KENYATTA NATIONAL HOSPITAL AND UNIVERSITY OF NAIROBI 4th ANNUAL

Document Sample
KENYATTA NATIONAL HOSPITAL AND UNIVERSITY OF NAIROBI 4th ANNUAL Powered By Docstoc
					                                         KNH 4th Annual Scientific Conference




          KENYATTA NATIONAL HOSPITAL AND UNIVERSITY OF NAIROBI
              4th ANNUAL SCIENTIFIC CONFERENCE PROGRAMME;
                    THURSDAY 13TH – 14TH OCTOBER 2011
                       VENUE: LECTURE THEATRE 111
                                 DAY 1-THURSDAY 13TH OCTOBER 2011

7.30am     Registration
8.00 -     Opening ceremony
11.00am
            Master of Ceremony: Dr. Kiboi Julius Githinji
8.30 -     Opening prayers: Rev. James Mwenda
8.40am
8.40 -     Curtain raiser: KNH Choir
9.00am
9.00 -     Introductory Remarks, KNHSRC Chairperson: Dr. Nelly Mugo
9.15am
9.15 -     Welcome Speech, Deputy Director Clinical Services: Dr. Simon Monda
9.20am
9.20 -     Principal, College of Health Sciences, University of Nairobi: Prof. Isaac O. Kibwage
9. 25am
9.25 -     Chief Executive Officer, KNH: Mr. Richard Leresian Lesiyampe
9.40am
9.40 -     Chairperson, KNH Board of Management: Mrs. Margaret Wanjohi
9.55am
9.55 -  Official Opening - Minister of Medical Services: Prof. Peter Anyang Nyong’o
10.30am
10.30 - Tea Break
11.00am




            Venue A , Lecture Thatre III                               Venue B, KAVI Conference Room
            Chairperson: Dr. John Ngigi                             Chairperson: Dr. Margaret Mackanyengo
          Rapporteur: Dr. John Kinuthia                                   Rapporteur: Dr. Irene Weru
  Note takers: Mr. Edwin Kabiru, Barbra Ligongo                  Note takers: Mr. Ali Wagara, Mona Nechessa
                                                                                  Munyendo


                                                          1
                                      KNH 4th Annual Scientific Conference



          OBSTETRICS & GYNEACOLOGY                                               QUALITY.



11.00 - 1/2011 - Provisions of Services and care for         30/2011 - Medical Quality Improvement; 5s
11.15am HIV: Authors: John Ong’ech, Heather J.               Concepts – Kaizen. Author: Agnes Chika
        Hoffman , Judith Kose, Michael Audo ,
        Lucy Matu, Peter Savosnick, Laura Guay,
11.15 -  37/2011 - Prevalence of chronic HBV                 9/2011 - Factors associated with type of health
11.30am infection among HIV negative individuals in          facilities visited by diabetic patients in Mombasa,
         HIV discordant relationships.                       Kenya Authors: Judy Mwai, Joseph Keriko,
         Author:Elizabeth Irungu                             Joseph Mutai:, Doris Njomo:
11.30 -  12/2011 - Screening for Intimate Partner            8/2011 - Patients’ perception of Theatre Services
11.45am Violence (IPV) at Kenyatta National                  at Kenyatta National Hospital, Nairobi, Kenya.
         Hospital (KNH): What do women think?                Author: Dominic Charles Okero
         Authors:Chi-Chi Undie, Catherine
         Maternowska, Margaret Mak’anyengo
 11.45 - 34/2011 - Partograph use and outcomes of                   DRUGS & SUBSTANCE ABUSE
12.00pm labor at Kenyatta National Hospital, Kenya:          10/2011 - Recovery rates of addicts in residential
         Author: Alice Njihia                                treatment centres, Nairobi. Author: Joseph
                                                             Mbuthia

12.00   49/2011 - Hormonal contraceptive use and             26/2011 - Alcoholics’ Rehabilitation in Soweto
12.15pm risk of HIV-1 transmission: a prospective            slum, Kahawa West. Author: Theresia Kavuli
        cohort analysis Authors: Renee Heffron,              Kinai
        Deborah Donnell, Helen Rees, Connie
        Celum, Nelly Mugo, Edwin Were, Guy de
        Bruyn, Edith Nakku-Joloba, Kenneth Ngure,
        James Kiarie, Robert W. Coombs, Jared M.
12.15 -                                                      28/2011 - An analysis of the right to health in the
12.30pm                                                      context of drug and substance abuse in Kenya.
                                                             Author:Mwaura Kelvin Karuga
12.30                   DISCUSSION                                             DISCUSSION
1.00pm
1.00pm                     LUNCH                                                  LUNCH
-
2.00pm
             VOLUNTARY COUNSELLING AND                                           MEDICINE
                            TESTING
2.00 -    3/2011 - Integrating HIV PEP into VCT              42/2011 - Musculoskeletal Rheumatic Diseases
2.15 pm   Services: Kenyatta National Hospital               at Kenyatta National Hospital. Authors:Paul
          Experience. Authors:Peter Maingi,David             Etau Ekwom,George Omondi Oyoo and Bernard
          Bukusi.                                            Owino



                                                       2
                                       KNH 4th Annual Scientific Conference



2.15 -   19/2011 - Factors associated with utilization        35/2011 - Surveillance of Multi-drug resistance in
2.30pm   of VCT services among men attending                  Tuberculosis (TB) and Treatment Outcome at
         Ongata Rongai health centre, Ngong,                  Kenyatta National Hospital. Authors: Wahome
         Kajiado North district, Kenya. Authors:              Eunice, Irimu Henderson, Mwai Paul
         Mwiti.P, Dr Opondo. S, Mutai. J
2.30 -   7/2011 - Characteristics of clients seeking          15/2011 - Differentiation of members of the
2.45pm   emergency pep services at KNH VCT                    Mycobacterium tuberculosis complex using a
         Centre Authors:Sila Angela, Bukusi David             Luminex assay. Authors: Meenu Sharma, Sara
         E,Kamene Anne.                                       Christianson, Joyce Wolfe
2.45 -   40/2011 - Assessment of factors associated           18/2011 - Innate immune responses at gut
3.00pm   with the uptake of Provider initiated HIV            epithelial surfaces. Authors:Mwende M. Mutuku,
         counselling and testing (PITC) among                 Denise Kelly, Annaig Lan, Murenga Mwimali
         clients at Kenyatta National Hospital
         Accident and Emergency Department,
         Nairobi, Kenya. Authors:Cherutich
         R.K.,Wanzala P., Makokha A. O.
3.00 -                  DISCUSSION                                              DISCUSSION
3.20pm
                           HIV/AIDS                                           LAB. MEDICINE
3.20 -   47/2011 - Exposure to selected                       16/2011 - Atypical Teratoid Rhabdoid Tumour –
3.35pm   Arboviruses, HIV, Hepatitis B Virus and              A Case Report. Authors: Barasa K. A, Okemwa
         Hepatitis C Virus among Febrile Patients at          M. P
         Selected Health Facilities in Trans Nzoia
         County, Kenya.Authors:Daniel Matemo,
         Alison C. Roxby, Alison L. Drake, John
         Kinuthia, Francisca Ongecha-Owuor, Grace
         C. John-Stewart, James Kiarie, Carey
         Farquhar
3.35 -   44/2011 - Articular manifestations in HIV            24/2011 - Macrocystic Meningioma: A Case
3.50pm   Infection: Prevalence and Characteristics.           Report of a Rare Case. Author: Sami Eldirdiri,
         Authors:Paul Etau Ekwom,George Omondi                M.P Okemwa
         Oyoo, E.O Amayo and I.M.Muriuki
3.50 -   43/2011 - Characteristics of Infants                 5/2011 - Simultaneous Detection of Enteric
4.05pm   Accessing PMTCT Services in Kenya.                   Bacterial Pathogens in Diarrheal Stool
         Authors:Irene Inwani, James N. Kiarie,               Specimens from Children attending Mbagathi
         John Ong’ech, Onesmus Gachuno, Peter                 District Hospital. Author: Ndege Alice Akeyo.,
         Muiruri, , John Kinuthia, Peter Cherutich,           Kariuki Samuel, Muigai W. T. Anne.
         Kamau Mubuu, Fridah Govedi4, Paul Mwai,
         Monica Mukunga




                                                         3
                                          KNH 4th Annual Scientific Conference



4.05 -     48/2011 - Utility of an algorithm of surrogate
4.25pm     markers for CD4 count to determine
           eligibility for HAART among HIV infected
           pregnant women. Authors:Winfred W.
           Mwangi, James M. M’imunya, James Kiarie
           , John Kinuthia, Walter Kudoyi , Rachel
           Spitzer , Hillary Mabeya , Danstun
           Mukoko,Janet Jekemoi, Kennedy Mutai
4.25-      6/2011 - Exposure to selected Arboviruses,
4.40pm     HIV, Hepatitis B Virus and Hepatitis C virus
           among febrile patients at selected health
           facilities in Trans Nzoia County,
           Kenya.Kenya. Authors:Demba Rodgers
           Norman., Matilu Mwau., Ongus R. Juliette.,
           Ouma Joh
4.40 -                       DISCUSSION                                             DISCUSSION
5.00pm
5.00pm                  TEA BREAK                                                 TEA BREAK
         DAY 2-FRIDAY 14TH OCTOBER 2011                                 DAY 2-FRIDAY 14TH OCTOBER 2011

    SYMPOSIUM: 30 YEARS OF HIV EPIDEMIC
         Venue: Lecture Theatre 111                                          Chairperson Dr.Sarah Muniu
           Facilitator: Mrs. Agnes Chika                                    Rapporteur: Dr. Alfred Birichi
Note takers: Mr. Eunice N. Ruhi, Barbra M. Ligogo                 Note takers: Mr. Ali Wagara, Mona Nechessa
                                                                                   Munyendo
       8.30 - 10.35am HIV PREVENTION                                              RADIOLOGY
    Moderator: Mr. Patrick Mwai/Ms. Emily Bass
8.30 -    Opening of symposium by NASCOP: 30                     23/2011 - MRI Safety.Author: Mrs. Veronica W.
8.45am years of HIV Epidemic: Why invest in HIV                  Njagi
          Prevention; Muraguri

8.45 -     Results of CAPRISA 004: Effectiveness                 22/2011 - Role of MRI in Oncology. Author:R.
9.05am     and Safety of Tenofovir Gel, an                       Nyabanda
           Antiretroviral Microbicide, for the Prevention
           of HIV Infection in Women: Elizabeth
           Bukusi
9.05 -     Partners PrEP Study Results: ‘Parallel                25/2011 - Overview of emergency imaging
9.25am     Comparison of Tenofovir and                           requests from Accident and Emergency
           Emtricitabine/tenofovir Pre- Exposure                 Departmentat KNH. Author:W.N Ndaihera
           Prophylaxis to Prevent HIV-1 Acquisition
           within HIV-1 Discordant Couples’: Nelly
           Mugo KNH


                                                            4
                                      KNH 4th Annual Scientific Conference



9.25 -  Results of Treatment as Prevention HPTN-             39/2011 - Effects of Ocular Lubricants on
9.45am  052: ‘A Randomized Trial to Evaluate the             Conjuctiva and Cornea Post Ultra Sound
        Effectiveness of ARVs to Prevent the                 Procedure: Author: Owen W. Ogony
        Sexual Transmission of HIV-1 in
        Serodiscordant Couples’ Lisa Mills, CDC
9.45 -  HIV-Vaccine Research: Updates and                    17/2011 - Use of Technology and Innovation in
10.05am Impact of recent results on Vaccine                  patient care: KNH Poison Centre. Author:T. B.
        research: Omu Anzala,                                Menge,
10.05 -                DISCUSSION
10.15am
10.15 - Global Advocacy for HIV Prevention: ARVs                              DISCUSSION
10.35am for HIV prevention: ‘Take a stand’: Emily
        Bass: AVAC
10.35 -                TEA BREAK                                               TEA BREAK
11.00am
         11.00am -1.00pm HIV PMTCT
        Moderator Mr. Onesmus Gachuno
11.00 -  Towards elimination of MTCT: James                  33/2011 - Telemedicine in KNH. Author:Peter
11.20am Kiarie                                               Matoke
11.20 - Option B vs Option A for PMTCT in low                2/2011 - Tungiasis (jigger infestation) in Rural
11.40am resource settings: John Ongech                       Kenya: Prevalence and Risk Factors. Authors:
                                                             Nicholas Njau N, Peter Wanzala, Marion Mutugi,
                                                             Liana Ariza, Jorg Heukelbach
11.40 - Contraception for PMTCT: John Kinuthia               29/2011 - Biomarkers in cardiovascular disease:
12.00pm                                                      yesterday, today and tomorrow.
                                                             Authors:Matheka Cyrus Wambua, Peter
                                                             Waweru
12.00 - Counseling in HIV – the concept: David               20/2011 - Isolation and Genetic Characterization
12.15pm Bukusi                                               of Human Parainfluenza Viruses from children at
                                                             Kenyatta National Hospital with Acute
                                                             Respiratory Infections. Authors:Beverlyn
                                                             Jacqueline Manjeri., Muigai W.T. Annel., Late
                                                             Walter Ochieng
12.15 - HTC for prevention TBD: David Bukusi                 46/2011 - Complete congenital atrioventricular
12.30am                                                      block.Author: C. Maina
12.30 - Optimizing survival of HIV exposed infant:
12.50pm Nduati

