Bio

Publications


2010

Kumar, R, Musoke R, Macharia WM, Revathi G.  2010.  Validation of c-reactive protein in the early diagnosis of neonatal sepsis in a tertiary care hospital in Kenya. Abstract

To evaluate utility of C-reactive protein (CRP) in the early diagnosis of neonatal sepsis in a tertiary care Newborn Unit in Kenya. DESIGN: Cross-sectional study. SETTING: Newborn Unit, Kenyatta National Hospital. SUBJECTS: All neonates admitted to Newborn Unit, Kenyatta National Hospital during the study period with suspected sepsis based on specified clinical criteria. RESULTS: Of the 310 infants, there were 83 episodes of proven sepsis and 94 episodes of probable sepsis. Using the standard CRP cut-off value of 5 mg/dl, a sensitivity of 95.2% in proven sepsis and 98.9% for probable septic episodes were noted. In proven sepsis, a specificity of 85.3%, positive predictive value of 80.6%, and a negative predictive value of 96.5% were noted. In probable sepsis, a specificity of 83.3%, positive predictive value of 80.9% and a negative predictive value of 99.1% were noted. The overall accuracy in proven sepsis was 96.5%, and in probable sepsis was noted to be 99.1%. Sub-analysis showed a lower positive predictive value (61.5%) for early onset sepsis compared to 93% for late onset sepsis. Repeat CRP tests were done in 33 babies. Twenty two of the 29 with proven/probable infection had a ten-fold increase in CRP levels, but levels were noted to be low or reducing in seven (24.1%) babies showing signs of improvement clinically. Using a receiver operator characteristic curve, the optimal cut-off point for CRP was found to be 5 mg/dl. CONCLUSIONS: Serum CRP is an accurate indicator of neonatal sepsis, with high sensitivity, specificity and predictive values, at the standard cut-off of 5. CRP is a better screening test for late-onset than early-onset neonatal sepsis. The standard recommended CRP cut -off point of 5 is appropriate for local use

Bark CM, Morrison CS, SRABJKKNHMRDMJBMRNN-.  2010.  Acceptability of treatment of latent tuberculosis infection in newly HIV-infected young women in Uganda. . nt J Tuberc Lung Dis. 2010 Dec;14(12):1647-9. . Abstract

Abstract

We studied the acceptability of isoniazid preventive therapy (IPT) in newly human immunodeficiency virus (HIV) infected Ugandan women. Women were followed in an out-patient clinic where they received HIV care including IPT. Of 52 women who were purified protein derivative-positive, 48 were eligible for IPT and 39 (81%) completed therapy. This completion rate was higher than reported in similar observational studies.

2009

Kiulia NM, Nyaundi JK, Peenze I, Nyachieo A, Musoke RN, Steele AD MJM.  2009.  Rotavirus infections among HIV-infected children in Nairobi, Kenya.. J Trop Pediatr. 2009 Oct;55(5):318-23. doi: 10.1093/tropej/fmp016. Epub 2009 Mar 10.. Abstract

Abstract
Human rotaviruses have emerged as a leading cause of acute diarrhea in children <5 years of age worldwide. Although there are previous reports relating to various aspects of rotaviruses, there is limited data on the involvement of rotavirus infection in HIV-infected children. We therefore evaluated the importance of rotavirus infections in HIV-related diarrhea in Kenyan children. Fecal samples were collected from a total of 207 children during the period February 1999 to June 2000 and screened for HRV antigen by enzyme-linked immunosorbent assay (ELISA). Positive samples were analyzed by VP6 subgroup specificity assay, by polyacrylamide gel electrophoresis (PAGE) and reverse transcriptase/polymerase chain reaction (RT-PCR). Fourteen percent (29/207) of the samples were positive. HIV-seropositive children with diarrhea were more likely than their counterparts without diarrhea to have rotaviruses [23.3% (10/43) versus 2.9% (2/70); p = 0.0001]. Rotavirus strain G3P[6] was predominant. These results indicate that rotavirus is an important viral etiological agent causing diarrhea in HIV-seropositive children.

