Abstract
Introduction: worldwide, plant based medicines are increasing in popularity due to perceptions of safety and efficacy. Herbalists in Kenya are widely consulted for the management of many diseases including Type 2 Diabetes Mellitus (T2DM). This study investigated the level of knowledge of the herbalists in management of T2DM.

Methods: purposive sampling was used to identify 4 herbalists working in the urban areas who actively manage T2DM. Key informant interviews were used to gather data about the management of T2DM. It was analyzed using a content thematic approach.

Results: diverse management methods which included both pharmacological and non- pharmacological were noted. Glycemic control was assessed with the help of a glucometer. In addition, presenting signs and symptoms were key in diagnosing T2DM. The herbalists used various herbs, minerals and animals as medicinal sources. The drugs were dispensed as decoctions with excipients being added appropriately. Adverse effects were recorded. The herbalists acknowledged that patients use both herbal and allopathic medicine together. A level of record keeping was observed but patient follow-up was poor. The cost of the herbal drugs was perceived to be excessive.

Conclusion: some similarities exist in the management of T2DM between allopathic and traditional medicine practitioners. Training of herbalists is required to improve the quality of care given to patients.

Introduction: Worldwide, plant based medicines are increasing in popularity due to perceptions of safety and efficacy. Herbalists in Kenya are widely consulted for the management of many diseases including Type 2 Diabetes Mellitus (T2DM). This study investigated the level of knowledge of the herbalists in management of T2DM.

Methods: Purposive sampling was used to identify 4 herbalists working in the urban areas who actively manage T2DM. Key informant interviews were used to gather data about the management of T2DM. It was analyzed using a content thematic approach.

Results: Diverse management methods which included both pharmacological and non- pharmacological were noted. Glycemic control was assessed with the help of a glucometer. In addition, presenting signs and symptoms were key in diagnosing T2DM. The herbalists used various herbs, minerals and animals as medicinal sources. The drugs were dispensed as decoctions with excipients being added appropriately.
Adverse effects were recorded. The herbalists acknowledged that patients use both herbal and allopathic medicine together. A level of record keeping was observed but patient follow-up was poor. The cost of the herbal drugs was perceived to be excessive.

Conclusion: Some similarities exist in the management of T2DM between allopathic and traditional medicine practitioners. Training of herbalists is required to improve the quality of care given to patients.

No abstract available

 No abstract available.

Field experiments were conducted over two croppi ng seasons to investigate the effectiveness of border crops in managing potato aphids and the associated viruses in seed potato production. Potato plots were surrounded with maize, sorghum and wheat borde rs. Aphid population was monitored on leaves and on yellow sticky traps. Other data collected included virus disease incidence and tuber yield. The border crops reduced aphid popula tion on leaves compared to non-bordered potato plots. More alate aphids we re caught on yellow sticky traps placed inside potato plots than on traps placed inside the border crops. In addition, virus disease incidence was reduced in all plots surrounded by the border cr ops. However, plots surrounded by border crops had reduced tuber yield, although the yield of s eed grade was increased. The results indicated that use of border crops would be beneficial in the management of virus diseases in small-holder seed potato production.

Field experiments were conducted over two croppi ng seasons to investigate the effectiveness of border crops in managing potato aphids and the associated viruses in seed potato production. Potato plots were surrounded with maize, sorghum and wheat borde rs. Aphid population was monitored on leaves and on yellow sticky traps. Other data collected included virus disease incidence and tuber yield. The border crops reduced aphid popula tion on leaves compared to non-bordered potato plots. More alate aphids we re caught on yellow sticky traps placed inside potato plots than on traps placed inside the border crops. In addition, virus disease incidence was reduced in all plots surrounded by the border cr ops. However, plots surrounded by border crops had reduced tuber yield, although the yield of s eed grade was increased. The results indicated that use of border crops would be beneficial in the management of virus diseases in small-holder seed potato production.

Field experiments were conducted over two croppi ng seasons to investigate the effectiveness of border crops in managing potato aphids and the associated viruses in seed potato production. Potato plots were surrounded with maize, sorghum and wheat borde rs. Aphid population was monitored on leaves and on yellow sticky traps. Other data collected included virus disease incidence and tuber yield. The border crops reduced aphid popula tion on leaves compared to non-bordered potato plots. More alate aphids we re caught on yellow sticky traps placed inside potato plots than on traps placed inside the border crops. In addition, virus disease incidence was reduced in all plots surrounded by the border cr ops. However, plots surrounded by border crops had reduced tuber yield, although the yield of s eed grade was increased. The results indicated that use of border crops would be beneficial in the management of virus diseases in small-holder seed potato production.

