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Mostert S.,VU University Amsterdam | Njuguna F.,Moi Teaching and Referral Hospital | Kemps L.,VU University Amsterdam | Strother M.,Indiana University | And 3 more authors.
Archives of Disease in Childhood | Year: 2012

Setting: Basic epidemiological information on childhood cancer in Western Kenya is lacking. This deficit obstructs efforts to improve the care and survival rates of children in this part of the world. Objective: Our study provides an overview of childhood cancer patients presenting for treatment in Western Kenya. Design: A retrospective analysis of childhood cancer patients presenting for treatment in Western Kenya was carried out using information from three separate databases at the Moi Teaching and Referral Hospital in Eldoret. All patients aged 0-19 years first presenting between January 2006 and January 2010 with a newly diagnosed malignancy were included. Results: A total of 436 children with cancer were registered during the period. There were 256 (59%) boys and 180 (41%) girls with a male/female ratio of 1.4:1. The group aged 6-10 years contained most children (29%). Median age at admission was 8 years. Non-Hodgkin's lymphoma was the most common type of cancer (34%), followed by acute lymphoblastic leukaemia (15%), Hodgkin's lymphoma (8%), nephroblastoma (8%), rhabdomyosarcoma (7%), retinoblastoma (5%) and Kaposi's sarcoma (5%). Only four (1%) children with brain tumours were documented. Ewing's sarcoma was not diagnosed. Conclusions: Our study provides an overview of childhood cancer patients presenting for treatment in Western Kenya. The distribution of malignancies is similar to findings from other equatorial African countries but differs markedly from studies in high-income countries. The new comprehensive cancer registration system will be continued and extended to serve as the basis for an evidence-based oncology program. Eventually this may lead to improved clinical outcomes.

Vedanthan R.,Mount Sinai School of Medicine | Kamano J.H.,Moi Teaching and Referral Hospital | Horowitz C.R.,Mount Sinai School of Medicine | Ascheim D.,Mount Sinai School of Medicine | And 4 more authors.
Annals of Global Health | Year: 2014

Background: Hypertension is the leading global risk factor for mortality. Hypertension treatment and control rates are low worldwide, and insufficient human resource capacity is among the contributing factors. Thus, a critical component of hypertension management is to develop novel and effective solutions to the human resources challenge. One potential solution is task redistribution and nurse management of hypertension in these settings. Objectives: The aim of this study is to investigate whether nurses can effectively reduce blood pressure in hypertensive patients in rural western Kenya and, by extension, throughout sub-Saharan Africa. Methods: An initial phase of qualitative inquiry will assess facilitators and barriers of nurse management of hypertension. In addition, we will perform usability and feasibility testing of a novel, electronic tablet-based integrated decision-support and recordkeeping tool for the nurses. An impact evaluation of a pilot program for nurse-based management of hypertension will be performed. Finally, a needs-based workforce estimation model will be used to estimate the nurse workforce requirements for stable, long-term treatment of hypertension throughout western Kenya. Findings: The primary outcome measure of the impact evaluation will be the change in systolic blood pressure of hypertensive individuals assigned to nurse-based management after 1 year of follow-up. The workforce estimation modeling output will be the full-time equivalents of nurses. Conclusions: This study will provide evidence regarding the effectiveness of strategies to optimize task redistribution and nurse-based management of hypertension that can be applicable to noncommunicable disease management in low- and middleincome countries. © 2014 Icahn School of Medicine at Mount Sinai.

Bloomfield G.S.,Duke University | Barasa F.A.,Moi Teaching and Referral Hospital | Doll J.A.,Duke University | Velazquez E.J.,Duke University
Current Cardiology Reviews | Year: 2013