2008

Musoke, RN.  2008.  Challenge of infant feeding choices among HIV infected mothers in Africa., 2008 Apr. East African medical journal. 85(4):153-5.
RN., M.  2008.  Determinants of nutritional status in children.. East Afr Med J. 2008 Oct;85(10):469-70. No abstract available.
N, PROFMUSOKERACHEL.  2008.  Musoke RN.Challenge of infant feeding choices among HIV infected mothers in Africa.East Afr Med J. 2008 Apr;85(4):153-5.. East Afr Med J. 2008 Apr;85(4):153-5.. : Far East Journal of Theoretical Statistics Abstract

PIP: In November and December, 1993, a self-administered questionnaire was distributed to men in the town of Machakos and to nonmedical hospital workers of Machakos General Hospital. The purpose of the study was to assess their knowledge about and attitude towards vasectomy. The majority of men were in the age group of 30-44 years and were married; the hospital group was more educated. The town men perceived the pill to be the best contraceptive method for women in contrast to the hospital group who gave more importance to bilateral tubal ligation. The hospital group also perceived vasectomy as the best method for men. Overall, 53.2% men were aware of the correct procedure of vasectomy, but only 24% had correct knowledge of how the procedure affects masculinity. The knowledge of the procedure among hospital workers was not very different from that of the town group. Recommendations were made to increase information and education to all groups of people through various media. author's modified

2004

Musoke, RN.  2004.  Perinatal mortality in Kenya: time for action., 2004 Nov. East African medical journal. 81(11):553-4.
O, PROFWASUNNAAGGREY, N PROFMUSOKERACHEL, N PROFWEREFREDRICK.  2004.  Were FN, Lusweti B, Wasunna A , Musoke RN.Isdelivery outside hospital a risk of development of early sepsis? Journal of Obstetrics and gynaecology East and Central Africa Vol 17:1; 19-24, 2004. : Far East Journal of Theoretical Statistics Abstract
n/a
N, PROFMUSOKERACHEL.  2004.  Perinatal mortality in Kenya: time for action. East Afr Med J . 2004 Nov; 81 ( 11 ): 553-4 . No abstract available. PMID: 15868962 [PubMed - indexed for MEDLINE] Musoke RN.. East Afr Med J . 2004 Nov; 81 ( 11 ): 553-4 .. : Far East Journal of Theoretical Statistics Abstract
No abstract available.

2003

Laving, AMR, Musoke RN, Wasunna AO, Revathi G.  2003.  Neonatal bacterial meningitis at the newborn unit of Kenyatta National Hospital., 2003 Sep. East African medical journal. 80(9):456-62. Abstract

Meningitis occurs in up to one third of neonates with septicaemia. Diagnosis is difficult due to its non-specificity of signs and symptoms. While neonatal septicaemia is a common problem at Kenyatta National Hospital (KNH), there are no recent data on the incidence and clinical characteristics of neonatal meningitis at the hospital.

MUSSA, DRLAVINGAHMEDMOHAMEDRAFIK, O PROFWASUNNAAGGREY, N PROFMUSOKERACHEL.  2003.  Neonatal bacterial meningitis at the newborn unit of Kenyatta National Hospital. East Afr Med J. 2003 Sep;80(9):456-62. Laving AM, Musoke RN, Wasunna AO, Revathi G.. East Afr Med J. 2003 Sep;80(9):456-62.. : Far East Journal of Theoretical Statistics Abstract
{ BACKGROUND: Meningitis occurs in up to one third of neonates with septicaemia. Diagnosis is difficult due to its non-specificity of signs and symptoms. While neonatal septicaemia is a common problem at Kenyatta National Hospital (KNH), there are no recent data on the incidence and clinical characteristics of neonatal meningitis at the hospital. OBJECTIVE: To evaluate the prevalence and the bacterial aetiology of meningitis in neonates at the Newborn Unit (NBU) of KNH. DESIGN: Descriptive cross-sectional study. SETTING: Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS AND METHODS: Lumbar punctures were performed on eighty-four neonates with suspected sepsis based on specified clinical criteria. Cases were defined as meningitis if the cerebrospinal fluid (CSF) was positive for bacteria by Gram stain, aerobic bacterial culture or latex particle agglutination assay. RESULTS: The prevalence of meningitis amongst cases of suspected sepsis was 17.9%. The male:female ratio was 1.5:1 mean birth weight 2116.7 grams (1682.2-2551.2) mean gestational age 35.7 weeks (32.6-38.8) and the mean postnatal age was 4.1 days (2.7-5.4) with none of the parameters being significantly different from those without meningitis. Feed intolerance and lethargy were the most common clinical features, present in 73.3% and 60% of patients with meningitis respectively. Neonates with meningitis had a higher mean CSF protein value (2.67 g/L vs 1.97 g/L

2002

Were, FN, Mukhwana BO, Musoke RN.  2002.  Neonatal survival of infants less than 2000 grams born at Kenyatta National Hospital., 2002 Feb. East African medical journal. 79(2):77-9. Abstract

Survival of patients is regularly used as a measure of the level and appropriateness of medical care provided by institutions. Newborn services have been evaluated in this manner since the 1960s. Though Kenyatta National Hospital has provided neonatal services for over 25 years, no survival data for the low birth weight infants has been published since 1978.

