DR. NYAMU DAVID GITONGA

Background: Diabetes mellitus (DM) is a disease that has significant morbidity and mortality worldwide resulting from complications arising from poor control. 1,3
There is no local data to show the level of diabetic patients' knowledge on this disease at KNH, an important aspect in DM management. In the present cross-sectional study, determination of the diabetic patient's knowledge of his/her disease was undertaken for the first time at KNH.
Study Objectives: To determine the proportion of KNH DM outpatients with adequate knowledge on the disease and to determine the level of provision of diabetic education to the DM outpatients.
Study design: This was a descriptive cross-sectional study from September 2007 to January 2008.105 DM patients (above 18 years) who had given informed consent were interviewed to determine the level of their knowledge on OM and hence the proportion of respondents with adequate knowledge. Codes were manually assigned to all questions and the respective answers. Five randomly selected KNH OM OPO healthcare providers were also interviewed to determine the level of KNH preparedness in the provision of diabetic education to the OM outpatients. A sequential sampling procedure was used to interview the diabetic patients. Every Wednesday during the course of the study one different OM healthcare provider was picked and interviewed.
Data Analysis: The data obtained were captured using Epi-data computer software which was then exported to SPSS version 15.0 for analysis. Statistical significance was determined using the Pearson Chi Square at p<0.05, at 95% confidence limit. Results: 105 diabetic patients aged 18 years and above were interviewed; 53(50.5%) were males and 52 (49.5%) females. The age categories 18-30, 31-40,41-50, 51-60, 61-70 and above 70 years accounted forl2 (11.4%), 24 (22.9%), 21 (20.0%),21 (20.0%),22 (21.0°) and 5(4.8%) OM patients respectively. The highest education levels; College/University, Secondary, Primary and Non-formal accounted for 27(25.7%), 42(40.0%), 25(23.8%) and 11(10.5%) DM patients respectively. 52 (49.5%)patients had sufficient knowledge on the diabetes mellitus disease itself, 64(61%) on DM complications, 35 (33.3%) on DM medications, 84 (80%), on the importance of dietary control, 73 (70%) on the importance of doing exercises and 11 (10.5%) on the importance of DM Affiliate Associations.
Patients with highest academic level had the highest proportion of patients with adequate knowledge on the disease (p=O.OOO 1), dietary control (p=O.O 1) and exercise (p=0.03). Patients' age influenced the proportion of patients with adequate knowledge on OM complications (p=0.03). The study also showed that diabetic patients' education was conducted mainly verbally at OPO clinic once a week for two hours and only one healthcare provider conducted the training at each education session though the number of staff was ten. Conclusion: Patients were mainly taught verbally. Two-thirds to three-quarter of the patients had sufficient knowledge on the OM disease, importance of dietary requirements and exercise programs.90% of patients had insufficient knowledge on diabetes organizations and two-thirds on rational use of DM medications. Recommendation: Hospital's training and education on rational use of DM medications should be improved. The hospital should make the healthcare providers and the DM patients aware of the DM' associations for patients' benefit. More research involving larger samples over longer periods should be carried out in order to reflect what happens over a longer period of time.

Background: Information about the prevalence of adverse drug reactions (ADRs) among HIV infected and HIV uninfected patients receiving anti-tuberculous therapy in Africa is limited due to unavailability of local data or publications and hence the basis of this study.
Objective: To determine the prevalence of adverse drug reactions among HIV infected and HIV uninfected adult patients on anti-TB therapy.
Design: A retrospective cohort study.
Setting: Kenyatta National Hospital, Kenya.
Subjects: HIV infected and HIV uninfected patients receiving anti-TB therapy between January 2006 to December 2007
Main Outcome Measures:Documented adverse drug reactions.
Results: Three hundred and fourteen records were reviewed, 157 for both HIV infected and HIV uninfected. Of the 314 patient files, 96 (30.5%) had ADRs; 70 (44.6%) verses 26 (16.6%) for HIV infected and HIV uninfected respectively. Overall, the most frequent ADR among the two groups was gastrointestinal disturbances (21.7%) verses (10.2%) for HIV infected and uninfected respectively, (RR=2.44 [1.28-4.63], P=0.006). This was followed by peripheral neuropathy (16.6%) verses (4.5%) for HIV infected and uninfected respectively, (RR=4.25 [1.79-10.12], P=0.005). 73(46.49%) of the HIV infected patients were also receiving anti-retroviral therapy, of
which 36(49.31 %) of them had ADRs documented. Twenty five (29.8%) of the HIV infected who were not taking anti-retroviral therapy, had ADRs documented.
Conclusions: Gastrointestinal disturbances and peripheral neuropathy were the most common ADRs in both groups. Surveillance systems should be established in hospitals for ADRs monitoring and control.

A retrospective study of poisoned patients admitted at Kenyatta National Hospital (KNH) over the period January 2002 to June 2003 was carried out. KNH is a national referral and university teaching hospital and patients are admitted from all parts of Kenya. The results of the study are therefore expected to mirror closely the situation in the rest of the country. Data analysis showed that 58.9% of poisoned patients were males. Pesticides and household/industrial chemicals, the two most important poisoning agents, accounted for 43% and 24% of poisoning, respectively. Organophosphates and rodenticides were the two most common pesticides accounting for 57.4% and 31% of poisoning, respectively. Kerosene accounted for 66% of poisoning with household agents. Self-poisoning was prevalent in the age bracket 21-30 years (70.7%)while accidental poisoning, mostly with kerosene,was prevalent in the age group 0-5 years (83.9%). The overall mortality rate from poisoning was 7.0%.

Antiretrovirals have been associated with serious adverse drug reactions. Several factors have been suggested as independent risk factors for their development. Identification of these factors may help in prevention and management of the adverse drug reactions.Current standard regimens in resource-limited countries are associated with an increased risk of adverse drug reactions. Almost half of adverse reactions are managed by addition of a non-anti-retroviral drug alone but 41% necessitated a change of anti-retrovirals.

There has been an increased access to anti-retrovirals in resource constrained settings. However, few studies have addressed the area of adverse drug reactions in these settings.This study indicates a high prevalence of adverse drug reactions among HIV/AIDS patients on anti-retroviral therapy at Kenyatta National Hospital, Comprehensive Care Centre.