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He LQ, Njambi L, Nyamori JM, Nyenze EM, Kimani K, Matende I, Rono H, Njom V, Bett J, Mukuria M, Gachago M, Roberts H, Dimaras H. "Developing Clinical Cancer Genetics Services in Resource-Limited Countries: The Case of Retinblastoma in Kenya." Public Health Genomics. 2014;17(4):221-227.
Kimani K, Lindfield R, Senyonjo L, Mwaniki A, Schmidt E. "Prevalence and Causes of Ocular Morbidity in Mbeere District, Kenya. Results of a Population-Based Survey.". 2013. Abstract

Ocular morbidity (OM) describes any eye disease regardless of resultant visual loss. Ocular morbidity may affect large numbers of people in low income countries and could lead to many episodes of care. However there is limited evidence about the prevalence of ocular morbidity or resulting health-seeking behavior. This study in Mbeere District, Kenya, set out to explore both these issues. Methods: A cross-sectional household survey was conducted in 2011. Trained teams moved from house to house examining and questioning residents on ocular morbidity and health-seeking behavior. Data were collected on standardized proformas and entered into a database for analysis. Results: 3,691 people were examined (response rate 91.7%). 15.52% (95% CI 13.86–16.92) had at least one ocular morbidity in at least one eye. The leading cause was presbyopia which affected 25.11% (95% CI 22.05–28.45) of participants over 35 and increased with age. Other leading causes of OM were conditions that affected the lens (32.58%) and the conjunctiva (31.31%). No association was found between educational attainment or employment and OM. 9.63% (7.87–11.74) self-reported an ocular morbidity in the previous six months and 45.94% (95% CI 37.1–55.04) stated that they had sought treatment for the condition. Conclusion: A large number of people were affected by an ocular morbidity in this survey. Most of these people could potentially be managed in their own communities through primary care services (e.g. those with presbyopia). Further work is required to understand the best way of providing an effective, equitable service for ocular morbidity.

Gallie BL, Chan HSL, White A, Gronsdahl P, Dimba EAO, Kimani K, Dimaras H. "Retinoblastoma.". 2013. Abstract

Retinoblastoma is an aggressive eye cancer of infancy and childhood. Survival and the chance of saving vision depend on severity of disease at presentation. Retinoblastoma was the first tumour to draw attention to the genetic aetiology of cancer. Despite good understanding of its aetiology, mortality from retinoblastoma is about 70% in countries of low and middle income, where most affected children live. Poor public and medical awareness, and an absence of rigorous clinical trials to assess innovative treatments impede progress. Worldwide, most of the estimated 9000 newly diagnosed patients every year will die. However, global digital communications present opportunities to optimise standards of care for children and families affected by this rare and often devastating cancer. Parents are now leading the effort for widespread awareness of the danger of leucocoria. Genome-level technologies could make genetic testing a reality for every family affected by retinoblastoma. Best-practice guidelines, online sharing of pathological images, point-of-care data entry, multidisciplinary research, and clinical trials can reduce mortality. Most importantly, active participation of survivors and families will ensure that the whole wellbeing of the child is prioritised in any treatment plan.

Gichigo N, Kimani K, Wanyoike MK. "Survival Among Retinoblastoma Patients at the Kenyatta National Hospital, Kenya." Journal of Ophthalmology of Eastern Central and Southern Africa. 2013;1:16-19.
Nyamori JM, Kimani K, Njuguna MW, Dimaras H. "The Incidence and Distribution of Retinoblastoma in Kenya." British Journal of Ophthalmology. 2012;96:141-143.
Dimaras H, Kimani K, Dimba EA, Gronsdahl P, White A, Chan HSL, Gallie BL. "Retinoblastoma." Lancet. 2012;379:1436-1446.
Kwaako OA, Kimani K, Ilako DR, Akafo S, Ekem I, Rodrigues O, Laryea CE, Nentwich MM. "Ocular Manifestations of Sickle Cell Disease at Korle bu Hospital, Accra, Ghana." European Journal of Ophthalmology. 2011;21(4):484-489.
Chantada GL, Qaddoumi I, Canturk S, Khetan V, Ma Z, Kimani K, Yeniad B, Sultan I, Sitorus RS, Tacyildiz N, Abramson DH. "Strategies to Manage Retinoplastoma in Developing Countries.". 2011. Abstract

