Publications

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2010
Dr Karimi PN. Etiology, Risk Factors And Management Of Infectious Diarrhoea In Children At Kenyatta National Hospital.; 2010. Abstract

Background: Infectious diarrhea is a common cause of mortality and morbidity in developing countries.
World Health Organization attributes 3.5 million deaths a year to diarrhea, with 80 percent of these deaths
occurring in children under the age of five, and most occurring in children between six months and three
years of age. The predisposing factors are mainly due to poor hygiene and most of the cases can be
treated using drugs and supportive measures. Prevention is the main intervention strategy used to prevent
this disease.
Objective: The main objective was to assess the factors that predispose children to diarrhea. The specific
factors assessed were prevalence of bacteria, protozoa, and helminthes, antimicrobial susceptibility of
bacteria, risk factors and management of diarrhea.
Methods: A cross section research design was used and target population was children suffering from
diarrhea and accompanied by their guardians who visited KNH to seek treatment. Three hundred and
eighty four children were selected for the study using simple random sampling. Data was collected using a
questionnaire and stool specimens analyzed in microbiology and parasitology laboratories of Kenyatta
National Hospital. The analysis of data was done using SPSS and data summarized in tables and charts.
Both inferential and descriptive statistics were derived using chi square and confidence intervals.
Results: Majority of the children were between 6-12 months of age and there were more males than
females. The average duration of diarrhea was 4.55 days and majority had suffered from the disease
before. Most of the parents had a certain level of formal education. The fathers had a source of income but
most of the mothers were either self employed or not employed at all. Tap water and toilet facilities were
available to most families and about half of the children had malnutrition.
No organisms were found from the stools of 80.2% of the children. The pathogens isolated were Giardia
lamblia, Entamoeba histolytica, Balantidium coli, Cryptosporidium petvum, Entamoeba coli, Blastocystis
hominis, Endolimax nana, Chilomastix mesnili, Trichiuris trichiura, Salmonella typhi and Salmonella
paratyphi. Bacteria isolated were sensitive to Ciprofioxacin and Levofioxacin but resisted most of the other
drugs tested.
xu
The risks found to be associated with diarrhea were overcrowding, inadequate hand washing methods,
mixed feeding, none or low level of education of the mother and administration of antibiotics. Majority of the
children had concurrent illnesses and the most common were pneumonia, meningitis, malaria, rickets and
malnutrition. Drugs were mainly prescribed to treat concurrent diseases. The most commonly prescribed
drugs were Zinc Sulphate, Paracetamol, Benzyl penicillin G, Gentamicin, Metronidazole, Multivitamin, Coamoxiclav,
Cefuroxime and Calcimax. ORS was most frequently used fluid and the intravenous ones
included Ringers lactate, Darrows solution, 5% Detrose, Hartmans solution, normal saline and Rehydration
salt for the malnourished.
Conclusion
Only a small proportion of diarrhea in children was caused by intestinal protozoa, helminthes or bacteria.
Majority of the cases occurred during weaning and rehydration was the comerstone of diarrhea
management Most of the drugs used were mainly for treating concurrent illnesses.
Recommendation
Mothers should be taught how to wean children especially on the type of food to use. They should also be
educated on proper hygienic practices especially washing of hands. Bottle feeding should be discouraged
and rational use of antibiotics encouraged

2009
Karimi PN, Bururia JM, Odhiambo PA, Amugune BK, Museve GO. "Prevalence and antimicrobial susceptibility of Enterobacteriaceae Collected from Patients with Wounds at Kenyatta National Hospital, Nairobi, Kenya.". 2009. Abstract

Prevalence and sensitivity' trend of Enterobacteriaceae isolated from septic wound were determined through' a prospective cross sectional study, One hundred and fifteen specimen isolated from in-patients in the Department of Orthopaedic were studied and antibiotic sensitivity testing performed using the Kirby and Bauer disc diffusion technique The prevalence of organism isolated was Proteus sPP (33.9%), Esherichia coli (13.2%), Klebsiella spp (7.9%), Alcaligenes (1.7%), Citrobacter freundii (O.9%) and serratia spp (0.9%) and Acinetobacter baumanii (0.9%). The sensitivity rate of ceftriaxone, ceftazidirne and ciprofloxacin was above 70% in all cases Co-amoxiclav, gentamicin, cefuroxime, minocycline and piperacillin showed moderate to high activity Kles iella spp isolates portrayed high resistance against several drugs. The sensitivity patterns showed that empirical prescribing should be discouraged since the organism appear to be developing resistance against commonly used antibiotics.

