School of Medicine

Optimal initial PEEP in management of preterm infant with respiratory distress syndrome: a prospective study at newborn unit of Moi Teaching and Referral Hospital

Mon, 01 Jan 2024 00:00:00 GMT

Optimal initial PEEP in management of preterm infant with respiratory distress syndrome: a prospective study at newborn unit of Moi Teaching and Referral Hospital Vulalo, Deborah Makasi; Mwangi, Ann; Chepkemoi, Audrey K.; Amubuomombe, Philippe Poli; Ayaya, Samuel O Background: Respiratory distress syndrome remains an important cause of 22 neonatal mortality and morbidity worldwide. Early initiation of continuous 23 positive airway pressure is a standard of care for preterm infants with 24 respiratory distress syndrome. Positive end-expiratory pressure reduces the ACCEPTED MANUSCRIPT ARTICLE IN PRESS ARTICLE IN PRESS2 25 need for invasive ventilation and prevents chronic lung disease. However, 26 the optimum positive end expiratory pressure level to effectively treat 27 respiratory distress syndrome in preterm infants remains unknown. 28 Objective: To determine the optimal initial positive end expiratory pressure 29 level in management of preterm infants with respiratory distress syndrome. 30 Methods: This prospective descriptive study was conducted from July 2023 31 to January 2024 in the newborn unit of Moi Teaching and Referral Hospital. 32 A total of 204 preterm infants (28-34 weeks gestational age) with 33 respiratory distress syndrome who required Continuous Positive Airway 34 Pressure treatment were recruited. Data on the maternal and neonatal 35 characteristics, low and high positive end expiratory pressure levels, and 36 outcomes at 72 hours were collected and analysed. Descriptive statistics 37 were used for continuous variables, and frequencies were used for 38 categorical data. A p value less than 0.05 was considered statistically 39 significant at the 95% confidence interval. Receiver operating characteristic 40 curves were used to determine the optimal positive end expiratory pressure 41 level. 42 Results: A total of 45 and 159 preterm infants were started on low and high 43 positive end expiratory pressure levels, respectively. Among 159 (77.9%) of 44 the preterm infants started on high positive end expiratory pressure levels, 45 majority (135, 66.2%) were initiated at a positive end expiratory pressure 46 level of 6 cmH2O. The Area under the curve for low positive end expiratory ACCEPTED MANUSCRIPT ARTICLE IN PRESS ARTICLE IN PRESS3 47 pressure levels was 0.5757 and the one for high positive end expiratory 48 pressure levels was 0.5405. DeLong's test for two ROC curves D = 0.82979, 49 df = 120.8, p value = 0.4083. The area under the curve of both low and high 50 positive end expiratory pressure levels were close and not significantly 51 different (p=0.4083). 52 Conclusion: In this study, low positive end expiratory pressure was 53 associated with low failure rate and complications. However low and high 54 positive end expiratory pressure levels were not significantly different to 55 determine the optimal initial PEEP. Further research are needed to 56 determine optimal PEEP for continuous positive airway pressure initiation 57 in preterm infants with respiratory distress syndrome

Radiological Morphometry of the Proximal Femur in Kenyan Adult Patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Thu, 01 Jan 2026 00:00:00 GMT

Radiological Morphometry of the Proximal Femur in Kenyan Adult Patients at Moi Teaching and Referral Hospital, Eldoret, Kenya Ambuka, Darwin; Ramadhani, Ayumba Barry; Njoroge, Antony N. Background: The prevalence of proximal femur and hip ailments is increasing, requiring appropriate treatments such as osteosynthesis and arthroplasty. Preoperative planning relies on morphometric dimensions of the proximal femur, yet anatomical variations across populations mean many commercial implants may not fit optimally. Selecting the correct implant is crucial to avoid postoperative complications, hence the need for this study. Objectives: To determine the radiomorphometric measurements of the neck-shaft angle (NSA) and femoral head diameter (FHD) in Kenyan adults at Moi Teaching and Referral Hospital (MTRH) to guide implant design and assess variations by gender, laterality, and influencing factors. Methods: A cross-sectional survey was done on 118 normal radiograph patients comprising of 57 (48.3%) males and 61 (51.7%) females. Student-t-test was used to compare the measurements of the proximal femur in relation to gender and laterality. Statistical significance was determined by a p-value less than 0.05. Continuous data was presented as mean, standard deviation, median, interquartile range, while categorical data as frequency and proportions. Results: Results reveal that, for factors affecting NSA and FHD, Age (p-value 0.911), Gender (p-value 0.643), Region (p-value 0.449) and Level of activity (p-value 0.498) did not have statistical significance on the findings while Diet (p-value 0.029) was statistically significant. Majority of patents were of middle age. The mean Femoral NSA and FHD diameter in Kenyan adult patients varied from those of other populations. The mean NSA and FHD varied in relation to gender (males greater) and laterality (right greater, but difference not statistically significant) in terms of measurements. Diet factor finding was statistically significant. Conclusion and Recommendations: Implants should be designed according to the new measurements in this study. Orthopaedic Surgeons should always consider morphometric dimensions before osteosynthesis in the proximal femur and arthroplasty of the hip.

