Objective: To establish the prevailing eye practices among traditional healers in Kitui district and establish whether these healers are able to identify ocular emergencies and refer in good time.
Design: Community based qualitative survey
Setting: Kitui district, Eastern Kenya
Subjects: A total of 87 healers from 3 divisions of Kitui district were interviewed.
Results: Seventy six (87.4%) said that they treat at least one of the eye conditions presented to them. Instillation of plant extracts into the conjuctival sac was the most preferred treatment modality and was practiced by 46(52.9%) healers for cataracts, 48(55.2%) for ocular injuries and 21(24.1%) for allergic conjunctivitis. The most commonly performed surgical procedures included rubbing the underside of the upper lid with a specifi c leaf for allergic conjunctivitis with papillary reaction performed by 43 (49.4%) healers; piercing chalazia with a thorn or needle by 11(12.6%) healers and making small incisions and applying herbs for ocular swelling by 4(4.6%) healers. The most preferred treatment for chemical injury was breast milk from any breast feeding mother practiced by 29 (33.3%) healers. Small extra ocular foreign bodies are removed by introducing seed from a specifi c plant in to the conjunctival sac by 51(58.6%) healers. Some healers mix traditional medicine with exorcism and rituals especially for squint as practiced by 14(16%) healers and ocular tumors by 9(10.3%) healers. The conditions the healers said they would refer included ocular tumors reported by 48(55.5%) healers, cataracts by 34(52.9%) healers, ocular injury by 30(34.5%) healers and squint by 21(24.1%) healers.
Conclusion: Majority of the healers interviewed treat patients who present to them with eye diseases. Most did not refer emergencies like ocular injuries.

Mwanda OW1, Fu P, Collea R, Whalen C, Remick SC.
Author information
Abstract
The clinical features of Kaposi's sarcoma (KS), in patients with and without HIV infection, were investigated in a tertiary referral centre in Kenya between 1997 and 1999. Although 186 cases were identified prospectively, the data analysis was restricted to the 91 (49%) cases who had pathological confirmation of Kaposi's sarcoma and documented HIV serostatus. Among these 91 subjects (58% of whom were male), the age-group holding the largest number of KS cases was that of individuals aged 31-40 years; most of the paediatric cases were aged 6-10 years. The ratio of HIV-seropositives to HIV-seronegatives was 8.5:1 for the adult cases and 0.9:1 for the paediatric. Of the signs and symptoms of Kaposi's sarcoma seen at presentation, only peripheral lympadenopathy was found to be significantly associated with underlying HIV infection (P = 0.05). The median survival was 104 days. It is apparent that, as the HIV epidemic advances in regions of the world with endemic KS, the clinical presentation and natural history of the endemic KS are blending with those of the epidemic or AIDS-associated disease, leading to a reduction in the mean age of the cases and a nearly identical incidence in men and women. In regions of the world where patients have ready access to such chemotherapy, the impact of treatment with highly active antiretroviral drugs on the incidence and natural history of KS has been dramatic. It will be important to monitor the clinico-pathological features of KS in the developing world, as more active antiretroviral regimens become available in clinical practice there.

We present two cases of neurofibromatosis type 1 (NF-1), one a 35 year old male who first recognised his problem at the age of fifteen years and at the time of assessment, satisfied the National Institute of Health (NIH) diagnostic criteria for NF-1 and had a nodular plexiform neurofibroma involving the left fifth dorsal nerve root and a diffuse plexiform neurofibroma involving the left lower limb. The second patient, a 45 year old female recognised her problem at the age of 39 years, did not quite satisfy the NIH diagnostic criteria for NF 1 and had diffuse plexiform neurofibroma involving both lower limbs and buttocks almost symmetrically, a finding which has not previously been described to the best of our knowledge. The scarcity of management options are briefly outlined.

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

{ Abuse of substances of dependence have risen dramatically and spawned major health problems in Kenya. We conducted a study on the effects of post-basic psychiatric training on nurses

Tetralones were converted to tetralinylamines via Leuckart reaction.These were then used to protect carboxamide side-chains of glutamine and asparagine. Clevage studies using trifluoroacetic acid and boron tristrifluoroacetate were then done on these derivatives. The groups 1-tetralinyl, 5,7-dimethyl-1-tetralinyl and 7-methoxy-1-tetralinyl were found to be good carboxamide protecting groups in asparagine.

Tetralones were converted to tetralinylamines via Leuckart reaction.These were then used to protect carboxamide side-chains of glutamine and asparagine. Clevage studies using trifluoroacetic acid and boron tristrifluoroacetate were then done on these derivatives. The groups 1-tetralinyl, 5,7-dimethyl-1-tetralinyl and 7-methoxy-1-tetralinyl were found to be good carboxamide protecting groups in asparagine.