2008
Kinyanjui P, Bururia JM, Waiyaki PG, Kariuki SM, Karimi PN. "Plasmid Borne Resistance in Klebsiella Isolates from Kenyatta National Hospital, Nairobi, Kenya.". 2008. Abstractplasmid_borne_resistance_in_klebsiella_isolates_from_kenyatta_national_hospital.pdf

Eighty six Klebsiella isolates from Kenyatta National Hospital and the Centre for Microbiology, Kenya Medical Research Institute, Nairobi were screened for resistance to commonly prescribed antimicrobial agents and for their plasmid content. Plasmids were transferred into Esherichia coli K-12 and resulting transconjugants screened for resistance to the antimicrobial agents used on Klebsiella donors and for their plasmid content. Plasmids from the Klebsiella isolates were also transformed into Eschericia coli and transformants analyzed for resistance and plasmid content. Endonuclease restriction mapping was done to characterize the plasmids from Klebsiella isolates and their Eschericia coli transformants. Resistance was found to be plasmid borne and transmissible.

2007
Karimi PN. Etiology and risk factors of bacterial wound infections.; 2007. Abstract

Background: Kenyatta National Hospital (KNH) is a referral center serving patients from
Kenya and beyond. There are several departments among them orthopedics which houses
many patients with wounds, some of which are infected thereby increasing morbidity and
mortality. This research focused on etiology and risk factors of bacterial wound infections in
the orthopedics wards.
Objective: To assess the factors that contribute to wound infections. The specific factors
assessed were prevalence of aerobic bacteria. use of antibiotics and clinical practices among
the nurses when dressing wounds.
:VIethods: A descriptive research design was used and target populations were nurses and
hospitalized patients in the department of orthopedics at KNH. Sixteen nurses and one
hundred and fifteen patients were selected using simple random sampling and convenience
sampling techniques respectively. Data was collected using a questionnaire and specimens
taken from wounds analyzed in microbiology laboratories ofUON and KNH.
Results: The prevalence of bacteria isolated was; Pseudomonas spp. (42.6%). Proteus spp.
(33.9%). Staphylococcus aureus (33%). Klebsiella spp. (7.9%), Streptococcus faecalis
(6.1%), Enterbacter spp. (2.6%), Alcaligenes spp. (1.7%), Citrobacter freundii (0.9%),
Serratia spp. (0.9%), and Acinetobacter baumanii (0.9%).
The sensitivity patterns were as follows: Pseudomonas spp.; Pipril/Tozabactam (89.9%),
Meropenem (75.5%). Gentamycin (55.1%), Amikacin (73.5%), Ceftazidime (82.6%),
Ceftriaxone (30.6%), TicatcilliniClavulonic acid (65.3%) and Piperacillin (83.7%).
Proteus spp.: Ceftazidime (89.7%), Ceftriaxone (79.5%), Ciprofloxacin (87.2%), Augmentin
(76.9°/0). Cefuroxime (61.5%). Piperaciliin H8.7%)"Gentamycin (-1-6.2%)

