Bio

Prof. Ezekiel M. Wafula



Professor and Consultant Paediatrician, Department of Paediatric and Child

Publications


2010

Hazan, L, Hernández Rodriguez OA, Bhorat A'adE, Miyazaki K, Tao B, Heyrman R, group(EM Wafula AESOPS.  2010.  A double-blind, dose-response study of the efficacy and safety of olmesartan medoxomil in children and adolescents with hypertension., 2010 Jun. Hypertension (Dallas, Tex. : 1979). 55(6):1323-30. Abstract

The current study investigated the efficacy and safety of olmesartan medoxomil in children with hypertension, defined as systolic blood pressure measured at or above the 95th percentile (90th percentile for patients with diabetes, glomerular kidney disease, or family history of hypertension) for age, gender, and height while off any antihypertensive medication. The active treatment phase was conducted in 2 periods, with 2 cohorts in each period (cohort A, 62% white; cohort B, 100% Black). In period 1, patients stratified by weight received low-dose (2.5 or 5 mg) or high-dose (20 or 40 mg) olmesartan medoxomil daily for 3 weeks. In period 2, patients maintained their olmesartan medoxomil dose or initiated placebo washout for an additional 2 weeks. Period 1 efficacy results showed a dose-dependent, statistically significant reduction in seated trough systolic and diastolic blood pressure for both cohorts, with mean blood pressure reductions numerically smaller in cohort B than in cohort A. The olmesartan medoxomil dose response remained statistically significant when adjusted for body weight. In period 2, blood pressure control decreased in those patients switching to placebo, whereas patients continuing to receive olmesartan medoxomil therapy maintained consistent blood pressure reduction. Adverse events were generally mild and unrelated to study medication. Olmesartan medoxomil was safe and efficacious in children with hypertension, resulting in significant blood pressure reductions.

2008

Grace Irimu, R W Nduati, E Wafula LJ.  2008.  Community understanding of pneumonia in Kenya. African Health Sciences 2008; 8(2): 103-107. Abstractcommunity_understanding.pdf

Abstract
Background: Effective management of pneumonia demands active participation by the caretaker to facilitate early seeking of
appropriate health care and adequate compliance to home
care messages. This would only be possible if the caretakers’ perception of pneumonia is appropriate. This study aims to determine
community’s perception of childhood pneumonia in a suburb of Nairobi.
Objectives: To determine community perception of childhood pneumonia.
Design: Cross sectional study utilizing qualitative ethnographic methodology.
Participants: Six key informants for in-depth interview and eight groups for focus group discussions from the study community.
Results: Pneumonia was perceived to be the most serious childhood illness. There was a great deal of diversity of Kikuyu phrases for
chest-in drawing. There was no term for rapid breathing. Chest in-drawing, fever, difficult in breathing, startling at night and
convulsions were perceived as features of pneumonia. Chest in-drawing, fever and convulsions were indicative of severe disease.
Conclusion: The caretakers perceived severe pneumonia as outlined in the IMCI guidelines. Non-severe pneumonia was not
perceived for what it should be. Inappropriate knowledge on causes of pneumonia and signs of non severe pneumonia are likely to
interfere with compliance with home care messages.
African Health Sciences 2008; 8(2): 103-107

2004

Murila, DF, Wafula PEM, Obimbo DE.  2004.  Bacteraemia, urinary tract infection and malaria in hospitalised febrile children in Nairobi: is there an association? East Afr Med J . 2004 Jan; 81 ( 1 ): 47-51 . PMID: 15080516 [PubMed - indexed for MEDLINE] Okwara FN, Obimbo EM, Wafula EM, Murila FV. East Afr Med J . 2004 Jan; 81 ( 1 ): 47-51 .. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract

Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya.
BACKGROUND: There is laboratory evidence of altered immune function in children with malaria. Bacterial infections have been documented to complicate severe forms of malaria. However, it remains unclear whether such infections are attributable to the malaria, other risk factors, or are coincidental. OBJECTIVE: To determine the prevalence of bacteraemia and urinary tract infections (UTI) in febrile hospitalised children with and without malaria. DESIGN: A cross-sectional survey. SETTING: General paediatric wards, Kenyatta National Hospital, Nairobi. SUBJECTS: Children aged between three months and 12 years admitted with an acute febrile illness, with no obvious focus of bacterial infection. MATERIALS AND METHODS: Using a standardised questionnaire, information on socio-demography, symptomatology, and nutritional status was obtained. Malaria slides, blood and urine cultures were performed on each child. RESULTS: Malaria parasitaemia was present in 158 (60%) of 264 children presenting with acute febrile illness with no obvious focus of bacterial infection. Bacteria were isolated from blood and/or urine of 62 (23%) of all enrolled children. Bacteraemia was prevalent among 11.4% of 158 children with malaria and among 13.2% of 106 without malaria. Gram-positive organisms comprised 28.1% of blood isolates, gram-negative 62.5%, and atypical bacteria 9.4%. UTI was prevalent among 13.3% of 158 children with malaria and 16.0% of 106 children without malaria. Gram-positive organisms comprised 18.4%, gram-negative 78.9%, and atypical bacteria 2.6% of the urine isolates. Presence of malaria parasitaemia was not associated with an increased risk of bacteraemia (OR 0.9, 95% CI [0.4-0.7], or UTI (OR 0.8 95% CI [0.4-1.6] in this study population. CONCLUSION: Among children hospitalised in Nairobi with fever and no obvious bacterial infective focus, there should be a high index of suspicion for malaria, followed by bacteraemia and UTI. Malaria parasitaemia does not appear to be associated with increased risk of bacterial co-infection.
PMID: 15080516 [PubMed - indexed for MEDLINE]