Ndwiga, DN, Were FN, Musoke RN.  2002.  Hyponatraemia in very low birth weight infants., 2002 Mar. East African medical journal. 79(3):120-3. Abstract

Infants less than 1500 grams at birth have been demonstrated to be particularly prone to development of low levels of serum sodium often leading to increased early neonatal morbidity and mortality. No local study has been done to quantify this problem among sick newborns. Studies elsewhere demonstrate a high incidence of hyponatraemia among such preterms.

2001

Musoke, RN, Ayisi RK, Orinda DA, Mbiti MJ.  2001.  Do healthy very-low-birth-weight infants fed on their own mothers' milk require sodium supplementation?, 2001 Advances in experimental medicine and biology. 501:431-7. Abstract

Sodium and potassium levels were measured weekly in mothers' milk and in serum and urine of 41 supplemented and 25 unsupplemented very-low-birth-weight infants whose mean birth weights were 1390g and 1332g, respectively (mean gestational age, 31 weeks). Sodium intake was 5.95mmol/kg/day for the supplemented group and 2.75mmol/kg/day for controls. None of the infants in either group was hyponatremic during the 6-week period of study. Urinary sodium in the supplemented group was 15.7mmol/L as compared with 7.5mmol/L in controls. Human milk sodium was significantly lower than reported elsewhere. Growth in the supplemented group was greater than in the unsupplemented group. Since no episode of hyponatremia occurred, it was concluded that routine sodium supplementation was unnecessary.

N, PROFMUSOKERACHEL.  2001.  Do healthy very-low-birth-weight infants fed on their own mothers' milk require sodium supplementation? Adv Exp Med Biol . 2001; 501 : 431-7 . PMID: 11787713 [PubMed - indexed for MEDLINE] Musoke RN, Ayisi RK, Orinda DA, Mbiti MJ. Adv Exp Med Biol . 2001; 501 : 431-7 .. : Far East Journal of Theoretical Statistics Abstract

Department of Paediatrics, University of Nairobi, Kenya. Sodium and potassium levels were measured weekly in mothers' milk and in serum and urine of 41 supplemented and 25 unsupplemented very-low-birth-weight infants whose mean birth weights were 1390g and 1332g, respectively (mean gestational age, 31 weeks). Sodium intake was 5.95mmol/kg/day for the supplemented group and 2.75mmol/kg/day for controls. None of the infants in either group was hyponatremic during the 6-week period of study. Urinary sodium in the supplemented group was 15.7mmol/L as compared with 7.5mmol/L in controls. Human milk sodium was significantly lower than reported elsewhere. Growth in the supplemented group was greater than in the unsupplemented group. Since no episode of hyponatremia occurred, it was concluded that routine sodium supplementation was unnecessary. PMID: 11787713 [PubMed - indexed for MEDLINE]

2000

N, PROFMUSOKERACHEL.  2000.  Emergence of multidrug-resistant gram-negative organisms in a neonatal unit and the therapeutic implications. J Trop Pediatr . 2000 Apr; 46 ( 2 ): 86-91 . PMID: 10822934 [PubMed - indexed for MEDLINE] Musoke RN, Revathi G.. J Trop Pediatr . 2000 Apr; 46 ( 2 ): 86-91 .. : Far East Journal of Theoretical Statistics Abstract
Department of Paediatrics, University of Nairobi, Kenya. Multidrug-resistant organisms are increasing worldwide. Over the years we have noted increasing resistance of organisms isolated in our neonatal unit. There is a need therefore to scrutinize the problem so as to be able to plan for the future. Over a 5-month period, 716 infants were admitted of which 192 were screened for sepsis. Overall, 121 (16.7 per cent) had positive blood cultures. The predominant organisms were Gram negative (73.6 per cent of isolates) with Klebsiella species topping the list at 31 per cent. Case fatality for infants infected with Gram negative organisms was 41 per cent. Resistance to gentamicin was 20 per cent chloramphenicol 23.6 per cent, and amoxicillin/ampicillin 66.3 per cent. Of worry is the resistance to ceftazidime 19.1 per cent, and cefuroxime 21.3 per cent, with the figures rising to 27 per cent when more specialized tests are done (disc approximation and potentiation tests). If these drugs cannot be used in 20-27 per cent of cases then the situation is serious. The contributory factors to increased resistance include: non-investigation of infants put on antibiotics (50 per cent of cases); prolonged (73 per cent) and sometimes unjustified (41.7 per cent) use of antibiotics; and non-utilization of investigations when these are done (52 per cent) together with the delay in getting results back in the ward (6 days). PMID: 10822934 [PubMed - indexed for MEDLINE]

