Aetiology of diarrhoea in pre-term neonates at Kenyatta National Hospital nursery, Nairobi, Kenya

The aetiology of two outbreaks of diarrhoea in pre-term neonates (March-August; September, 1987), at Kenyatta National Hospital was studied. The first outbreak involved 98 neonates and enteropathogenic E. coli of different serotypes were the most commonly isolated agents (54%), with serotype 086a:K61 dominating. These were followed by Salmonella (16%) also of different groups, and then rotavirus (6%). Two campylobacter and two Shigella were isolated from four individual neonates. Mixed infections were mainly those of Salmonella and E. coli (5 cases). E. coli serotype 086 was found to be in circulation throughout the study period (March-August, 1987), whilst 044:0125 and 0128 circulated for a limited period. Salmonella and some strains of E. coli caused persistent diarrhoea despite antibiotic therapy. Nosocomial infections were found to play a role in subsequent diarrhoeas. In the second diarrhoea outbreak, again enteropathogenic E. coli and Salmonella were the most frequently isolated. However, in this outbreak, there was no single E. coli serotype revealed that some possessed plasmids of 120-160 megadalton. However, a search for human immunodeficiency viral antibodies in 120 stools produced negative results.     

Testicular cancer at Kenyatta National Hospital, Nairobi

This retrospective study was undertaken to determine the prevalence, clinical characteristics, management methods and prognosis of testicular cancer at Kenyatta National Hospital, Nairobi. All histologically confirmed testicular cancer patients recorded at the Histopathology Department between 1993 and 1997 were analyzed. The mean age was 34.8 years with a peak incidence in the 30-44 year age group. About 10.26% of patients had history of cryptochirdism. The clinical symptoms presented were painless testicular swelling (n = 31, 79.49%), testicular pain (n = 11, 28.08%), scrotal heaviness (n = 9, 23.08%), abdominal swelling (n = 6, 15.38%), gynecomastia (n = 1, 2.56%), and eye swelling (n = 1, 2.56%). On examination, 32 patients (82.05%) had testicular masses, 10 (25.64%) had abdominal masses, 7 (17.91%) had supraclavicular and cervical lymphadenopathy, 1 had gynecomastia, and 1 had an orbital mass. More than 89% of patients had germ cell cancers with seminoma accounting for 67.35%, teratoma for 12.24%, embryonal carcinoma for 8.16%, rhabdomyosarcoma for 6.12%, and malignant germ cell tumor, orchioblastoma, and dysgerminoma each accounting for 2.04%. The various methods of treatment include orchidectomy and radiotherapy and chemotherapy in 3 patients (7.7%), orchidectomy and radiotherapy in 16 patients (41.03%), orchidectomy and chemotherapy in 6 patients (15.38%), and radiotherapy and chemotherapy in 10 patients (25.64%). No cisplatin-based chemotherapy was used. 18 patients were followed up, of whom 7 were alive after 5 years. Prognosis with current regimens was poor, with a 38.89% survival ratio in 5 years. Hence, cisplatin-based chemotherapy with up to 90% cure rates should be included in the testicular cancer management in this hospital.     

Childhood asthma at Kenyatta National Hospital, Nairobi

Between January 1986 and July 1988, 356 children with bronchial asthma below 14 years of age were evaluated at the Kenyatta National Hospital. 21.3% experienced initial asthmatic attacks before the age of six months and 55.1% before 2 years. Only 8% of the study patients were below the age of 2 years at recruitment. The male:female ratio was 1:1. Physical exercise led to precipitation or worsening of attacks in 43.4% while 71.6% of the patients experienced attacks in the evening or at night. 18.5% and 42.9% had personal history of atopic dermatitis and allergic rhinitis respectively. The study shows that a substantial number of patients experience initial asthmatic attacks before the age of 6 months contrary to what has been previously believed.     

Management pathway for congenital heart disease at Kenyatta National Hospital, Nairobi

BACKGROUND: Congenital heart disease (CHD) is a significant cause of death amongst infants. The timing of treatment in relation to the natural history of the disease correlates with the treatment outcome. OBJECTIVES: To determine the age at first suspicion of CHD, the age at confirmation of the diagnosis of CHD and the percentage follow-up at the first post diagnosis out patient clinic and to determine the influence of patient's sex, parental income and parental education have on the MP. DESIGN: A five year retrospective study. SETTING: Kenyatta National Hospital between January 1st 2000 and December 31st 2004. SUBJECTS: Two hundred and fourteen patients were studied. RESULTS: The overall mean age at referral to a paediatric cardiologist was 16.9 +/- 24.4 months [n = 102]. The mean age at which CHD was confirmed by echocardiography was 18.6 +/- 25.6 months [n = 202]. The mean age at which CHD was first suspected in patients from the province with the highest parental income was 9.5 +/- 5.1 months [n = 6]. The mean age at which CHD was first suspected in patients from a province with a significantly lower parent income was 19.1 +/- 23.2 months [n = 22], (p = 0. 046). The mean age at which CHD was confirmed in referred male patients was 16.0 +/- 17.6 months [n=48] and the mean age at which CHD was confirmed in referred female patients was 18.8 +/- 21.7 months [n = 52] (p = 0.25). CONCLUSION: The mean age at referral to a paediatric cardiologist was 16.9 months. This suggests that a significant number of patients may miss the opportunity to have optimal surgical intervention. Parental income appears to influence the MP, however, the level of parental education and patient sex did not.     

Battered baby syndrome at Kenyatta National Hospital, Nairobi

Thirty children presenting with Battered Baby Syndrome over a five year period were studied retrospectively. The male:female ratio was 1:1.1. The majority (60%) were aged 0-11 months. 14 children (46%) were abandoned while six (20%) had multiple fractures, six (20%) multiple bruises and bites, and four (13.3%) had other forms of abuse. Twelve (40%) children were malnourished while eight of the babies (26.6%) were small for gestational age. Children were most frequently brought to hospital by the police or their mothers. The children were most frequently abused by their mothers either through abandonment or through physical battering. Details of mothers of the 14 abandoned children were unknown. Among the mothers of the other children, nine mothers were single, seven married and living with spouses and one stepmother. Two children (6.6%) died while the fate of two others was not known. Three children were sent home without intervention of the social worker, while twenty three children were discharged following intervention of the social worker; fourteen sent home, nine to a childrens' home and one through the juvenile court.     

Epidemiological aspects of Fournier's gangrene at Kenyatta National Hospital, Nairobi

This was a retrospective epidemiological study of 171 patients with scrotal (Fournier's gangrene) at Kenyatta National Hospital over eleven year period. The age range was 11 days to 90 years with a mean of 35.38 years. This is different from other reports of a mean of 40.6 years in the older literature and a mean of 50 years in the more recent series. The ethnic distribution of Fournier's gangrene revealed equal susceptibility among all ethnic groups in this locality. Scrotal and genitourinary symptoms were the commonest being present in one hundred and two patients (59.7%). The onset of symptoms was insidious in 95 patients (55.6%), and abrupt in 76 patients (44.4%). Most patients (84.2%) presented after more than 48 hours of the onset of symptoms. One hundred and two patients (59.65%) presented with localised physical signs compared to sixty nine patients (40.35%) who presented with extended lesions. Sources of the lesion were known in 82.5% of the patients. Genitourinary sources accounted for 42.1%, extragenitourinary 29.2%, and mixed 11.11% among the known causes. Diabetes mellitus was the leading major illness associated with Fournier's gangrene, presenting in 11 patients (6.42%). Seven other patients (4.09%) had HIV infection.