KNH-UoN Ethics and Research Committee

To identify and describe populations at risk for HIV in 3 clinical research centers in Kenya and South Africa. DESIGN: Prospective cohort study. METHODS: Volunteers reporting recent sexual activity, multiple partners, transactional sex, sex with an HIV-positive partner, or, if male, sex with men (MSM; in Kenya only) were enrolled. Sexually active minors were enrolled in South Africa only. Risk behavior, HIV testing, and clinical data were obtained at follow-up visits. RESULTS: From 2005 to 2008, 3023 volunteers were screened, 2113 enrolled, and 1834 contributed data on HIV incidence. MSM had the highest HIV incidence rate of 6.8 cases per 100 person-years [95% confidence interval (CI): 4.9 to 9.2] followed by women in Kilifi and Cape Town (2.7 cases per 100 person-years, 95% CI: 1.7 to 4.2). No seroconversions were observed in Nairobi women or men in Nairobi or Cape Town who were not MSM. In 327 MSM, predictors of HIV acquisition included report of genital ulcer (Hazard Ratio: 4.5, 95% CI: 1.7 to 11.6), not completing secondary school education (HR: 3.4, 95% CI: 1.6 to 7.2) and reporting receptive anal intercourse (HR: 8.2, 95% CI: 2.7 to 25.0). Paying for sex was inversely associated with HIV infection (HR: 0.2, 95% CI: 0.04 to 0.8). 279 (13.0%) volunteers did not return after the first visit; subsequent attrition rates ranged from 10.4 to 21.8 volunteers per 100 person-years across clinical research centers. CONCLUSIONS: Finding, enrolling, and retaining risk populations for HIV prevention trials is challenging in Africa. African MSM are not frequently engaged for research, have high HIV incidence, need urgent risk reduction counseling, and may represent a suitable population for future HIV prevention trials.

Background: Subarachnoid Haemorrhage (SAH) has been shown to have a global incidence of 2-49 cases per 100 000 population, and it is associated with a high morbidity and mortality. There is a scarcity of data regarding this condition in Kenya. This paper presents the causes and risk factors for this condition in patients presenting to our hospital.
Methods: This descriptive cross sectional study was conducted in Kenyatta National Hospital in Kenya. All patients admitted between December 2010 and March 2011 with a diagnosis of SAH, were included in the study. A total of 55 patients with SAH were recruited in the study.
Results: Slightly more females suffered from SAH than men, with a male: female ratio of 1: 1.1. The mean age was 47.6 years with a modal age group being 41-50 years. Intracranial aneurysms were seen in 29% of patients, the commonest location being in the anterior communicating artery (31%). Arterio-venous malformations were seen in 4% of patients. 51% of the patients had poorly controlled hypertension. Other risk factors included alcohol intake (31%), cigarette smoking (15%), and use of hormonal contraceptives was reported in 22% female study subjects.
Conclusion: In our population, the commonest cause of spontaneous SAH is aneurysmal bleeds mainly in the anterior circulation. Further, most of the risks involved in causation of SAH are modifiable therefore interventions such as proper blood pressure control should be put in place so as to reduce the burden of this disease.

Ventriculoperitoneal shunt complications have scarcely been reported in sub-Saharan Africa. This study aimed at determining the frequency of these complications and their associated risk factors in a Kenyan National Teaching and Referral Hospital. {METHODS} This cross-sectional study retrospectively covered 117 patients admitted to the Kenyatta National Hospital neurosurgical ward between January 2005 and December 2007 with ventriculoperitoneal shunt complications. The data obtained were analysed using the Statistical Package for the Social Sciences. {RESULTS} The most common complication was obstruction in 63 patients (53.8%), followed by migration in 25 (21.4%) and infection in 23 (19.7%) of the patients. Up to 49.6% of the complications occurred in patients younger than 6 months. Multiple complications were seen in 23.9% of the cases. The mean shunt duration was 18.05 months. Positive correlations existed between the presence of a shunt complication and patient age, shunt duration and the number of complications developed. These correlations were, however, neither strong nor statistically significant. {CONCLUSION} This study reports the highest frequencies of shunt obstruction and migration ever recorded in the literature. The high rate of development of multiple shunt failures coupled with a short shunt duration calls for a closer monitoring of patients with ventriculoperitoneal shunts

No Abstract!

Abstract

OBJECTIVE: To determine the outcome of severe traumatic brain injury and to document the factors influencing mortality.
DESIGN: A six months prospective study. SETTINGS: The intensive care unit (ICU) of Kenyatta National Hospital (KNH), a tertiary referral centre in Kenya.
SUBJECTS: Eighty Seven adult patients with severe traumatic brain injury admitted between April and September 2005.
METHODS: Basic demographic, clinical, radiological and mechanism of injury data were recorded at admission and during ICU stay. The main outcome measure was survival or death.
The outcome groups were compared for the injury severity, mean arterial pressure, serum glucose level, grade of diffuse axonal injury and the presence of mydriasis and anisocoria
using the X2 test and the Fischers Exact test as appropriate.
RESULTS: Severe traumatic brain injury accounted for 14.3% of all ICU admissions. This study included 73 men (83.9%) and 14
women (16.1%) with a mean patient age of 34 ± 17 years. Motor vehicle accidents were the main cause (58.6%). Forty six patients (54.0%) died. Twenty nine percent of patients had
persistent vegetative state or severe disability. Factors that were associated with poor outcome on univariate analysis were Glasgow coma scale of less than 5, diffuse axonal injury and
intracerebral mass lesions and blood sugar greater than 10mmol / L.
CONCLUSION: Severe TBI is a frequent cause of hospital admission to critical care units among young men with a high mortality (54%) rate.

