of all burns, while flame burns accounted for 33%. The burn mortality averaged 17%, or the death of one of every five burn victims. Conclusions These statistics indicate the need for an urgent review of burn policies and related legislation across the sub-Saharan region to help reduce burns, and provide a safe environment for children. © 2015 Elsevier Ltd and ISBI. All rights reserved.

Loading AIC Kijabe Hospital collaborators
Loading AIC Kijabe Hospital collaborators