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Tetralones were converted to tetralinylamines via Leuckart reaction.These were then used to protect carboxamide side-chains of glutamine and asparagine. Clevage studies using trifluoroacetic acid and boron tristrifluoroacetate were then done on these derivatives. The groups 1-tetralinyl, 5,7-dimethyl-1-tetralinyl and 7-methoxy-1-tetralinyl were found to be good carboxamide protecting groups in asparagine.

Part of a detailed analysis of 864 unmarried teenage mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital is presented. Teenage pregnancy amounted for 42.3% of all deliveries of unmarried mothers. Most teenage patients were above 16 years of age, had a religious background of wide coverage, had low quality antenatal care and low education. 94.6% were found to be primigravidas. This dominance has also been found by other workers. PIP: A prospective cross-sectional descriptive study of unmarried mothers delivering in Pumwani Maternity Hospital and Kenyatta National Hospital, Nairobi, Kenya, from December 1986-April 1987, was conducted with a pretested open-ended questionnaire: the 864 teen mothers are described here. They ranged from 13.4-19 years, most were 17-19. 49.4% were Catholic and 45% Protestant. 88.5% attended prenatal clinics once; 51.5% attended 5 times, although only 13% went to hospital clinics for specialized care. For reasons for not going for prenatal care teens stated that they were too shy to undergo a clinical exam, afraid of parents' reaction, unaware of the pregnancy or of the existence of prenatal care, they had not menstruated, or were in school, in prison, or had long work hours. Most girls had primary education, and 97.9% had dropped out of school. 34% dropped out because of pregnancy, and 32% for lack of tuition fees. Reasons for dropping out of school were tabulated, encompassing a broad range of social problems such as war, death, divorce, alcoholism or illness of parents, no tuition or uniform funds, poor grades, and running away from school. In Africa, teen pregnancy is probably increasing because of decreasing age at menarche and relaxing of traditional values.

BACKGROUND: In Kenya the reported high rates of unwanted pregnancies (more than 90%), among adolescents have subsequently resulted in unsafely induced abortions with the associated high morbidity and mortality rates. OBJECTIVE: To evaluate the adolescents' behaviour regarding induced abortion. DESIGN: A cross-sectional, prospective study done from July 1995 to June 1996. SETTING: Schools and health facilities in Kiambu and Nairobi districts in Kenya. PARTICIPANTS: Interviews were conducted among adolescents aged 10-19 years in schools at the two districts and selected using a multi-stage random sampling procedure, as well as adolescent girls at two hospitals and two clinics in the immediate post-abortion period. MAIN OUTCOME MEASURES: The number of adolescents health programmes, aimed at reducing the dangers of unsafely induced abortion, which are designed and subsequently implemented. DATA COLLECTION: Demographic and health data, as well as data on behaviour regarding induced abortion were collected using a self-administered questionnaire. RESULTS: The study sample comprised 1820 adolescents. These were 1048 school girls (SG), 580 school boys (SB) and 192 post-abortion (PA). Many adolescents were aware of abortion dangers, with the awareness being significantly lower among the SB whose girlfriends (GF) had aborted than those whose GF had not (p < 0.01). The practice of abortion was reported among 3.4% SG, 9.3% SBs' GF and 100% PA. Direct and indirect costs of abortion were heavy on the girls. Knowledge of the abortion dangers had no influence on the choice of the abortionist. Abortion encounter positively influenced approval by the adolescents, of abortion for pregnant school girls (p < 0.01). CONCLUSION: Despite the costs and awareness of abortion dangers by adolescents, they will take risks.

BACKGROUND: Peptic ulcer disease (PUD) occurs in up to one fourth of patients with chronic renal failure (CRF). Some of the factors implicated in its causation include hypergastrinaemia, secondary hyperparathyroidism, drugs and, recently, Helicobacter pylori infection. Studies on the latter have been few, with none having been carried out in Kenya. OBJECTIVE: To evaluate the upper gastrointestinal tract endoscopic findings and to determine the prevalence of H. pylori in CRF patients with dyspepsia. STUDY DESIGN AND POPULATION: A prospective study of seventy seven consecutive patients with CRF and dyspepsia compared with consecutive age, sex and socio-economically matched seventy seven controls (no CRF) with dyspepsia. SETTING: Kenyatta National Hospital (KNH), the major referral and teaching hospital, Nairobi, Kenya. METHODS: In both the study population and the controls, upper gastrointestinal endoscopy was carried out. H. pylori was tested for using the biopsy urease test and histology. Patients were considered to have H. pylori if they tested positive on both tests. OUTCOME MEASURES: Findings at endoscopy and presence of H. pylori. RESULTS: Inflammatory lesions (gastritis, duodenitis) (42%) and duodenal ulcers (18.4%) were the commonest findings in the two groups combined. The prevalence of H. pylori in the 154 subjects studied was 54.5%. There was no statistically significant difference between the prevalence of H. pylori in CRF patients (53.2%) and the controls (55.8%) (p = 0.746). Patients with endoscopically proven PUD had a very high prevalence of H. pylori (87.3%) regardless of their renal function status. CONCLUSION: Dyspepsia in patients with or without CRF was due to multiple causes and over 50% were attributable to H. pylori. The prevalence of H. pylon in dyspeptic CRF patients was similar to that in dyspeptic patients with normal renal function.