2003

W., PROFNDUATIRUTH, MASIBO PROFWAFULAEZEKIEL, E DRSIMIYUMAJORD.  2003.  Mothers' knowledge, attitudes and practices regarding acute respiratory infections in children in Baringo District, Kenya. Simiyu DE, Wafula EM, Nduati RW.. East Afr Med J. 2003 Jun;80(6):303-7.. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
BACKGROUND: Control of acute respiratory infections (ARI) is a major public health problem in developing countries. Implementation of case management protocols requires participation of the community to reduce morbidity and mortality from ARI. Health education programmes can only be effective when designed to take into account the prevailing knowledge, attitudes and practices (KAP) of the community towards ARI in their children. OBJECTIVE: To determine the KAP of mothers regarding ARI in their children aged less than five years. DESIGN: Community based cross-sectional survey. SETTING: Baringo District, Kenya. SUBJECTS: Mothers with children aged 0-5 years were recruited following stratified random sampling in three areas of Baringo District to represent low, medium and high potential areas based on agricultural productivity. INTERVENTION: A mixed structured and unstructured questionnaire was administered to each of the respondent mothers by the investigator; with the help of an interpreter where necessary. RESULTS: A total of 309 mothers were interviewed. Their mean age was 31.5 years (range 16-51) and 34% had no formal education. Only 18% of mothers described pneumonia satisfactorily. 60.2% knew that measles is preventable by immunisation. 87.1% of the mothers said they would seek health centre services for severe ARI. Formal education had a positive influence on the KAP of the mothers. CONCLUSION: The study reveals that the mothers had good knowledge of mild forms of ARI but not the severe forms. Their attitude to ARI was appropriate but subsequent practices were not. Low utilisation of health services for moderate ARI may result in continued high mortality because of delayed identification of seriously ill children.

2002

C., DRWAMALWADALTON, FLORENCE DRMURILA, C. DRWAMALWADALTON, MASIBO PROFWAFULAEZEKIEL.  2002.  Pattern of use of skin care products in children with and without eczematous skin lesions. East Afr Med J. 2002 Dec;79(12):645-50. Wamalwa DC, Wafula EM, Munyao TM, Murila FV.. East Afr Med J. 2002 Dec;79(12):645-50.. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
OBJECTIVE: To compare the pattern of use of skin care products between children with eczematous skin lesions and those without. DESIGN: Case control study. SETTING: Two well baby clinics at the Kenyatta National Hospital and the Mbagathi District Hospital in Nairobi. SUBJECTS: Eighty nine infants with eczematous skin lesions and 89 age and sex matched controls without skin lesions. MAIN OUTCOME MEASURES: Presence and severity of skin lesions related to the type of skin care products used by the child. RESULTS: Exposure to various products was not significantly different between infants with skin lesions and those without. However, more mothers whose children had a skin rash had made a change in the type of soap and or skin cream used for their child (p<0.0001). The principal reason for changing products was skin rash in the baby and most mothers made changes away from scented baby soap products. CONCLUSION: The study found no significant difference between the cases and controls regarding the type of skin care products used.
MBORI-, PROFNGACHADOROTHYA, MASIBO PROFWAFULAEZEKIEL.  2002.  Evaluation of a proposed clinical case definition of paediatric acquired immune deficiency syndrome. East Afr Med J. 2002 Mar;79(3):111-4. Otieno FA,Mbori-Ngacha DA, Wafula EM, Ndinya-Achola JO.. East Afr Med J. 2003 Jun;80(6):303-7.. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
BACKGROUND: Control of acute respiratory infections (ARI) is a major public health problem in developing countries. Implementation of case management protocols requires participation of the community to reduce morbidity and mortality from ARI. Health education programmes can only be effective when designed to take into account the prevailing knowledge, attitudes and practices (KAP) of the community towards ARI in their children. OBJECTIVE: To determine the KAP of mothers regarding ARI in their children aged less than five years. DESIGN: Community based cross-sectional survey. SETTING: Baringo District, Kenya. SUBJECTS: Mothers with children aged 0-5 years were recruited following stratified random sampling in three areas of Baringo District to represent low, medium and high potential areas based on agricultural productivity. INTERVENTION: A mixed structured and unstructured questionnaire was administered to each of the respondent mothers by the investigator; with the help of an interpreter where necessary. RESULTS: A total of 309 mothers were interviewed. Their mean age was 31.5 years (range 16-51) and 34% had no formal education. Only 18% of mothers described pneumonia satisfactorily. 60.2% knew that measles is preventable by immunisation. 87.1% of the mothers said they would seek health centre services for severe ARI. Formal education had a positive influence on the KAP of the mothers. CONCLUSION: The study reveals that the mothers had good knowledge of mild forms of ARI but not the severe forms. Their attitude to ARI was appropriate but subsequent practices were not. Low utilisation of health services for moderate ARI may result in continued high mortality because of delayed identification of seriously ill children.