12.50 -                 DISCUSSIONS                                           DISCUSSIONS
1.00pm
          1.00 - 2.00pm LUNCH BREAK                                     1.00 - 2.00pm LUNCH BREAK
 2.00 - 3.40pm UPATES ON HIV/AIDS TRETMENT
                      Moderator Dr.Mecha

                                                       5
                                         KNH 4th Annual Scientific Conference



2.00 -    HIV in older People: S. Ojoo                          41/2011 - Infection Control: Current Issues on
2.20pm                                                          Standard Precautions. Author: Joan Shisoka
2.20 -    HAART Treatment failure: E. Omonge                    4/2011 - Non communicable diseases a global
2.40pm                                                          health problem. Author: Adegu William Jacob
2.40 -    Adherence to HAART:D. Bukusi
3.00pm
3.00 -    HIV and Tuberculosis: Chakaya
3.20pm
3.20 -                   DISCUSSION                                              DISCUSSION
3.40pm
         POSTER PRESENTATIONS
       1 Childhood Cancer; mothers awareness and understanding of causative factors in Chakol Division
         of Teso District in Western Province of Kenya. Author: Seruya Apalat Otiti

       2 High-dose valacyclovir suppressive therapy results in greater reduction in plasma HIV-1 levels
         compared to standard dose acyclovir suppression among HIV-1/HSV-2 co-infected persons: a
         randomized, open-label, crossover trial. Authors: K. Mugwanya; J. Baeten ; N. Mugo; E. Irungu;
         K. Ngure; C. Celum
       3 Contraceptive discontinuation by rural Kenyan women in HIV discordant partnerships after exiting
         an HIV prevention trial Authors:Kenneth Ngure , Jared Baeten, Jairam Lingappa, Renee Heffron,
         Paul Musingila, Elizabeth Irungu, Peterson Mwaniki, Lawrence Mwaniki , Ruth Wamae , Simon
         Mburu, Nelly Mugo
       4 A Qualitative Study of Barriers to Consistent Condom Use among HIV-1 Serodiscordant Couples in
         Kenya. Authors:Kenneth Ngure, Nelly Mugo, Connie Celum, Jared M. Baeten, Martina Morris,
         Owuor Olungah, Joyce Olenja, Harrison Tamooh, Bettina Shell-Duncan
3.40 -   Closing cremony
4.30pm
3.40 -    Deputy Director Administration and Finance KNH: Mr. Kennedy Auka
3.45pm
3.45 -    Deputy Director Clinical Services KNH: Dr. Simon Monda
3.50pm
3.50 -    Chief Executive Officer, KNH: Mr. Richard Leresian Lesiyampe
4.00pm
4.10 -     KNH Board of Member: Dr. Achola Pala
4.20pm
          Vote of Thanks: Deputy Director Nursing Services: Mrs. Philomena Maina
          Closing prayers: Dr. Stephen Njogu




                                                          6
                                         KNH 4th Annual Scientific Conference



                                DAY 1, THURSDAY 13TH OCTOBER, 2011
                                             VENUE A
                                        LECTURE THEATREIII

PROVISIONS OF SERVICES AND CARE FOR HIV

Authors: John Ong’echMBChB, MMed, MPH1,2, Heather J. Hoffman PhD3, Judith KoseMBChB, MMed1,
Michael AudoMBChB, MPH 1, Lucy MatuMBChB, MSc1, Peter Savosnick MA1, Laura Guay, MD1, 3

Affiliations:1 Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya; 2 Kenyatta National
Hospital/University of Nairobi, Nairobi, Kenya, 3 The George Washington University School of Public Health
and Health Services, Washington DC USA

Background: Over 90% of pediatric HIV infections, acquired through mother-to-child transmission, are in
sub-Saharan Africa. From routine service delivery data collected on uptake of testing for HIV among HIV
exposed infants, Kenya’s Ministry of Health realized that prevention of mother-to-child transmission of HIV
and HIV care and treatment programs were parallel structures within the HIV care delivery system,
negatively impacting the continuum of care for HIV-exposed infants. The Elizabeth Glaser Pediatric AIDS
Foundation, with funding from the Bill & Melinda Gates Foundation, conducted a study in Kenya in 2009 –
2010 to evaluate the effectiveness of provision of routine care and HIV care for HIV-exposed infants in two
facility models. These models are the Maternal and Child Health (MCH) Clinic model and the
Comprehensive Care Centre (CCC) model. In the MCH model, infants receive immunizations, growth
monitoring as well as HIV-related services including early infant diagnosis by polymerase chain reaction
(PCR), initiation on cotrimoxazole (CTX), and infant HIV antibody test at one year of age in the MCH. In the
CCC model, HIV-exposed infants receive routine immunizations and growth monitoring in the MCH and are
referred to the CCC to receive all HIV-related services. Delivery of follow-up care for HIV-exposed infants
was assessed. The evaluation measured and compared indicators such as the number of follow-up visits,
early infant diagnosis by PCR testing or HIV antibody testing, and initiation on CTX prophylaxis for HIV
exposed infants up to one year of age.

Methods:This quasi-experimental, observational, prospective cohort study enrolled 363 HIV-exposed
infants at 6-8 weeks of age in two district hospitals in Western Province, Kenya throughout 2009. The
hospitals differed in their service delivery models; one offered a CCC approach (n=184) and one a MCH
approach (n=179). Both, however, catered to populations with similar HIV prevalence rates and socio-
economic status. Both hospitals had the same client volume level and both had the same level of human
resource capacity. Data were captured at the 6 – 8 week immunization visit and 14 week, 6-month, 9-month,
and 12-month follow-up visits.

Results: Compared to infants receiving HIV-related services in the CCC model, the infants enrolled in the
MCH model of care are 1.4 (95% CI; 1.04, 1.26) times more likely to attend the 14-week immunization, 1.8
(95% CI; 1.49, 2.16) times more likely to attend the 6-month postnatal follow-up, 2.2 (95% CI; 1.73, 2.80)
                                                          7
                                         KNH 4th Annual Scientific Conference



times more likely to attend the 9-month postnatal follow-up, and 1.35 (95% CI; 1.10, 1.67) times more likely
to attend the 12-month postnatal follow-up visits. Infants in the MCH are 5.51 (95% CI; 3.23, 9.38) times
more likely to attend all four follow-up visits than those in CCC. While infants in the MCH were 1.33 (95%
CI; 1.10,1.62) times more likely to have HIV antibody test at 1 year of age than the CCC, there were no
differences between uptake of PCR testing or CTX initiation at 6-8 weeks.

Conclusion:HIV services integrated in the MCH model yield better follow-up of HIV-exposed infants than
the CCC model.


PREVALENCE OF CHRONIC HBV INFECTION AMONG HIV NEGATIVE INDIVIDUALS IN HIV
DISCORDANT RELATIONSHIPS

Authors: Elizabeth Irungu

Background:Sub-Sahara Africa is highly endemic for chronic HBV infection and also has the largest burden
of new HIV infections with more than half of the infections occurring in stable heterosexual HIV discordant
relationships. A special consideration for understanding HBV prevalence in this high risk population is
tenofovir-based pre-exposure prophylaxis (PrEP) for HIV prevention for which several trials are underway.
Tenofovir has anti-HBV activity and its withdrawal from a person with chronic HBV has been associated with
a flare up of liver disease.

The aim of this study was to determine the prevalence of and factors associated with chronic HBV infection,
as measured by Hepatitis B Surface Antigen (HBsAg), among HIV uninfected partners in HIV discordant
relationships who screened for the Partners PrEP Study in Kenya and Uganda.

Results:We analyzed data from 7797 HIV uninfected participants. The mean age for the males and females
was 36 years and 33 years respectively. Twenty percent of the men reported having more than one wife.
Thirty percent of the participants had greater than 8 years of formal education. Five percent of men and
0.5% of women reported consumption of more than 6 alcoholic drinks per week.

Three hundred and thirty one participants (4.1%), comprising 96 (3.2%) females and 235 (5.3%) males had
chronic HBV infection. Men were more likely to be infected (OR 1.7 95% CI 1.34-2.17). The prevalence of
HBV among Kenyan participants was 3.7% and 5.0% among Ugandan participants (P =0.01). People who
consumed 3-5 alcoholic drinks per week were 1.7 times more likely to have HBV compared to those who did
not take any alcohol (95% CI 1.07 – 2.60). None of the HBV infected persons had abnormal liver enzyme
assays.

Age, marital status, income and education did not predict HBV infection. HBV infection of the HIV infected
partner did not predict HBV infection in the HIV uninfected participants.


                                                          8
                                          KNH 4th Annual Scientific Conference



Conclusion: Predictors of chronic HBV infection include gender, country and alcohol use. These data are
helpful in anticipating the presence of active HBV infection in HIV- persons in HIV serodiscordant
partnerships who may be eligible for tenofovir-based PrEP, should it prove effective for HIV prevention in
ongoing clinical trials.

Prevalence of chronic HBV infection among HIV negative individuals in HIV discordant relationships




SCREENING FOR INTIMATE PARTNER VIOLENCE (IPV) AT KENYATTA NATIONAL HOSPITAL
(KNH):WHAT DO WOMEN THINK? WHAT DO WOMEN WANT?

Authors:1Chi-Chi Undie, 2Catherine Maternowska, 3Margaret Mak’anyengo

Affiliations: 1Population Council, P.O. Box 17643-00500, Nairobi, Kenya, cundie@popcouncil.org;
2UNICEF ESARO and Bixby Center for Global Reproductive Health, University of California, San Francisco,

maternowska@obgyn.ucsf.edu; 3Gender-Based Violence Recovery Centre, Kenyatta National Hospital,
Nairobi, Kenya, mg_amak@yahoo.com

Background:Routine screening for physical and sexual abuse by intimate partners has not been a priority in
developing countries. Yet, failing to inquire about sexual coercion and other forms of violence compromises
quality of care and misses opportunities for ensuring optimal reproductive health outcomes for women.

Objective: The objective of the study upon which this paper is based was to assess the acceptability of
conducting routine screening for IPV at KNH from the perspective of clients, providers, and stakeholders.
This paper centers on the client perspective in particular.

Design: The study is based on a qualitative research design involving semi-structured interviews with nearly
70 women, aged 18 and above, who sought care (within either the Antenatal Care clinic, the Gender-Based
Violence Recovery Center, the Comprehensive Care Clinic, or the Youth Center) at KNH from April to June,
2011. Interviews were recorded by hand, transcribed in MS Word, and analyzed using thematic analysis as
part of a larger study assessing the acceptability and feasibility of IPV screening.

Results: Major themes emerging from the data include: 1) women’s conceptualizations of IPV; 2) women’s
comfort with the idea of undergoing routine screening for IPV at KNH; 3) women’s concerns around
confidentiality; 4) preferred provider characteristics in regard to conducting the actual screening; 5) the need
for a convenient referral process; and 6) the need for choice.

Conclusion: The nature, complexity, and potential implications of women’s perspectives on conducting
routine screening for IPV at KNH support the findings of studies in non-African contexts that highlight the
critical importance of women’s voices in planning for female-centered screening interventions.




                                                           9
                                          KNH 4th Annual Scientific Conference




PARTOGRAPH USE AT KENYATTA NATIONAL HOSPITAL

Authors:Alice W. Njihia; Evelyn Rotich; Prof. Kyllike;

Affiliations:Kenyatta National Hospital; Moi Referral Hospital; Karolinska

Background:ThePartograph is a graphical tool recommended by WHO for recording progress of women in
active labor. Studies have shown that using the Partograph can be highly effective in reducing complications
from prolonged labor for the mother and for the newborn.

Objective: To evaluate the impact of Educating midwives on Partograph use.
Methods: This was a post intervention observational study by use of a structured checklist.
Thirty two out of forty midwives working in labor ward went through one day training on proper use of
Partograph. Three months after the training, post intervention audit to find out whether there was change in
Partograph use was done for a period of one month. Partograph for 98 mothers in active normal labor were
assessed for completeness. The Data was entered and analyzed on SPSS.