1999

Oyatsi, DP, Musoke RN, Wasunna AO.  1999.  Incidence of rickets of prematurity at Kenyatta National Hospital, Nairobi., 1999 Feb. East African medical journal. 76(2):63-6. Abstract

Reports of osteopaenia/rickets of prematurity are on the increase due to improved survival rates of low birthweight infants.

Obimbo, E, Musoke RN, Were F.  1999.  Knowledge, attitudes and practices of mothers and knowledge of health workers regarding care of the newborn umbilical cord., 1999 Aug. East African medical journal. 76(8):425-9. Abstract

To determine the knowledge, attitudes and practices (KAP) of mothers and the knowledge of health workers regarding care of the newborn umbilical cord.

O., DROYATSIDONALDP, O. DROYATSIDONALDP, O PROFWASUNNAAGGREY, N PROFMUSOKERACHEL.  1999.  Incidence of rickets of prematurity at Kenyatta National Hospital, Nairobi.East Afr Med J. 1999 Feb;76(2):63-6. PMID: 10442123 [PubMed - indexed for MEDLINE] Oyatsi DP, Musoke RN, Wasunna AO.. East Afr Med J. 1999 Feb;76(2):63-6.. : Far East Journal of Theoretical Statistics Abstract
BACKGROUND: Reports of osteopaenia/rickets of prematurity are on the increase due to improved survival rates of low birthweight infants. OBJECTIVE: To establish the incidence of rickets of prematurity by the age of six months in premature infants born at Kenyatta National Hospital, Nairobi. DESIGN: Prospective cohort study. SETTING: Newborn unit and paediatric outpatient follow up clinic of Kenyatta National Hospital. SUBJECTS: Successive surviving infants of birthweight less than 2000 g residents in Nairobi. RESULTS: Incidence of rickets of prematurity by six months of age was 58.8%. Rickets appeared more commonly in male infants compared to female infants. CONCLUSION: Rickets of prematurity is a common problem in the premature infants seen at Kenyatta National Hospital. Routine vitamin D supplements to premature infants in adequate doses of at least 400iu per day should be adopted in our centre.
O, PROFWASUNNAAGGREY, W. PROFNDUATIRUTH, N PROFMUSOKERACHEL.  1999.  Growth and development of abandoned babies in institutional care in Nairobi. Otieno PA, Nduati RW, Musoke RN, Wasunna AO.. East Afr Med J. 1999 Aug;76(8):430-5.. : Far East Journal of Theoretical Statistics Abstract

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants. PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