2000

Muasya, C;, Wafula EM.  2000.  Knowledge Attitudes and Practices (KAP) of parents and guardians of children with epilepsy at Kenyatta National Hospital, Nairobi, Kenya.. Abstract

OBJECTIVE:
To determine the knowledge, attitudes and practices (KAP) of parents and guardians of children with epilepsy regarding the illness.
DESIGN: cross-sectional study.
SETTING: Paediatric Neurology Clinic at Kenyatta National Hospital (KNH).
RESULTS: 116 parents and guardians were interviewed using a semi-structured questionnaire. Focused group discussions (FGDs) were also carried out on 42 other parents and guardians. More than 77% of the parents/ guardians (P/G) had some knowledge on the type of illness their children were suffering from, the features of a convulsion, the alerting features before convulsions, the type of antiepileptic drug treatment their children were receiving and the potential hazards to an epileptic child during a convulsion. Many P/G did not know the causes of epilepsy, alerting features prior to a convulsion or the complications of epilepsy. 60% of the P/G administered some recommended first aid measures to their epileptic children during a fit, but many of them combined these with potentially harmful first aid measures. 40% of the epileptic children of school going age in this study were not attending school because of problems which should not have interfered with school. Spiritual healing, and to a lesser extent traditional herbal medicine were perceived to be important components of therapy for epilepsy when used in conjunction with western treatment. A higher level of formal education of the P/G had a positive influence on their KAP towards epilepsy. The findings of the FGD’s corroborated those of the questionnaire interviews.
RECOMMENDATIONS: Health Education should be given at all levels of contact with P/G, to enhance their KAP towards epilepsy, as this was likely to impact positively on the care accorded the children living with epilepsy.

MASIBO, PROFWAFULAEZEKIEL.  2000.  Effect of improved stoves on prevalence of acute respiration infection and conjunctivitis among children and women in a rural community in Kenya. Wafula EM, Kinyanjui MM, Nyabola L, Tenambergen ED.. East Afr Med J. 2000 Jan;77(1):37-41. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
OBJECTIVE: To compare the pattern of use of skin care products between children with eczematous skin lesions and those without. DESIGN: Case control study. SETTING: Two well baby clinics at the Kenyatta National Hospital and the Mbagathi District Hospital in Nairobi. SUBJECTS: Eighty nine infants with eczematous skin lesions and 89 age and sex matched controls without skin lesions. MAIN OUTCOME MEASURES: Presence and severity of skin lesions related to the type of skin care products used by the child. RESULTS: Exposure to various products was not significantly different between infants with skin lesions and those without. However, more mothers whose children had a skin rash had made a change in the type of soap and or skin cream used for their child (p<0.0001). The principal reason for changing products was skin rash in the baby and most mothers made changes away from scented baby soap products. CONCLUSION: The study found no significant difference between the cases and controls regarding the type of skin care products used.

1999

FLORENCE, DRMURILA, M. PROFMACHARIAW, MASIBO PROFWAFULAEZEKIEL.  1999.  Iron deficiency anaemia in children of a peri-urban health facility. East Afr Med J . 1999 Sep; 76 ( 9 ): 520-3 . PMID: 10685324 [PubMed - indexed for MEDLINE] Murila FV, Macharia WM, Wafula EM.. East Afr Med J . 1999 Sep; 76 ( 9 ): 520-3 .. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract

Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.

OBJECTIVE: To ascertain the prevalence of iron deficiency anaemia(IDA) and its risk factors. DESIGN: A cross-sectional survey. SETTING: A peri-urban health centre in Nairobi, Kenya. SUBJECTS: Four hundred and three children, aged six months to six years. INTERVENTION: Demographic data were obtained and each child examined for signs of iron deficiency anaemia. Blood was drawn for haemoglobin determination. MAIN OUTCOME MEASURE: The diagnosis of iron deficiency anaemia was made using a pre-defined criteria. RESULTS: Iron deficiency anaemia had a prevalence of 7.4% (95% CI = 4.8-10.0) and was predominantly mild (93.6%). Age was found to be significantly associated with iron deficiency anaemia with a prevalence of (14.6%) in infants. No association was found between IDA and sex, birthweight, weaning age and weaning diet, sanitation, water source or mother's education. CONCLUSION: The prevalence of iron deficiency anaemia in this health facility was relatively low and was predominantly mild.

PIP: This cross-sectional survey, conducted in a periurban health center in Nairobi, Kenya, determined the prevalence of iron deficiency anemia (IDA) and its risk factors among 403 children aged 6 months to 6 years. Demographic data were obtained and each child was assessed for signs of IDA. Blood was drawn for hemoglobin determination. The diagnosis of IDA was made using predefined criteria. Findings revealed that the prevalence of IDA was 7.4% (95% confidence interval = 4.8-10.0) and was predominantly mild (93.6%). Age was found to be significantly associated with IDA, with a 14.6% prevalence rate in infants. No association was found between IDA and factors such as sex, birth weight, weaning age and weaning diet, sanitation, water source, or education of the mother. Although the study showed that IDA was not a major health problem in the area, as evidenced by the low prevalence rate and presence of only mild cases, there is still a need for emphasis on health education at the health facility since young children are at high risk of IDA.