Results: All the 98 partographs were not complete. Demographic patients details were at 77.6%, foetal
condition were at 44.2% completion, maternal condition were at 32.4% with the Temperature being at the
lowest completion level at 5.2% , birth summary was at the highest 99%.

Conclusion: The overallPartograph completion was at 63.3 % post intervention and at 62.6% pre
intervention. The remaining 36.7 % and 37.4 % respectively of uncompleted parts of the Partograph means
that the training of midwives had no impact on the clinical relevance of completing Partograph.




HORMONAL CONTRACEPTIVE USE AND RISK OF HIV-1 TRANSMISSION: A PROSPECTIVE COHORT
ANALYSIS

Authors:1Renee Heffron,Deborah Donnell, Helen Rees, Connie Celum, Nelly Mugo, Edwin Were, Guy de
Bruyn, Edith Nakku-Joloba, Kenneth Ngure, James Kiarie, Robert W. Coombs, Jared M. Baeten for the
Partners in Prevention HSV/HIV Transmission Study Team*

Affiliations:1University of Washington, Seattle, USA

Background: Hormonal contraceptives are used widely but their effects on HIV-1 risk are unclear.

Methods: We followed 3790 heterosexual HIV-1 serodiscordant couples from seven African countries
participating in two longitudinal HIV-1 incidence studies. Among hormonal contraceptive users (including
injectable and oral contraceptive users) and nonusers, we compared rates of HIV-1 acquisition in women
and HIV-1 transmission from women to men.

Findings: Among 1314 couples in which the HIV-1 seronegative partner was female, HIV-1 acquisition rates
were 6.61 and 3.78 per 100 person-years among hormonal contraceptive users and nonusers (adjusted
                                                          10
                                          KNH 4th Annual Scientific Conference



hazard ratio [AHR]=1.98, 95% confidence interval [CI] 1.06-3.68, p=0.03). Among 2476 couples in which the
HIV-1 seronegative partner was male, HIV-1 transmission rates from women to men were 2.61 and 1.51 per
100 person-years in those whose partners currently used versus did not use hormonal contraception
(AHR=1.97, 95% CI 1.12-3.45, p=0.02). In subgroup analysis, injectable contraceptive users had increased
risk for acquiring and transmitting HIV-1 to their partner and HIV-1 seropositive women using injectable
contraception had higher genital HIV-1 RNA concentrations, suggesting a mechanism for increased
transmission risk. Oral contraceptives were used too infrequently to draw definitive conclusions about HIV-1
risk.

Interpretation: Women should be counseled about potentially increased risk of HIV-1 acquisition and
transmission with hormonal contraception, particularly injectable methods, and about the importance of dual
protection with condoms to decrease HIV-1 risk. Non-hormonal or lower-dose hormonal contraceptive
methods should be considered for women with or at-risk for HIV-1.

Funding: National Institutes of Health (R03 HD068143, R01 AI083034, P30 AI027757, and T32 AI007140)
and the Bill and Melinda Gates Foundation (26469 and 41185).

Key words: HIV-1, serodiscordant couples, Africa, hormonal contraception




INTEGRATING HIV PEP INTO VCT SERVICES, KENYATTA NATIONAL HOSPITAL EXPERIENCE

Authors: 1Peter Maingi ,1Dr. David Bukusi

Affiliations:1Kenyatta National Hospital, VCT

Introduction:HIV Post-exposure prophylaxis (PEP) is any prophylactic treatment started immediately after
exposure to a pathogen, in this case HIV, in order to prevent infection by the pathogen and the
development. This strategy is widely acknowledged as effective and there are both national and WHO
guidelines for its practice.

Background: KNH VCT opened its doors to the public in the year 2001, two years after HIV was declared a
National disaster, to offer HTC services (HIV Testing and Counseling) to persons voluntarily seeking know
there HIV status. Since that time over 100,000 clients have been offered VCT services. During this time, it
was noted from the VCT service providers in counseling sessions that a number of clients coming for VCT
services had been recently exposed to HIV and hence would probably benefit from HIV PEP management at
the soonest contact with a health care provider. It is for this reason that the centre introduced the service in
the year 2009 to offer HIV PEP management to client seeking VCT services.

Methodology: The KNH HIV PEP service integration is closely monitored by a doctor and nurses working at
the KNH VCT centre. Prior to the introduction of the service, a series of CMEs on HIV PEP management
were given to all HTC service providers. The guidelines were printed and displayed at all HTC service
                                                          11
                                          KNH 4th Annual Scientific Conference



delivery points and notices put up at the VCT reception informing clients of the availability of the service and
the need to notify the receptionist in case of emergency. ARV drugs were then ordered from the
Comprehensive Care pharmacy after a HIV PEP register had been opened for accountability of the drugs
and a lockable cupboard identified for storage of the drugs. Management of HIV exposed clients has been
as per the guidelines after going through the VCT process.

Results: The numbers of clients offered HIV PEP services at the KNH VCT centre were 237 against 11110
clients seen at the centre in 2009 and 251 against 16659 in the year 2010.

Conclusions: There is demand for this service at the KNH VCT centre. We would recommend this strategy
be adopted nationally across all HTC services that can monitor and refer appropriately clients that come
after accidental exposure to HIV for strengthening of prevention programs.




FACTORS ASSOCIATED WITH UTILIZATION OF VCT SERVICES AMONG MEN ATTENDING ONGATA
RONGAI HEALTH CENTRE, NGONG, KAJIADO NORTH DISTRICT, KENYA.

Authors: ¹ 3Mwiti.P.¹Dr Opondo.S, ²Mutai. J

Affiliation: ¹Jomo Kenyatta University of Agriculture and Technology (JKUAT) Institute of Tropical Medicine
and Infectious Diseases, ²Kenya Medical Research Institute, Centre for Public Health Research, 3kenyatta
National Hospital

Background: Globally, People living with HIV/AIDS (PLWHIV) are estimated to be 42 million. Worldwide,
only 5% of PLWHIV are estimated to be aware of their status.Utilization of Voluntary counseling and testing
(VCT) services among men in Kenya is 40.4%.

Objective: To determine factors associated with utilization of VCT services among men attending
OngataRongai health centre, Ngong, Kajiado North district, Kenya.

Design: The study was descriptive cross-sectional study employing both quantitative and qualitative method
of data collection.

Result: The findings were 56% of (330) men were aware of their HIV status. 53.94% (178) of 330 men have
visited and used VCT services. After adjusting for patient age and marital status, a VCT being near the place
of residence increased the odds of VCT utilization by 2.6 (CI 1.4 – 4.7) times and this was significant at a p
value of 0.003 however no other factor when adjusted for other covariates in model was significant. The
most stable prognostic model for the behavioral factors influencing VCT utilization included the number of
sex partners in the last one year, reason for choosing a VCT centre and how comfortable they were if seen
in a VCT with a LRT of <0.001. If a client was comfortable being seen at VCT significantly increased the
odds of VCT utilization by 9.9 (CI 5.6 – 17.5; p value <0.001) times, however no other factor when adjusted
for other covariates in model was significantly associated with VCT utilization. On focused group discussion,
key finding was men fear getting HIV result.

                                                          12
                                         KNH 4th Annual Scientific Conference




Conclusion: The key findings of the study may be beneficial to the relevant government line ministry of
public health and sanitation, stakeholders and non governmental organization in motivating relevant
program that go a long way in enhancing utilization of VCT services.




CHRACTERISTICS OF CLIENTS SEEKING EMERGENCY PEP SERVICES AT KNH VCT CENTRE

Author:Sila Angela, Bukusi David, K. Anne.

Affiliations:1Kenyatta National Hospital, VCT

Back ground: KNH VCT centre serves many clients. Some access services in need of PEP due to possible
exposure to HIV accidentally. This review of data seeks to examine the characteristics of clients accessing
preliminary PEP services at the centre.

Objective: To identify the demographic characteristics of clients seeking PEP services at the VCT centre.

Design: Cross sectional; data from standardized forms for VCT clients seeking PEP services at the centre
from January 2009 to January 2011 was disaggregated and subjected to various statistical analytical
procedures which include EPI info and excel.

Results: Of 36,080 clients tested this period, 1.4% sought PEP services-64.2 % males, 35.8% females. 6.9
% were tested as couples. 62% were above 25 and 38% between 15-24 years. 73.1% were professionals,
16.9% skilled, 0.2 % had no education. About general condom use; 31.8% had never used condoms with
the steady partner, 17.1% had never used with non steady partners. 19.1 % always used condoms with
steady partners, 26.9 % always used with non steady partners. 6.7 % clients had never used. 1.2%
clients were not sexually active for the last twelve months, 3.5% had never had sex before. On condom
use in last sex, 40.6% had not used, 8.1 %had used, 46% had used but it burst.20.2% had never been HIV
tested before, 79.8% had tested with a Negative result. The most common time to seek PEP services is
9am-11am. Mondays-27.7% and Saturdays -20.6% are most frequent days for seeking PEP

Conclusion: The observed highest risk of HIV exposure accidentally is sexual. Professionals seek PEP
services more than the skilled. There’s increased uptake of PEP following condom burst, therefore the need
for condom skills in HIV prevention.HIV exposure sexually happens more around weekend days.




                                                         13
                                          KNH 4th Annual Scientific Conference



ASSESSMENT OF FACTORS ASSOCIATED WITH THE UPTAKE OF PROVIDER INITIATED HIV
COUNSELLING AND TESTING (PITC) AMONG CLIENTS AT KENYATTA NATIONAL HOSPITAL
ACCIDENT AND EMERGENCY DEPARTMENT, NAIROBI, KENYA.

Authors:1, 2Cherutich R.K.,2, 3Dr.Wanzala P., 2 Prof. Makokha A. O.

Affiliations:1 Kenyatta National Hospital, National Referral and Teaching Hospital, Nairobi Kenya.2Jomo
Kenyatta University of Agriculture & Technology, Institute of Tropical Medicine and Infectious Diseases,
Nairobi, Kenya.3Kenya Medical Research Institute, Centre for Public Health Research and The
Epidemiology, Public Health & Health Systems Research Programme, Nairobi, Kenya


Background: HIV/AIDS has contributed to a high proportion of morbidity and mortality among people
around the globe. Proper care, treatment and preventive measure needs to be put in place in order to curb
this. HIV testing and counseling is one of such measures and is the critical entry-point for engagement into
treatment and care as well as for primary and secondary prevention efforts.Despite the importance of this
step, most HIV-infected patients globally, and particularly in resource-poor settings, are unaware of their HIV
status. To improve the HIV status awareness, provider-initiated HIV counseling and testing (PITC) was
introduced.

Objective:The main objective of this study was therefore to assess factors associated with the uptake of
provider initiated HIV counseling and testing (PITC)

Methods: A cross sectional hospital-based survey was carried out, where a structured questionnaire was
administered to 340 subjects selected to participate in the study.

Results: The results showed a significant association between PITC uptake and informal employment (P =
0.006), HIV risk behaviors (p = 0.04), the decision of the respondents to allow their children play with
children who are HIV positive (p = 0.018), and fearing HIV test (P < 0.001). The odds of accepting to test
HIV was 1.1 among clients who were generally young in age. Using fear as the reference category for
whether one would fear to take an HIV test or not, the odds of not fearing to test was 10.0. A high proportion
(96.2%) of the clients accepted to test for HIV through the PITC.

Conclusion: Having informal employment, HIV risk behaviours and not fearing to test for HIV was
significantly associated with PITC uptake. PITC was highly acceptable. More studies need to be carried out
to identify barriers to provider initiated HIV testing and counseling among clients who declined in this study.

Key Words: Provider Initiated HIV testing and Counseling (PITC), HIV risk behaviours, HIV/AIDS.




                                                          14
                                          KNH 4th Annual Scientific Conference



EXPOSURE TO SELECTED ARBOVIRUSES, HIV, HEPATITIS B VIRUS AND HEPATITIS C VIRUS
AMONG FEBRILE PATIENTS AT SELECTED HEALTH FACILITIES IN TRANS NZOIA COUNTY,
KENYA.

Authors: Daniel Matemo, Alison C. Roxby, Alison L. Drake,JohnKinuthia,FranciscaOngecha-Owuor,Grace
C. John-Stewart,JamesKiarie, Carey Farquhar.

Background: In Kenya, women in antenatal care are encouraged to share their HIV test results with their
sexual partners. Disclosure of HIV status is a significant factor in adoption of HIV prevention strategies;
however prevalence and timing of disclosure after antenatal testing have not been well defined.

Methods: Data on disclosure was collected from 148 HIV-1/HSV-2 co-infected women enrolled in a clinical
trial in Nairobi, Kenya. Timing and correlates of disclosure were assessed using structured questionnaires
during antenatal visits and at 12 months postpartum. T-tests were used to compare continuous variables;
and chi-square tests were used to compare categorical variables.