Field experiments were conducted over two croppi ng seasons to investigate the effectiveness of border crops in managing potato aphids and the associated viruses in seed potato production. Potato plots were surrounded with maize, sorghum and wheat borde rs. Aphid population was monitored on leaves and on yellow sticky traps. Other data collected included virus disease incidence and tuber yield. The border crops reduced aphid popula tion on leaves compared to non-bordered potato plots. More alate aphids we re caught on yellow sticky traps placed inside potato plots than on traps placed inside the border crops. In addition, virus disease incidence was reduced in all plots surrounded by the border cr ops. However, plots surrounded by border crops had reduced tuber yield, although the yield of s eed grade was increased. The results indicated that use of border crops would be beneficial in the management of virus diseases in small-holder seed potato production.

OBJECTIVES: To determine the clinico-pathologic and prognostic factors, treatment and outcome of non-Hodgkin's lymphomas as seen at the Kenyatta National Hospital in the 1990s. DESIGN: Retrospective study of patients with non-Hodgkin's Iymphoma. SETTING: Kenyatta National Hospital, Nairobi, Kenya, between January 1990 and January 2000 inclusive. SUBJECTS: Patients aged 13 years and above, with non-Hodgkin's Iymphomas. RESULTS: Case records were available for 207 patients, 146 males and 60 females, with one having had gender not clarified. Fifty two per cent of the patients were aged less than 40 years and 18.4% over 60 years. Forty one per cent were not properly classified histologically, seventy patients out of 190 evaluable (36.8%) had stages IVA and IVB disease at diagnosis. Twenty five out of 77(32.5%) tested positive for HIV infection, none of them being of the indolent variety. Up to 57.1% of cases of Burkitt's lymphoma tested positive for HIV infection. Cyclophosphamide, doxorubicin, vincristine and prednisone, (CHOP) chemotherapy was given to 68.7% of the patients with complete remission rates of 55.6% for those who got a minimum of six courses of chemotherapy. Only 15.3% of 105 patients evaluable were followed up for 36 months and above, the majority of patients having been lost to follow-up. Poor performance status at diagnosis correlated with shorter follow-up durations (p<0.05). CONCLUSION: A good percentage of the patients were not comprehensively characterized pathologically. Standard treatment was offered to the majority of patients, and those who could afford to purchase the medicines stood good chance of achieving complete remission. Poor performance status at diagnosis correlated with shorter follow-up durations and early stage disease correlated with longer follow-up durations. Overall, the outlook for NHLs treated at KNH in the 1990s appears to have improved tremendously.

Approximately 30-40% of retinoblastoma patients Sub-Saharan Africa have orbital disease at presentation. This presents the ophthalmologist with several challenges among them if to do a primary excentaration or not, if to aim at cure or palliation and which adjuvant therapy to give. At Kenyatta National Hospital, Protocol based management of retinoblastoma developed by the Kenya National Retinoblastoma society has been used to manage these cases with promising success in terms of survival and cosmesis. All retinoblastoma cases with orbital disease are evaluated for distant metastases and if free, then aim to cure treatment started with Chemoreduction. After the proptosis reduces, enucleation with primary orbital implant is done. Chemotherapy is then continued to a total of six courses then radiotherapy upto 40 Grays.

Male erectile dysfunction is common although some patients are embarrassed and delay seeking medical advice. Recent improvements in the understanding of the anatomy, physiology and pharmacotherapy of penile erections, and the introduction of intracavernosal pharmacotherapy has resolved most of the controversies regarding the aetiology of erectile dysfunction. Impotence is equally divided into organic and psychogenic causes. Arterial insufficiency, alcoholism, venosinusoidal, neurological and endocrine disorders are known to cause organic erectile dysfunction. Two most popular options in the management of erectile dysfunction are intracavernosal injections with vasoactive drugs like papavarine, phentolamine, and prostaglandin EI with discontinuation rates of 40-50%, and the use of external vacuum devices whose limitations include failure to achieve and maintain full erection. The use of inflatable penile prostheses is successful but limited with periprosthetic infection and cylinder erosion through the skin or urethra. Surgical procedures have included revascularisation of penile vessels without good results. Surgical ligation of penile veins for venosinusoidal incompetence has been successful compared to excision and embolisation which has disappointing results. Currently the role of oral medications in the treatment of erectile dysfunction is limited. However, there are now several new agents including sildenafil, a phosphodiasterase inhibitor, which is undergoing clinical trials that appear to be effective.