PMID: 10685324 [PubMed - indexed for MEDLINE]

MASIBO, PROFWAFULAEZEKIEL.  1999.  Effects of passive smoking and breastfeeding on childhood bronchial asthma. Wafula EM, Limbe MS, Onyango FE, Nduati R.. East Afr Med J. 1999 Nov;76(11):606-9.. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
{ OBJECTIVE: To evaluate the effect of passive smoking and breastfeeding on the severity and age of onset of bronchial asthma. DESIGN: Cross-sectional study. SETTING: Paediatric observation ward and paediatric chest clinic, Kenyatta National Hospital. PATIENTS: Children aged between one and 120 months. RESULTS: More than fifty per cent of the children had their first wheeze at less than 12 months of age and 68% were categorised as having moderate to severe asthma. Passive smoking was positively significantly associated with early onset of wheezing (chi 2 = 6.22

1998

MASIBO, PROFWAFULAEZEKIEL.  1998.  X-ray diagnosable pneumonia in children with severe malnutrition at Kenyatta National Hospital. East Afr Med J . 1998 Oct; 75 ( 10 ): 567-71 . PMID: 10065188 [PubMed - indexed for MEDLINE] Wafula EM, Ngamau DW, Onyango FE, Mirza NM, Njeru EK.. East Afr Med J . 1998 Oct; 75 ( 10 ): 567-71 .. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
Department of Paediatrics and Child Health, University of Nairobi. OBJECTIVES: To estimate the prevalence of radiologically evident pneumonia among children with severe malnutrition and to evaluate the diagnostic utility of commonly used clinical indicators of pneumonia among children with severe malnutrition. METHODS: All children with severe malnutrition and admitted at the then Paediatric Observation Ward without congestive cardiac failure, severe anaemia, or severe dehydration, were clinically evaluated and a posteroanterior chest X-ray taken for each child. Pneumonia was diagnosed on the basis of radiological changes consistent with pneumonia as reported by an experienced radiologist. The performance of the various clinical parameters as diagnostic tests for pneumonia were also evaluated. SETTING: Kenyatta National Hospital, a tertiary level teaching institution for the University of Nairobi. RESULTS: One hundred and seven children comprising 68 males and 39 females were recruited into the study. Of these children, 38 had kwashiorkor, 40 had marasmus, while 29 had marasmic kwashiorkor. Radiological evidence of pneumonia was found in 58% of children with kwashiorkor, 75% with marasmic kwashiorkor, and 82% with marasmus. All the commonly used clinical parameters performed poorly as diagnostic tests for pneumonia among children with severe malnutrition. CONCLUSION: Prevalence of pneumonia was very high among children with severe malnutrition. Available clinical parameters, singly or in combination, are poor diagnostic tools for pneumonia in children with severe malnutrition. It is advisable to treat children with severe malnutrition as if they had pneumonia, even in the absence of suggestive clinical signs. PMID: 10065188 [PubMed - indexed for MEDLINE]

1995

MASIBO, PROFWAFULAEZEKIEL.  1995.  Acute respiratory infections. Wafula EM.. East Afr Med J. 1995 Oct;72(10):617-8.. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
No abstract available.
MASIBO, PROFWAFULAEZEKIEL.  1995.  Bacteriology and sensitivity patterns of pyogenic meningitis at Kenyatta National Hospital, Nairobi, Kenya Wanyoike MN, Waiyaki PG, McLiegeyo SO, Wafula EM.. East Afr Med J. 1995 Oct;72(10):658-60.. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
A descriptive cross sectional study on bacteriology and sensitivity patterns of laboratory-proven pyogenic meningitis was carried out over a six month period. A total of 92 patients (52 adults, 40 children) were studied. In 75 (82%) of the cases, the cerebrospinal fluid cultures were bacteriologically positive. Common isolates included Streptococcus pneumoniae (45%), Neisseria meningitidis (14%) and Haemophilus influenzae (12%). Other isolates included Cryptococcus neoformans from four (4.3%) adults who were also HIV-l positive. Sensitivity to antibiotics was determined using the disk diffusion method. There was no resistance to chloramphenicol among the three most common bacterial isolates. However, 7% and 15% of Streptococcus pneumoniae and N. meningitidis isolates, respectively, were resistant to crystalline penicillin. Twenty seven percent of Haemophilus influenzae was resistant to ampicillin. Sensitivity of the three organisms to the third generation cephalosporin (ceftazidime, cefotaxime, ceftriaxone) a second generation cephalosporin (cefuroxime) and augmentin was almost 100%. We recommend that chloramphenicol and crystalline penicillin or ampicillin be initial blind therapy for adults and older children with pyogenic meningitis and ampicillin and chloramphenicol for pre-school children. The above cephalosporins and augmentin are alternative therapy but their use will be limited by cost.

