William M Macharia

Aga Khan University Hospital, Nairobi · Department of Paediatrics and Child Health

Background. Childhood lead exposure from recycling used lead-acid batteries (ULAB) in unregulated areas is a significant cause of lead toxicity, particularly in low and middle-income countries. This study aimed to assess the proportion of children with increased blood lead levels (BLLs) in an informal settlement where ULAB recycling occurs. Methodo...

Serum procalcitonin (PCT) was measured in 228 children aged 1 month to 15 years at an emergency department of a hospital located in an area without local malaria transmission in children with suspected infections; 21% (49) children had a clinical syndrome for suspected bacterial infections (Syndrome+ve). In children with Syndrome+ve criteria, 27/49...

Importance Previous work has underscored subnational inequalities that could impede additional health gains in Kenya. Objective To provide a comprehensive assessment of the burden, distribution, and change in inequalities in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) interventions in Kenya from 2003 to 2014. Design, Se...

eTable. Countdown Indicators and Corresponding Definitions eFigure 1. Composite Coverage of Selected Interventions and Corresponding Coverage Gap (how much is needed to reach universal coverage), By Wealth Quintile eFigure 2. Co-coverage of Health Interventions: Percentage of Mothers and Children <5 Receiving 0 to 9 Essential Interventions By Wealt...

Introduction Despite recent gains, Kenya did not achieve its Millennium Development Goal (MDG) target for reducing under-five mortality. To accelerate progress to 2030, we must understand what impacted mortality throughout the MDG period. Methods Trends in the under-five mortality rate (U5MR) were analysed using data from nationally representative...

Objectives: This study sought to determine the diagnostic utility of serum pre-albumin in predicting weight loss in hospitalised children. Design: A hospital-based longitudinal survey was carried out between December 2013 and February 2014. Setting: Aga Khan University Hospital, Nairobi, Kenya, a tertiary care hospital. Subjects: A total of 170 chi...

Background: Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis o...

Objectives: This study sought to investigate the incidence and factors associated with hospital-acquired malnutrition in children. Design: A hospital-based longitudinal survey carried out between December 2013 and February 2014. Setting: Aga Khan University Hospital, Nairobi, Kenya, a tertiary care hospital. Subjects: One hundred and seventy childr...

Background: Information on adverse events (AEs) in hospitalised patients in developing countries is scanty. Objective: To compare the magnitude and characteristics of inpatient AEs in a tertiary, not-for-profit healthcare facility in Kenya, using medical records review and incident reporting. Methods: Estimation of prevalence was done using in...

Background Countdown to 2015 was a multi-institution consortium tracking progress towards Millennium Development Goals (MDGs) 4 and 5. Case studies to explore factors contributing to progress (or lack of progress) in reproductive, maternal, newborn and child health (RMNCH) were undertaken in: Afghanistan, Bangladesh, China, Ethiopia, Kenya, Malawi,...

Background: Each year, more than 200 million children under the age of 5 years, almost all in low- and middle-income countries (LMICs), fail to achieve their developmental potential. Risk factors for compromised development often coexist and include inadequate cognitive stimulation, poverty, nutritional deficiencies, infection and complications of...

Sub-Saharan Africa suffers an inordinate burden of disease and does not have the numbers of suitably trained health care workers to address this challenge. New concepts in health sciences education are needed to offer alternatives to current training approaches. A perspective of integrated training in population health for undergraduate medical and...

Attention deficit hyperactivity disorder is the most common childhood neurobehavioral disorder with well documented adverse consequences in adolescence and adulthood, yet 60-80% of cases go undiagnosed. Routine screening is not practiced in most pediatric outpatient services and little information exists on factors associated with the condition in...

A commentary is presented on the urgent need for a comprehensive effort to improve the practice of pediatric therapeutics in Africa. A call for action is addressed to a variety of practitioners internationally, many of whom possess skills that could be fruitfully applied to the improvement of health outcomes for African children. Successful engagem...

Objective: The aim was to determine relative frequencies of acute leukemia immunophenotypes using commonly expressed markers and to describe the clinicopathological characteristics. Design: This was a prospective cross-sectional study. Setting: The study was based at Aga khan clinical laboratory department. Subjects: One hundred and thirty two...

To assess the frequency and nature of adverse events to patients in selected hospitals in developing or transitional economies. Retrospective medical record review of hospital admissions during 2005 in eight countries. Ministries of Health of Egypt, Jordan, Kenya, Morocco, Tunisia, Sudan, South Africa and Yemen; the World Health Organisation (WHO)...