Survival of retinoblastoma is >90% in developed countries but there are significant differences with developing countries in stage at presentation, available treatment options, family compliance, and survival. In low-income countries (LICs), children present with advanced disease, and the reasons are socioeconomic and cultural. In middle-income countries (MICs), survival rates are better (>70%), but there is a high prevalence of microscopically disseminated extraocular disease. Programs for eye preservation have been developed, but toxicity-related mortality is higher. Although effective treatment of microscopically extraocular disease improved the outcome, worldwide survival will be increased only by earlier diagnosis and better treatment adherence.

Lewallen S, Williams TD, Dray A, c Stock B, Mathenge W, Oye J, Nkurikiye J, Kimani K, Muller A, Courtright P. "Estimating Incidence of Vision-Reducing Cataract in Africa-A New Model With Implications For Pogram Targets." Archives of Ophthalmology. 2010;128(12):1584-1589.
Muma MK, Kimani K, Kariuki – Wanyoike MM, ILAKO DR, Njuguna MW. "Prevalence of Refractive errors among Primary School Pupils in Kilungu Division of Makueni District, Kenya.". 2009. Abstract

To determine the magnitude and pattern of significant refractive errors in primary school children in Kilungu division of Makueni District, Kenya. Design: A cross – sectional primary school based study. Setting: Eight (8) Primary school in Kilungu division of Makueni District, Kenya. Target population: 1439 Primary school pupils aged between 12 and 15 years. Results: The prevalence of significant refractive error was 5.2%, 75/1439, (95% CI) being responsible for 92.6 % of all causes of poor eyesight. Hypermetropia accounted for 3.2% (95% CI), myopia 1.7% (95% CI) and astigmatism 0.3% (95% CI) of refractive errors. Myopia was more likely to be present in the pupils aged 14 to 15 years than those aged 12 to 13 years with OR 2.9 (0.1 – 9.2) which was statistically significant (p = 0.022). Conclusion: The overall prevalence of significant refractive errors in pupils aged 12 to 15 years in Makueni's Kilungu division at 5.2% (95% CI) was high enough to justify a regular school eye screening in primary schools in Kenya.

KAHAKI DRKIMANI, MARTIN DRKOLLMANNKH. "Listo BN, Kollmann KHM, Kimani K, Owino C.Ocular manifestations of HIV/AIDS at Moi Teaching and Referral Hospital (AMPATH Clinic). East Afr. j. ophthalmol. 2009 Jul; 15(1): 27-34.". In: African Journal of Midwifery and Womens. Prof. Anna karani, Prof. Simon Kangethe & Johannes Njagi Njoka; 2009. Abstract

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Objective: To determine the prevalence and pattern of ocular conditions in HIV/AIDS patients attending HIV/AIDS care clinic (AMPATH).

Design: Hospital-based cross sectional study.

Setting: Moi Teaching and Referral Hospital (AMPATH CLINIC) ,Eldoret, Kenya.

Subjects: HIV/AIDS patients seen at AMPATH, clinic.

Results: Two hundred patients with HIV/AIDS were examined. The overall prevalence of ocular findings was 154 patients (77%). One hundred and eighteen patients (59%) were on ARV therapy. The main findings were posterior segment lesions (53%), anterior segment disorders (26.5%). Posterior segment findings included; Retinal microvasculopathy (75 patients ,37.5%), chorioretinitis (9 patients, 4.5%), vitreous opacities (8 patients, 4%), macula edema (8 patients, 4%) and CMV retinitis (5 patients , 2.5%). Fibrous membrane attached to the iris mostly near the pupillary margin (37 patients, 18.5%) and iridocyclitis (11 patients, 5.5%) were the main anterior segment findings. Conjunctival growths (13 patients, 6,5%) and Kaposi (10 patients, 5%), conjunctival microvasculopathy (8 patients, 4%) and molluscum contagiosum (5 patients, 2.5%) were the main ocular adnexal findings. Tuberculosis was the main systemic findings (53%). This study found that ocular findings are directly related to the severity of clinical disease staging (e.g. WHO stages III and IV) and severity of immune suppression (CD4+ count).

