Address/Contacts:

P.   O. Box 19676, Nairobi.

 

Official:   P. O. Box 19676, Nairobi, Kenya

Telephones;

Cell   +254705849623 / +254733714386,  -

Office:   University office 2738414 or KNH 2726300 Ext. 43661/654/586

 

Residential:   2711561 

Email   

walter.mwanda@uonbi.ac.ke

Fax:

(254-20-725624/711561

 

Associate   Professor University of Nairobi, Department of Human Pathology (Section of   Haematology and Blood Transfusion)

Current posts University of   Nairobi:

Director   University of Nairobi Institute of Tropical and Infectious Diseases (UNITID),   College of Health Sciences University of Nairobi 

 

Consultant   – Haematology, blood transfusion and –Oncology (Kenyatta National Hospital.)

               

In-Charge,   Paediatric Oncology Kenyatta National Hospital and University of Nairobi

 

In-Charge   Blood Transfusion services (Kenyatta National Hospital )

FORMAL EDUCATION:

1996-2001

Thesis   and course work for the degree of Doctor of Medicine (MD) in the Department   of Haematology and Blood Transfusion, Faculty of Medicine of the University   of Nairobi.

1996

Post-Graduate   course in Epidemiology and Biostatistics in Clinical Epidemiology and Bio   statistics of John Hopkins University, Maryland, USA

1988-1990

Glasgow   Royal Infirmary in Scotland (UK) Department of Haematology

1986-1988

Postgraduate   training in haematology and blood transfusion at Kenyatta National   Hospital. 

1983-1986

Post-Graduate   course, Royal College of Pathologists (PMRCPath) Primary level in general   pathology by course work and examination in Nairobi and Royal Infirmary,   Glasgow Scotland

1976-1981

Graduate   course, University of Nairobi medical for the degree of Bachelor of Medicine   and Bachelor of Surgery of the University of Nairobi.

1970-1973.

Secondary   school at Alliance High School. For the East African Certificate of   Examination (O level)

1962-1969

Primary   education at Hono Primary School in Siaya District. For the Certificate of   Primary Education (C P E).

 

WORKING EXPERIENCE/POSITIONS HELD

2013   to date

Director   University of Nairobi Institute of Tropical and Infectious Diseases (UNITID)

2012

Chairman   Department of Human Pathology, Syllabus and curriculum development.   -Examinations coordinator department of human pathology.-Senate   representative for the school of medicine university of Nairobi

2005   - 2011    

Head   of haematology and blood transfusion thematic unit.

2003 - to 2006

Senior   Lecture in Haematology, Blood Transfusion and paediatric oncology, Department   of Haematology and Blood Transfusion, Faculty of Medicine, College of Health   Sciences University of Nairobi.

2003   – 2004

Chairman,   Department Haematology and Blood Transfusion at Kenyatta.

1992 –2003 

Lecturer   in haematology, blood transfusion and paediatric oncology, Department of   Haematology and Blood Transfusion, Faculty of Medicine, College of Health   Sciences University of Nairobi.

1991-1993

Pathologist   and specialist haematologist at the Kenyatta National Hospital, honorary   lecturer Department of Haematology and Blood Transfusion of the University of   Nairobi since 1993. Registrar Paediatrics Oncology.

1994   to date

In-charge   of Paediatric Oncology ward KNH, quality assurance for the Department of   Haematology and Blood Transfusion at Kenyatta National Hospital

1994      

Chairman   Department of Haematology and Blood Transfusion

 

In-charge   Haematology and Oncology Clinical services at the KNH

1986-1988

Senior   House officer, Pathology section of Haematology and Blood Transfusion at   Kenyatta National Hospital.

1984 – 1986

Senior   House Officer, Department of Pathology at Kenyatta National Hospital.

1980 - 1983

Medical   Officer in-charge –Casualty and Out Patients Departments at the Coast General   Hospital Mombasa

1976

Research   Bursar at the International Centre for Insect Physiology and Ecology (ICIPE)

1975      

Captain   Alliance high school

1973      

Prefect   Alliance High school

1973      

Deputy   Prefect Alliance High School.