To evaluate utility of C-reactive protein (CRP) in the early diagnosis of neonatal sepsis in a tertiary care Newborn Unit in Kenya. Cross-sectional study. Newborn Unit, Kenyatta National Hospital. All neonates admitted to Newborn Unit, Kenyatta National Hospital during the study period with suspected sepsis based on specified clinical criteria. Of...

Effectiveness and toxicity of childhood cancer treatments have never been evaluated in Kenya since introduction of structured care in the early seventies. To evaluate effectiveness and toxicity of two treatment protocols for Non-Hodgkin's lymphoma (NHL). Historical cohort study using medical records. Kenyatta National Hospital, a tertiary care and...

To determine clinical-pathologic characteristics, treatment modalities and treatment outcomes of children diagnosed with neuroblastoma. Cross-sectional descriptive study based on secondary data from patient records. Records department of Kenyatta National Hospital (KNH), a tertiary teaching and referral hospital based in Nairobi. Children aged 15 y...

Road traffic injuries (RTI) are on increase in developing countries. Health care facilities are poorly equipped to provide the needed services. Determine access and quality of care for RTI casualties in Kenya. Cross-sectional survey 53 large and medium size private, faith-based and public hospitals. In-patient road traffic crash casualties and heal...

Establishment of baseline epidemiology of intussusception in developing countries has become a necessity with the possibility of reintroduction of rotavirus vaccine. The current study assessed the seasonal trend in cases admitted with intussusceptions and dehydrating acute watery diarrhoea in children aged 2 months to 10 years. In a prospective sur...

To determine the seroprevalence of varicella zoster in paediatric patients at a high risk of developing complications. A cross-sectional study. Paediatric general wards at Kenyatta National Hospital. Children with malignancies, severe malnutrition and were HIV positive. The sample size was calculated at 147 subjects. Venous samples were tested for...

This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Okebe JU, Lasserson TJ, Meremikwu MM, Richards S. Therapeutic interventions for Burkitt's lymphoma in children. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005198. DOI: 10.1002/14651858.CD005198.pub2. Further information for this C...

Angio-oedema may be hereditary or acquired and is characterised by episodes of potentially life threatening localised tissue oedema and swelling resulting from deficiency of compliment pathway C1 esterase inhibitor. Acquired angio-oedema is about ten times less frequent than the hereditary type and has been associated with immune-deficiency disorde...

We systematically reviewed existing national child health research priorities in Sub-Saharan Africa, and the processes used to determine them. Collaborators from a purposive sample of 20 WHO-AFRO Region countries, assisted by key informants from a range of governmental, non-governmental, research and funding organisations and universities, identifi...

Background: The developing world continues to experience a disproportionate burden of injury. About one half of injury deaths are due to motor vehicle collisions. Road traffic fatalities per 10,000 vehicles are ten to 20 times higher in Africa compared to Europe. Patients and Methods: 233 patients were consecutively analyzed. Injury acuity was dete...

To identify bacterial isolates and determine antibiotic sensitivity pattern in children with severe Protein Energy Malnutrition (PEM) presenting at the Paediatric Filter Clinic (PFC) of Kenyatta National Hospital (KNH). Hospital based cross-sectional survey. Paediatric Filter Clinic of Kenyatta National Hospital (KNH), a tertiary level teaching ins...

Kenya has a soaring rate of road traffic fatalities. Available evidence suggests significant alcohol-relatedness to trauma. We know little about the prevalence of alcohol-related injuries in Nairobi. To determine the extent and pattern of alcohol use in subjects admitted following road traffic accident. A descriptive hospital based survey. Kenyatta...

Little is known about the influence of the site of research or publication on the impact of the research findings on clinical practice, particularly in developing countries. The International Clinical Epidemiology Network (INCLEN) is dedicated to improving the quality of health research in the Developing World through institutional capacity buildin...

To review the clinical presentation and management of children with nephroplastoma and the factors influencing the outcome at Kenyatta National Referral and Teaching Hospital (KNH). This was a retrospective case series study based on secondary data accumulated between 1990 and 1996. The relevant data were extracted from records of all children aged...

There are few data on the practice of evidence based medicine in the developing world, nor on the actual sources of evidence that clinicians use in practice. To test the hypothesis that there was variation between and within developing countries in the proposed management of a patient with hospital acquired pneumonia, and that part of the variation...