The heart failure syndrome has been recognized as a significant contributor to cardiovascular disease burden in sub-Saharan African for many decades. Seminal knowledge regarding heart failure in the region came from case reports and case series of the early 20th century which identified infectious, nutritional and idiopathic causes as the most common. With increasing urbanization, changes in lifestyle habits, and ageing of the population, the spectrum of causes of HF has also expanded resulting in a significant burden of both communicable and non-communicable etiologies. Heart failure in sub-Saharan Africa is notable for the range of etiologies that concurrently exist as well as the healthcare environment marked by limited resources, weak national healthcare systems and a paucity of national level data on disease trends. With the recent publication of the first and largest multinational prospective registry of acute heart failure in sub-Saharan Africa, it is timely to review the state of knowledge to date and describe the myriad forms of heart failure in the region. This review discusses several forms of heart failure that are common in sub-Saharan Africa (e.g., rheumatic heart disease, hypertensive heart disease, pericardial disease, various dilated cardiomyopathies, HIV cardiomyopathy, hypertrophic car-diomyopathy, endomyocardial fibrosis, ischemic heart disease, cor pulmonale) and presents each form with regard to epidemiology, natural history, clinical characteristics, diagnostic considerations and therapies. Areas and approaches to fill the remaining gaps in knowledge are also offered herein highlighting the need for research that is driven by regional disease burden and needs. © 2013 Bentham Science Publishers.

O'Meara W.P.,George Washington University | Mangeni J.N.,Moi Teaching and Referral Hospital | Steketee R.,Voltaire | Greenwood B.,London School of Hygiene and Tropical Medicine
The Lancet Infectious Diseases | Year: 2010

The burden of malaria in countries in sub-Saharan Africa has declined with scaling up of prevention, diagnosis, and treatment. To assess the contribution of specific malaria interventions and other general factors in bringing about these changes, we reviewed studies that have reported recent changes in the incidence or prevalence of malaria in sub-Saharan Africa. Malaria control in southern Africa (South Africa, Mozambique, and Swaziland) began in the 1980s and has shown substantial, lasting declines linked to scale-up of specific interventions. In The Horn of Africa, Ethiopia and Eritrea have also experienced substantial decreases in the burden of malaria linked to the introduction of malaria control measures. Substantial increases in funding for malaria control and the procurement and distribution of effective means for prevention and treatment are associated with falls in malaria burden. In central Africa, little progress has been documented, possibly because of publication bias. In some countries a decline in malaria incidence began several years before scale-up of malaria control. In other countries, the change from a failing drug (chloroquine) to a more effective drug (sulphadoxine plus pyrimethamine or an artemisinin combination) led to immediate improvements; in others malaria reduction seemed to be associated with the scale-up of insecticide-treated bednets and indoor residual spraying. © 2010 Elsevier Ltd.

Pastakia S.D.,Purdue University | Karwa R.,Purdue University | Kahn C.B.,Brown University | Nyabundi J.S.,Moi Teaching and Referral Hospital
Annals of Pharmacotherapy | Year: 2011

BACKGROUND: The initial focused effort on addressing the HIV pandemic in sub- Saharan Africa has helped set the groundwork for addressing many of the other areas of the health-care system requiring support in resource-constrained settings. With the growing prevalence of diabetes in this setting, the US Agency for International Development-Academic Model Providing Access to Healthcare Partnership (USAID-AMPATH) has begun developing infrastructure to meet the growing need for diabetes care. OBJECTIVE: To describe the evolution of diabetes care in the rural, resourceconstrained setting of western Kenya and to analyze preliminary data on the current status of glucose control of patients. METHODS: Through partnerships, USAID-AMPATH has facilitated the provision of basic modalities of diabetes care, including reliable stocks of insulin, hemoglobin A1c (A1C) testing, and point-of-care glucose-testing supplies. RESULTS: Through the introduction of A1C testing, the poor quality of diabetes care was revealed, as the average A1C for the clinic population was 10.4%, with insulin-dependent patients constituting the majority of individuals with markedly elevated A1C levels. To address this, a contextualized electronic medical record and a cell phone-based home glucose monitoring program were created to improve glycemic control, which has led to significant reductions in A1C levels. CONCLUSIONS: Through the inclusion of clinical data within the electronic medical record, there is an ongoing effort to research various aspects of diabetes care in this understudied population, with the goal of addressing many of the unanswered questions surrounding diabetes care in sub-Saharan Africa. The lessons learned from this pilot program will be used to create sustainable infrastructure for diabetes care in partnership with the Kenyan government and will serve as a model for similar programs.

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