N, PROFMUSOKERACHEL, ELIZABETH DROBIMBO, N PROFWEREFREDRICK.  1999.  Obimbo E, Musoke RN, Were F. Knowledge, attitudes and practices of mothers and knowledge of health workers regarding care of the newborn umbilical cord. E. Afr Med J, 1999: 76 (8); 425-429.. East Afr Med J. 1999 Aug;76(8):425-9.. : Far East Journal of Theoretical Statistics Abstract
Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi. OBJECTIVE: To determine the knowledge, attitudes and practices (KAP) of mothers and the knowledge of health workers regarding care of the newborn umbilical cord. DESIGN: Cross-sectional survey. SUBJECTS: Mothers with infants less than three months of age attending well child clinics and health workers (HW) in the clinics, maternity and newborn units of public health, facilities serving an urban slum area in Nairobi, Kenya. RESULTS: Of the 307 mothers interviewed, 91% and 28% of mothers knew of the need for hygiene whilst cutting and tying the cord, respectively. Regarding postnatal cord care, 40% had good knowledge and 66% good practice. Fifty-one percent of mothers knew and 54% practised postnatal cord care for the appropriate duration of time. Seventy-nine percent of mothers were afraid of handling an unhealed cord. After multivariate analysis, the following variables showed significant independent association with good maternal KAP; increased level of education (OR 2.3, p < 0.001), living in middle class areas rather than slums (OR 1.5, p < 0.03), increased maternal age (OR 1.8, p < 0.001), acquisition of knowledge from a HW rather than from other sources (OR 1.5, p < 0.001), and living in stone/brick houses rather than mud houses (p = 0.01). Fifty per cent of HW had correct knowledge on type of postnatal cord care, and 79% had correct knowledge on duration required for the same. The knowledge of 50% on type of care was incorrect by international standards, but was in keeping with Nursing Council of Kenya teaching. CONCLUSION: Mothers had good knowledge on the need for hygiene when cutting the cord, had poor knowledge and practice in other aspects of cord care, and were afraid of handling the cord. Poor KAP was associated with young, poor mothers of low education, who had acquired their knowledge from sources other than HW. The knowledge of a large proportion of HW was incorrect and outdated. We recommend that health education on cord care be given at all levels of contact with mothers and that knowledge of all primary HW on cord care be updated. PIP: Using a cross-sectional survey, this study investigated the knowledge, attitudes, and practices (KAP) of mothers and the knowledge of health workers regarding care of the umbilical cord. The study interviewed a total of 307 mothers with infants less than 3 months old and 64 health workers (HWs) in an urban slum area in Nairobi, Kenya. The results showed that 91% and 28% of mothers knew of the need for hygiene while cutting and tying the cord, respectively. As to postnatal cord care, 40% had good knowledge and 66% had good practice. However, 79% of mothers were afraid of handling an unhealed cord. Results of multivariate analysis showed that the following variables had significant independent association with good maternal KAP: increased level of education, living in middle class areas, increased maternal age, and acquisition of knowledge from HWs rather than from other sources. 50% of HWs had correct knowledge on type of postnatal cord care, but the knowledge of 50% on type of care was incorrect by international standards. Based on the findings, it was recommended that good health and cord care practices be taught at all levels of contact with mothers and that knowledge of all primary HWs on cord care be updated.

1997

Musoke, RN.  1997.  Rational use of antibiotics in neonatal infections., 1997 Mar. East African medical journal. 74(3):147-50. Abstract

Review of the management of neonatal infections is done with the aim of guiding the clinician on appropriate therapy. Minimum investigations should include a white blood cell count including the L:T ratio and a blood culture. The bulk of infections at Kenyatta National Hospital newborn unit are caused by Klebsiela, Citrobacter and Staphylococcus aureus. During the 1990's considerable resistance to gentamicin has developed. Currently, cephalosporins chloramphenicol have the best sensitivity pattern. The diagnosis must be carefully verified at different stages of treatment to ensure that only those requiring antimicrobial therapy get it. Indiscriminate use is thus avoided. This in turn minimises development of antibiotic resistant organisms. Failure of response to antimicrobials sometimes means a non infectious cause of illness or poor supportive management. Continuous surveillance is recommended with emphasis on primary prevention of infection as well as cross infections.

1995

1994

Musoke, RN, Jitta JN.  1994.  Postnatal growth of abandoned preterm babies., 1994 Aug. East African medical journal. 71(8):519-23. Abstract

Eighteen abandoned low birth weight infants matched for sex and gestational age with infants who had mothers were followed up till discharge or death. Anthropometric measurements were taken on recruitment and then weekly. Initially all infants were on breast milk. For the abandoned ones, milk was obtained from other mothers. Results show that the abandoned infants were on breast milk until they attained a mean weight of 1960gm. This coincided with a postnatal age of 6 weeks. For the rest of the period they were on artificial feed. Mean birth weight was 1403 +/- 302 and 1337 +/- 204 for cases and controls respectively while the mean gestation was 30 weeks. Anthropometric measurements were similar at the beginning of the study and both groups regained birth weight at 2 weeks. Thereafter the rate of weight gain of 16gm per day for the cases was significantly lower than that of 22gm per day for the controls. Similarly midarm circumference increases were much lower in the cases than in controls (0.2cm versus 0.4 per week). There were however no significant differences in length and head circumference increases. A significant number of cases (94.4%) had one or more episodes of serious infection and 38.9% died. None of the control infants died and only 10.5% had serious infection.

1992

Brady, JP, Wasunna AO, Bowker MH, Musoke RN.  1992.  Does the "Baby Cloche" heat shield keep low birth-weight infants warm?, 1992 Jan East African medical journal. 69(1):37-9. Abstract

To determine whether the "Baby Cloche" heat shield improves temperature control in low birth-weight infants we compared serial temperatures in 11 preterm infants nursed with or without the Cloche. Mean birth weights were 1490 and 1510 gm, mean weights at time of study 1680 and 1710 gm and mean postnatal age 20 and 27 days for study and control infants respectively. Serial measurements of rectal, abdominal skin, dorsum of the foot, Cloche wall and room temperature were recorded once or twice daily for 2 to 5 days. Mean rectal temperatures increased with increasing age from 35.3 in the first week of life to 37.0 degrees C by the third week (P less than 0.001). In infants nursed under the Cloche who were over 2 weeks of age mean rectal, abdominal and foot temperatures were 0.5, 0.6 and 1.6 degrees C higher (P less than 0.001); in younger infants there was no significant difference in any of the temperatures. Our findings suggest that the "Baby Cloche" improves temperature control in preterm infants over 1600 gm who are more than 2 weeks of age.