Surgical management of patients with diabetic foot ulcers at MOI Teaching and Referral Hospital, Eldoret, Kenya

Thu, 01 Jan 2026 00:00:00 GMT

Surgical management of patients with diabetic foot ulcers at MOI Teaching and Referral Hospital, Eldoret, Kenya Obare, Sophie K.; Ayumba, Barry R; Ongaro, Neford Background: The Diabetic Foot Ulcer (DFU) is a break in epidermis below ankle in person with Diabetes Mellitus (DM). The prevalence of this disorder is increasing and there is a 15% chance in lifetime of a diabetes mellitus patient developing it. The worldwide prevalence of DFUs has been estimated to be between 4% - 17%. In Kenya, diabetes has a prevalence of 3.3 % - 10%. It is a public health problem particularly in developing countries. DFU is due to neuropathy and poor blood circulation, which can progress to complications such as gangrene and infection, which are attributed to late presentation, poor awareness both among healthcare workers and patients, as well as late referral once they occur. The management of patients faces many challenges though the combination of nonoperative and operative strategies are in use. There is paucity of publication locally, hence the need for this study. Objective: To evaluate the surgical management of patients with diabetic foot ulcers at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Methods: A cross sectional study done in the surgical wards and the diabetic clinic of MTRH between 1st May 2017 and 31st April 2019, involving census of 89 adult patients with diabetic foot ulcers who met the inclusion criteria. Characterization of these patients had been previously done by same team of authors. Relevant data regarding the management with particular interest in treatment modality, and association between some risk factors (peripheral neuropathy, body mass index and glycated haemoglobin) and treatment modality was collected using interviewer administered questionnaires. Data was then cleaned, coded and analyzed using statistical package (SPSS version 19). Presentation was in diagrammatically and in prose formats. Results: The 89 patients were graded using Wagner’s classification: grade 1- 4 were 19, 30, 28 and 12 respectively. Debridements were done to 78 (87.6%) while amputation to 11 (12.4%). Of factors associated with surgical management (debridement and amputation), statistically significant findings (p<0.05) were for peripheral neuropathy (pricking and weakness). However, there was no statistically significant association between body mass index and surgical treatment as well as glycated haemoglobin and surgical treatment. Conclusion: Grade 2 DFUs was the commonest. Debridements were done in most patients, while eleven patients with grade 4 were done amputations. Association between surgical management and peripheral neuropathy was statistically significant. Recommendations: Creating public awareness, early identification of DFUs in patients and appropriate management to salvage the foot are necessary to prevent progression into stage requiring amputation. Multidisciplinary team approach should be adopted.

Perspectives on enhancing peer support services for mothers living with HIV in Kenya: A qualitative assessment of Mentor Mothers and the mothers they serve

Tue, 01 Sep 2026 00:00:00 GMT

Perspectives on enhancing peer support services for mothers living with HIV in Kenya: A qualitative assessment of Mentor Mothers and the mothers they serve Wools-Kaloustian, Kara; McGuire, Alan; Were, Edwin; Carlucci, James G.; Hawryluk, Bridget; Humphrey, John M.; Ndiema, Rosa Chemwey; Naanyu, Violet; Kiano, Marylydia Atieno Mentor Mother (MM) services are an evidenced-based peer support strategy embedded within prevention of mother-to-child transmission of HIV (PMTCT) programs. The current MM strategy in Kenya provides monthly, facility-based, one- size-fits-all antiretroviral therapy adherence counselling and health education to women living with HIV (WLHIV) who are navigating PMTCT services. MMs receive a small monthly stipend as compensation for providing these services. We aimed to gather formative information from MMs and their client WLHIV, with the goal of developing an enhanced MM strategy that accounts for the unique needs of each WLHIV. From April-July 2023, we conducted qualitative interviews with MMs (n = 16) and WLHIV (n = 36) from three public health facilities supported by Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Interviews and analysis were guided by the Practical, Robust Implementation and Sustainability Model (PRISM). Key findings included that both MMs and client WLHIV had favorable opinions about the possibility of developing and implementing a risk-stratified MM strategy wherein client WLHIV with identifiable risk factors receive intensified, problem-focused services while low-risk WLHIV are eligible for less intensive services. MMs and client WLHIV also agreed that empathetic MM-client relationships that leverage shared lived experiences to build trust and address stigma should remain central to the MM program. However, MMs were clear that a better-defined scope of work and capacity building through training and skills development would be necessary for successful implementation of an enhanced MM strategy. Additionally, motivating MMs with fair compensation and recognition for their work, as well as providing more resources for client WLHIV with economic barriers to care, could promote adoption and sustainability of an enhanced MM strategy. Additional participatory research, as well as input from system-level stakeholders, is needed to ensure feasible enhancements to MM services are contextualized within the real- world constraints of PMTCT programs