African Journal of Primary Health Care & Family Medicine
Background: Diabetes and hypertension pose a significant socio-economic burden in developing coun... more Background: Diabetes and hypertension pose a significant socio-economic burden in developing countries such as Kenya, where financial risk-protection mechanisms remain inadequate. This proves to be a great barrier towards achieving universal health care in such settings unless mechanisms are put in place to ensure greater access and affordability to non-communicable disease (NCD) management services.Aim: This article aims to examine outpatient management services costs for patients with diabetes and hypertension attending public primary healthcare facilities.Setting: The study was conducted in Busia and Trans-Nzoia counties in Western Kenya in facilities supported by the PIC4C project, between August 2020 and December 2020.Methods: This cross-sectional survey included 719 adult participants. Structured interviewer-administered questionnaires were used to collect information on healthcare-seeking behaviour and associated costs. The annual direct and indirect costs borne by patients w...
Methods: We did a retrospective chart review of laboratory and inpatient files of patients diagno... more Methods: We did a retrospective chart review of laboratory and inpatient files of patients diagnosed and managed for COVID-19 at the Moi Teaching and Referral Hospital in Kenya and analyzed the data using Stata ® version 16 (StataCorp LP, College Station, TX, USA) and calculated measures of association at 95% CI. The patients (n = 1,770) had a mean age of 43 years (SD 20 years) and 55.4% were male. Close to 70% had asymptomatic disease, with the symptomatic cases largely being respiratory in nature. One-quarter had comorbidities. The case fatality rate was 13.6% (n = 240). Male sex increased the odds of mortality by 1.69 (95% CI 1.27-2.25; p ≤ 0.001), and the presence of comorbidities increased the odds of mortality by 3.16 (95% CI 2.38-4.18; p ≤ 0.001). Those aged 59 years and above were 18 times more likely to die from COVID-19 than those below 15 years of age (95% CI 1.61-90.66; p = 0.015). Conclusion: COVID-19 had a significantly high mortality rate in western Kenya. Male sex and the presence of comorbidities increased the risk of severe disease and mortality.
Anthropometric Measurements as Predictors of Mortality in a Community Population Aged 70 Years and Over
Age and Ageing, 1990
Corrected arm muscle area (CAMA), triceps skin-fold thickness (TSF) and body mass index (BMI) wer... more Corrected arm muscle area (CAMA), triceps skin-fold thickness (TSF) and body mass index (BMI) were measured in a community sample of 758 people who were then followed for 40-46 months. Percentile values were calculated for each sex in 5-year age groups. The relative risk of death of those in the upper and lower percentiles was compared with those between the 10th and 90th percentiles, controlling for age and sex. Subjects below the 5th percentile for CAMA, TSF and BMI and between the 5th and 10th percentile for CAMA had a significantly increased risk of death. There was no increased risk of death in those subjects above the 90th percentile in any measurement. In the logistic regression model, both low CAMA and low TSF were associated with a significantly increased risk of subsequent mortality. Poor nutritional state shown by low muscle bulk and fat stores was an important predictor of mortality, but obesity had no adverse effect on survival.
Background Alcohol use disorder is prevalent globally and in Kenya, and is associated with signif... more Background Alcohol use disorder is prevalent globally and in Kenya, and is associated with significant health and socio-economic consequences. Despite this, available pharmacological treatment options are limited. Recent evidence indicates that intravenous (IV) ketamine can be beneficial for the treatment of alcohol use disorder, but is yet to be approved for this indication. Further, little has been done to describe the use of IV ketamine for alcohol use disorder in Africa. The goal of this paper, is to: 1) describe the steps we took to obtain approval and prepare for off-label use of IV ketamine for patients with alcohol use disorder at the second largest hospital in Kenya, and 2) describe the presentation and outcomes of the first patient who received IV ketamine for severe alcohol use disorder at the hospital. Case presentation In preparing for the off-label use of ketamine for alcohol use disorder, we brought together a multi-disciplinary team of clinicians including psychiatri...