Results: At 34 weeks gestation, 79 (49%) of 148 participants reported disclosing their HIV-seropositive
status to current sexual partners. Disclosing women were in partnerships longer (mean 6 years) than non-
disclosing women (4 years, P=0.006). Data on partner HIV testing was available for 80 women and
disclosure was linked to higher rates of partner testing; 5 (26%) women who had not disclosed knew their
partner had been tested for HIV, compared to 34 (57%) women who had disclosed (P=0.02). Among 65
women who had not disclosed at 34 weeks, 55 were seen at 12 months postpartum, of whom 14 (25%) had
disclosed and 33 (60%) still had not disclosed despite receiving regular counseling to promote disclosure.
Twenty-three (42%) women stated that they did not ever intend to disclose their HIV status to their partner.
Among 52 women who reported the timing of disclosure, 31 (61%) disclosed within 3 days of testing.

Conclusion: Women who disclosed their HIV status were in longer-lasting partnerships, more likely to have
a partner who had been tested, and most likely to disclose within 3 days of their positive HIV test. Efforts to
improve rates of HIV disclosure should focus on counseling women during the first point-of-contact.


ARTICULAR MANIFESTATIONS IN HIV INFECTION: PREVALENCE AND CHARACTERISTICS

Authors:Dr. Paul Etau Ekwom1, Dr. George Omondi Oyoo2, Prof. E.O Amayo2 and Dr I.M.Muriuki3

Affiliations:Department of Medicine, Kenyatta National hospital 2.Department of clinical medicine and
therapeutics, University of Nairobi 3.Department of Diagnostic radiology and imaging.

Background: Articular manifestations have been reported in HIV infection with a prevalence ranging from
2.5 to 68%.


                                                          15
                                         KNH 4th Annual Scientific Conference



Objectives: To determine the prevalence, types and characteristics of articular manifestations in the anti-
retroviral treatment naïve HIV infected patients.

Study design: Cross sectional descriptive study.

Study Setting: Comprehensive care clinic (HIV outpatient clinic) at the Kenyatta National Hospital (KNH)
from October 2007 to March 2008.

Patients:193 patients; 158 females and 58 males, aged between 19 to 65 years of age with Human
immunodeficiency virus (HIV) infection who were naïve to antiretroviral drug therapy.

Main outcome measure: Presence of articular manifestations that included HIV associated arthritis, HIV
associated spondyloarthropathies, HIV associated arthralgia, painful articular syndrome and avascular
necrosis.

Results: Thirty three of these 193 patients had articular manifestation with a prevalence of 17.1% which
comprised HIV associated arthralgia; 15.6%, undifferentiated spondyloarthropathy; 1% and HIV associated
arthritis; 0.5%.The mean age of these patients was 36+ 9 years, range 23-63 years; with a female
preponderance, male to female ratio of 1: 2.3 and majority of the patients were in World health organization
(WHO) clinical staging of HIV infection class II and III with a mean CD4 cell count of 330 cells/mm3.
Seventeen (51.5%) of the patients with articular disease had oligo-articular presentation, 10(30.3%).
monoarticular while 6(18.2%) had polyarticular presentation. The mean duration of joint pains was53.3 days
(range of 2-365 days).Six (18.2%) of these 33 patients missed work or school due to the articular disease.

Conclusion: Articular manifestations is common in HIV infection with a prevalence of 17.1%. HIV
associated arthralgia was the commonest manifestation. Majority of these patients were female. The mean
age of these patients was 36 years with a mean CD4 cell count of 330 cells/mm3with 18.2 % of them missing
school or work.


CHARACTERISTICS OF INFANTS ACCESSING PMTCT SERVICES IN KENYA

Authors: James N. Kiarie1, John Ong’ech1, Onesmus Gachuno1, Peter Muiruri1, Irene Inwani1*, John
Kinuthia1, Peter Cherutich2, Kamau Mubuu3, Fridah Govedi4, Paul Mwai1, Monica Mukunga1,


Affiliations:1University of Nairobi and Kenyatta National Hospital, Nairobi KENYA, 2National AIDS and STD
Control Programme, Nairobi KENYA, 3School of Journalism and Mass communication, University of Nairobi,
Nairobi KENYA4Pumwani Maternity Hospital, Nairobi KENYA.



                                                         16
                                         KNH 4th Annual Scientific Conference



Background: Characteristics of infants accessing Prevention of mother-to-child transmission (PMTCT)
services in Kenya have not been documented in a national survey, although these services have been
offered in Kenya from 1994.

Methods: This was a national cross sectional survey of mother-infant pairs coming for their 6, 10 and 14
weeks pentavalent immunization, at 354 health facilities selected by stratified random sampling from 2422
Ministry of Health registered facilities weighted by annual number of immunizations. . Quantitative data was
obtained through a survey questionnaire and qualitative data was elicited through focus group discussions
on access to comprehensive PMTCT services, care and treatment, family planning, HIV prevention, issues
of sexuality and pregnancy intention. All consenting mothers and HIV exposed infants were tested for HIV.

Results: We recruited 13,360 mother-infant pairs from 354 facilities between June and November 2010.
Most mothers were 20-34 years (67%), married (87%) and had primary education (55%). Infants were 49%
male, mean age 10 weeks (IQR 6-16). Ninety nine percent of women reported they were giving breast milk
to their infants but only 62% were exclusively breastfeeding. Reported antenatal clinic attendance was 96%,
facility delivery 64%. Of 12,659 mother-infant pairs, 1004 (7.9 %) maternal blood samples and 77 (7.7%)
HIV exposed infants tested (Antibody and DNA-PCR respectively) positive for HIV. Among HIV-infected
women 567 (57%) and 464 (46%), respectively, reported using maternal and infant antiretroviral while 9
(2%) and 196 (28%) knew they were positive but used no maternal or infant antiretrovirals, respectively, and
304 (30%) did not know they were HIV-infected.
HIV transmission to infants was higher among mothers who were mixed feeding (5% vs 13%: P=0.05) and
whose partners had not been tested for HIV (3% vs 14%: P<0.001).

Discussion: This is the first national survey to document characteristics of infants accessing the Kenya
PMTCT program. Only 46% of infants received antiretrovirals for PMTCT and 62% were exclusively
breastfeeding. Transmission rate was 7.7%, similar to those seen in single dose nevirapine trials. More
efforts need to be put to increase uptake of HIV testing, PMTCT interventions and promote safe infant
feeding practices.




UTILITY OF AN ALGORITHM OF SURROGATE MARKERS FOR CD4 COUNT TO DETERMINE
ELIGIBILITY FOR HAART AMONG HIV INFECTED PREGNANT WOMEN.

Authors:Winfred W. Mwangi *1,2 , James M. M’imunya 2, James Kiarie2, John Kinuthia2, Walter Kudoyi2,
Rachel Spitzer 3,4, Hillary Mabeya4 , DanstunMukoko5,Janet Jekemoi4, Kennedy Mutai2

Affiliations:1Moi Teaching and Referral Hospital, Eldoret, Kenya, 2 University of Nairobi,Department of
Obstetrics and Gynaecology, 3 University of Toronto, Department of obstetrics and Gynaecology, 4AMPATH,


                                                         17
                                          KNH 4th Annual Scientific Conference



Moi University and 5Deputy Chief Medical entomologist, Division of Vector-Borne & Neglected Tropical
Diseases, Ministry of Public Health & Sanitation, Kenya

Background: CD4 count is a marker of HIV disease progression and used to identify patients eligible for
HAART. However CD4 count testing is not always readily available in developing countries. In light of
expanding Prevention of Mother to Child Transmission (pMTCT) services there was need to assess
sensitivity, specificity and the predictive accuracy of clinical algorithms using total lymphocyte count (TLC),
WHO Clinical Stages (WCS), Body Mass Index(BMI) and Haemoglobin (HB).

Methods: This was a retrospective analysis of cross-sectional data from HIV- infected, pregnant, ARV-
naive women within the USAID-Academic Model Providing Access to Healthcare (AMPATH) in western
Kenya. Correlation and optimal cut-off points for TLC, BMI, HB and WCS were calculated using Pearson’s
Correlation and linear regression. Sensitivity, specificity, positive predictive value (PPV) and negative
predictive value (NPV) were calculated and used to compute area under the Receiver Operating Curve
(ROC) to determine their predictive accuracy.

Results: Of 362 HIV- positive pregnant women, 160(44.5%) had CD4 count <350 cells/mm3. The optimal
cut-off points for TLC, HB, and BMI were 850cell/mm3, 8.4g/dl and 15.5kg/m2 with Sensitivity and Specificity
of (8% and 97%), (17.4% and 92.5%), and ( 3.7% and 100%) respectively. A 3-step algorithm of WHO
Clinical Stages II&III, TLC≤1000 and HB≤12g/dl; in that order was the most optimal with a 86% Sensitivity,
92% Specificity, 94% PPV, 74% NPV , 78% Youden’s index(J) and 89% ROC AUC .

Conclusion: TLC, HB, WCS and BMI have low predictive accuracy for CD4 count <350cell/mm3.
Combination of markers increased the sensitivity but lowered the specificity at all TLC thresholds. The above
algorithm does not account of all those who had CD4 count <350cell/mm3 and were classified as WCS I
disease.

Key words:(Total Lymphocyte count, CD4 Count, HAART, pregnant women, Kenya.)




                                                          18
                                           KNH 4th Annual Scientific Conference



CO-INFECTIONS BETWEEN SELECTED ARBOVIRUSES AND HIV, HEPATITIS B VIRUS AND/OR
HEPATITIS C VIRUS AMONG FEBRILE PATIENTS AT SELECTED HEALTH FACILITIES IN TRANS
NZOIA COUNTY, KENYA.

Authors: Demba Rodgers Norman1.,Matilu Mwau2., Ongus R. Juliette3., Ouma John4.

Affiliations: 1Institute of Tropical Medicine and Infectious Diseases, KEMRI. 2Centre for infectious and
Parasitic Diseases Control Research, Busia KEMRI.3Department of Medical Laboratory Sciences,
JKUAT.4Centre for Public Health Research, KEMRI.

Objectives: To determine the prevalence of co-infections between selected arboviruses and HIV, Hepatitis
B virus and/or Hepatitis C virus among febrile patients at selected health facilities in Trans Nzoia County,
Kenya.

Methods: A total of 264 serum samples were screened for three arboviruses; Chikungunya virus (CHIKV),
West Nile virus (WNV), and Dengue-2 (DENV-2) virus. The samples were further screened for HIV, HBV
and HCV. Blood was obtained from febrile patients in three different health facilities, Kitale District Hospital,
Andersen Medical Clinic and Endebess District Hospital, all located in Trans Nzoia County. Samples were
analysed using ELISA and Plaque Reduction Neutralisation Test (PRNT) for Dngue-2, CHIKV, and WNV.
ELISA was used to screen HIV, HBV and HCV using the Abbott Murex HIV-1.2.0, HepanostikaHBsAg Ultra
and Abbott Murex anti HCV (Version 4.0) test kit respectively.

Results: Antibodies detected by indirect ELISA were, 100 (37.9%) CHIKV, 23 (8.7%) WNV, 41 (15.5%),
Dengue-2 virus, 28 (10.6%) HBV, 6 (2.3%) HCV, and 27 (10.2%) HIV. PRNT was therefore done to confirm
the seroprevalence of CHIKV, DENV-2, and WNV. Of all the samples that showed a positive reaction for
PRNT, 57 (21.6%) were CHIKV, 8 (3%) DENV-2 virus, and 5 (1.9%) WNV. Co-infection present included 1
(0.4%) CHIKV/HIV, 7 (2.7%) CHIKV/HBV, 1 (0.4%) WNV/HIV, 1 (0.4%) WNV/HBV, 3 (1.1%) HIV/HBV, and
1 (0.4%) HIV/HCV.

Conclusion and Recommendation: There is potential for re-emergence of viral diseases in Trans Nzoia
County. Surveillance systems should be put in pl




                                                           19
                                          KNH 4th Annual Scientific Conference



                                DAY 1, THURSDAY 13TH OCTOBER, 2011
                                             VENUE B


MEDICAL QUALITY IMPROVEMENT; 5S CONCEPTS, THE FIRST STEP TOWARD WORLD CLASS
MANAGEMENT

Author:Agnes Chika

Affiliation: Kenyatta National Hospital

Introduction: Quality improvement requires knowledge resources instead of financial resources, and that it
could improve quality more effectively than investment structure. The 5s comes from the Japans’ product
concept called Kaizen. Kaizen has been used for the success of the Japanese industries. Kai – Zen
means -change for the better.

Sample area: Kenyatta National Hospital (Private Wing), Ward 1C, ward 9A seminar room &Private Wing
Pharmacy. 5S practice from 1st -3-2011 to 6th -6-2011.