1969      

Head   prefect Std VII.

1964   -1968

Timekeeper   for the primary school.

National:

Organised and hosted International Meetings Local, National and International Service

  1. 2012 Convener D43Second annual Spring Pathology Training workshop at the Department of Human Pathology, University of Nairobi
  2. 2012 Convener D43 Second annual Fall Pathology Training workshop at the Department of   Human Pathology, University of Nairobi
  3. 2011 Convener The World Federation of Haemophilia (WFH) & the Kenya Haemophilia Association Regional Workshop on Physiotherapy Aspects of Haemophilia Care at Kenyatta National Hospital
  4. 2002 to date Ad Hoc Reviewer East African Medical Journal
  5. 2009 Convener Regional African course and Haemophilia Laboratory management
  6. 2004 Convener International Course and haemophilia Laboratory Management
  7. 2004 Convener World Federation of Haemophilia – Homeostasis course
  8. 2003 Convener World Federation of  Haemophilia, Haemostasis course
  9. 1998 Headed the blood donation programme for the victims of the August  bomb blast in Nairobi.
  10. Chairman and convener KECANSA cancer awareness week 8th-14th October 2001 early detection and prevention of cancer.

 

Professional Society Memberships

 

Nationally

  1. 2000 to      African Society of Blood transfusion Kenya Chapter
  2. 2003 to      date Kenya Society for Haematology Oncology (KESHO)
  3. 1992 to      date Kenya Cancer Associations
  1. 1992 to date Kenya chapter of World Haemophilia Federation
    1. Member National AIDS and STIs Control Programme(NASCOP), Scientific, Monitoring and Evaluation Technical Committee
    2. Member national blood transfusion supervisory board
  1. 1992      World Federation of Haemophilia– Head Kenya chapter
  2. 2002      to date Ad Hoc Reviewer East African Medical Journal
  1. Member      National Blood Safety Committee

Internationally

  1. 2000 to date The African Society of Blood Transfusion (PSBT)
  2. 2000 to date The South African Paediatric Oncology Study Group (SAPOSG)
  3. 1996 Centre for AIDS Research (CFAR) – OHIO USA
  4. Executive  Member of Pan Africa Psycho Oncology Society (PAPOS) 
  5. 1994 Africa Blood Transfusion Association – ZIMBABWE/SOUTH AFRICA
    1. 1989 New York Academy of Scientists – NEW YORK
    2. (DAIDS) of NIAD CO infections and Complications Data and Safety Monitoring Board (CC DSMB) - Member

Bio

Prof. Mwanda

Address/Contacts:

P.   O. Box 19676, Nairobi.

 

Official:   P. O. Box 19676, Nairobi, Kenya

Telephones;

Cell   +254705849623 / +254733714386,  -

Office:   University office 2738414 or KNH 2726300 Ext. 43661/654/586

PDF Upload: 

Publications


2018

Subramanian, S, Gakunga R, Kibachio J, Gathecha G, Edwards P, Ogola E, Yonga G, Busakhala N, Munyoro E, Chakaya J, Ngugi N, Mwangi N, Von Rege D, Wangari L-M, Wata D, Makori R, Mwangi J, Mwanda W.  2018.  Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors., 2018. PloS one. 13(1):e0190113. Abstract

The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients' ability to pay for the services.

Gitobu, CM, Gichangi PB, Mwanda WO.  2018.  The effect of Kenya's free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities., 2018 03 27. BMC pregnancy and childbirth. 18(1):77. Abstract

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.

Gitobu, CM, Gichangi PB, Mwanda WO.  2018.  Satisfaction with Delivery Services Offered under the Free Maternal Healthcare Policy in Kenyan Public Health Facilities., 2018. Journal of environmental and public health. 2018:4902864. Abstract

Patients' satisfaction is an individual's positive assessment regarding a distinct dimension of healthcare and the perception about the quality of services offered in that health facility. Patients who are not satisfied with healthcare services in a certain health facility will bypass the facility and are unlikely to seek treatment in that facility.