Ayisi, RK, Mbiti MJ, Musoke RN, Orinda DA.  1992.  Sodium supplementation in very low birth weight infants fed on their own mothers milk I: Effects on sodium homeostasis., 1992 Oct. East African medical journal. 69(10):591-5. Abstract

Sodium supplementation was done on 41 very low birth weight (VLBW) preterm infants with 25 other infants of similar weight status as controls. All the infants were fed on their own mothers milk whose sodium and potassium content was determined. Serum and urinary sodium, potassium and creatinine levels were determined in both groups during the study period of six weeks. Determination of weight gain, length gain and head circumference gain showed that these anthropometric parameters are significantly increased by sodium supplementation while sodium and potassium concentrations were not significantly affected. There were no cases of either hypernatraemia or hyponatraemia though renal excretion of sodium was very high in the supplemented group. Conclusions drawn from the study are that very little weight gain could have been due to fluid retention and that though sodium supplementation does not affect sodium profiles in these infants it has significant effect on their growth rate which may be due to its indirect/direct association with bone and protein metabolism.

O, PROFWASUNNAAGGREY, N PROFMUSOKERACHEL.  1992.  Does the "Baby Cloche" heat shield keep low birth-weight infants warm? East Afr Med J . 1992 Jan; 69 ( 1 ): 37-9 . PMID: 1628548 [PubMed - indexed for MEDLINE] Brady JP, Wasunna AO, Bowker MH, Musoke RN. East Afr Med J . 1992 Jan; 69 ( 1 ): 37-9 .. : Far East Journal of Theoretical Statistics Abstract
Department of Paediatrics, University of Nairobi. To determine whether the "Baby Cloche" heat shield improves temperature control in low birth-weight infants we compared serial temperatures in 11 preterm infants nursed with or without the Cloche. Mean birth weights were 1490 and 1510 gm, mean weights at time of study 1680 and 1710 gm and mean postnatal age 20 and 27 days for study and control infants respectively. Serial measurements of rectal, abdominal skin, dorsum of the foot, Cloche wall and room temperature were recorded once or twice daily for 2 to 5 days. Mean rectal temperatures increased with increasing age from 35.3 in the first week of life to 37.0 degrees C by the third week (P less than 0.001). In infants nursed under the Cloche who were over 2 weeks of age mean rectal, abdominal and foot temperatures were 0.5, 0.6 and 1.6 degrees C higher (P less than 0.001); in younger infants there was no significant difference in any of the temperatures. Our findings suggest that the "Baby Cloche" improves temperature control in preterm infants over 1600 gm who are more than 2 weeks of age. PMID: 1628548 [PubMed - indexed for MEDLINE]
N, PROFMUSOKERACHEL.  1992.  Sodium supplementation in very low birth weight infants fed on their own mothers milk I: Effects on sodium homeostasis. East Afr Med J . 1992 Oct; 69 ( 10 ): 591-5 . PMID: 1473517 [PubMed - indexed for MEDLINE] Ayisi RK, Mbiti MJ, Musoke RN, Orinda DA.. East Afr Med J . 1992 Oct; 69 ( 10 ): 591-5 .. : Far East Journal of Theoretical Statistics Abstract
Department of Paediatrics, College of Health Sciences, University of Nairobi, Kenya. Sodium supplementation was done on 41 very low birth weight (VLBW) preterm infants with 25 other infants of similar weight status as controls. All the infants were fed on their own mothers milk whose sodium and potassium content was determined. Serum and urinary sodium, potassium and creatinine levels were determined in both groups during the study period of six weeks. Determination of weight gain, length gain and head circumference gain showed that these anthropometric parameters are significantly increased by sodium supplementation while sodium and potassium concentrations were not significantly affected. There were no cases of either hypernatraemia or hyponatraemia though renal excretion of sodium was very high in the supplemented group. Conclusions drawn from the study are that very little weight gain could have been due to fluid retention and that though sodium supplementation does not affect sodium profiles in these infants it has significant effect on their growth rate which may be due to its indirect/direct association with bone and protein metabolism. PMID: 1473517 [PubMed - indexed for MEDLINE]

