Kenya abolished delivery fees in all public health facilities through a presidential directive effective on June 1, 2013 with an aim of promoting health facility delivery service utilization and reducing pregnancy-related mortality in the country. This paper aims to provide a brief overview of this policy's effect on health facility delivery service utilization and maternal mortality ratio and neonatal mortality rate in Kenyan public health facilities.

Health care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science.

Squamous cell carcinoma of conjunctiva has increased tenfold in the era of HIV/AIDS. The disease pattern has also changed in Africa, affecting young persons, with peak age-specific incidence of 30-39 years, similar to that of Kaposi sarcoma, a well known HIV/AIDS defining neoplasm. In addition, the disease has assumed more aggressive clinical course. The contributing role of exposure to high risk HPV in the development of SCCC is still emerging.

Erythrocyte complement regulatory proteins, complement receptor 1 (CR1) and decay accelerating factor (CD55) protect red blood cells (RBCs) from complement mediated damage by controlling complement activation cascade and potentially protect RBCs from complement mediated damage that may occur when immune complexes are formed following malaria infection. Given the important role of RBCs in regulation of complement activation, we considered the competence of sickle cell trait RBCs in these functions. Methods: Children (age 0-192 months; n=116) were enrolled in a nested case controlled study conducted in Kombewa Division, Kisumu west District between October and December 2004. Based on hemoglobin (Hb) type, children were stratified into those with HbAS (n=47) and HbAA (n=69). The 47 HbAS individuals were matched to the 69 HbAA individuals of similar age (± 2 months or ± 24 months for those below or more than 192 months, respectively) at a ratio of 1:1 or 1:2. Circulating CR1 levels and CD levels were quantified using a FACScan cytometer under normal and reduced oxygen saturation. Results: The mean CR1 copy numbers per RBC was comparable in the two groups. However, between the ages of 49-192 months, the mean CR1 copy numbers per erythrocyte was significantly higher in children who had HbAS compared to those with HbAA (P=0.0332). The mean CD55 levels were comparable between the two groups but after deoxygenation, the mean CD levels in RBCs of individuals with HbAS was significantly higher than in the HbAA (P=0.011). Conclusion: The mean CR1 and CD55 copy numbers per RBC were comparable between the two groups under normal and reduced oxygen saturation. Beyond the age of 49 months, the CR1 copy numbers was higher in the HbAS compared to HbAA and this was also true for CD55 levels under deoxygenated conditions. Taken together, these results demonstrate that in the younger age groups, the protection afforded by HbAS against severe manifestations of malaria may be due to other factors other than complement regulatory proteins but beyond the age of 49 months, this protection may be partly due to the high CR1 copy numbers in the HbAS individuals.

To determine the levels of both TSA and HD antibody in sera of patients with various malignancies and evaluate their potential role as diagnostic and/ or prognostic markers. DESIGN: Laboratory based analysis. SETTINGS: Kenyatta National Hospital, Kenya Medical Research Institute and the Department of Biochemistry, University of Nairobi. SUBJECTS: A total of 909 serum samples, 420 from cancer patients recruited at Kenyatta National Hospital and 509 from normal blood donors recruited at Nairobi Hospital. RESULTS: The mean age for the patients and controls was 36 and 37 years respectively. Carcinoma patients constituted 54%, sarcoma 12.1%, lymphoma 16.4% and 17.4% had other types of tumours. The mean TSA in patients was 0.86 mg/ml +/- 0.026 compared to 0.82 mg/ml +/- 0.014 in controls. The TSA level was significantly higher in patients compared to controls (Student's t-test p = 0.031 at 0.05 confidence level). The TSA increased with age in both study groups. In patient sera, both gender gave the same mean of 0.83 mg/ml while it was 0.82 mg/ml and 0.83 mg/ml in control females and in males respectively. Sarcomas had the highest amount of 0.93 mg/ml but there was no significant statistical variation between tumour types (p = 0.076). The HD antibody mean readings were 0.004 in pathologic sera compared to 0.011 in controls. The values were significantly elevated in patients (p = 0.03) with females giving a higher value for both study groups (p = 0.628). HD antibody readings was significantly higher in carcinomas (p = 0.017) compared to those of sarcomas and lymphomas. There was no association between antibody readings and age of patient (p = 0.601). CONCLUSION: Both TSA and HD antibody values were significantly elevated in patients compared to clinically healthy controls and while TSA levels increased with age and was independent of gender, HD antibody levels were independent of age, gender and also tumour type. The study demonstrates that although TSA is normally elevated in malignancy, most of the sialic acid shed is of N-acetyl type as some patients do not express HD antibody directed to the N-glycolyl sialic acid. The reason why some tumours would express Neu5Gc at any one time needs further evaluation.

Author:

Mwanda OW

Source:

East African Medical Journal. 2005 Jun; 273-274.

Abstract:

Aflatoxicosis remains unrecognised by medical professional experts till several people are involved yet the global scale would show that approximately 4-5 billion people living in developing countries are chronically exposed to unacceptable aflatoxin levels. There is also no comprehensive data set from which to evaluate the exact extent and severity of biological exposure and direct measurements(1). Aflatoxin is a common contaminant of food particularly the staple diets of many developing countries. The toxin is produced by a fungal action during food production, harvest, storage and processing. The most affected are grains, rice, maize/corn; others are cassava, nuts, peanuts, chilies and spices. The toxins are produced as secondary metabolites by Aspergillus flavus, and Aspergillus parasiticus fungi when the temperatures are between 24°C and 35°C and the moisture content exceeds 7% to 10%. These conditions are prevalent in geographical latitudes between 40° N and 40° S of the equator.

Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY 13210, USA. BACKGROUND: Strategies to circumvent or lessen the myelotoxicity associated with combination chemotherapy may improve the overall outcome of the management of patients particularly in resource poor settings. OBJECTIVES: To develop effective non-myelotoxic therapies for Burkitt's Lymphoma (BL) and AIDS-related non-Hodgkin's lymphoma. DATA SOURCES: Publications, original and review articles, conference abstracts searched mainly on Pubmed indexed for medline. DATA EXTRACTION: A systematic review of the clinical problem of combination chemotherapy. Identification of clinical strategies that circumvent or lessen the myelotoxicity of combination cytotoxic chemotherapy. Length of survival, lack of clinically significant (> grade 3) myelosuppression and weight loss were used as markers of myelotoxicity. DATA SYNTHESIS: Review of published experience with some of these strategies including dose-modification of multi-agent chemotherapy; rationale for targeted therapies, and the preclinical development of a mouse model exploring the role of metronomic scheduling substantiate pragmatism and feasibility of these approaches. CONCLUSION: Myelotoxic death rates using multi-agent induction chemotherapy approach 25% for endemic Burkitt's lymphoma and range between 20% to 60% for AIDS-related malignancy. This is mostly explained by the paucity of supportive care compounded by wasting and inanition attributable to advanced cancer and HIV infection making patients more susceptible to myelosuppressive side effects of cytotoxic chemotherapy. Investigations and alternative approaches that lessen or circumvent myelotoxicity of traditional cytotoxic chemotherapy for the management of Burkitt's lymphoma and AIDS-related non-Hodgkin's lymphoma in the resource-constrained setting are warranted. Pertinent pre-clinical and clinical data are emerging to support the need for abrograting the myelosuppressive effects of traditional cytotoxic chemotherapy. This can be achieved by developing targeted anti-viral and other strategies, such as the use of bryostatin 1 and vincristine, and by developing a preclinical mouse model to frame the clinical rationale for a pilot trial of metronomic therapy for the treatment of Burkitt's and AIDS-related lymphoma. Implementation of these investigational approaches must be encouraged as viable anti-cancer therapeutic strategies particularly in the resource-constrained settings.

Department of Haematology and Blood Transfusion, Kenyatta National Hospital and the University of Nairobi College of Health Sciences, Kenya. OBJECTIVES: To describe the clinical characteristics of Burkitt's lymphoma (BL) from three regions in Kenya at different altitudes with a view towards understanding the contribution of local environmental factors. DESIGN: Prospective cross-sectional study. SETTING: Kenyatta National Hospital and seven provincial hospitals in Kenya. METHOD: Histologically proven cases of Burkitt's lymphoma in patients less than 16 years of age were clinically examined and investigated. MAIN OUTCOME MEASURES: For every case the following parameters were documented: chief complaint(s); physical examination, specifically pallor, jaundice, oedema, lymphadenopathy, presence of masses, splenomegaly and hepatomegaly. Reports of evaluation of chest radiograph, abdominal ultrasound/scan, bone marrow aspiration, cerebral spinal fluid cytology, liver and kidney function tests, urinalysis, stool occult blood and full blood count results. Stage of disease was assigned A, B, C or D. Cases of BL from three provinces of Kenya with diverse geographical features were analysed: Central, Coast, and Western. RESULTS: This study documented 471 BL cases distributed as follows: Central 61 (males 39 and 22 females), M:F ratio 1.8:1; Coast 169 (111 males and 58 females), M:F ratio 1.9:1; and Western 241 (140 males and 101 females), M:F ratio 1.4:1. The major presenting complaints were: abdominal swelling–Central 36%, Coast 4% and Western 26%; swelling on the face–Central 31%, Coast 81% and Western 64%; and proptosis–Central 3%, Coast 1% and Western 9%. The mean duration of these complaints in weeks were Central 6.9, Coast 6.08, and Western 5.05. The initial physical finding was a tumour mass in 39%, 72% and 54% of cases for Central, Coast and Western respectively. Tumour stage at diagnosis was: stage A–Central 21%, Coast 43% and Western 34%; stage B–Central 10%, Coast 5% and Western 10%; stage C–Central 41%, Coast 34% and Western 30%; and stage D–Central 28%, Coast 17% and Western 26%. For the age and sex matched cases the results show that commonly involved sites were: abdomen–Central 35%, Coast 9% and Western 14%; jaw (mandible)–Central 24%, Coast 22% and Western 31%; maxilla–Central 6%, Coast 24% and Western 11%; and lymph nodes–Central 10%, Coast 4% and Western 8%. The disease stage was A–Central 33%, Coast 44% and Western 36%; stage B–Central 11%, Coast 10% and Western 27%; stage C–Central 39%, Coast 34% and Western 27%; and stage D–Central 21%, Coast 13% and Western 37%. CONCLUSION: This study shows that clinical features of childhood BL vary with geographical region. The variations are documented in proportion of jaw, maxilla, abdominal and lymph nodal sites involvement. The differences observed are potentially due to the local environmental factors within these provinces. BL cases from Western province had features, intermediate between endemic and sporadic. Coastal province BL cases were similar to endemic BL, while BL cases from Central province resembled more or less sporadic BL subtypes. Strategies to explain and investigate the local environmental factors associated with the observed differences may certainly contribute towards improved understanding and clinical management of BL.

D. M. Ndetei, D. M. Kathuku, O. W. Mwanda. Research proposal: Psychological aspects of the paediatric cancer patients in Kenyatta National Hospital . 2005