2017

Oiye, S, Mwanda W, Mugambi M, Filteau S, Owino V.  2017.  Exclusive Breastfeeding Is More Common Among HIV-Infected Than HIV-Uninfected Kenyan Mothers at 6 Weeks and 6 Months Postpartum., 2017 06. Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine. 12:283-289. Abstract

To compare breastfeeding practices determined by mothers' own recall versus a stable isotope technique (deuterium oxide dilution) among human immunodeficiency virus (HIV)-infected and HIV-uninfected mothers at 6 weeks and 6 months postpartum.

2016

Fu, P, Hughes J, Zeng G, Hanook S, Orem J, Mwanda OW, Remick SC.  2016.  A comparative investigation of methods for longitudinal data with limits of detection through a case study., 2016 Feb. Statistical methods in medical research. 25(1):153-66. Abstract

The statistical analysis of continuous longitudinal data may be complicated since quantitative levels of bioassay cannot always be determined. Values beyond the limits of detection (LOD) in the assays may not be observed and thus censored, rendering complexity to the analysis of such data. This article examines how both left-censoring and right censoring of HIV-1 plasma RNA measurements, collected for the study on AIDS-related Non-Hodgkin's lymphoma (AR-NHL) in East Africa, affects the quantification of viral load and explores the natural history of viral load measurements over time in AR-NHL patients receiving anticancer chemotherapy. Data analyses using Monte Carlo EM algorithm (MCEM) are compared to analyses where the LOD or LOD/2 (left censoring) value is substituted for the censored observations, and also to other methods such as multiple imputation, and maximum likelihood estimation for censored data (generalized Tobit regression). Simulations are used to explore the sensitivity of the results to changes in the model parameters. In conclusion, the antiretroviral treatment was associated with a significant decrease in viral load after controlling the effects of other covariates. A simulation study with finite sample size shows MCEM is the least biased method and the estimates are least sensitive to the censoring mechanism.

Osanjo, GO, Oyugi JO, Kibwage IO, Mwanda WO, Ngugi EN, Otieno FC, Ndege W, Child M, Farquhar C, Penner J, Talib Z, Kiarie JN.  2016.  Building capacity in implementation science research training at the University of Nairobi., 2016 Mar 08. Implementation science : IS. 11:30. Abstract

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.

Ndhine, EO, Slotved H-C, Osoro EM, Olsen KN, Rugutt M, Wanjohi CW, Mwanda W, Kinyagia BM, Steenhard NR, Hansen J-ES.  2016.  A Biosecurity Survey in Kenya, November 2014 to February 2015., 2016 Jul-Aug. Health security. 14(4):205-13. Abstract

A biosecurity survey was performed to gather information on the biosecurity level and laboratory capacity in Kenya for the purpose of providing information outlining relevant components for biosecurity legislation, biosecurity implementation, and enforcement of biosecurity measures in Kenya. This survey is, to the authors' knowledge, the first to be published from an African country. A total of 86 facilities with laboratories covering relevant categories, such as training laboratories, human diagnostic laboratories, veterinary diagnostic laboratories, and research laboratories, were selected to participate in the survey. Each facility was visited by a survey team and staff were asked to answer 29 groups of questions from a questionnaire. The survey showed that Kenyan laboratory facilities contain biological agents of biosecurity concern. The restrictions for these agents were found to be limited for several of the facilities, in that many laboratory facilities and storage units were open for access by either students or staff who had no need of access to the laboratory. The survey showed a great deal of confusion in the terms biosecurity and biosafety and a generally limited biosecurity awareness among laboratory personnel. The survey showed that the security of biological agents of biosecurity concern in many facilities does not meet the international requirements. The authors recommend developing a legal framework in Kenya for effective controls, including national biosecurity regulations, guidelines, and procedures, thereby reducing the risk that a Kenyan laboratory would be the source of a future biological attack.