Conclusion: The results of this study suggest a high prevalence of ocular findings in adolescents and adults with HIV/AIDS. Retinal microvasculopathy was the commonest posterior segment finding observed. Further studies are needed to investigate the unusual findings of the fibrous membrane attached to the iris observed in this study.

Kahaki K, Ciku M, Sheila M, Onyango O, Wachira W, Elkana O, Kagondu F, Karimurio J, Hans L. "Cataract Surgical Services, Outcome and Barriers in Kericho, Bureti and Bomet Districts, Kenya.". 2008. AbstractWebsite

Objective: To assess the cataract surgical coverage, outcome of cataract surgery and barriers to uptake of cataract surgical services. Setting: Kericho, Bureti and Bomet districts CES Project. Design: Cross-sectional population based survey using rapid assessment of avoidable blindness (RAAB) method. Participants: Fifty one clusters of 50 people aged 50 years or older were selected by probability proportionate to size sampling of clusters. Compact segment sampling was used to select households within the clusters. Two thousand fi ve hundred and forty six people were eligible for the survey of which 2419 (95%) were examined. Methods: Participants underwent a comprehensive ocular examination in their homes by an ophthalmologist. The visual acuity was measured using a tumbling E chart. The cause of visual impairment was established. Those who had undergone cataract surgery were questioned about the details of the operation and their satisfaction with the surgery. Those who were visually impaired from cataract were asked why they had not gone for surgery. Results: Cataract was found to be the main cause of blindness (42.9%) and visual impairment (42.7%) in those aged 50 years and older. The cataract surgical coverage was high, with 87.2% of those with bilateral cataract who needed surgery having had surgery at V/A<3/60. The quality of surgery was of concern with 20.7% of the 222 eyes that had undergone cataract surgery having a best corrected vision of <6/60. The main barriers to cataract surgery were cost and lack of awareness. Conclusions: The cataract surgical coverage in Kericho, Bureti and Bomet districts is high. The outcome of surgery is below the WHO standard and needs improvement.

Saiba ES, Kimani K, Ilako DR. "Outcome of Childhood Cataract Surgery at Kenyatta National Hospital." east African Journal of Ophthalmology. 2008;14(2):13-18.
Muinde T, Kimani K, Ilako D, Kathuku D. "The prevalence and pattern of ocular disorders among mentally ill patients in Mathari Hospital, Nairobi, Kenya.". 2008. Abstract

To establish the prevalence and pattern of ocular disorders in psychiatric patients admitted in Mathari Hospital. Design: Hospital based cross sectional study. Setting: Mathari Hospital wards from November 2006 to February 2007. Subjects: Three hundred patients admitted in Mathari Hospital wards that scored >22 marks on the mini mental state exam (MMSE) and gave consent. Results: A total of 300 patients were seen. The prevalence of ocular disorders in this group of patients was 41.3%. The commonest disorders were lens and corneal deposits which contributed 42.7%, refractive errors 25.8%, cataracts 5.6%, glaucoma 4.8%, while other conditions contributed 21.1%. There were no reported cases of self-infl icted ocular injuries. Fifty four patients had ocular side effects commonly associated with antipsychotic drugs (lens and corneal deposits and retinal pigmentary changes) and hence the prevalence of ocular side effects of antipsychotic drugs was 18%. Conclusions: There is a relatively high prevalence of ocular disorders in this group of patients (41.3%). The prevalence of ocular side effects for antipsychotic drugs was relatively high at 18%.

