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(Last updated: March 22, 2013)

Publications

2011

Hatcher, J, Smith A, Mackenzie I, Thompson S, Bal I, Macharia I, Mugwe P, Okoth-Olende C, Oburra H, Wanjohi Z.  2011.  A prevalence study of ear problems in school children in Kiambu district, Kenya, May 1992. Abstract

Information on the prevalence of hearing impairment and related ear pathologies in children in sub-Saharan Africa is scarce. A pilot study for a clinical trial of simple treatments for chronic suppurative otitis media (CSOM) in school children in Kiambu district, Kenya, provided information on the prevalence of hearing impairment and ear pathologies. Five-thousand-three-hundred-sixty-eight children from 57 randomly chosen primary schools in Kiambu district were examined. Simple otoscopy was performed by clinical officers with specialty training in ENT, and hering testing was performed by trained nurses, using a hand held field audiometer. Microbiological specimens were obtained from those children with CSOM. Five-point-six percent of the children had a hearing impairment of > 30 dB HL in one or both ears, with 2.2% having bilateral hearing impairment. Two-point-four percent had at least one perforated tympanic membrane, and 1.1% had CSOM. Eight-point-six percent of the children had wax obstructing the tympanic membrane. There is evidence of a relationship between hearing impairment and both CSOM and wax obstructing the tympanic membrane. The most common organisms found were Pseudomonas spp. (34%), Proteus spp. (34%) and Eschericia coli (19%). These results are comparable with other studies in Africa and indicate a considerable burden of ear disease in Kiambu district, Kenya

2006

MUTHURE, PROFMACHARIAISAAC.  2006.  Onyango JF, Awange DO, Njiru A, Macharia IM.Pattern of occurrence of head and neck cancer presenting at Kenyatta National Hospital, Nairobi.East Afr Med J. 2006 May;83(5):288-91.. East Afr Med J. 2006 May;83(5):288-91.. : University of Nairobi Case, in the proceedings of the IST-Africa 2008 Conference; Windhoek, Namibia Abstract
BACKGROUND: Currently there is a dearth of data on the pattern of occurrence of head and neck cancers in Kenya. OBJECTIVE: To provide a comprehensive analysis of the pattern of occurrence of head and neck cancers in a Kenyan population. DESIGN: Retrospective hospital-based descriptive study. SETTING: Kenyatta National Hospital, Nairobi. RESULT: A total of 793 cases were recorded consisting of 507 male and 286 female (M: F = 2:1). Most of the lesions arose from the upper aerodigestive pathway. The larynx was the most common site for aerodigestive malignancies. This was followed in order of frequency, by the tongue, the mouth, and the nasopharynx. Outside the aerodigestive pathway the eye was the most commonly affected site followed by the thyroid. Squamous cell carcinoma was the most common malignancy. Sarcomas were typically rare. Gender and age distribution showed an overall male preponderance and a wide age range. However, specific tumour sites and tumour types showed varying patterns of gender and age distribution. CONCLUSION: This study confirms the relative prominence of laryngeal, oral and nasopharyngeal cancers in the African population. It is, however, at variance with other African studies regarding the relative frequency of nasal and paranasal cancers.
MUTHURE, PROFMACHARIAISAAC.  2006.  Onyango JF, Macharia IM.Delays in diagnosis, referral and management of head and neck cancer presenting at Kenyatta National Hospital, Nairobi.East Afr Med J. 2006 Apr;83(4):85-91.. East Afr Med J. 2006 Apr;83(4):85-91.. : University of Nairobi Case, in the proceedings of the IST-Africa 2008 Conference; Windhoek, Namibia Abstract
BACKGROUND: The most important prognostic factor in head and neck cancer is the stage of the disease at presentation. Early cancer has an excellent prognosis following treatment. Unfortunately most patients present with late disease that requires radical treatment with considerable morbidity and mortality. Clinical experience at Kenyatta National Hospital (KNH) shows that most patients present with late disease. OBJECTIVE: To determine the causes of late presentation of head and neck cancer. DESIGN: A prospective descriptive study. SETTING: Kenyatta National Hospital, Nairobi. RESULTS: Forty four cases were seen among whom 34 were males and 10 were females. The age range was 20 to 90 years with a peak incidence between 50 and 60 years. Most of the patients had little or no education and the majority lived in the rural areas. Seventy one percent of the patients came from the Central and Eastern provinces. Tobacco and alcohol use were the most common risk habits. The larynx was the most common site affected followed by the tongue. In 61% of the cases the size of the tumours at presentation was unknown. In 14% the size was 1-2cm, in 7% of the cases it was 2-4 cm while in 5% of the cases it was 4-6 cm. In 14% of the cases the tumour size was over 6 cm. The most common presenting symptom was hoarseness followed by swelling. The majority of the patients attended a public health facility nearest them. For most patients the facility lay within 5 km and could be accessed by walking. However, most of the patients went through multiple referrals to get to KNH. By the time the patients reached KNH, 35 patients (77%) had been treated with unspecified medications, two (4%) had had tooth extraction, and seven (16%) had had biopsies done. The time-lapse between the first symptom and consultation ranged from zero and eight months. Forty five percent of the patients presented to a medical facility within one month of their symptom and 45% presented after three months. The time lapse between referral and attendance at KNH ranged from zero and thirteen weeks and 45% of the patients presented to KNH within two weeks of referral. The overall duration of symptoms by the time of diagnosis ranged from zero months to unspecified years. Thirty two percent of the cases had experienced symptoms for six months or less by the time of diagnosis. However, a number of patients had had their symptoms for a number of years by the time of diagnosis. The distribution of the tumours by stage at the time of final diagnosis were as follows: stage I were 2%, stage II 6%, stage III 14% and stage IV 56%. CONCLUSION: This study showed that the referral system was the main cause of delayed presentation of head and neck cancer to Kenyatta National Hospital.
MUTHURE, PROFMACHARIAISAAC.  2006.  Omondi D, Ogol C, Otieno S, Macharia I.Parental awareness of hearing impairment in their school-going children and healthcare seeking behaviour in Kisumu district, Kenya.Int J Pediatr Otorhinolaryngol. 2007 Mar;71(3):415-23. Epub 2006 Dec 18. Int J Pediatr Otorhinolaryngol. 2007 Mar;71(3):415-23. Epub 2006 Dec 18. : University of Nairobi Case, in the proceedings of the IST-Africa 2008 Conference; Windhoek, Namibia Abstract