Findings: Ward 1C Staffs toilets; There was leakage of water on the floor , due to a broken pipe, The toilet
had no seat cover, There was no tissue holder and no tissue available for the users, no soap dispenser,
and the door signage was hanging down because of being secured with one pin. Ward 9A seminar room:
The room was being used as a store; boxes of supplies were being stored there and even unused food
trolleys. This made the lighting of the room poor and the space of the room small. Private Wing Pharmacy:
The expired drugs had been packed in boxes and kept on top of the drug cupboards, the dust bin was kept
next to the drugs. Their documents were not arranged neatly in the cupboards.

Results: Ward 1C Staffs toilets; The broken pipe was repaid, The toilet seat cover was put, and tissue is
available for the users, there is a soap dispenser, and the door signage was fixed. Ward 9A seminar room:
The room has good lighting conducive for continuous medical education (CME) .and the space of the room
is now big. The boxes with supplies were removed to the supplies store, and the unused food trolleys were
repaired and taken to kitchen.Private Wing Pharmacy: The expired drugs were disposed off according to the
protocol. The dust bin was relocated away from drugs. Their documents have been neatly arranged in the
cupboards.

Conclusion: To all the KNH staffs, I would have to say that the 5-S program is neither for the lowly workers
nor for a “special” area of the hospital. It is a contribution to effective, productive work for everyone,
everywhere. Quality comes about in a manner of total participation and extensive education.




                                                          20
                                           KNH 4th Annual Scientific Conference




FACTORS ASSOCIATED WITH TYPE OF HEALTH FACILITIES VISITED BY DIABETIC PATIENTS IN
MOMBASA, KENYA

Authors:a Judy Mwai:* Msc Public health (student), b Joseph Keriko: PhD Phytochemistry, aJosephMutai:
MA Sociology, a Doris Njomo: PhD Public Health

Affiliations:aKenya Medical Research Institute., b Jomo Kenyatta University of Agriculture and Technology.

Background: Diabetes mellitus is a chronic disease whose current global spread has the
characteristics of a pandemic, type 2 is more common than type 1 in developed countries. The increase
in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes,
perhaps most importantly a "Western-style" diet. As a result people put on weight, making them more
susceptible to chronic illness including, heart disease and cancer, adding to the strain on already
overstretched health care systems. The main objective of this study was to determine factors associated
with the type of health facilities visited by diabetic patients in Mombasa. A descriptive cross sectional study
was conducted.

Methodology: Atotal of250 diabetic patients were purposively selected for the study. Quantitative data
was collected and analyzed using epi info. Data from questionnaires were entered into the Statistical
Package for Social Scientists computer packages.

Results: Level of education was significantly associated with the type of hospital attended (P < 0.001).
Majority of patients with primary education and below (96.15%) attended public health facilities and only
(1.925%) attending private for profit and private for charity health facilities. In contrast patients with higher
percentages of the secondary and post secondary education levels attended private for profit health facilities
(16.4%). Patients’ Knowledge on their diabetes status was significantly associated with the type of health
facility attended (P < 0.001). Up to 97% of the patients informed that they had diabetes sort medical services
from public health facilities, Compared to only 57.5% of those who had not been informed that they had
diabetes. Income levels as well as age of the respondents were not significantly associated with the type of
hospital visited (P=0.297 and P=0.650 respectively).

Conclusion/Recommendation: It’s needful to invest in health education using various methods of
information dissemination to reach out to the public. This would improve the public knowledge regarding
diabetes prevention, management and care. T

Key words: Mombasa, Diabetes, Hospital type, Management, Knowledge, Lifestyle.




                                                           21
                                           KNH 4th Annual Scientific Conference




PATIENTS’ PERCEPTION OF THEATRE SERVICES AT KENYATTA NATIONAL HOSPITAL, NAIROBI,
KENYA

Author: Dominic Charles Okero

Objectives: To determine the patients’ perceptions on aspects of theatre services.

Specific: To determine the perceptions of patients on staff interpersonal skills, the staff performance,
theatre benefits andquality of services in relation to five dimensions of quality.

Design:The design was cross-sectional descriptive

Results: Overall, patients’ perception on all the aspects considered was positive apart from the dimensions
of quality which scored an equivalent of somewhat positive aggregate. Hence they perceived the output
(technical aspect) more positively compared to the functional aspect (the process) of service delivery.
General comments from 78% of those who commented were positive, 9% negative and 13% neutral and
unclassified. The male perception was not significantly different from the female perception (t=-0.564,
p>0.05) (T-Statistic). The results indicated that there was no statistically significant defference between staff
interpersonal skills and performace (z=-1.088, p>0.05) (Wilcoxon sign rank test). Further, it however showed
that there was a positive correlation between staff interpersonal skills and performance (ρ=0.588, p<0.05).
(Pearson’s correlation). There was a weak positve correlation between age and perception (ρ=0.022,
p>0.05) (Pearson’s Correlation). Perception of emergency cases did not significantly differ from that of
elective cases (p-value 0.182).

Conclusion: The majority of clients visiting main theatres had positive perception towards the services.
However, patients perceived the output (technical aspect) positively but had relatively negative perception
on the functional aspect of the services (the process). The results suggested that there was no statistically
significant defference between perception on staff interpersonal skills and performace although there was
noted to be a positive correlation between the two. Neither the type of theatre schedule nor the personal
characteristics of respondents played significant roles in influencing perception.




                                                           22
                                          KNH 4th Annual Scientific Conference




RECOVERY RATES OF ADDICTS IN RESIDENTIAL TREATMENT CENTRES, NAIROBI.

Author:Joseph Mbuthia,

Introduction: Kenyans are turning to drug rehabilitation as a way of treating drug addiction. This is because
Alcoholism and drug abuse (DA) has increase societal and family ills. The recent setting up of drugs and
substance abuse rehabilitation centres is an indication that the society is starting to view drug addiction as a
real threat.

Objectives: To establish the different admission criteria in the centres, the ratio of voluntary to involuntary
admission, investigate reasons for involuntary admission, find out whether there was a correlation between
the mode of admission and recovery and verify whether addicts were referred to aid their recovery

Design: The study employed descriptive survey design. Two questionnaires (clients’ and counselors’) were
administered. Nairobi used because of heterogeneity.

Results: a) bio data - Male 84.8% female 15.2. Age 20—30 = 37%, 31-40 = 41%. Educational level:
university = 45.7%, college = 26.1%, secondary = 17.4% primary = 2.2%. b) Ratio of forced to not forced 7:
2. c) There is justification for forced admission. d) There is no significant difference in recovery rates for
both categories (63.2% co.) Frederick, (1974) and NIDA (2007) noted forced are slightly better. e) The
forced drop out more

Conclusion: Using data from 6 treatment centres.There is an admission criteria.Most addicts are forced to
undergo the treatment. Several reasons were given for involuntary admission thereby justifying it.The mode
of recovery did not have a significant effect on recovery of the patients.The addicts upon completion are
usually advised to visit or work with the AA, NA, half way houses, churches, counselors, NACADA, hospital,
and SAPTA in order to remain sober.




                                                          23
                                          KNH 4th Annual Scientific Conference




ALCOHOLICS’ REHABILITATION IN SOWETO SLUM, KAHAWA WEST

Author:TheresiaKavuliKinai Ph.D.

Affiliation: Kenyatta University

Introduction: Kissim&Beglier (1977) model of alcoholism views it as an incurable disease, whereby
patients cannot control alcohol consumption. Hester and Milla (1980) moral theory of alcoholism declares
personal choice as the cause of drunkenness, people decide to drink or not. Treatment through abstinence
and spiritual guidance is possible in rehabilitation centres.

Objective:Investigate the types of rehabilitation centers and therapeutic services offered to recovering
alcoholics to make adjusted and functional members of the community.

Methodology: Survey research design, 6 counsellors and 12 recovering alcoholics were interviewed to
gather data as per the study objective.

Results: Rehabs were (i) Rehabilitation Drop Centre providing outpatient treatment in the community hall
rehabilitated 6 males and 21 females, August 2010 to March 2011(ii)Levuka Rehabilitation Centre providing
inpatient treatment 5 males and 5 females rehabilitated, November 2010 to March 2011, (iii) Servers of
Health and Environment -Drug and Alcohol Support (SHE-DAS) Programme training clients in basic
counseling skills, 26 males and 21 females total 47 trained May 2010 - March 2011. Proportion of males:
females under going rehabilitation is 37:47 or 44.4%:55.6% The owners of the rehabs were private investors
and NGOs consequently expensive fees treatment Only the affluence can afford (Gelinas, 2006).

Therapeutic services: were assessment, detoxification and behavioural treatment. Assessment to get
alcoholics’problems. Detoxification and behavioural treatment is done in rehabs for 90 days. Detoxification is
done by medical specialists while behavioural therapy done by counselors. (i) Group therapy to give
recovering alcoholics’ emotional support. (ii) Family therapy to rectify alcoholics’ family dysfunctions. (iii)
Recitation of the 12 steps of Alcoholic Anonymous for God’s intervention and facilitate alcoholics’ acquisition
of sobriety. (iv) Provision of specific social support according to the needs of the clients to make them
functional in the community (Langabaugh, Wirtz& O’Malley, 2010).

Conclusion:Efforts be made to ensure affordable rehabilitation of alcoholics. Encourage more men to go for
rehabilitation. Educate the community the about the where in their locality alcoholics can be rehabilitated.
                                                          24
                                          KNH 4th Annual Scientific Conference



AN ANALYSIS OF THE RIGHT TO HEALTH IN THE CONTEXT OF DRUG AND SUBSTANCE ABUSE IN
KENYA

Author:Mwaura Kelvin Karuga

Affiliation: Moi University School of Law

Specific Objectives: To analyze state and non-state actors as regards the achievement of minimum core
obligations under customary international health law in the context of drug and substance abuse.Evaluation
of the success in the fight against drug and substance abuse as it is in the republic of Kenya by its
legislation, state policy with a focus to comparing these to global best practices.

Design: The study was based on relevant legal skills as legal research methods and writing techniques that
include, but not limited to issue isolation and development. An analysis of customary international health law
and global best practices in lieu of drug and substance abuse entailed a study of authoritative and
persuasive sources of law thereof. Readings of scholarly articles on the subject, municipal and international
law and, case law was reviewed in addition to global issues on the subject.

Result: The United Nations on drugs and crime UNODC has the unique position to ameliorate the condition
of victims of crime drug users vulnerable to HIV, to human trafficking, violence and perpetuators of crime
unconditional Right to Health. The objective is to protect the health of people, particularly the most
vulnerable from the dangerous effects of drug use disorders. Health care reduces drug related diseases and
social consequences. Success in the fight against drug and substance abuse can evaluated in regard to the
approach undertaken: What is not working in the prevention of drug and substance abuse is scare tactics
employed, curricula that relies solely on information about drugs and their dangers, curricular that only aims
to promote self-esteem and emotional well-being, testimonials of former addicts, counseling in peer group
context, recreation and community service activities. What is working is training in resistance skill, normative
education, and life skills in communication, impulse control, interactive methods /reliable information .In the
area of drug user’s health care what is working is reliable information and counseling ,low-threshold
pharmacological interventions for example opioid-agonists and antagonist drugs that are easily accessible
,adequate social assistance for marginalized drug dependents ,vaccination programs against Hepatitis to all
drug abusers, medication and emergency kits for management of overdoses in appropriate places
availability of measures to prevent acute consequences of stimulants abuse well-equipped street workers
and peer outreach workers unit ,social assistance for children of drug dependent individuals. This is in
addition to science-based practice dissemination, advocacy/ethical approach and adaptation to regional
country needs/ownership guidelines and therapeutic tools.

Conclusion: Adding any psychosocial support to maintenance treatment improves the number of
participants abstinent at follow up. (20% increase in 48 weeks) Among countries with treatment UNODC
activities worldwide features Kenya, in addition to those with IDU/ HIV/ UNODC activities ,those with
HIV/UNODC activities in prisons .The UNODC-WHO joint programme on drug dependence envisages
                                                          25
                                         KNH 4th Annual Scientific Conference



effective and humane treatment for all people with drug use disorders ,nothing less than would be expected
for any other disease. Further, social support and integration enables prevention of illicit drug use, HIV
epidemic and crime.



MUSCULOSKELETAL RHEUMATIC DISEASES AT KENYATTA NATIONAL HOSPITAL

Authors:Dr. Paul Etau Ekwom1, Dr. George Omondi Oyoo2 and Dr. Bernard Owino. 1

Affiliations:1Department of Medicine, Kenyatta National hospital; 2.Department of clinical medicine and
therapeutics, University of Nairobi.