2015

Chanzu, NM, Mwanda W, Julius Oyugi, Anzala O.  2015.  Mucosal Blood Group Antigen Expression Profiles and HIV Infections: A Study among Female Sex Workers in Kenya., 2015. PloS one. 10(7):e0133049. Abstract

The ABO blood group antigens are carbohydrate moieties expressed on human red blood cells however; these antigens can also be expressed on some other cells particularly the surface of epithelial cells and may be found in mucosal secretions. In many human populations 80% secrete ABO antigens (termed 'secretors') while 20% do not (termed 'non-secretors'). Furthermore, there are disease conditions that are associated with secretor status.

2014

Korir, A, Mauti N, Moats P, Gurka MJ, Mutuma G, Metheny C, Mwamba PM, Oyiro PO, Fisher M, Ayers LW, Rochford R, Mwanda WO, Remick SC.  2014.  Developing clinical strength-of-evidence approach to define HIV-associated malignancies for cancer registration in Kenya., 2014. PloS one. 9(1):e85881. Abstract

Sub-Saharan Africa cancer registries are beset by an increasing cancer burden further exacerbated by the AIDS epidemic where there are limited capabilities for cancer-AIDS match co-registration. We undertook a pilot study based on a "strength-of-evidence" approach using clinical data that is abstracted at the time of cancer registration for purposes of linking cancer diagnosis to AIDS diagnosis.

Mwololo, A, Joshua Nyagol, Rogena E, Ochuk W, Kimani M, Noel Onyango, Pacenti L, Santopietro R, Leoncini L, Mwanda W.  2014.  Correlation of EGFR, pEGFR and p16INK4 expressions and high risk HPV infection in HIV/AIDS-related squamous cell carcinoma of conjunctiva., 2014 Feb 26. Infectious agents and cancer. 9(1):7. Abstract

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.

Kiarie, JN, Farquhar C, Redfield R, Bosire K, Nduati RW, Mwanda W, M'Imunya JM, Kibwage I.  2014.  Strengthening health systems by integrating health care, medical education, and research: University of Nairobi experience., 2014 Aug. Academic medicine : journal of the Association of American Medical Colleges. 89(8 Suppl):S109-10.

2013

OW, M, KA B, GK K, er CS G.  2013.  Antiphospholipid antibodies in patients with venous thrombosis at Kenyatta National Hospital. Afr J Rheumatol . 2013(1(2): ):52-56.
Stoute, JA, Aluoch JR, Gondi SMO, Odera MM, Estambale BBA, Otieno W.  2013.  Sickle Cell Trait (HbAS) is Associated with Increased Expression of Erythrocyte Complement Regulatory Proteins CR1 and CD55 Levels in Children. Abstractbenson_b._a._estambale.pdfAbstractAbstract

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.

2012

O., MW.  2012.  Sporadic Burkitt’s Lymphoma. . : Philadelphia: Springer / CM: Current Medicine Group, LLC, 2012.

2011

2010

2009

and D. G Njeru, W. O Mwanda, KNGWEC.  2009.  Prevalence of Cytomegalovirus Antibodies in Blood. Review Article MEDICOM. 2009(8, 12):58–68.abstract_-_prevalence_of_cytomegalovirus_antibodies_in_blood_donors.pdf
Leucci E, Onnis A, CDFIACCMMGFG.  2009.  ‘ B cell. Int J Cancer.. 15(126):1316-1326.b-cell_differentiation_in_ebv-positive_burkitt_lymphoma_is.pdf

2007

Kanduma, EG, Mukuri JC, Mwanda OW.  2007.  Survey of Hanganutziu and Deicher (HD) Antibody in Cancer Patients Attending Kenyatta National Hospital. Abstractsurvey_of_hanganutziu-_--.pdf

