Publications


2010

SAMSON, DROTIENOEDWIN.  2010.  ES. Otieno, JN. Micheni , SK. Kimende and KK. Mutai. Delayed presentation of breast cancer patients. East African Medical Journal Vol. 87 No. 4 April 2010. Comp Biochem Physiol B. 1991;99(4):811-4.. : Kisipan, M.L. Abstract
Objective: To determine the extent and nature of delayed presentation of patients treated for breast cancer at  Kenyatta National Hospital (KNH). Design : Prospective cross sectional study. Setting: Kenyatta National Hospital (KNH) which is a Tertiary, Teaching and Referral hospital in Nairobi, Kenya Patients and methods: All patients attending the KNH breast clinic or admitted to the 3 surgical wards for the first time with a cytologically or histologically proven diagnosis of late stage breast cancer (Manchester Classification  1940 stage III and IV) were entered into the study. The study covered a two and a half year period starting the 1st of October 2003. Results:  A total of 166 patients were recruited into the study.  The mean age was 47 years with a range between 17 and 88 years. Females constituted 98.8%. The female study population had an average of 4.5 children per subject with a median of 4 and a range of 0-11. A lump as the first noticed symptom was seen in 87.3% and 52.1% were pre-menopausal.  Only 11 (6.62%) patients presented within 30 days of discovering their breast symptom, 34 (20.4%) presented between thirty and ninety days and the remaining 115 (73.1%) presented three months after noticing their symptom. Three reasons accounted for 67.5% of the delay. 33 (19.9%) kept away fearing that they would be told they had cancer while 39 (23.5%) presented late because their breast symptom was painless.  Another 40 (24.1%) said they had earlier visited medical personnel who had reassured them that their symptoms were benign. Conclusion:  Majority of patients treated for advanced breast disease presented to the health care providers at KNH more than three months after noticing their breast symptom and a sizeable number of patients are being reassured falsely that they have benign disease without the benefit of biopsy.   East African  Medical Journal Vol. 87 No. 4 April 2010

2009

Njeru, S, Otieno S, Karimurio J.  2009.  Prevalence and pattern of significant refractive errors in high school students in Meru municipality. Abstract

Uncorrected refractive errors are an important cause of visual impairment in many. Visually disabling refractive error affects a significant proportion of both genders of the global population. Lack of practitioners is the main reason for high rates of visual problem due to uncorrected refractive errors. In developing countries, it is difficult to provide refractive services mainly due to lack of sufficient data on these errors. The proportion of school children who are visually impaired due to refractive errors can be used to assess the level at which the development of refractive services for schools can be established in a country or region. The main objective of this study was to investigate prevalence, pattern and some of the factors for continued presence of uncorrected significant refractive errors (SRE) among high school students in Meru Municipality, Meru Central District of Eastern Province, Kenya. This was a crosssectional study that was conducted in two selected secondary schools. Stratified random sampling technique was used to select the study population. Data was collected through structured questionnaires and physical examination of the study subjects who met the eligibility criteria. Chi square test of independence was used to determine the relationship between variables such as prevalence, pattern, refractive status, health seeking behaviour and their association with the sex of the study subjects. The number of students who participated in the study was 164 with boys and girls having equal representation. The participants were between 13 to 18 years old, with a mean of 15.4 years. The study showed that the overall prevalence of SRE was 8.5% (n=164). Sex specific prevalence indicated no significant difference between the two sexes c2 = 1. 24, d.f =1 p> 0.05). The pattern of SRE revealed that myopia was the leading cause of decreased visual acuity, contributing 6.7% of all the students who underwent the screening process. All boys with SIZE were myopic, compared to 66.6% for girls. However, there was no significant difference between them (c2 =2.05, d.f =1 p>0.005). Astigmatism was second with 1.1% prevalence and lastly, hypermetropia with 0.6%. The study has shown poor health seeking behaviour by students, with 78.6 % (n=14) having not sought correction of their visual problem. About 7.1% of students with SIZE had spectacle correction with correct power of lenses while 14.2% (n=14) had spectacles with wrong lens power. The main reason for students with SRE not wearing glasses was inaccessibility to refractive services, with 52.6% of them having never been examined for their refractive state. SRE among students was also associated with family history of wearing spectacles. In conclusion, SRE among high school students in Meru Municipality require attention, with myopia being the main problem. Screening programmes for refractive services through primary health care can offer a reasonable solution to the problem and is therefore highly recommended. Multisectoral approach between stakeholders in the ministries of Health and Education can yield meaningful output in alleviating the situation.

2008

SAMSON, DROTIENOEDWIN.  2008.  Otieno ES, Kimende, SK, Micheni JN. The pattern of breast diseases at Kenyatta National Hospital. The Annals of African Surgery: 2008 June; Vol 2, pg 97-101.. Comp Biochem Physiol B. 1991;99(4):811-4.. : Kisipan, M.L. Abstract
Objective: To determine the pattern of breast disease at Kenyatta National Hospital (KNH) Study design:    Retrospective descriptive study Study setting:    Kenyatta National Hospital, a University teaching and National Referral Hospital Patients: Records of 1172 patients were reviewed. Results: An average 469 new patients per year or 11 new patients per clinic visit were seen at the clinic over a two and a half year period. Females predominated (98.9%) in this series. The mean age was 34.71 years (range 1 to 96 years). The average age at menarche was 14.49 years and the mean duration of symptoms was 6.86 months. Only 2.6% of 843 patients had a positive family history of breast disease. Fibroadenoma was the commonest diagnosis made (33.2%) followed by ductal carcinoma (19.7%). Gynaecomastia was the most common lesion seen in males. Two thirds of patients presenting with tumors had masses measuring more than 5cm.  Overall five conditions (fibroadenoma, ductal carcinoma, breast abscesses, fibrocystic disease and mastalgia) accounted for over 85% of all breast ailments. Surgery formed the main stay of care in over 80% of patients. Conclusions: The pattern of breast diseases at KNH closely mirrors those reported in other studies in the region and beyond. This study indicates that a large proportion of patients presenting with breast disease are treated initially by surgery. It may be wise to consider other alternative forms of therapy where appropriate. The Annals of African Surgery: 2008 June; Vol 2, pg 97-101.

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