BACKGROUND: Hearing-impaired children who are identified early and appropriately managed have improved outcomes in speech, language, cognitive and social development. Enhanced parental awareness of their child's hearing disability, behavioral, developmental and psychosocial limitations is essential to sustaining timely detection and appropriate intervention. Additionally, availability of services for diagnosis, treatment and habilitation would improve the demand for pedaudiological care in this community. OBJECTIVE: To describe level of parental awareness of childhood HI and the pattern of access to and utilization of ambulatory care services. SUBJECTS: Thirty-three parents of lower primary school-going children who failed audiometric screening from sampled schools in Kisumu district, western Kenya. MAIN OUTCOME MEASURES: First person to detect HI, age of child at first suspicion of HI, source of ambulatory health care and use of the health care facilities. RESULTS: The prevalence of HI was 2.48%. Most parents/guardians (69.7%) were aware of their child's hearing impairment. Of these, 63.6% were first to detect HI in the pupils, while 30.3% were detected by screen. Most children (57.2%) were first recognized with (HI) after age 2 years. The mean age at identification was 5.5 years. The median travel distance to the preferred health care facility was 2 km (IQR 1-2.5). Parents seldom sought or lacked help for their hearing-impaired children. Of 27.3% who asked for hearing assessment, 9.1% received some counsel on HI and 12.1% received medication, one (3%) was referred for audiological assessment and none used a hearing aid. Use of health facilities for maternal care was (65.7%) and immunization (62.9%). CONCLUSIONS: Despite adequate parental awareness of chronic childhood disability, health facilities were underutilized. This indicates the need to further stimulate and maintain a desirable level of uptake of services for diagnosis, treatment and habilitation of childhood HI, while sustaining delivery of effective and acceptable high quality paediatric care.
MUTHURE, PROFMACHARIAISAAC.  2006.  Omoro SA, Fann JR, Weymuller EA, Macharia IM, Yueh B.Swahili translation and validation of the Patient Health Questionnaire-9 depression scale in the Kenyan head and neck cancer patient population.Int J Psychiatry Med. 2006;36(3):367-81.. Int J Psychiatry Med. 2006;36(3):367-81.. : University of Nairobi Case, in the proceedings of the IST-Africa 2008 Conference; Windhoek, Namibia Abstract

{ BACKGROUND: Depression is an important predictor of post therapy quality of life (QOL) in head and neck (H&N) cancer patients. In addition, depression rates may vary among cultures. OBJECTIVE: As part of a larger cross cultural study on post therapy QOL differences in H&N cancer patients, the goal of this project was to translate a well-validated English language depression scale into Swahili, and then validate this scale in Kenyan H&N cancer patients. METHODS, SETTINGS AND SUBJECTS: In Part 1 of the study, we translated the Patient Health Questionnaire-9 (PHQ-9) into Swahili, adhering to established International Quality of Life Association (IQOLA) guidelines. In Part 2, we psychometrically validated the newly translated scale using a prospective study of 48 patients at the Kenyatta National Hospital ENT clinic in Nairobi, Kenya. RESULTS: The Swahili PHQ-9 had good test retest reliability (Intraclass correlation coefficient, 0.71) and internal consistency (Cronbach's alpha = 0.80). It also had good construct validity, as scores correlated strongly with TNM stage (Chi square = 123, p < 0.05), and with the compositeand global scores of an H&N cancer specific QOL scale (UW-QOL