Background: Musculoskeletal rheumatic diseases are common and are cause of morbidity and disability

Objectives: To determine the total number , types of musculoskeletal diseases, age and gender
distributions of patients seen at the KNH rheumatology clinic from 1st April 2010 to 30th April 2011.

Design: A retrospective audit

Study setting: Patients seen at the rheumatology clinic KNH from1st April 2010 to 30th April 2011.

Methodology and data analysis: Records of the patients were retrieved. Data was entered into data
sheets and analyzed by use of SPSS version 17.

Results: Mean age of patients seen:40, range 2-91 years; male to female ratio of 1:6. Rheumatoid arthritis
was the commonest condition seen with a prevalence of 37.9%. Other conditions include osteoarthritis 17%,
connective tissue diseases 16.5%, gout 0.98%, HIV associated arthritis 1.47%, soft tissue rheumatism
0.97%and Fibromyalgia 2.46%.

Conclusion: Rheumatoid arthritis is the commonest musculoskeletal rheumatic disorder at the Kenyatta
National Hospital rheumatology clinic.




                                                         26
                                         KNH 4th Annual Scientific Conference



SURVEILLANCE OF MULTI-DRUG RESISTANCE IN TUBERCULOSIS (TB) AND TREATMENT
OUTCOME AT KENYATTA NATIONAL HOSPITAL

Authors:Wahome Eunice1, Irimu Henderson1, Mwai Paul1

Affiliations:1Kenyatta National Hospital-Partnership for Advanced Care & Treatment-Centre of Excellence
(PACT-CoE)Word Count: 314

Background:The World Health Organization (WHO’s) 2009 Global TB report estimated more than 132,000
new TB cases and an incidence rate of 142 sputum smear-positive cases per 100,000 population in Kenya.
According to USAID, Kenya is ranked 13th on the list of 22 high-burden tuberculosis countries in the world. A
WHO 2007 report estimated there were around 2,000 cases of multidrug-resistant (MDR) TB in Kenya with
only a 4.1% detection rate. As a result of this, the Division of Leprosy, Tuberculosis and Lung Disease
Program (DLTLD) is currently overseeing quality-assured drug-susceptibility testing for early detection of
MDR-TB thus providing laboratory case verification criterion of 100%.

Methods: MDR-TB surveillance data was abstracted from the Ministry of Health MDR-TB category IV
register at Kenyatta National Hospital using a standard tool. The surveillance period was 2007 through July
2011.

Results: A total of 62 MDR-TB cases distributed as new 3 (5%) vs previously-treated 59 (95%); pulmonary
60 (97%) vs Extra-pulmonary 2 (3%); age-group ≤ 15 years, 1 (2%) vs> 15 years 61 (98%); female 26
(42%) vs male 36 (58%) have been reported.

Drug susceptibility testing reviewed primary resistance to Isoniazid and Rifampicin was 100%, Ethambutol,
33 (53.2%) while Streptomycin resistance was 40 (65%). Among those previously-treated, those who failed
after first treatment were 10/59 (17%) while those failing after re-treatment were 49 (83%). There were no
relapse cases or patients returning after defaulting treatment. The epidemiology of TB has further been
confounded by co-infection with HIV thus making its treatment difficult. The estimated HIV co-infection rate
was 11.3%.

The Direct Observed Treatment strategy (DOTs) coverage is 90%. Treatment outcome among patients ever
started on treatment are cured/completed 20 (32.3%) with medium (range) treatment duration of 27 (24, 28)
months; those still on treatment 23 (37.1%); mortality 10 (16.1%); failed 0%; defaulted 5 (8.1%); while
referral to other MDR-TB sites for decentralized care was 4 (6.5%).




                                                         27
                                         KNH 4th Annual Scientific Conference



DIFFERENTIATION OF MEMBERS OF THE MYCOBACTERIUM TUBERCULOSIS COMPLEX USING A
LUMINEX ASSAY

Authors:Meenu Sharma*, Sara Christianson, Joyce Wolfe

Background: Rapid differentiation of members of the Mycobacterium tuberculosis complex (MTBC) has
important clinical and epidemiological applications. Current methods include sequence analysis or probe-
based systems such as the Genotype MTBC strip (HainLifescience). Sequence analysis can be time
consuming, and the GenoType MTBC strips can be cumbersome to work with in large numbers and the data
must be manually interpreted from the strip. Molecular differentiation is based largely on single nucleotide
polymorphisms (SNPs) within multiple genes in the MTBC genome. The Luminex system allows for
simultaneous detection of up to 600 probes for specific nucleotide sequences within a segment of DNA. We
have applied this methodology to the identification of the SNPs that are currently used to differentiate MTBC
members.

Methods: Primers for PCR and probes for the Luminex assay were developed that corresponded with SNPs
in the gyrB, pncA, 16srRNA genes along with, region of difference (RD) 1. Luminex probes included each
previously observed nucleotide at SNP sites. Polymerase chain reaction and hybridization conditions were
optimized for each of the PCR products and probes. Probes were coupled to polystyrene beads which were
detected using the LuminexFlexMap 3D system. DNA sequences were confirmed using Sanger-based
sequencing.

Results: Amplification of the various genes was successful in each of the complex members tested. Probes
were hybridized to a panel of strains with sequences representing each of the probe sequences. All of the
probes were successfully hybridized and detected using the Luminex system. Optimization of conditions
shows that the PCR and hybridization conditions lend themselves to multi-plexing of these assays.

Conclusions: The Luminex system is able to provide high throughput, rapid and accurate differentiation of
members of the MTBC complex. This system is advantageous due to its rapid turn around time, ability to
multi-plex, and expandability.




                                                         28
                                           KNH 4th Annual Scientific Conference



INNATE IMMUNE RESPONSES AT GUT EPITHELIAL SURFACES

Authors: Mwende M. Mutuku1, Denise Kelly2, Annaig Lan2 and Murenga Mwimali3

Affiliations: 1 P.O. Box 455-00204 Athi River, Kenya, 2Rowett Institute of Nutrition and Health, University of
Aberdeen, Bucksburn, Aberdeen AB21 9SB, Scotland, 3African Centre for Crop Improvement, University of
KwaZulu Private Bag X01 Scottsville 3209 KwaZulu-Natal, South Africa.

Background: Several studies have been carried out on host microbe interactions in vitro to assessthe
impact of microbial-associated molecular patterns (MAMPS), pathogenic and commensal bacteria on
epithelial toll-like receptor (TLR) signalling. In this study, human intestinal epithelial cell lines (Caco2, HT-29
and T84) were used to compare and contrast biological effects of different Toll-Like receptor (TLR) ligands.
Nuclear Factor Kappa B (NF- B) an important transcription factor linked to TLR activation downstream was
investigated. Hypothesis: Commensal and pathogenic bacteria differentially modulate innate immune
responses at level of intestinal epithelial cells.

Objective: To assess the role of Toll-Like receptor (TLR) ligands and defined commensal and pathogenic
bacteria by studying host cell interaction in vitro.

Methodology: Activation and nuclear recruitment of the NF- B subunit, p65 (RELA) was determined using
immunocytochemistry in response to TLR ligands and gut bacteria. Similarly, cytokine and chemokine
expression were determined at the gene and protein level using RT-PCR and cytometric bead arrays.

Results: The results suggest that the influence of different MAMPS, commensal and pathogenic bacteria on
immune responses at gut epithelial surfaces can be deduced.

Conclusion: The findings may imply that cytokine and chemokine profiles indicated by the human intestinal
epithelial cells are important determinants of innate immune cell recruitment and maturation. These
observations indicate that such events either promote intestinal mucosal homeostasis or drive pro-
inflammatory responses associated with inflammatory bowel disease (IBD).

Keywords: Toll-Like receptors, MAMPs, Nuclear Factor Kappa B, cytokine, chemokine, inflammatory bowel
disease




                                                           29
                                         KNH 4th Annual Scientific Conference




ATYPICAL TERATOID RHABDOID TUMOUR – A CASE REPORT

Authors:Barasa K. A, Okemwa M. P

Affiliations:Department of Human Pathology, School of Medicine, University of Nairobi

Introduction: Atypical teratoidrhabdoidtumours (AT/RT) are rare, highly aggressive and progressive
malignant neoplasms primarily seen in infancy and early childhood. Majority are intracranial, with
approximately two-thirds of the cases arising in the posterior fossa. This tumour is associated with a poor
clinical outcome.

Case Report: A nine month old male presented with a one-month history of progressive head enlargement,
and associated projectile vomiting and regression of milestones. Computed tomography of the brain showed
a large posterior fossa midline tumour with prominent calcification, cystic areas, and associated
hydrocephalus. Intra-operatively, a whitish grey midline tumour was encountered, that was adherent to the
dura and compressing the right cerebellar hemisphere. Debulking of the tumour was done.
Histopathological examination showed an atypical teratoidrhabdoidtumour, composed of large, markedly
pleomorphic cells with eccentric nuclei and dense eosinophilic cytoplasm, and smaller neuronal cells with
prominent nucleoli. Post-operatively, the infant did not regain consciousness, and was declared brain-dead
on the ninth post-operative day.

Conclusion: AT/RTs are associated with malignant local invasion, and gross total resection is seldom
possible because of their size and attachment to surrounding structures. They are histologically-mixed
tumours, with most featuring a population of large cells with ample eosinophilic cytoplasm, called “rhabdoid”
cells, in combination with other smaller cells. Recognition of the “rhabdoid” element by the pathologist is
critical because this phenotype correlates with a significantly poor prognosis. Survival times are brief, 6
months to 1 year, despite aggressive chemotherapy. Differentiation of AT/RT from other brain tumours is
important because of the poor prognosis and necessity for more aggressive treatment.




                                                         30
                                        KNH 4th Annual Scientific Conference




MACROCYSTIC MENINGIOMA: A CASE REPORT OF A RARE CASE

Authors: DR. M.P Okemwa,SamiEldirdiri


Affiliations: University of Nairobi

Summary and Background: this is the first case reported, to the best of our knowledge, in the available
English literature of Macrocystic meningioma.

Objectives: to report a rare case of meningioma from the KNH theatre 9.

Design: A 43 years female with 4 years history of headache and 2 years history of deteriorating vision by
the time she has been operated she was bling A CT scan showed a a large 6x5 cm Sella/Suprasella mass
expanding and eroding the sellaturcica mixed solid and cystic components with hyperdense capsule. The
mass extends into the right frontal & temporal lobes with effacement of ipsilateral and dilatation of
contralateral lateral ventricles.

Results: Clinical and radiological findings favored a craniopharyngioma rather than a meningioma because
of the cystic material involved. Intraoperative cytology, histology and immunohistochemistry confirmed the
diagnosis

Conclusion: it’s unusual that meningioma to form cyst thus a rare case of Macrocystic meningioma was
presented. KNH theatre 9 encounters many rare cases hence implementation and adoption of proper
diagnostic modality at the proper time is essential for the correct diagnosis and the patient management.




SIMULTANEOUS DETECTION OF ENTERIC BACTERIAL PATHOGENS IN DIARRHOEAL STOOL
SPECIMENS FROM CHILDREN LESS THAN FIVE YEARS OF AGE ATTENDING MBAGATHI DISTRICT
HOSPITAL

Author: Ndege Alice Akeyo1.,Kariuki Samuel2., Muigai W. T. Anne3..

Affiliations:1Institute of Tropical Medicine and Infectious Diseases, JKUAT / KEMRI, 2Centre for Medical
Microbiology Research, KEMRI, 3Jomo Kenyatta University of Agriculture and Technology



                                                        31
                                          KNH 4th Annual Scientific Conference



Background:Bacterial pathogens continue to be the most common cause of enteric infections that lead to
diarrhoea. Diarrhoea continues to be a major cause of morbidity and mortality in children less than five
years and yet it is preventable when preventive measures are put in place.Diarrhoea is rated by the World
Health Organization as the second contributory factor in the mortality and morbidity of children together with
worm infestation. Multiplex polymerase chain reaction (mPCR) enables simultaneous amplification of many
targets of interest in one reaction by using more than one pair of primers.

Rationale; Infections due to bacterial pathogens have a vast effect on the systems of the patients involved
and children are very susceptible to environmental health related diseases such as diarrhoea and worm
infestations due to their under developed immune systems (Garrett, et al., 2008). The major factors
contributing to diarrhoea morbidity and mortality in developing countries are lack of access to safe clean
water and sanitation,(Garrettet al., 2008).

Objectives: To simultaneously detect enteric bacterial pathogens from stool specimens from children less
than five years diagnosed with diarrhea and are seeking health care at Mbagathi District Hospital

Methods:100 stool samples from children less than five years with diarrhea was collected in poly pots. The
samples were enriched on Selenite F, and then grown on XLD and MacConkey agar. Biochemical tests
were carried out to differentiate the organisms. DNA was isolated directly from stool samples and amplified
using Multiplex PCR. Amplifications were carried out using a Robocycler gradient 40 temperature cycler.
The DNA fragments were separated in 2% agarose gel.