The sensitivity of HD antibody in cancer diagnosis/prognosis could be improved by detection of Immune Complex (IC) dissociated antibody. Combined evaluation of native HD and Immune Complex (IC) dissociated antibody was carried out. Presence and titre of these antibodies in cancer patients was investigated in serum samples obtained from 420 patients with various types of tumors. Results were compared with those of 246 age and sex-matched controls. The serum samples were analysed for hemagglutination antibodies by hemagglutination (HA) test and the antibodies quantified by ELISA. Dissociation was achieved by treating the samples with Glycine Hydrochloride (pH 1.8), then neutralised by Tris-HCl (pH 7.4). Mean HA titre was 16.8 in controls and 67.4 in patients (p<0.001). Patients aged between 26-35 years had the highest mean titre of 75.9 (p=0.397) while controls of the same age had the highest mean titres of 19.9 (p=0.043). Carcinomas had a mean titre of 81 compared to 54 for sarcoma and 52 for lymphoma (p=0.117) among histological types. Female patients had a titre of 75.2 compared to 55.7 of males (p<0.05) while the difference by gender in controls was 15.1 for males and 19.3 for females (p=0.199). The mean level of native HD antibody was -0.011 in controls compared to 0.004 in patients (p=0.03). The levels were significantly high in carcinoma (p=0.017) compared to sarcoma and carcinoma type of malignancy. There was no association between HD antibody levels and age. Mean levels were higher in females than males in both study groups (p=0.628) (p=0.601). IC dissociated antibody mean level was -0.06 in the control group compared to 0.014 in test cases (p=0.000). Levels were independent of gender (p=0.984) while they were highest in sarcoma type compared to other types of tumors that were negative for the antibodies (p=0.413). Both native and antigen-bound HD antibodies are significantly increased in cancer disease.

Mwanda, OW, Mukuria JC, Kanduma EG.  2007.  Total Sialic acid (TSA) and Hanganutziu and Deicher (HD) antibody in malignant and healthy sera. Abstract

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.

Rainey JJ, Mwanda WO, WMAMWMLRPR.  2007.  Spartial distribution of Burkitt’s. Trop Med Int Health. 8(12):936-43..spatial_distribution_of_burkitts_lymphoma_in_kenya_and.pdf

2006

OTIENO, PROFMWANDAWALTER.  2006.  Orem J, Otieno MW, Remick SC.Challenges and opportunities for treatment and research of AIDS-related malignancies in Africa.Curr Opin Oncol. 2006 Sep;18(5):479-86. Review.PMID: 16894296 [PubMed - indexed for MEDLINE]. Curr Opin Oncol. 2006 Sep;18(5):479-86.. : MBA Abstract

PURPOSE OF REVIEW: Following our review of AIDS-associated cancer in developing nations in 2004, we sought to update recent publications and review data on the challenges and opportunities for the treatment and research of AIDS malignancies in Africa. RECENT FINDINGS: It is apparent that the burden of AIDS-related malignancies and other virus-associated tumors is significant and increasing in Africa. Several recent studies report findings on conjunctival squamous cell carcinoma and there is a report that Hodgkin's disease, a non-AIDS-defining neoplasm, is increasing in incidence. International collaborative partnerships dedicated to AIDS malignancies in developing countries are feasible and invaluable for clinical strategies to address this aspect of the pandemic. A departure point is the ongoing work of the East Africa - Case Western Reserve University Collaboration in AIDS malignancies. SUMMARY: The burden of neoplastic complications of HIV infection and endemic virus-associated tumors are assuming increasing significance in Africa. There is a need to develop nonmyelotoxic therapies and approaches that are hypothesis-driven and pathogenesis-based. The scarcity and shortages in this region demand that our scientific and therapeutic strategies are both suitable and pragmatic for testing in this setting. It is also imperative that African investigators lead us in this important endeavor.