2005

K, DRKARIUKIDAVID, MUTHURE PROFMACHARIAISAAC, PETER DRMUGWE.  2005.  Macfadyen C, Gamble C, Garner P, Macharia I, Mackenzie I, Mugwe P, Oburra H, Otwombe K, Taylor S, Williamson P.Topical quinolone vs. antiseptic for treating chronic suppurative otitis media: a randomized controlled trial.Trop Med Int Health. 2005 Feb;10(2. Trop Med Int Health. 2005 Feb;10(2):190-7.. : University of Nairobi Case, in the proceedings of the IST-Africa 2008 Conference; Windhoek, Namibia Abstract
OBJECTIVE: To compare a topical quinolone antibiotic (ciprofloxacin) with a cheaper topical antiseptic (boric acid) for treating chronic suppurative otitis media in children. DESIGN: Randomized controlled trial. SETTING AND PARTICIPANTS: A total of 427 children with chronic suppurative otitis media enrolled from 141 schools following screening of 39 841 schoolchildren in Kenya. Intervention Topical ciprofloxacin (n = 216) or boric acid in alcohol (n = 211); child-to-child treatment twice daily for 2 weeks. MAIN OUTCOME MEASURES: Resolution of discharge (at 2 weeks for primary outcome), healing of the tympanic membrane, and change in hearing threshold from baseline, all at 2 and 4 weeks. RESULTS: At 2 weeks, discharge was resolved in 123 of 207 (59%) children given ciprofloxacin, and in 65 of 204 (32%) given boric acid (relative risk 1.86; 95% CI 1.48-2.35; P < 0.0001). This effect was also significant at 4 weeks, and ciprofloxacin was associated with better hearing at both visits. No difference with respect to tympanic membrane healing was detected. There were significantly fewer adverse events of ear pain, irritation, and bleeding on mopping with ciprofloxacin than boric acid. CONCLUSIONS: Ciprofloxacin performed better than boric acid and alcohol for treating chronic suppurative otitis media in children in Kenya.