To ascertain the prevalence of iron deficiency anaemia(IDA) and its risk factors. A cross-sectional survey. A peri-urban health centre in Nairobi, Kenya. Four hundred and three children, aged six months to six years. Demographic data were obtained and each child examined for signs of iron deficiency anaemia. Blood was drawn for haemoglobin determin...

Neutropaenia and immunosuppression place children on treatment for malignancies at a high risk for infections. We undertook to determine the prevalence of urinary tract infection (UTI) in children on treatment for cancer at the Kenyatta National Teaching and Referral hospital. With the understanding that many laboratories in the rural areas of the...

Not every research paper is worth the time taken to read it To be of value to the reader, the research question needs to be not only in the reader's field of interest but should also have been addressed using rigorous methodology, Further, absolute care should have been taken in collection of data or outcome assessment to ensure reliability (reprod...

This was a cross-sectional survey in which 80 children with malignancies were studied at the Kenyatta National Hospital to determine cardiac status before and during cancer therapy. An equal number of age and sex matched subjects admitted to the surgical wards for minor procedures was recruited as a comparison group. All the subjects underwent clin...

To identify child feeding behavior and household hygiene practices that are risk factors for prolonged diarrheal illness, a longitudinal community study was conducted over a 14-month period among 920 children aged 3-37 months who lived in an urban slum settlement in Nairobi, Kenya. Morbidity surveillance was done by home visits every third day in t...

The objective of this study was to evaluate knowledge, attitudes and beliefs (KAB) that may influence health seeking behaviour of caretakers of children with sickle cell disease (SCD). A cross-sectional survey was undertaken at Nyanza provincial hospital in Kenya between March and September 1993 to identify socio-demographic and economic factors th...

The response of acute lymphoblastic leukaemia (ALL) to treatment remains very low in developing countries. Many factors have been cited to be probable determinants of prognosis. To compare the prognostic determinants of childhood ALL in developed Western countries and developing African countries, a review of published data was carried out. Both an...

Following the outbreak of human immune deficiency virus (HIV) infection in the early 1980's, there has been an increase in reported cases of Kaposi's sarcoma, among other childhood malignancies, from the East and Central African region. To assess the status of childhood cancers at Kenyatta National Hospital during the AIDS epidemic period and to co...

Clinical findings in 54 consecutive negroid children with atopic dermatitis (AD) are presented. The age range was 0.25 to 10.25 years. Male:Female ratio was 1.2:1. Time of onset range between 1 week and 8 years with onset before the age of 1 year in 81.1%. Facial and flexural involvement were observed in 81.5% and 70.4% of patients respectively. Th...

CLINICAL SCENARIOS Case 1 A 28-year-old woman presents to the emergency department in acute distress with a 3-day history of worsening asthma. Her prescribed medications include an inhaled β2-agonist and an inhaled steroid. When questioned, she breathlessly admits to "occasionally" missing her medications but indicates that this is "maybe only o...

To determine, by a quantitative meta-analysis of randomized trials, the effectiveness of strategies to improve patient compliance with screening, referral, and clinic appointments for health services that are provided at the time of the visit. Computerized searches of MEDLINE (1966 through 1990) were done using two search strategies: (1) (Patient C...

Objective. —To determine, by a quantitative meta-analysis of randomized trials, the effectiveness of strategies to improve patient compliance with screening, referral, and clinic appointments for health services that are provided at the time of the visit.Data Sources. —Computerized searches of MEDLINE (1966 through 1990) were done using two searc...

There is little published literature on the effects of skin contactants during early infancy on eventual development of atopic dermatitis (AD). The purpose of this study was to determine whether or not a relationship exists between the use of skin care products in early infancy and the subsequent development of AD. We studied a group of 54 Kenyan c...

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. P...

Causes of death of 239 children below the age of 5 years in a rural community were determined using structured questionnaires. It was found that mortality was highest in infancy, accounting for 63% of all deaths with a trend of decreasing mortality with increasing age. The commonest cause of death was ARI (pneumonia and measles) accounting for 49%...

Verbal autopsy was used to determine causes of death in 239 children under the age of 5 years. The diagnosis derived from verbal autopsy was corroborated with hospital diagnosis in 39 cases. There was concurrence of diagnosis in 72% of the cases. Using the diagnosis of bronchopneumonia to validate the method, verbal autopsy was found to have a sens...

The epidemiology of acute respiratory tract infection (ARI) was investigated in a rural community 80 km north of Nairobi, Kenya. This research was conducted prospectively on 250 families with 470 children <5 years of age who were contacted every 8 days during the 3-year study. The yearly incidence of respiratory tract infections decreased from 5.2...