2005

Mwanda, O W; Fu, CWRP; R; C;.  2005.  Kaposi's sarcoma in patients with and without human immunodeficiency virus infection, in a tertiary referral centre in Kenya. Abstract

Mwanda OW1, Fu P, Collea R, Whalen C, Remick SC.
Author information
Abstract
The clinical features of Kaposi's sarcoma (KS), in patients with and without HIV infection, were investigated in a tertiary referral centre in Kenya between 1997 and 1999. Although 186 cases were identified prospectively, the data analysis was restricted to the 91 (49%) cases who had pathological confirmation of Kaposi's sarcoma and documented HIV serostatus. Among these 91 subjects (58% of whom were male), the age-group holding the largest number of KS cases was that of individuals aged 31-40 years; most of the paediatric cases were aged 6-10 years. The ratio of HIV-seropositives to HIV-seronegatives was 8.5:1 for the adult cases and 0.9:1 for the paediatric. Of the signs and symptoms of Kaposi's sarcoma seen at presentation, only peripheral lympadenopathy was found to be significantly associated with underlying HIV infection (P = 0.05). The median survival was 104 days. It is apparent that, as the HIV epidemic advances in regions of the world with endemic KS, the clinical presentation and natural history of the endemic KS are blending with those of the epidemic or AIDS-associated disease, leading to a reduction in the mean age of the cases and a nearly identical incidence in men and women. In regions of the world where patients have ready access to such chemotherapy, the impact of treatment with highly active antiretroviral drugs on the incidence and natural history of KS has been dramatic. It will be important to monitor the clinico-pathological features of KS in the developing world, as more active antiretroviral regimens become available in clinical practice there.

Mwanda, OW.  2005.  Aflatoxicosis: health implications. AbstractWebsite

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.

OTIENO, PROFMWANDAWALTER.  2005.  R. Rochford, G. Feuer, J. Orem, C. Banura, E. Katongole-Mbidde, W. O. Mwanda, A. Moorman, W. J. Harrington, S. C. Remick. Strategies to overcome myelotoxic therapy for the treatment of Burkitt's and AIDS-related Non-Hodgkin's lymphoma. EAMJ, 2005; 82 (9):. East Afr Med J. 2005 Sep;82(9 Suppl):S155-60.. : MBA Abstract

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.

OTIENO, PROFMWANDAWALTER.  2005.  Orem J, Otieno MW, Banura C, Katongole-Mbidde E, Johnson JL, Ayers L, Ghannoum M, Fu P, Feigal EG, Black J, Whalen C, Lederman M, Remick SC.Capacity building for the clinical investigation of AIDS malignancy in East Africa.. Fogarty AIDS International Training and Research Program, Case School of Medicine, Case Western Reserve University, Cleveland, OH, USA.. : MBA Abstract

PURPOSE: To build capacity in the resource-poor setting to support the clinical investigation and treatment of AIDS-related malignancies in a region of the world hardest hit by the AIDS pandemic. METHODS: An initial MEDLINE database search for international collaborative partnerships dedicated to AIDS malignancies in developing countries failed to identify any leads. This search prompted us to report progress on our collaboration in this aspect of the epidemic. Building on the formal Uganda-Case Western Reserve University (Case) Research Collaboration dating back to 1987, established NIH-supported centers of research excellence at Case, and expanding activities in Kenya, scientific and training initiatives, research capital amongst our institutions are emerging to sustain a international research enterprise focused on AIDS and other viral-related malignancies. RESULTS: A platform of clinical research trials with pragmatic design has been developed to further enhance clinical care and sustain training initiatives with partners in East Africa and the United States. An oral chemotherapy feasibility trial in AIDS lymphoma is near completion; a second lymphoma trial of byrostatin and vincristine is anticipated and a feasibility trial of indinavir for endemic Kaposi's sarcoma is planned. CONCLUSIONS: In the absence of published reports of evolving international partnerships dedicated to AIDS malignancy in resource constrained settings, we feel it important for such progress on similar or related international collaborative pursuits to be published. The success of this effort is realized by the long-term international commitment of the collaborating investigators and institutions to sustain this effort in keeping with ethical and NIH standards for the conduct of research; the provision of formal training of investigators and research personnel on clinical problems our East African partners are faced with in practice and the development of pragmatic clinical trials and therapeutic intervention to facilitate technology transfer and enhance clinical practice.