Background Kenya is in the process of implementing universal health care whose success and sustai... more Background Kenya is in the process of implementing universal health care whose success and sustainability will be determined by its funding mechanism and by uptake of National Hospital Insurance Fund (NHIF) by its populace. Unfortunately, NHIF enrollment is currently voluntary hence geared to those in formal employment who represent only 16.4% of the population. To improve the voluntary uptake of the scheme, it is important to have increased awareness as well as implement strategies that address factors that currently affect NHIF uptake. Methods This was a cross sectional community-based survey conducted in Busia, Trans Nzoia, Vihiga and Siaya counties between October and December 2018. It utilized multistage stratified sampling technique. Interviewer assisted questionnaires were used to collect socio-demographic, socio-economic, Non-Communicable Diseases (NCD) knowledge, NHIF awareness and uptake data. Descriptive statistical analysis and multiple logistic regression were conducted...
Background: Early Infant Male Circumcision (EIMC) is part of sustainable HIV prevention strategie... more Background: Early Infant Male Circumcision (EIMC) is part of sustainable HIV prevention strategies in Kenya. The goals of the national EIMC program are to circumcise at least 40% of all newborn male infants delivered at hospitals offering the service and keep the rate of moderate and adverse events below 2%. Objectives: To determine the proportion of early male infants (age less than 60 days) born at hospitals in four counties of western Kenya who got circumcised and document the prevalence of adverse events (AEs) among those circumcised. Methods: A retrospective descriptive study involving all records for EIMC from 1st March 2014 through 31st March 2018 in four counties of western Kenya. Data analysis was done using EXEL to document proportion of facilities offering EIMC and compare EIMC uptake and outcomes in the four counties against the national goals for the program. Results: A mean of 4.3% of total health facilities offer EIMC in the region. Siaya had the highest proportion of...
Background: Research has demonstrated disparities in the outcomes of patients admitted to hospita... more Background: Research has demonstrated disparities in the outcomes of patients admitted to hospital on weekends in high-income countries. No published research has evaluated if any similar discrepancy exists in lowresource settings. Methods: To determine if any difference in mortality exists between weekend and weekday admissions on the public medical wards at a Kenyan referral hospital, we performed a retrospective observational study of inpatients over a 3-month study period. Results: During the study period, 261 (27.3%) of the 956 patients were admitted over the weekend. The mortality rates for patients admitted on weekends and weekdays did not differ with 156 (22.4%) of the 695 patients admitted on weekdays dying compared to 55 (21.1%) of the 261 patients admitted on weekends. After adjusting for age, insurance status, co-morbid illness, HIV status, employment, referral status and gender, still no association existed between weekend admission and mortality. Conclusions: Among adult patients on the medical wards, patients admitted on weekends had similar mortality rates to those admitted on weekdays. This similarity may reflect a stable level of care or a generalized shortage of resources and staffing that subsumes any impact of weekly variations. Future research examining optimal staffing and resource levels is needed in such settings.
Background: Observational data in the United States suggests that those without health insurance ... more Background: Observational data in the United States suggests that those without health insurance have a higher mortality and worse health outcomes. A linkage between insurance coverage and outcomes in hospitalized patients has yet to be demonstrated in resource-poor settings. Methods: To determine whether uninsured patients admitted to the public medical wards at a Kenyan referral hospital have any difference in in-hospital mortality rates compared to patients with insurance, we performed a retrospective observational study of all inpatients discharged from the public medical wards at Moi Teaching and Referral Hospital in Eldoret, Kenya, over a 3-month study period from October through December 2012. The primary outcome of interest was in-hospital death, and the primary explanatory variable of interest was health insurance status. Results: During the study period, 201 (21.3%) of 956 patients discharged had insurance. The National Hospital Insurance Fund was the only insurance scheme noted. Overall, 211 patients (22.1%) died. The proportion who died was greater among the uninsured compared to the insured (24.7% vs. 11.4%, Chi-square015.6, p B0.001). This equates to an absolute risk reduction of 13.3% (95% CI 7.9Á18.7%) and a relative risk reduction of 53.8% (95% CI 30.8Á69.2%) of in-hospital mortality with insurance. After adjusting for comorbid illness, employment status, age, HIV status, and gender, the association between insurance status and mortality remained statistically significant (adjusted odds ratio (AOR) 0 0.40, 95% CI 0.24Á0.66) and similar in magnitude to the association between HIV status and mortality (AOR 0 2.45, 95% CI 1.56Á3.86). Conclusions: Among adult patients hospitalized in a public referral hospital in Kenya, insurance coverage was associated with decreased in-hospital mortality. This association was comparable to the relationship between HIV and mortality. Extension of insurance coverage may yield substantial benefits for population health.
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Papers by Thomas Andale