1994

MASIBO, PROFWAFULAEZEKIEL.  1994.  Characteristics related to the incidence and prevalence of acute respiratory tract infection in young children in Kenya. Clin Infect Dis . 1994 Apr; 18 ( 4 ): 639-47 . PMID: 8038325 [PubMed - indexed for MEDLINE] Stanek EJ 3rd, Wafula EM, Onyango FE, Musi. Clin Infect Dis . 1994 Apr; 18 ( 4 ): 639-47 .. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract

Department of Paediatrics and Microbiology, University of Nairobi, Kenya Medical Research Institute.

Acute respiratory tract infection (ARI) in children is a prevalent condition that results in substantial morbidity and consumes large portions of health care resources in developing countries. We examined factors associated with the reported incidence and prevalence of ARI in a 3-year longitudinal study of 485 children < 5 years of age in rural Kenya. A large number of environmental factors, household and family characteristics, and child-specific factors were examined with use of multivariable methods. Few variables that may play a role in the incidence and prevalence of ARI (e.g., household tobacco use and weight z-score) were found to be related to such rates. Several factors related to ARI incidence and prevalence (e.g., mother's age, number of children, and community) were found to be associated with only mild ARI episodes. Evidence is presented to support the hypothesis that these factors are related to differential reporting of mild ARI episodes. The impact of such differential reporting on health care utilization and health education is discussed.

PMID: 8038325 [PubMed - indexed for MEDLINE]

1993

Brady, JP, Awan FB, Wafula EM, Onyango FE.  1993.  Recognition of illness in very young infants by inexperienced health workers. Abstract

To determine whether inexperienced health workers can recognize severe infection in infants less than 3 months of age, a study was conducted of 200 infants with cough, fever or 'not feeling well'. The presence or absence of five symptoms: cough, difficulty in breathing, feeding problem, fever or history of convulsions, and ten signs: appearing ill, respiratory rate > or = 60/min, chest indrawing, grunting, cyanosis, wheeze, lethargy, 'too hot', 'too cold' or abdominal distension, were recorded by a health worker, who made a diagnosis of 'ill' or 'mildly ill'. Each infant was then reviewed by an experienced paediatrician who made a diagnosis of 'ill' (pneumonia, sepsis, meningitis or other severe illness) or 'mildly ill'. Using these diagnoses as the 'gold standard', the sensitivity, specificity, and positive predictive values of each parameter were calculated. In 89% of the 200 infants, the health worker made the correct diagnosis. Forty infants were admitted. In 36 instances (90%) the health worker made the correct decision. The most discriminating symptoms and signs were 'not feeding well', 'appears ill', chest indrawing and grunting. A respiratory rate > or = 60/min was 78% sensitive and 69% specific. Our study suggests that inexperienced health workers can recognize severe illness in infants under 3 months of age.

MASIBO, PROFWAFULAEZEKIEL.  1993.  Hypoxaemia in young Kenyan children with acute lower respiratory infection. BMJ . 1993 Mar 6; 306 ( 6878 ): 612-5 . PMID: 8369033 [PubMed - indexed for MEDLINE] Onyango FE, Steinhoff MC, Wafula EM, Wariua S, Musia J, Kitonyi J.. BMJ . 1993 Mar 6; 306 ( 6878 ): 612-5 .. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstracthypoxaemia_in_young_kenyan_children.pdf

Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.

OBJECTIVES–To determine the prevalence, clinical correlates, and outcome of hypoxaemia in acutely ill children with respiratory symptoms. DESIGN–Prospective observational study. SETTING–Paediatric casualty ward of a referral hospital at 1670 m altitude in Nairobi, Kenya. SUBJECTS–256 Infants and children under 3 years of age with symptoms of respiratory infection. MAIN OUTCOME MEASURES–Prevalence of hypoxaemia, defined as arterial oxygen saturation < 90% determined by pulse oximetry, and condition of patient on the fifth day after admission. RESULTS–Over half (151) of the children were hypoxaemic, and short term mortality was 4.3 times greater in these children. In contrast, the relative risk of a fatal outcome in children with radiographic pneumonia was only 1.03 times that of children without radiographic pneumonia. A logistic regression model showed that in 3-11 month old infants a respiratory rate > or = 70/min, grunting, and retractions were the best independent clinical signs for the prediction of hypoxaemia. In the older children a respiratory rate of > or = 60/min was the single best clinical predictor of hypoxaemia. The presence of hypoxaemia predicted radiographic pneumonia with a sensitivity of 71% and specificity of 55%. CONCLUSIONS–Over half the children presenting to this referral hospital with respiratory symptoms were hypoxaemic. A group of specific clinical signs seem useful in predicting hypoxaemia. The clear association of hypoxaemia with mortality suggests that the detection and effective treatment of hypoxaemia are important aspects of the clinical management of acute infections of the lower respiratory tract in children in hospital in developing regions.