PMID: 15829373 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2005.  J. Orem, P. Fu, A. Ness, W.O. Mwanda, S. C. Remick. Oral combination chemotherapy in the treatment of AIDS-associated Hodgkin's disease. EAMJ, 2005; 82 (9): S144-S150.. East Afr Med J. 2005 Sep;82(9 Suppl):S144-9.. : MBA Abstract

{ Uganda Cancer Institute, Mulago Hospital and the Makerere University School of Medicine, Kampala, Uganda. OBJECTIVES: To determine the effectiveness of an oral combination chemotherapy regimen administered to patients with AIDS-associated Hodgkin's disease. DESIGN: Prospective, pilot phase II clinical trial. SETTING: Consecutive patient recruitment occurred at two medical centers in the United States: Albany Medical Center, Albany, New York, where patients were recruited prior to December 31, 1996 (pre-HAART era); and University Hospitals of Cleveland, Cleveland, Ohio, where patients were recruited after January 1, 1997 (HAART era). INTERVENTION: Oral chemotherapy consisted of lomustine (100 mg/m2 day I for cycle one and odd cycles thereafter); etoposide (200 mg/m2 days 1 through 3); and cyclophosphamide and procarbazine (each 100 mg/m2 days 22 through 31). Cycles were repeated every six weeks. Colony-stimulating factor support (G-CSF in all instances) was allowed. MAIN OUTCOME MEASURES: Clinical demographic variables, peripheral blood counts, serum chemistries, CD4 lymphocyte count, histopathological subtype of Hodgkin's disease were identified for all patients, who were staged according to Ann Arbor criteria. DATA ANALYSIS: Common Toxicity Criteria were utilized to assess safety; response was assessed using ECOG criteria; and survival was analyzed by Kaplan-Meier methods and difference of survival between pre-HAART and HARART era was compared using log-rank test. RESULTS: Eleven patients (six in pre-HAART era), all but one male, with a median age of 36 years, excellent performance status and advanced International Prognostic Score were treated. Myelosuppression was the major side effect and there were minimal other grade 3 or greater toxicity all of which were promptly reversible. An overall objective response rate of 82% (with 18% complete responses) and median survival duration of 24 months (range 2.5 +/- 68) were observed. Survival was markedly improved in patients treated in the HAART era (median not reached versus 7.25 months

OTIENO, PROFMWANDAWALTER.  2005.  W.O. Mwanda, J. Orem, S. C. Remick, R. Rochford, C. Whalen, M. L. Wilson. Clinical characteristics of Burkitt's lymphoma from three regions in Kenya . EAMJ, 2005; 82 (9): S135-S143.. East Afr Med J. 2005 Sep;82(9 Suppl):S135-43.. : MBA Abstract

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.

OTIENO, PROFMWANDAWALTER.  2005.  O.W. Mwanda, C. F. Otieno, E. Omonge. Acute Aflataoxicosis: Case Report. EAMJ, 2005; 82:320-324.. EAMJ, 2005; 82:320-324.. : MBA Abstract

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

OTIENO, PROFMWANDAWALTER.  2005.  W.O. Mwanda, C. Whalen, S. C. Remick. Burkitt's lymphoma and emerging therapeutic strategies for EBV and AIDS-associated lymphoproliferative diseases in East Africa . EAMJ, 2005; 82 (9): S133-S134.. East Afr Med J. 2005 Sep;82(9 Suppl):S133-4.. : MBA Abstract

Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi, Kenya. PMID: 16619688 [PubMed - indexed for MEDLINE]

OTIENO, PROFMWANDAWALTER.  2005.  Otieno MW, Fu P, Collea R, Whalen C and Remick SC. Kaposi's sarcoma in patients with and without human immunodeficiency virus infection in a tertiary referral center in Kenya . Ann Trop Med Parasitol, 2005; 99 (1): 81-91. Ann Trop Med Parasitol, 2005; 99 (1): 81-91. : MBA Abstract

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

OTIENO, PROFMWANDAWALTER.  2005.  Psychological aspects of the paediatric cancer patients. Curr Opin Oncol. 2006 Sep;18(5):479-86.. : MBA AbstractWebsite