2001

K, DRKARIUKIDAVID, MUTHURE PROFMACHARIAISAAC.  2001.  Macharia I. M.adenotonsillitis, editorial.. East Afr. Med J.2001;337. : University of Nairobi Case, in the proceedings of the IST-Africa 2008 Conference; Windhoek, Namibia Abstract
OBJECTIVE: To determine the bacteriology and antibiotic sensitivity of the bacterial isolates in chronic maxillary sinusitis patients seen at the Kenyatta National Hospital. DESIGN: Cross-sectional study. SETTING: Kenyatta National Hospital, ENT department. SUBJECTS AND METHODS: Seventy-three patients had bilateral sntral washout done and the lavage submitted for culture and anti-microbial sensitivity between January and June 1996. RESULTS: Antral lavage yielded secretions in 63% of patients but bacteria were cultured in only 28.8% of the specimens. The isolates included Streptococcus pneumonia (22.2%), Staphylocococus albus (18.5%), Staphylocococus aureus (11.1%) and Enterobactericiae (11.1%). Anaerobic bacteria were cultured in 22.2% of the specimens. Of the commonly used antibiotics, there was high sensitivity to erythromycin, cefadroxyl, chloramphenicol and amoxicillin and poor sensitivity to ampicillin, cotrimoxazole and perfloxacin. CONCLUSION: The bacteriology of chronic maxillary sinusitis at Kenyatta National Hospital is generally similar to that found elsewhere. The bacteria are susceptible to relatively affordable antibiotics like amoxicillin, erythromycin and cefadroxyl.
MUTHURE, PROFMACHARIAISAAC.  2001.  Macharia IM.Adenotonsillectomy.East Afr Med J. 2001 Jul;78(7):337.. East Afr Med J. 2001 Jul;78(7):337.. : University of Nairobi Case, in the proceedings of the IST-Africa 2008 Conference; Windhoek, Namibia Abstract
OBJECTIVE: To determine the bacteriology and antibiotic sensitivity of the bacterial isolates in chronic maxillary sinusitis patients seen at the Kenyatta National Hospital. DESIGN: Cross-sectional study. SETTING: Kenyatta National Hospital, ENT department. SUBJECTS AND METHODS: Seventy-three patients had bilateral sntral washout done and the lavage submitted for culture and anti-microbial sensitivity between January and June 1996. RESULTS: Antral lavage yielded secretions in 63% of patients but bacteria were cultured in only 28.8% of the specimens. The isolates included Streptococcus pneumonia (22.2%), Staphylocococus albus (18.5%), Staphylocococus aureus (11.1%) and Enterobactericiae (11.1%). Anaerobic bacteria were cultured in 22.2% of the specimens. Of the commonly used antibiotics, there was high sensitivity to erythromycin, cefadroxyl, chloramphenicol and amoxicillin and poor sensitivity to ampicillin, cotrimoxazole and perfloxacin. CONCLUSION: The bacteriology of chronic maxillary sinusitis at Kenyatta National Hospital is generally similar to that found elsewhere. The bacteria are susceptible to relatively affordable antibiotics like amoxicillin, erythromycin and cefadroxyl.
K, DRKARIUKIDAVID, MUTHURE PROFMACHARIAISAAC.  2001.  Kamau J. K., Macharia I. M.,Odhiambo P. A Bacteriology of chronic maxillary sinusitis at Kenyatta National Hospital, Nairobi.. East Afr. Med J. 2001;. : University of Nairobi Case, in the proceedings of the IST-Africa 2008 Conference; Windhoek, Namibia Abstract
OBJECTIVE: To determine the bacteriology and antibiotic sensitivity of the bacterial isolates in chronic maxillary sinusitis patients seen at the Kenyatta National Hospital. DESIGN: Cross-sectional study. SETTING: Kenyatta National Hospital, ENT department. SUBJECTS AND METHODS: Seventy-three patients had bilateral sntral washout done and the lavage submitted for culture and anti-microbial sensitivity between January and June 1996. RESULTS: Antral lavage yielded secretions in 63% of patients but bacteria were cultured in only 28.8% of the specimens. The isolates included Streptococcus pneumonia (22.2%), Staphylocococus albus (18.5%), Staphylocococus aureus (11.1%) and Enterobactericiae (11.1%). Anaerobic bacteria were cultured in 22.2% of the specimens. Of the commonly used antibiotics, there was high sensitivity to erythromycin, cefadroxyl, chloramphenicol and amoxicillin and poor sensitivity to ampicillin, cotrimoxazole and perfloxacin. CONCLUSION: The bacteriology of chronic maxillary sinusitis at Kenyatta National Hospital is generally similar to that found elsewhere. The bacteria are susceptible to relatively affordable antibiotics like amoxicillin, erythromycin and cefadroxyl.

1999

K, DRKARIUKIDAVID, MUTHURE PROFMACHARIAISAAC.  1999.  P.A. Odhiambo., A.Opiyo., I. Macharia., P. Akuku Okoth. Some rare lesions of the oesophagus: Case reports.. Medicom 1999; 14(2): 43-46.. : University of Nairobi Case, in the proceedings of the IST-Africa 2008 Conference; Windhoek, Namibia Abstract
OBJECTIVE: To determine the bacteriology and antibiotic sensitivity of the bacterial isolates in chronic maxillary sinusitis patients seen at the Kenyatta National Hospital. DESIGN: Cross-sectional study. SETTING: Kenyatta National Hospital, ENT department. SUBJECTS AND METHODS: Seventy-three patients had bilateral sntral washout done and the lavage submitted for culture and anti-microbial sensitivity between January and June 1996. RESULTS: Antral lavage yielded secretions in 63% of patients but bacteria were cultured in only 28.8% of the specimens. The isolates included Streptococcus pneumonia (22.2%), Staphylocococus albus (18.5%), Staphylocococus aureus (11.1%) and Enterobactericiae (11.1%). Anaerobic bacteria were cultured in 22.2% of the specimens. Of the commonly used antibiotics, there was high sensitivity to erythromycin, cefadroxyl, chloramphenicol and amoxicillin and poor sensitivity to ampicillin, cotrimoxazole and perfloxacin. CONCLUSION: The bacteriology of chronic maxillary sinusitis at Kenyatta National Hospital is generally similar to that found elsewhere. The bacteria are susceptible to relatively affordable antibiotics like amoxicillin, erythromycin and cefadroxyl.

1996

Smith, AW, Hatcher J, Mackenzie IJ, Thompson S, Bal I, Macharia I, Mugwe P, Okoth-Olende C, Oburra H, Wanjohi Z.  1996.  Randomised controlled trial of treatment of chronic suppurative otitis media in Kenyan schoolchildren.Lancet. 1996 Oct 26;348(9035):1128-33.

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