PIP: In 1989, pediatricians followed 256 children 7 days to 36 months old with symptoms of respiratory infection at Kenyatta National Hospital (1670 m altitude) in Nairobi, Kenya. The symptoms were serious enough to warrant hospital admission for 209 of these children. The most common clinical diagnoses were pneumonia (53%) and bronchiolitis (33%). 59% of the children admitted to the hospital were hypoxemic (arterial oxygen saturation or + to 90%). 10% of all admitted children died. 90.4% of them were hypoxemic with arterial oxygen saturations ranging from 40-88%. Children with hypoxemia were 4.3 times more apt to die within 5 days than those with no hypoxemia (p = .02). On the other hand, children with radiographic pneumonia had a relative risk of short-term mortality of only 1.03. Hypoxemia on admission predicted short-term mortality with 90% sensitivity and 34% specificity. It predicted pneumonia with 71% sensitivity and 55% specificity (p .0001). Children who lived for at least 5 days had arterial oxygen saturations ranging from 41-98. Even though all of the children with clinically evident cyanosis were less than a year old, 89% of the hypoxemic infants less than 1 year old did not exhibit cyanosis. Mothers' reports of blueness in newborns and infants less than 2 months was the best predictor of hypoxemia (62% accuracy; p .05). For children 3-11 months old, the best predictors of hypoxemia, with an accuracy of 70%, were a respiratory rate of at least 70/minute (odds ratio [OR] 2.6; p .001). For children at least 12 months old, the sole best predictor was a respiratory rate of at least 60/minute (70% accuracy; OR 5.1; p .01). This study should be followed by well-designed studies of the clinical effectiveness of proper treatment with oxygen in preventing mortality in hypoxemic infants and children.

PMID: 8369033 [PubMed - indexed for MEDLINE]

PMCID: PMC1676956

1990

Wafula, EM, Onyango FE, Thairu H, Boleij JS, Hoek F, Ruigewaard P, Kagwanja S, De Koning H, Pio A, Kimani E.  1990.  Indoor air pollution in a Kenyan village., 1990 Jan. East African medical journal. 67(1):24-32. Abstract

In April 1986, a study was carried out within rural households in Maragua area, Muranga District, Republic of Kenya, to assess the degree of indoor air pollution and to find its relationship, if any, to acute respiratory infections (ARI) among children aged below 5 years within the study. This study was carried out within an ongoing aetiological and epidemiological community study on ARI as a collaborative effort between the Department of Paediatrics, University of Nairobi; the Department of Chemistry, Kenyatta University; the Department of Environmental Sciences, Agricultural University, Wagenigen, The Netherlands; the World Health Organization; and the Ministry of Health, Republic of Kenya. Repeated 24 hour measurements of respirable suspended particles (RSP) and nitrogen dioxide (NO2), were carried out in 36 randomly selected houses where most of the cooking was done on open fires using firewood and crop residues as fuel. Data on house characteristics and activity in the study were gathered by questionnaire. The mean of 24 hour average RSP concentration (1400mg/m3), average during the 7 hours of daily burning (3000-4000mg/m3), and evening peak levels (up to 3600mg/m3) indicate that deleterious health effects due to exposure to excessive levels of toxic pollutants in smoke from biomass combustion are likely to occur especially among pre-school children and women. Concentrations of selected polycyclic hydrocarbons in the particulate material were found to be high. It was not possible to demonstrate a relationship between the indoor air pollution and episodes of ARI partly because of small sample size and also the more or less homogeneous nature of pollution among all the households.

Weinberg, GA, Spitzer ED, Murray PR, Ghafoor A, Montgomery J, Tupasi TE, Granoff DM, EM W.  1990.  Antimicrobial susceptibility patterns of Haemophilus isolates from children in eleven developing nations. BOSTID Haemophilus Susceptibility Study Group., 1990. Bulletin of the World Health Organization. 68(2):179-84. Abstract

The antimicrobial susceptibilities of 426 isolates of Haemophilus species, which were collected as part of a worldwide study of the etiology of acute respiratory disease in children in selected developing countries, were determined. Eleven antibiotics were tested using the recently described Haemophilus Test Medium. There was a low prevalence of antibiotic resistance; 6% of strains were resistant to ampicillin, and 1.6% were resistant to chloramphenicol. Strains resistant to both ampicillin and chloramphenicol were recovered only from Thailand. Susceptibility to penicillin G was also determined; the minimum inhibitory concentrations for penicillin and ampicillin were concordant within one 2-fold dilution in 97% of the isolates. Thus, Haemophilus isolates were as susceptible to penicillin G as they were to ampicillin, and penicillin resistance was infrequent overall. These data provide support for the current protocols for the management of acute respiratory infections in children in developing countries, in which penicillin G is a first-line agent.