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

2004

OTIENO, PROFMWANDAWALTER.  2004.  Orem J, Otieno MW, Remick SC. AIDS-associated cancer in developing nations. Current Opinion in Oncology 6:468-476; 2004.. MEDICOM, 2004; 19, 1: 13-18.. : MBA Abstract

PURPOSE OF REVIEW: With the emergence of the highly active antiretroviral therapy era, it is apparent that the incidence of Kaposi sarcoma, in particular, and lymphoma in patients with AIDS is declining, especially in regions of the world where these regimens are routinely available. The burden of HIV infection and AIDS is greatest in the developing world, and no doubt neoplastic complications are increasingly encountered. The purpose of this review is to highlight recent developments of this aspect of the AIDS epidemic in the developing world. RECENT FINDINGS: It was readily apparent that the incidence of Kaposi sarcoma sharply increased after the onset of the AIDS epidemic in developing countries. By the end of the second decade of the epidemic, non-Hodgkin lymphoma is increasing in incidence and the natural history of Burkitt lymphoma is evolving in the backdrop of HIV infection as well. Cervical cancer is the most common cancer in women in many developing countries, yet the true impact of HIV infection on the development of this neoplasm is not fully understood. Squamous cell carcinoma of the conjunctiva appears to be a unique AIDS-associated neoplasm that is encountered in sub-Saharan Africa as well. Finally, although the epidemiologic and clinicopathologic features for many AIDS-associated neoplasms are well characterized in developing regions of the world, there is a paucity of data on the therapeutic approach to these tumors in this setting. SUMMARY: It is apparent that as the AIDS pandemic proceeds, the burden of neoplastic diseases is increasing in developing nations. Current therapeutic approaches are not well documented. Pragmatic prevention and therapeutic interventions suitable for the resource-constrained setting are clearly needed.

KHALFAN, DRABDALLAHFATMAH, OTIENO PROFMWANDAWALTER.  2004.  Quality of-life in male cancer patients at Kenyatta National Hospital, Nairobi. East Afr Med J. 2004 Jul;81(7):341-7.. East Afr Med J. 2004 Jul;81(7):341-7.. : MBA Abstract

BACKGROUND: The quality of life of cancer patients is likely to be influenced by psychological reactions of the cancer patients yet there are no documented issues related to quality of life in cancer patients in Kenyan hospitals. OBJECTIVE: To investigate issues which affect the quality of life in male cancer patients. DESIGN: Prospective cross sectional study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. METHODS AND SUBJECTS: Cancer patients above 12 years of age were interviewed during the course of their stay in the hospital, specifically to gather information on; semi structured questions and a modified Beck's 24 item depression inventory with a view to solicit for their reaction on issues which pertains to quality of life. MAIN OUTCOME MEASURES: Age group, level of education, tribe, geographical place (province) of birth, chief complains, main concerns, views on doctors, contact with psychiatrist and psychologist, the anatomic site of cancer, treatment given and responses on modified Beck's depression inventory. RESULTS: Forty two patients were studied, their age range 13-72 years, mean 43.2 and peak 13-26 years. Forty seven per cent of cases had no formal education. The cancers were gastrointestinal tract 33%, blood and lymphoid tissue (26%), bone and muscle (11.9%), skin (9.4%) and genitourinary tract (4.8%). Treatment given was chemotherapy, radiotherapy and surgery. Ninety three per cent were unable to cope. Chief complaints were pain, inability to work, feeling miserable and concerns were families, health and work retardation. Modified Beck's depression score was 20%, with major issues being; work retardation, insomnia, weight loss, and anorexia. Most affected were, age group 27-35 years (and least 13-26 years), uneducated, living in Nairobi (city), having carcinomas, treatment with combined surgery and radiotherapy. Low education level and residence in Nairobi coped poorly. Radiation therapy group appeared to cope better than other modalities. CONCLUSION: The issues affecting the quality of life of male cancer patients stated were pain, inability to work, poor coping with cancer and psychological reactions of work retardation, insomnia, weight loss, fatigability and depression. Gambling, suicidal ideas and social withdrawal were minimal. Other concerns were families, health and work.

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