STEPHEN DRGICHUHI, MARCO DRSHEILAAKINYI, JEFITHA DRKARIMURIO, KAHAKI DRKIMANI, R. DRILAKODUNERA. "Barriers to utilization of eye care services in Kibera and Dagoreti Divisions of Nairobi, Kenya. E Afr J Ophthalmol. 2008 Nov; 14(2): 55-61. 2. Kimani K, Karimurio J, Gichuhi S, Marco S, Nyaga G, Wachira J, Ilako D.". In: East African Journal of Ophthalmology Nov; 14(2): 49-54. Prof. Anna karani, Prof. Simon Kangethe & Johannes Njagi Njoka; 2008. Abstract

OBJECTIVE: To determine the barriers to uptake of eye care services and to establish the pattern of utilization of eye care services 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 15th to 31st October 2007. Setting: Kibera and Dagoreti divisions of Nairobi City. SUBJECTS: Of the 4,200 people of all ages who were randomly selected; 4,056 were examined giving a response rate of 96.6%. Of those not examined, 126 (3.0%) were not available and 15 (0.4%) refused to be examined. Mean age of the study population was 22 years. RESULTS: A total of 294 subjects (7.2%) despite having some ocular disorder, had not visited any health facility to seek treatment. The majority, 144 (49%) gave the reason as no perceived need to seek treatment as the problem did not bother them; especially those with refractive error. A third, 97 (33%), gave the reason as lack of money, 22 (7.5%) said that they did not know where to seek eye care and 20 (6.8%) said they had no time to seek eye care. Only 3 said that the health facility where to go for eye care was too far. The population in the survey area has vast number of nearby secondary and tertiary eye care facilities to choose from. The majority of subjects indicated Mbagathi District Hospital (20.9%), Kikuyu Eye Unit (18.5%), Kenyatta National Hospital (12.1%) and private clinics (10.9%) as their health facilities of choice for eye care. The rest preferred Lions Sight First Eye Hospital, St Mary's Hospital, City Council Health Centers and optical shops. 7.7% of the subjects would visit a health centre or dispensary if they had an eye problem. A signifi cant proportion of respondents (7.5%) had no idea where they could seek treatment for eye disorders; most of them knew Mbagathi District Hospital and Kenyatta National Hospital but were not aware that eye care services were available at these facilities. CONCLUSION: Despite the large number of eye care facilities surrounding the NCES, community members are not able to access their services mainly because of lack of felt need (ignorance) and lack of money (poverty). RECOMMENDATIONS: There is need for eye health education and review of cost of services to the very poor communities within the NCES. It is important to strengthen the community eye care structures and referral network now that the project area has excess secondary and tertiary health facilities offering eye care services.

STEPHEN DRGICHUHI, MARTIN DRKOLLMANNKH, JEFITHA DRKARIMURIO, KAHAKI DRKIMANI. "Baseline trachoma survey in ELCK-Arsim integrated development project area of Samburu North, Kenya.E Afr J Ophthalmol. 2008 Nov; 14(2): 49-54. 3. Karimurio J, Kimani K, Gichuhi S, Kollmann KHM.". In: East African Journal of Ophthalmology Nov; 14(2): 49-54. Prof. Anna karani, Prof. Simon Kangethe & Johannes Njagi Njoka; 2008.
JEFITHA DRKARIMURIO, KAHAKI DRKIMANI, STEPHEN DRGICHUHI, MARCO DRSHEILAAKINYI, R. DRILAKODUNERA. "Karimurio J, Kimani K, Gichuhi S, Marco S, Nyaga G, Wachira J, Ilako D. Eye disease and visual impairment in Kibera and Dagoreti Divisions of Nairobi, Kenya. East Afr. j. ophthalmol. 2008 May; 14(1): 42-50.". In: East African Journal of Ophthalmology Nov; 14(2): 49-54. Prof. Anna karani, Prof. Simon Kangethe & Johannes Njagi Njoka; 2008. Abstract

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.

Muma MK, Kollmann M, Kimani K, Ilako DR. "Prevalence of Refractive Errors in Primary School Children of a Rural Distrct in Kenya." East African Journal of Ophthalmology. 2007;13(3):48-51.
Kimani K, Onsomu E, Onyango O, Sheila M, Nyaga G. "Rapid assessment of avoidable blindness (RAAB) in Kericho district.". 2005.

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