M., PROFMACHARIAW, MASIBO PROFWAFULAEZEKIEL.  1990.  Verbal autopsy: a tool for determining cause of death in a community. East Afr Med J . 1990 Oct; 67 ( 10 ): 693-8 . PMID: 2282890 [PubMed - indexed for MEDLINE] Mirza NM , Macharia WM , Wafula EM , Agwanda RO , Onyango FE .. East Afr Med J . 1990 Oct; 67 ( 10 ): 693-8 .. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
Department of Paediatrics, College of Health Sciences, University of Nairobi, Kenya. Verbal autopsy was used to determine causes of death in 239 children under the age of 5 years. The diagnosis derived from verbal autopsy was corroborated with hospital diagnosis in 39 cases. There was concurrence of diagnosis in 72% of the cases. Using the diagnosis of bronchopneumonia to validate the method, verbal autopsy was found to have a sensitivity of 71%, specificity of 92%, a positive predictive value of 85%. Reliability index of agreement was 0.654. Recall period up to 29 months after death was found to be reliable. PMID: 2282890 [PubMed - indexed for MEDLINE]
M., PROFMACHARIAW, MASIBO PROFWAFULAEZEKIEL.  1990.  Childhood asthma at Kenyatta National Hospital, Nairobi. Macharia WM, Mirza NM, Wafula EM, Onyango FE.. East Afr Med J. 1990 Dec;67(12):837-41.. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
Between January 1986 and July 1988, 356 children with bronchial asthma below 14 years of age were evaluated at the Kenyatta National Hospital. 21.3% experienced initial asthmatic attacks before the age of six months and 55.1% before 2 years. Only 8% of the study patients were below the age of 2 years at recruitment. The male:female ratio was 1:1. Physical exercise led to precipitation or worsening of attacks in 43.4% while 71.6% of the patients experienced attacks in the evening or at night. 18.5% and 42.9% had personal history of atopic dermatitis and allergic rhinitis respectively. The study shows that a substantial number of patients experience initial asthmatic attacks before the age of 6 months contrary to what has been previously believed.
EM, W, FE O, WW M, NM M.  1990.  Epidemiology of acute respiratory tract infections among young children in Kenya. Rev Infect Dis . 1990 Nov-Dec; 12 Suppl 8 : S1035-8 . PMID: 2270401 [PubMed - indexed for MEDLINE] Wafula EM, Onyango FE, Mirza WM, Macharia WM, Wamola I, Ndinya-Achola JO,. Rev Infect Dis . 1990 Nov-Dec; 12 Suppl 8 : S1035-8 .. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract

Department of Paediatrics, University of Nairobi, Kenya.
The epidemiology of acute respiratory tract infection (ARI) was investigated in a rural community 80 km north of Nairobi, Kenya. This research was conducted prospectively on 250 families with 470 children less than 5 years of age who were contacted every 8 days during the 3-year study. The yearly incidence of respiratory tract infections decreased from 5.2 to 3.4 during the study; less than 5% of these infections involved the lower respiratory tract. The incidence was inversely related to age, and the illnesses were generally mild and brief in length. Fifteen children died during the study period. The precise causes of death are unknown, but respiratory infections possibly played a role in most cases. This study emphasizes the importance of determining the risk factors responsible for unusually severe morbidity and high mortality in children with ARI in developing countries.
PMID: 2270401 [PubMed - indexed for MEDLINE]

M., PROFMACHARIAW, MASIBO PROFWAFULAEZEKIEL.  1990.  Wafula EM, Onyango FE, Mirza NM, Macharia WM, Wamola, I et al: Epidemiology of Acute Respiratory infections among young children in Kenya. Res. Infect Dis 12(SB), S1035-S1038, Nov-Dec 1990.. East Afr Med J 67:823-829. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
Department of Paediatrics, College of Health Sciences, University of Nairobi. Causes of death of 239 children below the age of 5 years in a rural community were determined using structured questionnaires. It was found that mortality was highest in infancy, accounting for 63% of all deaths with a trend of decreasing mortality with increasing age. The commonest cause of death was ARI (pneumonia and measles) accounting for 49% of the deaths, followed by diarrhoeal illnesses (8.8%). Only half of the deaths (51.5%) occurred at some health facility, though 77% of all children had been taken to a health facility for treatment during the fatal illness. PMID: 2076684 [PubMed - indexed for MEDLINE]
M., PROFMACHARIAW, MASIBO PROFWAFULAEZEKIEL.  1990.  Mortality Patterns in a Rural Kenyan Community: East Afr Med J 67:823-829, 1990. Mirza NM, Macharia WM, Wafula EM, Agwanda RO and Onyango FE:. East Afr Med J 67:823-829. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
Department of Paediatrics, College of Health Sciences, University of Nairobi. Causes of death of 239 children below the age of 5 years in a rural community were determined using structured questionnaires. It was found that mortality was highest in infancy, accounting for 63% of all deaths with a trend of decreasing mortality with increasing age. The commonest cause of death was ARI (pneumonia and measles) accounting for 49% of the deaths, followed by diarrhoeal illnesses (8.8%). Only half of the deaths (51.5%) occurred at some health facility, though 77% of all children had been taken to a health facility for treatment during the fatal illness. PMID: 2076684 [PubMed - indexed for MEDLINE]