Abstract

Healthcare waste management in health facilities should include quantification of all categories to support minimisation strategies. The hazardous healthcare waste categories under study, infectious, pathological, sharps and chemical waste were weighed in the two teaching and referral institutions, Kenyatta National Hospital (KNH) and Moi Teaching Hospital (MTRH) during the wet and dry season. The comparison for the two hospitals, during the wet season was significant for infectious waste (0.0001) but not so for pathological waste (p = 0.7393) and sharps waste (p = 0.3363). During the dry season, coefficient of variation for the two hospitals was significantly different, infectious waste (p = 0.0027) and pathological waste (p = 0.0086). Sharps waste was not significant (p = 0.3615). The studied hazardous healthcare waste generation rate was 0.61 kg/bed/day for KNH and 1.03 kg/bed/day for MTRH. The two institutions should practice healthcare waste minimisation and segregate their waste accurately.
Keywordshealthcare waste, segregation in categories, quantification, referral hospitals

Management of Haemorrhoids – A local experirnce; East and Central African Journal of Surgery, submitted for publication. To be published in their December 2005 issue.

{ OBJECTIVES To compare sociodemographic profiles, child care, child feeding practices and growth indices of children born to HIV-1 seropositive and seronegative mothers. METHODS: A cohort study of 234 children (seropositive and seronegative) born to HIV-1 seropositive mothers and 139 children born to seronegative mothers in Pumwani Maternity Hospital which serves a low-income population in Nairobi, Kenya from December 1991 and January 1994. RESULTS: With few exceptions, at the time of their birth children in all three cohorts had parents with similar characteristics, lived in similar housing in similar geographical areas, had their mothers as their primary care givers, had similar feeding practices and similar growth status and patterns. However, the HIV-1 seropositive mothers were slightly younger (23.8 years vs. 25.0 years, P < 0.01), if married they were less likely to be their husband's first wife (79% vs. 91%

A prospective study involving the management of forty six patients with Fournier's gangrene was carried out at the Kenyatta National Hospital, Nairobi over a period of two years. The age range was nine to 81 years with a mean of 40.27 years indicating that the lesion is common and affects all age groups in this locality. The majority of patients (60.86%) presented with advanced lesions involving scrotal ulcers (45.65%) and gangrene (15.22%). Results of bacterial culture from scrotal wound swabs isolated multiple organisms in 8.15% of the patients, a point which should be taken into consideration during antibiotic selection. Forty one patients (89.13%) had surgical procedures in addition to antibiotics and other supportive measures. Five other patients (10.87%) who presented with early lesions had medical treatment only with antibiotics, antipyretics and analgesics. The average duration of hospitalisation was sixteen days. Two patients (4.35%) one of whom was HIV positive died from septicaemia during the study period. Recurrent scrotal infection occurred in two patients (4.35%) after discharge from the hospital and were treated satisfactorily at the surgical outpatient clinic.

Objective: To carry out a review of the management of early (clinically localised) prostate cancer.
Data Source: Review of all published literature on the management of early prostate cancer was carried out through medline and index medic us searches.
Data Selection: Published data of the management of early prostate cancer over the last three decades were included in the review.
Data Extraction: Abstracts of articles identified were assessed, read and analysed to determine their relevance to the title under review.
Data Synthesis: After establishing relevance from the abstract, the entire paper was read, and the significant points included in the review.
Conclusion: Greater number of men are currently being diagnosed with early prostate cancer. This is due to widespread use of Prostate Specific Antigen (PSA) screening available worldwide. Radical treatment including radical prostatectomy and radical radiation therapy have proven curative value for a significant number of men with localised disease. Survival outcomes indicate that radical prostatectomy offers more reliable cure than radiation therapy for clinically localised disease.

Immediate treatment related morbidity of radical prostatectomy and radiation therapy is currently quite low. Both treatment methods have similar impact on erectile function and continence. Rectal complications are however unique to radiation therapy. Surgical and radiation therapy delivery techniques should be further improved to reduce treatment related morbidity and quality of life outcomes.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

To report the intricacies of managing complications that arose out of cosmetic iris implants (BrightOcular) placement.

Partial penectomy is effective in the treatment of T1 and T2 penile carcinoma with 80% five-year survival rates in the absence of inguinal metastases, and the residual stump is serviceable for upright micturition and sexual function. The use of micrographic surgery first introduced by Mohs in 1941 for small distally located lesions of upto one centimetre diametre achieves results comparable to partial penectomy. Carbon dioxide and Neodymium-Yag lasers have also been used in the treatment of T1 and T2 tumours with 89% five year survival rates. Radiotherapy is also ideal for the treatment of T1 and T2 primary penile carcinoma because failure is corrected with salvage partial penectomy. In T3 disease with extensive local growth total penectomy and removal of scrotal contents followed by perineal reconstruction with scrotal flap is associated with 90% five year survival rates. In advanced T4 tumours with fixed inguinal nodes (N3), hemipelvectomy or hemicorporectomy with combination cytotoxic chemotherapy is considered in selected cases. Various cytotoxic agents like bleomycin, vincristine and methotrexate have been used in adjuvant and neoadjuvant therapy with mixed results. Pre operative radiotherapy is useful in the treatment of patients with metastatic groin lymph nodes of greater than or equal to 4 cm in size. Radiotherapy also provides effective palliation in patients with advanced regional and/or distant metastases. Groin block dissection is commonly performed to treat groin node metastasis and to stage nodal disease in patients with clinically negative groins. The procedure is however associated with significant morbidity resulting in complications such as wound infection and skin necrosis leading to wound breakdown and lymphoedema.(ABSTRACT TRUNCATED AT 250 WORDS)