1991

Musoke, RN, Anabwani GA.  1991.  Patent ductus arteriosus in African preterm infants., 1991 Aug. East African medical journal. 68(8):637-41. Abstract

During a 7 month period, April to October, 1984, 537 consecutive babies weighing upto 2000 gm were studied at the Kenyatta National Hospital's newborn unit. Of these 48 (8.9%) had murmurs suggestive of patent ductus arteriosus (PDA). Their mean birth weight was 1364 +/- 482 gm while the mean gestation was 30.5 weeks. The peak incidence occurred in the weight group 1001 to 1500 gm. 15 (31%) of all infants with PDA died. The PDA closed spontaneously in 21 (43.7%) infants before discharge from hospital and 4 closed after discharge bringing the total closure of 25 (52%). This represented 76% of the survivors. 4 were lost to follow up. In another 4 infants there was inadequate information as to when the ductus closed. It is suggested that the relatively low incidence of PDA may be due to underdiagnosis and the high mortality infants less than 1000 gm in the first few days of life before diagnosis of PDA can be made. Wider use of objective diagnostic modalities may help to make definitive diagnosis.

N, PROFMUSOKERACHEL.  1991.  Patent ductus arteriosus in African preterm infants. East Afr Med J . 1991 Aug; 68 ( 8 ): 637-41 . PMID: 1765017 [PubMed - indexed for MEDLINE] Musoke RN, Anabwani GA.. East Afr Med J . 1991 Aug; 68 ( 8 ): 637-41 .. : Far East Journal of Theoretical Statistics Abstract

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

During a 7 month period, April to October, 1984, 537 consecutive babies weighing upto 2000 gm were studied at the Kenyatta National Hospital's newborn unit. Of these 48 (8.9%) had murmurs suggestive of patent ductus arteriosus (PDA). Their mean birth weight was 1364 +/- 482 gm while the mean gestation was 30.5 weeks. The peak incidence occurred in the weight group 1001 to 1500 gm. 15 (31%) of all infants with PDA died. The PDA closed spontaneously in 21 (43.7%) infants before discharge from hospital and 4 closed after discharge bringing the total closure of 25 (52%). This represented 76% of the survivors. 4 were lost to follow up. In another 4 infants there was inadequate information as to when the ductus closed. It is suggested that the relatively low incidence of PDA may be due to underdiagnosis and the high mortality infants less than 1000 gm in the first few days of life before diagnosis of PDA can be made. Wider use of objective diagnostic modalities may help to make definitive diagnosis.

PIP: During a 7 month period, April-October 1984, 537 consecutive babies weighing up to 2000 gm were studied at the Kenyatta National Hospital's newborn unit. Of these, 48 (8.9%) had murmurs suggestive of patent ductus arteriosus (PDA). Their mean birth weight was 1364 +or- 482 gm while the mean gestation was 30.5 weeks. The peak incidence occurred in the weight group 1001-1500 gm. 15 (31%) of all infants with PDA died. The PDA closed spontaneously in 21 (43.7%) infants prior to discharge from the hospital and 4 closed after discharge bringing the total closure of 25 (52%). This represented 76% of the survivors. 4 were lost to follow up. In the cases of 4 other infants, there was inadequate information as to when the ductus closed. It is suggested that the relatively low incidence of PDA may be due to underdiagnosis and the high mortality infant 1000 gm in the 1st few days of life prior to when the diagnosis of PDA can be made. Wider use of objective diagnostic modalities may help to make a definitive diagnosis. author's modified

PMID: 1765017 [PubMed - indexed for MEDLINE]

1990

Musoke, RN.  1990.  Breastfeeding promotion: feeding the low birth weight infant., 1990. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 31 Suppl 1:57-9;discussion67-8. Abstract

Though there is still some reluctance to use human milk for low birth weight infants, we have shown that it is possible exclusively to feed these infants on milk from their own mothers. The infants have adequate weight gain and are less likely to get infections, especially gastrointestinal and respiratory. It is possible to sustain lactation through manual expression during the period that the mother is not nursing her infant directly on the breast. A cup rather than a bottle can be used to feed these small infants. The mothers are thus encouraged because the infant does not suffer nipple confusion with a bottle and they continue breastfeeding after discharge from the hospital.