Objective: To determine the prevalence and pattern of eye diseases and visual<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

impairment in the Nairobi Comprehensive Eye Care Services (NCES) Project; the

catchment area of the Mbagathi District Eye Unit of Nairobi.

Design: Community based survey conducted from October 15th to 31st 2007

Setting: Kibera and Dagoreti divisions of Nairobi City

Subjects: 4200 people of all ages were randomly selected; 4056 were examined

(96.6% response rate). 122 (2.9%) were not available and 15 (0.4%) declined

to be examined.

Results: Females: 54.2%, Males: 45.8%. Mean age; 22.4 years, SD; 16.5. Only

241(5.9%) aged >50years old. The leading eye disorders in Kibera and Dagoretti

divisions are conjunctival disorders including allergic conjunctivitis and conjunctival

growths. This was found to affect 7.6% of the subjects. This was followed by

refractive errors found in 5.3% of the subjects. Cataract was found in 30 subjects

(0.7%). Disorders of the retina and the optic nerve were found in 1.1% of the

subjects and corneal disorders in 0.5%. The prevalence of visual impairment was

0.6%, severe visual impairment was 0.05% and blindness was 0.1%. This indicates

that most of the ocular disorders encountered were not visually threatening. The

main cause of visual impairment is refractive errors and the causes of severe visual

impairment and blindness are cataract, corneal opacity and glaucoma.

Conclusion: The population of the NCES is relatively young and the prevalence of

blindness and visual impairment is low. The main cause of visual impairment was

refractive errors and the causes of severe visual impairment and blindness were

cataract, corneal opacity and glaucoma.

Recommendations: The level of blindness in NCES is low and the project should

focus more on rendering eye care and not treatment of blindness. There is need to

address the issue of refractive errors as this was one of the main ocular problems

encountered. In this survey, it was not possible to perform detailed refraction and

hence it was recommend that a refractive error survey be conducted; especially

in school going children.

Objective: To determine the prevalence and pattern of eye diseases and visual<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

impairment in the Nairobi Comprehensive Eye Care Services (NCES) Project; the

catchment area of the Mbagathi District Eye Unit of Nairobi.

Design: Community based survey conducted from October 15th to 31st 2007

Setting: Kibera and Dagoreti divisions of Nairobi City

Subjects: 4200 people of all ages were randomly selected; 4056 were examined

(96.6% response rate). 122 (2.9%) were not available and 15 (0.4%) declined

to be examined.

Results: Females: 54.2%, Males: 45.8%. Mean age; 22.4 years, SD; 16.5. Only

241(5.9%) aged >50years old. The leading eye disorders in Kibera and Dagoretti

divisions are conjunctival disorders including allergic conjunctivitis and conjunctival

growths. This was found to affect 7.6% of the subjects. This was followed by

refractive errors found in 5.3% of the subjects. Cataract was found in 30 subjects

(0.7%). Disorders of the retina and the optic nerve were found in 1.1% of the

subjects and corneal disorders in 0.5%. The prevalence of visual impairment was

0.6%, severe visual impairment was 0.05% and blindness was 0.1%. This indicates

that most of the ocular disorders encountered were not visually threatening. The

main cause of visual impairment is refractive errors and the causes of severe visual

impairment and blindness are cataract, corneal opacity and glaucoma.

Conclusion: The population of the NCES is relatively young and the prevalence of

blindness and visual impairment is low. The main cause of visual impairment was

refractive errors and the causes of severe visual impairment and blindness were

cataract, corneal opacity and glaucoma.

Recommendations: The level of blindness in NCES is low and the project should

focus more on rendering eye care and not treatment of blindness. There is need to

address the issue of refractive errors as this was one of the main ocular problems

encountered. In this survey, it was not possible to perform detailed refraction and

hence it was recommend that a refractive error survey be conducted; especially

in school going children.