Partial penectomy is effective in the treatment of T1 and T2 penile carcinoma with 80% five-year survival rates in the absence of inguinal metastases, and the residual stump is serviceable for upright micturition and sexual function. The use of micrographic surgery first introduced by Mohs in 1941 for small distally located lesions of upto one centimetre diametre achieves results comparable to partial penectomy. Carbon dioxide and Neodymium-Yag lasers have also been used in the treatment of T1 and T2 tumours with 89% five year survival rates. Radiotherapy is also ideal for the treatment of T1 and T2 primary penile carcinoma because failure is corrected with salvage partial penectomy. In T3 disease with extensive local growth total penectomy and removal of scrotal contents followed by perineal reconstruction with scrotal flap is associated with 90% five year survival rates. In advanced T4 tumours with fixed inguinal nodes (N3), hemipelvectomy or hemicorporectomy with combination cytotoxic chemotherapy is considered in selected cases. Various cytotoxic agents like bleomycin, vincristine and methotrexate have been used in adjuvant and neoadjuvant therapy with mixed results. Pre operative radiotherapy is useful in the treatment of patients with metastatic groin lymph nodes of greater than or equal to 4 cm in size. Radiotherapy also provides effective palliation in patients with advanced regional and/or distant metastases. Groin block dissection is commonly performed to treat groin node metastasis and to stage nodal disease in patients with clinically negative groins. The procedure is however associated with significant morbidity resulting in complications such as wound infection and skin necrosis leading to wound breakdown and lymphoedema.(ABSTRACT TRUNCATED AT 250 WORDS)

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Many organizations in Kenya have adopted and tried to implement the total quality management (TQM) programmes. Many of these firms have failed to achieve the expected results for various reasons. This study examines how TQM implementation is influenced by leadership in a large organization. The result show that control systems, involvement of employees in decision making and the provision of a conducive psychological environment are quiet difficult to provide for by the leadership in a large organization. It is suggested that creating smaller organization and/or autonomous Divisions of firm will help to address these challenges.

a paper presented to the Conference on Project Management in the Construction Industry for Eastern Africa Region, 20th - 23rd November, 1996, Machakos, Kenya.

OBJECTIVE: To evaluate the management and survival of patients with advanced prostate cancer in this locality. DESIGN: A prospective case study. SETTING: Kenyatta National Referral Hospital and the Nairobi and Mater Hospitals. PATIENTS: Fifty nine patients with advanced cancer of prostate (extra prostatic locally advanced and metastatic cancer). RESULTS: Transperineal trucut needle biopsies of the prostate revealed 15 patients (25.42%) had poorly differentiated cancers with Gleasons scores greater than 7. Fifteen patients (25.42%) had moderately differentiated cancers with Gleason scores of 6; and twenty nine other patients (49.2%) had well differentiated cancers with Gleason scores of 4 and below. Surgical castration was effected on 15 patients four of whom also had 50 mg of oral bicalutamide (casodex) daily. Thirty six patients were treated with subcutaneous goserelin (zoladex) depot 3.6 mg every 28 days. Ten of these patients also had 50 mg oral casodex daily in addition to the zoladex. Three patients in this group also had external radiotherapy for severe bone pains. Only eight patients were treated with oral diethylstilboestrol 3 mg daily. All the 15 patients with undifferentiated cancers died within 12 months. Of the 22 patients surviving at 48 months irrespective of the method of treatment, 20 of them had well differentiated cancers with Gleasons scores of 4 or less. CONCLUSION: Survival in the undifferentiated and poorly differentiated prostrate cancer Gleasons grades 4 and 5 with a score of over 7 is poor irrespective of the mode of treatment as all the patients in this group were dead within 12 months of diagnosis. Twenty patients (90.90%) of the surviving patients at 48 months had well differentiated cancers Gleasons grades 1 and 2 with scores of 4 or less indicating better prognosis for these tumours which are known to be slow growing with a much longer tumour doubling time.

East Afr Med J. 2000 May;77(5):260-3.

This essay looks at Somali oral poetry, using poetry now committed to writing primarily from B. W. Andrzejewski and I. M. Lewis