Results:73%of the samples were positive for Salmonella and Shigella, 26% were positive for
Campylobacter spp, 6% for Vibrio spp.whilenoClostridiumdifficiletoxinBweredetected using multiplex PCR.
Multiplex PCR was found to be both sensitive and specific allowing the detection of the organisms present in
the stool samples as opposed to the standard culture method in which some of the organisms were not able
to be detected.

Conclusion and Recommendation:mPCR was found to be sensitive, reproducible, specific and simple to
perform, providing a new tool with the potential to be employed for epidemiological and diagnostic purposes.
mPCR was able to simultaneously detect Salmonella,Shigella, Vibrio, and Campylobacter from stool
samples obtained from children seeking health care at the peadriatic clinic at the Mbagathi District Hospital.




                                                          32
                                          KNH 4th Annual Scientific Conference




                                DAY 2, THURSDAY 14TH OCTOBER, 2011
                                             VENUE B




MRI SAFETY

Author: Veronica W. Njagi


Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to visualize detailed
internal structures. MRI makes use of the property of nuclear magnetic resonance (NMR) to image nuclei of
atoms inside the body. An MRI machine uses a powerful magnet to generate an image.

MRI provides good contrast between the different soft tissues of the body, which make it especially useful in
imaging the brain, muscles, heart, abdomen and pelvis compared other medical imaging techniques. Unlike
CT scans or traditional X-rays, MRI uses a magnetic field not ionizing radiation .

MRI is generally a safe procedure, but it is important to be aware of potential danger it can cause especially
if the patient is not well prepared and cancelled.

The powerful magnetic field of the MR system will attract iron-containing (also known as ferromagnetic)
objects and may cause them to move suddenly and with great force which can lead to catastrophic
accidents. It is vital that you remove all metallic belongings in advance of an MRI exam, including watches,
jewelry, and items of clothing that have metallic threads or fasteners.

There is also the question of claustrophobia where some patients who undergo MRI examinations may feel
confined, closed-in, or frightened.

Is MRI safe in pregnancy? How about in paediatric patients?

The objective of this presentation is to attempt to answer the above questions and also to prepare the
clinician and potential clients on the safety measures of MRI, patient preparation before and during an exam.
It will also outline the various implants and prostheses that are unsafe during an MRI examination, staff,
public and environmental safety.




                                                          33
                                             KNH 4th Annual Scientific Conference




TITLE: ROLE OF MRI IN ONCOLOGY

Author: R. Nyabanda

Statistics in Kenya has shown that about 50 Kenyans die daily from various forms of cancers. According Pact Kenya
Cancer Assessment in Africa and Asia (2010), about 80,000 cases of Cancer are diagnosed each year. There are
more Cancer cases being reported in Kenya now than 10 years ago. Sadly, most of the reported Cancers are
diagnosed at late stages, when very little can be achieved. Increasingly, younger Kenyans seem to be more affected
by Cancer, unlike in the past, when it was considered a disease of the old.

In KNH data bank the statistics show similar trend with increase prevalence and incidence of cancer in both adult and
paediatric age group.Cancer has emerged as a major public health problem in developing countries, matching its
effect in industrialized nations.

The clinical management of cancer requires a multidisciplinary team consisting of medical oncologists, surgeons,
radiotherapists, pathologists, radiologists, oncology nurses, counselors, and palliative care specialists among others.
To reduce patient morbidity and mortality, screening programmes, early diagnosis and treatment is very important.

Radiodiagnosis plays an important role in the early diagnosis and management of these patients. With newer imaging
modalities, including ultrasound, CT, MRI and interventional procedures we are now able to diagnose and stage
cancers early. Interventional procedures also play an important role in tissue diagnosis and delivery of
chemotherapeutic agents.

MRI is a new imaging modality that plays an important role in detection and staging of cancer. This paper gives an
overview of the various regions where MRI is important in screening, diagnosis and staging of cancer. It will also give
the advantages and limitations of MRI vis-a-vis other imaging modalities.




OVERVIEW OF EMERGENCY IMAGING REQUESTS FROM ACCIDENT AND EMERGENCY
DEPARTMENTAT KNH

Author:W.N Ndaihera


There is a tremendous increase in imaging requests from the accident and emergency department (A&E) at
KNH. These requests include CT Scans,Ultrasound, and general X-ray examinations.Doppler ultrasound
examinations requests have also increased.There is a tendency to use imaging services for screening
patients.CT scan examinations are the most misused.This raises concern due to the radiation doses
received by patients.The objective of this article is to raise awareness amongst clinicians in A&E department
and other areas, the shortcomings of these requests and evaluate whether the results contribute to better
management of the patients.


                                                             34
                                          KNH 4th Annual Scientific Conference




EFFECTS OF OCULAR LUBRICANTS ON CONJUCTIVA AND CORNEA POST ULTRA SOUND
PROCEDURE

Author:Owen W. Ogony

Problem:Incidences of corneal cloudiness and conjuctival injection were observed in patients undergoing
ophthalmic ultrasound procedure using K-Y Jelly as interface lubricant.Interface lubricants enable good
sound transmission during ultrasound procedure.

The objective: Was to compare the effects of the lubricants on the cornea and conjunctiva and to give
recommendation based on the above findings.

The study was both prospective and retrospective. Private patients and/or clients referred for ultrasound
examination and were not KNH eye clinic patients and any other patients who could not come for follow-up
were excluded.

Three types of lubricants were used for the study: Maitri Jelly, Johnson and Johnson K-Y Jelly and 2%
Viscoelastic Gel (Sodium Hyaluronate).

A total 57 cases for ophthalmic ultrasound were studied of age range 0-70 years (mean = 36.6, median =
31, mode = 20-30). 20 patients were subjected to Maitri Jelly, 18 to Johnson and Johnson Jelly and 19 to
Viscoelsastic Gel for ophthalmic ultrasound. 18 had conjuctival injection with Maitri Jelly, 7 with Johnson K-
Y Jelly and 0 with 2% Viscoelsastic Gel. Two (2) patients developed cloudy cornea from Maitri Jelly though
this was not statistically significant.

2% Viscoelastic gel is recommended for ophthalmic ultrasound. It is already being used in diagnostic
contact lens procedures and cataract surgery.

USE OF TECHNOLOGY AND INNOVATION IN PATIENT CARE: KNH POISON CENTRE

Author:T. B.Menge,

The growing incidences of poisoning from accidental and deliberate exposures to chemicals have
highlighted the importance of countries having special programmes for poison control and, in particular,
facilities for diagnosis, treatment, and prevention of poisoning.

Kenya has experienced numerous poisoning disasters which have led to death. These include several
instances of methanol poisoning in illegal alcoholic beverages, aflatoxin poisoning due to poor storage of



                                                          35
                                         KNH 4th Annual Scientific Conference



grains, pesticide poisoning and many other cases resulting from deliberate, accidental, environmental or
occupational exposure.

The Poisons Information and Management centre was established in May 2008 at Kenyatta National
Hospital to provide integrated Medicines and Poison information and support management of Poisoning
patients in Kenya and the East and Central Africa region.

This presentation outlines how the centre collects and collates data on Poisoning from the region, utilises
technology to support healthcare providers in management of poisoning patients and collaborates with other
poison centres.




TELEMEDICINE IN KNH

Author:Peter Matoke

World class health facilities embrace the innovations that technology brings to them in order to move with
the times in which we live in. It is high time KNH considered expanding our reach to remote locations within
and outside our boarders, by use of Telemedicine, bearing in mind that we are a teaching and referral health
institution. This is the use of medical information exchanged from one site to another via electronic
communications to improve patients' health status. Closely associated with telemedicine is the term
"telehealth," which is often used to encompass a broader definition of remote healthcare that does not
always involve clinical services. Videoconferencing, transmission of still images, e-health including patient
portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all
considered part of telemedicine and telehealth. Telemedicine can be extremely beneficial for people living in
isolated communities and remote regions and is currently being applied in the medical field. Patients who
live in such areas can be seen by a doctor or specialist, who can provide an accurate and complete
examination, while the patient may not have to travel or wait for long hours to be seen. Telemedicine has
been shown to reduce the cost of healthcare and increase efficiency through better management of chronic
diseases, shared health professional staffing, reduced travel times, and fewer or shorter hospital stays,
among many other benefits. This paper seeks to sensitize the Medical fraternity at KNH of; how it works, the
benefits, what does Telemedicine/eHealth offer today for optimizing healthcare at anytime, anywhere?,
lessons learned from how other countries are taking it, what can be done with limited resources?, how we
can benefit from networking with other stakeholders in this venture.




                                                         36
                                          KNH 4th Annual Scientific Conference



TUNGIASIS (JIGGER INFESTATION) IN RURAL KENYA: PREVALENCE AND RISK FACTORS

Authors:Nicholas Njau N *(1), Peter Wanzala(2), Marion Mutugi(1), Liana Ariza (3), JorgHeukelbach(4,5)

Affiliations: 1Institute of Tropical Medicine and Infectious Diseases, Department of Public Health Jomo
Kenyatta University of Agriculture and Technology, Kenya. 2 Kenya Medical Research Institute, Center for
Public Health Research, Kenya.3Post-Graduation Program in Medical Sciences, School of Medicine, Federal
University of Ceará, Fortaleza, Brazil; 4Department of Community Health, School of Medicine, Federal
University of Ceará, Fortaleza, Brazil; 5Anton Breinl Centre for Public Health and Tropical Medicine; School
of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville,
Australia.

Objective: To describe the prevalence of tungiasis (jigger flea infestation) and associated risk factors in a
sentinel group (children 5-12 years of age) in rural Central Kenya.

Methods: A cross-sectional study was carried out in Murang’a South district during high transmission
season (dry season, August – September 2009). A total of 385 randomly selected households were visited.
Children were examined for presence of tungiasis, and a questionnaire was administered to collect
demographic, behavioral and environmental data.

Results: Prevalence of tungiasis was 57% (218/385; 95% CI=51.7%-61.6%). Itching (89.1%) was the most
common associated symptom, followed by pain upon pressure (67.3%), sleep disturbance (58.2%) and
walking difficulties (53%).In multivariate logistic regression analysis the following independent factors were
identified to be associated with tungiasis: living in houses with an earthen floors (adjusted OR=3.84; 95%IC:
2.09-7.06), walking barefooted (OR=3.28; 1.78-6.04), having a common resting place outside the house
(OR=2.36; 1.01-5.51) and presence of rats on the compound (OR=1.69; 1.03-2.75).

Conclusion:Tungiasis is a neglected disease found in Africa. It is highly endemic in rural Central Kenya and
associated with considerable morbidity. The disease is associated with poverty. Modifiable risk factors were
identified that should be the focus of sustainable and effective control measures.

Key words: tungiasis, modifiable risk factors, Morbidity, epidemiology, prevalence, Kenya




                                                          37
                                          KNH 4th Annual Scientific Conference



BIOMARKERS IN CARDIOVASCULAR DISEASE: YESTERDAY, TODAY AND TOMORROW.

Authors: Matheka Cyrus Wambua1, Peter Waweru2.

Affiliations:1School of Medicine-University of Nairobi 2Department of Medical Physiology-University of
Nairobi

Background: Cardiovascular diseases remain a paramount focus of basic and clinical investigation. They
are the leading cause of death in developed countries and their prevalence is increasing in the developing
countries. Early detection of the formation and progression of atherosclerotic plaques is therefore essential.
Proteomics is a tool designed to address this need at the level of signal transduction, organelle and cellular
mechanism and biomarker development. This review examines the increasing use of traditional and novel
biomarkers that are transforming cardiovascular medicine.

Objective: To review the literature on the use of biomarkers with diagnostic, prognostic and therapeutic
value in cardiovascular medicine.

Design and methods: Retrospective literature review of published articles. Search strategies using the
words ‘biomarkers and cardiovascular disease’ were employed.

Results: Several biomarkers were found to predict a higher cardiovascular disease risk, provide diagnostic
information and serve as therapeutic targets. These could be classified as inflammatory markers,
haemostatic/rheological markers, lipid associated markers, metabolic markers, oxidative stress markers,
necrosis factors, markers of endothelial activation/dysfunction and proteolysis markers. Biomarkers
identified using proteomic analyses were found to be among the newest biomarkers of identifying a sub-
population of persons with high risk for cardiovascular disease.