2006
MUTUIRI DRBURURIAJOHN, NDIRANGU DKARIMIPETER, MAHINDRA DRMARUSHITAL, MOSES DRKURIAKIMANIARTHUR. "P.N. Karimi, S.M. Maru, J.M. Bururia, K.A.M. Kuria and P.A. Odhiambo (2006). Prevalence and Antimicrobial Susceptibility of Staphylococcus aureus at the Kenyatta National Hospital, Nairobi. East Centr. Afr. J. Pharm. Sci.9:71-73.". In: East Centr. Afr. J. Pharm. Sci. Heinrich Boll Foundation.; 2006. Abstract
A cross sectional study of 115 patients admitted at the Department of Orthopedics, Kenyatta National Hospital, Nairobi, Kenya was carried out to determine the prevalence and antibiotic susceptibility of Staphylococcus aureus isolated from infected wounds. The prevalence of Staphylococcus aureus was 33.0 %. The drugs tested and their corresponding sensitivity was amoxycillin (13.2 %), co-amoxyclav (39.5 %), oxacillin (55.3 %), erythromycin (44.7 %), gentamicin (60.5 %), ciprofloxacin (62.2 %), minocycline (86.8 %), cefuroxime (57.9 %), and clidamycin (84.2 %). These results show the sensitivity profile of Staphylococcus aureus and can be used to choose suitable drugs in the management of wounds for hospitalized patients.
2004
Ndungu TK, Maru SM, Kuria KAM, Karimi PN, Bururia JM. "Prescription audit carried out at the pharmacy practice centre of the University of Nairobi between June and November 2004.". 2004. Abstract

A retrospective descriptive study was carried out from June to November 2004 in a retail pharmacy situated at the School of Pharmacy, University of Nairobi within the Kenyatta National Hospital complex. The objective was to evaluate prescribing habits and to determine the frequency of prescribing of commonly used drug classes in a hospital. The average number of drugs per prescription was 2.20  1.16. The prevalence of prescribing was 28.6% anti-infective drugs, 21.1% musculoskeletal agents, 16.6% respiratory system drugs, 8.1% cardiovascular system drugs, 7.2% central nervous system drugs, 7.1% gastrointestinal system drugs, 4.3% minerals and vitamins, 2.1% ear, nose and throat drugs, 1.1% endocrine drugs, 2% skin preparations, 0.9% anticancer drugs and 0.74% eye preparations. The prescribing habits evaluated were compared to the legal requirements in Kenya and to recommended international practice. The information gathered may serve as a basis for rational use of drugs.

1994
Ndirangu K, Ngugi M. "Problems of indwelling Foley catheters.". 1994. Abstract

One hundred patients undergoing urinary bladder catheterization for various reasons were studied. 42 patients received Sewoon catheters of various sizes. 38 received Eschmann catheters of various sizes and 20 received Bard catheters of various sizes. The duration of catheterization ranged from a few hours to 21 days. Various problems associated with catheterization were recorded whenever encountered. Stuck catheter was found to occur in 15 of the 40 patients who received Sewoon catheters. There were no stuck catheters recorded for Eschmann or Bard catheters. Infections occurred in 9 out of 100 patients, 7 of whom had Sewoon catheters. Leakage was recorded in 12 of the 100 patients, 9 of whom had Sewoon catheters. Blockage of balloon occurred in 5 patients, 3 of whom had Sewoon catheters. Painful spasms occurred in 8 patients, 4 with Bard, 4 with Sewoon catheters. It is concluded that Sewoon type of Foley catheters was associated with more problems than the other types studied

1993
Ndirangu K. "Transsexual surgery: a case of true gender dysphoria.". 1993. Abstract

A 28 year old male was screened, investigated and diagnosed as a case of true gender dysphoria. Subsequently he was operated and transsexual surgery successfully carried out. Four years after surgery, the patient has been followed up and found to be living a normal life as a female

1990
Ndirangu K, Ngwanyam NY. "Surgical management of urolithiasis at the Kenyatta National Hospital.". 1990. Abstract

Over a ten-year-period, 82 patients with 89 episodes of urinary stones were seen and managed in the General Surgical Units of Kenyatta National Hospital. The management procedures were evaluated and the magnitude of complications (morbidity/mortality) assessed. Some recommendations are made for the prevention and management of stone disease in this and similar communities

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