N, PROFMUSOKERACHEL.  1990.  Breastfeeding promotion: feeding the low birth weight infant. Int J Gynaecol Obstet . 1990; 31 Suppl 1 : 57-9; discussion 67-8 . PMID: 1972088 [PubMed - indexed for MEDLINE] Musoke RN.. Int J Gynaecol Obstet . 1990; 31 Suppl 1 : 57-9; discussion 67-8 .. : Far East Journal of Theoretical Statistics Abstract
Department of Paediatrics, University of Nairobi, Kenya. Though there is still some reluctance to use human milk for low birth weight infants, we have shown that it is possible exclusively to feed these infants on milk from their own mothers. The infants have adequate weight gain and are less likely to get infections, especially gastrointestinal and respiratory. It is possible to sustain lactation through manual expression during the period that the mother is not nursing her infant directly on the breast. A cup rather than a bottle can be used to feed these small infants. The mothers are thus encouraged because the infant does not suffer nipple confusion with a bottle and they continue breastfeeding after discharge from the hospital. PMID: 1972088 [PubMed - indexed for MEDLINE]

1989

N, PROFMUSOKERACHEL.  1989.  Postnatal weight gain of exclusively breast fed preterm African infants. J Trop Pediatr . 1989 Oct; 35 ( 5 ): 241-4 . PMID: 2585581 [PubMed - indexed for MEDLINE] Muhudhia SO, Musoke RN.. J Trop Pediatr . 1989 Oct; 35 ( 5 ): 241-4 .. : Far East Journal of Theoretical Statistics Abstract
The weight of 64 preterm appropriate for gestational age infants were followed closely during the period of stay in the newborn unit. They were subdivided into three groups: A (1001-1250 g), B (1250-1500 g), and C (1501-1750 g). The mean gestation for these groups were 28.7, 30.5, and 31 weeks, respectively, while mean birth weights were 1132 +/- 81.7 g, 1377 +/- 85.6 g, and 1641 +/- 88.6 g. All were fed their own mothers breast milk during the period of study with no supplements. During the first week, there was significant weight loss in all groups as follows: A (12.0 per cent), B (7.7 per cent), and C (4.4 per cent). Thereafter, only group A lost weight in the second week, but the loss was not significant. Birth weights were regained at 23, 16, and 15 days, respectively. The weight gain after the initial loss was A (20.0 g), B (20.4 g), and C (20.2 g) per day. Group A had the fastest growth rate. PMID: 2585581 [PubMed - indexed for MEDLINE]

1987

1986

Greenfield, C, Osidiana V, Karayiannis P, Galpin S, Musoke R, Jowett TP, Mati P, Tukei PM, Thomas HC.  1986.  Perinatal Transmission Of Hepatitis B Virus In Kenya: Its Relation To The Presence Of Serum Hbv-dna And Anti-hbe In The Mother. Abstract

In Kenya hepatitis B virus (HBV) infection and its sequelae are common. We followed up 49 hepatitis B surface antigen (HBsAg)- positive mothers and their newborn infants for 9 months to determine the importance of perinatal transmission in the African and to relate this to the HBe and HBV-DNA status of the mother. Our study shows that perinatal transmission is relatively unimportant in Kenya and that this may be a consequence of the low levels of circulating HBV-DNA in the maternal plasma. These results imply that vaccination without hyperimmune globulin may be adequate to control HBV infection in Kenya

Musoke, RN.  1986.  Low birthweight..
Greenfield, C, Wankya BM, Musoke R, Osidiana V, Nyangao J, Tukei PM, Owino N.  1986.  An Age Related Point Prevalence Study Of Markers Of Hepatitis B Virus Infection In Kenya. Website
O, PROFBWIBONIMROD, N PROFMUSOKERACHEL.  1986.  Composition of early human milk of Kenyan mothers of preterm and term infants. East Afr Med J . 1986 Nov; 63 ( 11 ): 693-8 . No abstract available. PMID: 3582225 [PubMed - indexed for MEDLINE] Jitta JN, Musoke RN, Bwibo NO, Kioni J.. East Afr Med J . 1986 Nov; 63 ( 11 ): 693-8 .. : Far East Journal of Theoretical Statistics Abstract
No abstract available
N, PROFMUSOKERACHEL.  1986.  Low birthweight. East Afr Med J . 1986 Feb; 63 ( 2 ): 89-90 . No abstract available. PMID: 3720609 [PubMed - indexed for MEDLINE] Musoke RN.. East Afr Med J . 1986 Feb; 63 ( 2 ): 89-90 .. : Far East Journal of Theoretical Statistics Abstract
No abstract available.

1985

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