OBJECTIVE: To study the factors influencing the outcome of severe head injury. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Six hundred and seventy seven patients with severe head injuries who were seen at Kenyatta National Hospital between January 1992 and December 1996. RESULTS: Six hundred and seventy seven patients with severe head injuries were treated at Kenyatta National Hospital, between January 1992 and December 1996. Three hundred and eighty one patients died while undergoing treatment, 56.2% overall mortality. Age specific mortality was 35.7% in patients below 13 years, 44% in age group 14-25 years, 56% in age group 26-45 years. The admission Glasgow coma scale (GCS) was recorded in 637 patients. Patients with admission GCS of 3-4 had a mortality of 88%, those with GCS 5-6 had a mortality of 60% and those with admission GCS 7-8 had a mortality of 52%. Ninety per cent of the patients who had bilaterally dilated pupils not reacting to light on admission died and 66% of the patients with bilaterally constricted pupils at the time of admission died. Only 20% of patients with severe head injury who had normal pupillary reaction to light at the time of admission died. Eighty five per cent of the patients with systolic BP of less than 90 mmHg on admission died while 60% of those with systolic BP greater than 120 mmHg died. CONCLUSION: In this study, factors associated with poor outcome in severe head injury patients at Kenyatta National Hospital were age, admission GCS, admission blood pressure (systolic), presence of other associated injuries and pupillary reaction to light.

OBJECTIVE: To study the frequency, mode of presentation and outcome following surgery of anomalies of the craniovertebral junction at the Kenyatta National Hospital. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Thirty eight patients with craniovertebral junction anomaly who were treated at the Kenyatta National Hospital. RESULTS: Thirty eight patients were diagnosed to have craniovertebral junction anomaly at the Kenyatta National Hospital between January 1988 and December 1994. Thirty of those patients underwent surgery. The ages ranged between 10 years and 49 years with a peak in the third decade. The male to female ratio was 2:1. The common mode of presentation was weakness of the extremities (90%) followed by sensory disturbances such as numbness of the extremities (30%), headache (30%) and neck pain (20%). The common clinical findings were ataxia, muscle wasting, sensory loss and brisk deep tendon reflexes. Most of the patients had computerised tomography (CT) scanning (80%) done. Other radiological investigations which were done were plain x-rays of the skull and cervical spine (50%), myelographic studies (36%) and tomographic studies (12%). Forty percent of the patients improved following surgery while further neurological deterioration was prevented in 48%. There was an immediate post-operative mortality of 8%. CONCLUSION: Craniovertebral junction anomaly is an important clinicopathological, condition common amongst certain ethnic groups found in high altitude areas of the Kenya. Surgery may cause clinical improvement in 40% of the patients, mainly those who have been symptomatic for less than three years.
East Afr Med J. 2000 Mar;77(3):162-4.

OBJECTIVE: To study the frequency, mode of presentation and outcome following treatment of gliomas in patients treated at the Kenyatta National Hospital. DESIGN: A retrospective study. SETTING: Kenyatta National Hospital, Nairobi, between January 1984 and December 1993. SUBJECTS: Two hundred and fourteen patients with intracranial tumours who underwent brain surgery at the Kenyatta National Hospital. RESULTS: Two hundred and fourteen histologically confirmed intracranial tumours were seen at the Kenyatta National Hospital between 1984 and 1993. Ninety seven (45.8%) of these were gliomas of which eighty one were astrocytomas, ten ependymomas and six oligodendrogliomas. Meningiomas were the next common tumours (34.4%). Gliomas affected the young age group most, with the peak in the first decade of life. Males were most affected with a male to female ratio of 1.4:1. Features of increased intracranial pressure were the commonest mode of clinical presentation. The parietal region was the commonest site of intracranial gliomas (37.5%). Surgery and radiotherapy were the main forms of definitive/palliative treatment given. The two year survival rate was 25%, for patients who had undergone total tumour excision with or without radiotherapy. Tumour debulking only without post-operative radiotherapy was associated with a seven per cent two year survival rate. CONCLUSION: Gliomas were the commonest intracranial tumours (45.8%) seen at the Kenyatta National Hospital over a ten year period (1983-1994). Radical surgery with or without radiotherapy was associated with a 25% two year survival rate, debulking and radiotherapy with 20% two year survival, biopsy and radiotherapy with 20% two year survival and debulking only with a seven per cent two-year survival. Gliomas are less commonly seen in the Kenyan African in comparison with rates of occurrence in the Caucasian race.
East Afr Med J. 2000 Aug;77(8):444-7.

study infections complicating ventriculoperitoneal (VP) shunt surgery in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. DESIGN: A retrospective survey. SETTING: Kenyatta National Hospital, Nairobi between January 1982 and December 1991. SUBJECTS: Three hundred and forty five patients who underwent V-P shunt placement for non-tumour hydrocephalus. RESULTS: Three hundred and forty five patients underwent V-P shunt placement for non-tumour hydrocephalus. There were 107 infection episodes involving 85 patients. The ages of these patients ranged from three months to 12 years. Most of the patients had congenital hydrocephalus. The infection rate was high (24.6%) although comparable to infection rates reported for clean surgery in the hospital. Fever, septic wounds and features of shunt malfunction were the main presenting features. Bacteriological studies confirmed Staphylococcus aureus and coagulase negative staphylococci as the two most commonly isolated micro-organisms. CONCLUSION: This study emphasises need to reduce infection rate in ventriculoperitoneal shunt surgery at the Kenyatta National Hospital. Definitive surgical treatment for hydrocephalus was in most cases delayed and this problem was also observed during revision of infected shunts. Late presentation was often due to ignorance and the fact that many patients went for traditional forms of treatment first before going to hospital.