1989

Boleij, JS, Brunekreef B, EM W, FE O, de Koning, A P.  1989.  Domestic pollution as a factor causing respiratory health effects., 1989 Sep. Chest. 96(3 Suppl):368S-372S.
MASIBO, PROFWAFULAEZEKIEL.  1989.  The diagnostic value of various features for acute lower respiratory infection among under fives. East Afr Med J. 1989 Oct;66(10):678-84. Wafula EM, Tindyebwa DB, Onyango FE.. East Afr Med J. 1989 Oct;66(10):678-84.. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
One hundred and fifty children aged between 5 months and 5 years with cough of less than 2 weeks duration, and presenting at the paediatric filter clinic and paediatric observation ward of the Kenyatta National Hospital between July and December 1985 were each evaluated by a complete history, physical examination, and a chest X-ray. Ninety of them (or 60%) had radiological evidence of pneumonia. Respiratory rate of over 50 per minute, chest indrawing, flaring of alae nasae, and a history of rapid breathing were found to be valuable indicators of pneumonia.
MASIBO, PROFWAFULAEZEKIEL.  1989.  Indoor air pollution in developing countries and acute respiratory infection in children. Lancet . 1989 Feb 25; 1 ( 8635 ): 427-9 . Review. PMID: 2563799 [PubMed - indexed for MEDLINE] Pandey MR, Boleij JS, Smith KR, Wafula EM.. Lancet . 1989 Feb 25; 1 ( 8635 ): 427-9 . Review. PMID: 2563799 [PubMed - indexed for MEDLINE]. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract

Trihuvan University, Kathmandu, Nepal.

PIP: Indoor air pollution emerges as an important risk factor for acute respiratory infections (ARI) in developing countries. In many developing countries, in addition to an increasing amount of tobacco smoke, many homes contain high levels of smoke from the combustion of biofuels such as wood, crop residues, and animal dung for cooking or heating. In about half the world's households, such fuels are used for cooking daily, usually without a flue or chimney and with poor ventilation. Results of investigations in 6 developing nations have shown the range of indoor pollution in such circumstances. The best single indicator for comparison of toxic noncarcinogenic effects is most likely respirable particulates, similar to tar reported for cigarette emissions. Results of studies in animals suggest any difference in respiratory-system toxicity according to mass is not likely to be large. On the basis of the small amount of evidence available, peak and daily exposures to indoor particulate levels in villages in developing countries seem to be about 20 times greater than in developed nations. The results of a semi-quantitative epidemiological study conducted in Nepal showed a direct relation between reported hours/day spent near the stove by infants and children aged under 2 years and episodes of life threatening acute respiratory infections. If one discounts the many possible confounding factors, extrapolation shows that by moving all children into the lowest smoke exposure groups as much as 25% of moderate and severe infections would be eliminated. Extrapolation from studies of both ARI and environmental tobacco smoke also indicates indirectly the potential effect of indoor smoke from biofuels. Some environmental tobacco smoke studies have reported a dose-response relation between the number of cigarettes smoked in the home and respiratory symptoms in children. In sum, biofuel smoke is likely to be a factor in ARI, but its importance in relation to other risk factors is difficult to establish. It may be that prevention of acute respiratory infections could be best realized by initially addressing other risk factors or by addressing smoke solely in the context of broad based programs for several risk factors.

PMID: 2563799 [PubMed - indexed for MEDLINE]

1988

1987

Wafula, EM, Tukei PM, Bell TM, Nzanze H, Ndinya-Achola JO, Hazlett DT, Ademba GR, Pamba A.  1987.  Diagnosis of acute respiratory infections (ARI) among under fives in the paediatric observation ward (POW), Kenyatta National Hospital, Nairobi., 1987 Apr. East African medical journal. 64(4):263-9.

1985

Wafula, EM, Tukei PM, Bell TM, Nzanze H, Ndinya-Achola JO, Hazlett DT, Ademba GR, Pamba A.  1985.  Aetiology of acute respiratory infections in children aged below 5 years in Kenyatta National Hospital. Website
MASIBO, PROFWAFULAEZEKIEL.  1985.  The experience of foreign body inhalation among children at Kenyatta National Hospital over a five-year-period. East Afr Med J . 1985 May; 62 ( 5 ): 323-31 . No abstract available. PMID: 4042941 [PubMed - indexed for MEDLINE] Ojwang J, Wafula EM.. East Afr Med J . 1985 May; 62 ( 5 ): 323-31 .. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
No abstract available.

1984

Jitta, JN, Wafula EM, Wasunna A.  1984.  The comatose child in Paediatric Observation Ward of Kenyatta National Hospital, Nairobi, Kenya., 1984 Dec. East African medical journal. 61(12):917-24.
MASIBO, PROFWAFULAEZEKIEL.  1984.  Chest x-rays in children with acute respiratory infections or bronchospasm at Kenyatta National Hospital. East Afr Med J . 1984 Dec; 61 ( 12 ): 900-6 . No abstract available. PMID: 6536466 [PubMed - indexed for MEDLINE] Wafula EM, Muruka FJ.. East Afr Med J . 1984 Dec; 61 ( 12 ): 900-6 .. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
No abstract available.

1982

O, PROFBWIBONIMROD, MASIBO PROFWAFULAEZEKIEL.  1982.  Serological determination of prevalence of congenital syphilis in two hospitals in Kenya. East Afr Med J . 1982 Nov; 59 ( 11 ): 750-3 . No abstract available. PMID: 6764198 [PubMed - indexed for MEDLINE] Wafula EM, Bwibo NO.. East Afr Med J . 1982 Nov; 59 ( 11 ): 750-3 .. : EM Ngatia, LW Gathece, FG Macigo, TK Mulli, LN Mutara, EG Wagaiyu. Abstract
No abstract available.

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