Conclusion: The application of a biomarker approach provides opportunities to improve our understanding
of cardiovascular pathophysiology and enables improved diagnosis and therapeutic approaches. Early
screening of patients using biomarkers elevated early in disease may go a long way in reducing
cardiovascular morbidity and mortality. Use of biomarkers may also help in evaluating the response to
therapeutic intervention




                                                          38
                                         KNH 4th Annual Scientific Conference



ISOLATION AND GENETIC CHARACTERIZATION OF HUMAN PARAINFLUENZA VIRUSES FROM
CHILDREN AT KENYATTA NATIONAL HOSPITAL WITH ACUTE RESPIRATORY INFECTIONS

Author:Beverlyn Jacqueline Manjeri1.,Muigai W.T. Annel2., Late Walter Ochieng 3

Affiliations:1Institute of Tropical Medicine and Infectious Diseases, J.K.U.A. 2Jomo Kenyatta University of
Agriculture and Technology,3 National Influenza Centre KEMRI

Objectives: To isolate, identify and characterize HPIV virus isolates in children with ARI at KNH.To isolate
and identify HPIV from the clinical samples in children with ARI, To determine the most prevalent serotype of
HPIV in children. To determine the genetic character of HPIVs & their phylogeny.

Methods: The samples collected were inoculated to LLCMK2 cell line, which had been prepared from a
T75cm2 flask and later seeded to a 24-well plate. The cells were examined every other day for the presence
of cytopathic effect (CPE).
The wells showing CPE were marked and after 12days the 24-well plate was frozen at -800C.and prepared
for IFA.RNA was extracted from HPIV positive samples using the QiAmp Viral RNA kits (QIAamp viral RNA
mini kit®, Qiagen), according to the manufacturer’s protocol at −80 ◦C until the day when PCR would be ran
on the samples. Primers for PCR targeting the haemagglutininnucleocapsid genes of hPIV1 (Echevarria et
al., 1998) and hPIV3 (Karron et al., 1994) were used.

Results: It was found out from the results that human parainfluenza viruses were a major cause of
respiratory infection in children at Kenyatta paediatric ward from Kenyatta national hospital. The virus
caused more cases of lower respiratory infections of 74% than upper of 26% it was also very clear that
HPIV-1 and HPIV-3 were highly isolated from the samples,

Conclusion and Recommendation: The Human parainfluenza viruses causes most of acute respiratory
infection in children, therefore these results can be used to spearhead the manufacture of the vaccine
against these virus.


COMPLETE CONGENITAL ATRIOVENTRICULAR BLOCK

Author:Christopher Maina.

We present a case of congenital atrioventricular block diagnosed in utero and confirmed on birth. AK, 22
year old primigravidae reported to her gynaecologist at a peripheral facility in Meru complaining of reduced
foetal movements at 32 weeks gestation. A uterine ultrasound was done in Meru. It was reported to reveal
severe foetalbradycardia, with a fetal heart rate of 40 beats a minute. with markedly reduced contractility.
The mother was referred to our facility for further evaluation and management. A repeat ultrasound
confirmed the bradycardia but in addition, there was a massive foetal pericardial effusion with markedly

                                                         39
                                          KNH 4th Annual Scientific Conference



reduced contractility and ascitis, features of hydropsfoetalis. The mother was blood group O positive. VDRL
and HIV were negative. A decision to deliver the baby was made and the mother was put on a three dose
cause of Dexamethasone to help mature the lungs.

The baby was delivered by caesarean section on 27/5/11 at 32 weeks (LMP 8/10/10 with EDD 15/7/11). The
baby weighed 1400 grams. The baby scored 6/1, 8/5, 8/10. The baby could not attain a score of 10 on the
APGAR scale as the heart rate remained at an ff 40 BPM. However, the baby was considered stable based
on other criteria; for example the saturation were with normal, been above 97% on room air. The baby was
however very tachypaenic with a respiratory rate of 80/min. She was therefore put on oxygen to reduce the
work of breathing. A 12 lead ECG was done. It showed complete heart block with a ventricular rate of
42BPM and an atrial rate. A pacemaker was successfully implanted and the baby is thriving well with good
weight gain.




INFECTION CONTROL: CURRENT ISSUES ON STANDARD PRECAUTIONS

Author: Joan Shisoka1,2 .

Affiliations: University of Nairobi2, Kenyatta National Hospital1

Introduction: A standard precaution is the primary strategy for successful Nasocomial infection control and
exposure reduction for healthcare workers and clients. To date, the only protection against infection is to
minimize risk by modifying behavior and practice patterns. Education and communication play a major role
in enhancing the precautions.

Background: In today’s rapidly changing healthcare environment protecting healthcare workers and
patients from pathogen transmission has become more difficult and more imperative.
Currently infections cause an overwhelming 87,000 maternal deaths worldwide annually. In Kenya, sepsis is
the second major cause of maternal deaths as well as worldwide (Wendy& Barbara, 1999)

Objective: To determine knowledge, attitude and practice of standard precautions on infection
prevention and control among nurses at KNH main theatres

Methodology: Study design; descriptive cross sectional study, Study area; KNH main theatres
Sampling method; simple random sampling, 78 theatre nurses were interviewed
Study instrument; Questionnaire, Data analysis; SPSS, Data presentation; tables, graphs and pie charts

Findings: 98% respondents were aware of standard precautions, 68% were able to state the SP
guidelines. 71% said SP should be routine, 17% SP should be applied when there is contact with body


                                                          40
                                        KNH 4th Annual Scientific Conference



fluids, while 12% said should be applied when dealing with infectious cases only. Hand washing was a major
concern where 49% routinely hand washed before, after and between procedures.

Conclusion: The nurses were knowledgeable on SP. There was care free attitude on SP. The practice was
wanting where the respondents applied SP on confirmed infectious cases. Basic practices such as hand
washing were not adhered to.




NON COMMUNICABLE DISEASES A GLOBAL HEALTH PROBLEM

Author:Adegu William Jacob

Objectives: To understand effects of non-communicable diseases both life expectancy and economic
intensification, to compare Non communicable diseases versus infectious diseases, to understand levels of
prevention of Non communicable diseases, to understand demography and globalization, to understand the
hindrances to Non communicable diseases action. WHO’s response and Strategies to reduce risk.

Design: This presentation is done in PowerPoint. It also incorporates charts, reference information from
reliable sources and is in three dimension. It covers the main aspects of non communicable diseases
globally and narrows down to effects of non communicable diseases on vision 2030 (which is more relevant
in reference to our local population)

Results: Expected results and their tabulation explained.

Conclusion: Non communicable diseases are overriding infectious diseases and therefore double the
burden of diseases in most developing countries, hence necessitates global attention and action.




                                                        41
                                          KNH 4th Annual Scientific Conference




                                     POSTER PRESENTATIONS


P1.1 CHILDHOOD CANCER; MOTHERS AWARENESS AND UNDERSTANDING OF CAUSATIVE
FACTORS IN CHAKOL DIVISION OF TESO DISTRICT IN WESTERN PROVINCE OF KENYA

Author: Seruya Apalat Otiti
Affiliation: Kenyatta National Hospital

Introduction: Early detection of childhood cancers is key to effective management. It is therefore necessary
that mothers have requisite knowledge on early signs and symptoms of these cancers.

Objective: To determine mothers’ awareness of childhood cancer in Chakol division of Teso District, Kenya.

Methodology: 100 mothers were subjected to oral interviews to determine their awareness and baseline
knowledge on cancer and causative agents.

Results: 64 of 100 (64%) defined cancer as a swelling but 29 (29%) did not know what cancer is. 72% had
seen someone with cancer, 7%, a child with cancer. 49 of 100 (49%) did not know what causes cancer while
12 of 100 (12%) thought that cigarette smoking causes cancer. Recommendation: Early detection, prompt
and efficient management could be realized if mothers were educated on early signs and symptoms of
childhood cancer.




HIGH-
DOSEVALACYCLOVIRSUPPRESSIVETHERAPYRESULTSINGREATERREDUCTIONINPLASMAHIV-1
LEVELSCOMPAREDTOSTANDARDDOSEACYCLOVIRSUPPRESSIONAMONGHIV-1/HSV-2CO-
INFECTED PERSONS:ARANDOMIZED,OPEN-LABEL,CROSSOVERTRIAL

Authors: K. Mugwanya1; J. Baeten1,2,3 ; N. Mugo1,4; E. Irungu3,4; K. Ngure4; C. Celum1,2,3


                                                          42
                                         KNH 4th Annual Scientific Conference




Affiliations: 1 Department of Global Health, University of Washington, Seattle, USA;Departments of
Medicine2, and Epidemiology3, University of Washington, Seattle, USA; 4Kenyatta National Hospital,
Nairobi, Kenya

Background:StandarddosesofHSV-2suppressivetherapy(acyclovir400mgtwicedaily) reducedplasmaHIV-
1levels    by~0.25log10copies/mLandriskofHIV-1disease progression    by16%amongHIV-1/HSV-2co-
infectedpersons.WhetherhigherdoseHSV-2suppressive                therapymightfurthersuppressHIV-1
levelsisunknown.
Methods:Weenrolled32HIV-1/HSV-2co-infected,antiretroviral-naïve                       individualswith
CD4>250cells/µ LinThika,Kenyaintoarandomized,open-label,cross-overtrialoftwo            dosesofHSV-
2suppression:valacyclovir1.5gtwicedailyoracyclovir400mgtwicedailyfor12 weeks,2 weekswash-out,and
thenthealternativeregimenfor12weeks.WeeklyplasmaHIV-1                 RNAquantitywasmeasuredbyPCR.
(ClinicalTrials.govnumber NCT01026454)

Results: At enrollment, mean plasma HIV-1 RNA was 4.10 log10 copies/mL, all had detectableHIV-
1RNA,andmedianCD4countwas441cells/mm3.                                               MeanplasmaHIV-1
levelsweresignificantlyloweronvalacyclovircomparedwithacyclovir(figure1),by0.62
log10copies/mL(95%confidence        interval:-0.68,  -0.55;    p<0.001),a76%    decrease.   HIV-1was
undetectable(<40copies/mL)in13.5%ofweeksonvalacyclovirversus3.2%ofweekson
acyclovir(p=0.02).Adherence                         wassimilarbyarm:median99.4%ofdispensedstudytablets
takenasmeasuredbypillcount.


CONTRACEPTIVE DISCONTINUATION BY RURAL KENYAN WOMEN IN HIV DISCORDANT
PARTNERSHIPS AFTER EXITING AN HIV PREVENTION TRIAL

Authors: Kenneth Ngure , Jared Baeten, JairamLingappa, Renee Heffron, Paul Musingila, Elizabeth Irungu,
Peterson Mwaniki, Lawrence Mwaniki , Ruth Wamae , Simon Mburu, Nelly Mugo

Background: Women in biomedical HIV prevention clinical trials are frequently counseled to use effective
contraceptive methods in order to avoid pregnancy during the study and consequent withholding of study
products. Moreover, research study participants often have access to medical care at research clinics that
might not otherwise be as readily available in their communities. We evaluated change in contraceptive use
among women after exiting from a biomedical HIV prevention clinical trial in Kenya.

Methods: The Partners in Prevention HSV/HIV Transmission Study enrolled HIV serodiscordant couples at
14 sites in East Africa and Southern Africa, including a site in Thika, Kenya. Participants were offered
contraception free-of-charge at the research site during the clinical trial. Unblinding visits, at which the
results of the trial were conveyed to participants, were conducted after the trial results were reported.
Contraceptive use data were collected at the trial exit visit and at the later study unblinding visit.




                                                         43
                                          KNH 4th Annual Scientific Conference



Results: Among 213 women from Thika in the trial, 114 returned for the unblinding visit, of whom 80
(70.2%) were HIV positive. The median time between exit and the unblinding visit was 1.11 years (ranging
from 0.84 - 2.13 years). Non-barrier contraceptive prevalence (i.e. use of oral, injectable, implantable
contraceptives, intrauterine devices [IUD] or surgical) dropped from 62.3% to 47.4% (P=0.01) between exit
and unblinding visits: from 70.0% to 53.8%, (P=0.03) among HIV positive women and from 44.1% to 32.4%,
(P=0.31) among HIV negative women. However, the prevalence of IUD use among the HIV positive women
increased from 3.8% to 20%, (P=0.002) during this period. Additionally, the proportion of women who were
using condoms as their sole contraceptive method decreased, from 29% at study exit to 1.8% at the
unblinding visit (P<0.0001), resulting in greater numbers of women who were not using any contraceptive
method.

Conclusions: There was a high rate of contraceptive discontinuation, both hormonal and barrier
methods, after women exited from a biomedical HIV prevention trial. Discontinuation of contraception may
reflect participant fertility desires after trial procedures are completed, or may reflect loss of clinical and
counseling services available during the study. Innovative strategies to support the contraceptive needs of
women after exiting HIV prevention trials are urgently needed.




                                                          44

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:282
posted:11/20/2011
language:English
pages:44