William Macharia

Where do developing World clinicians obtain evidence for practice: a case study on pneumonia

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 can be explained by the sources of evidence used. Questionnaire responses to hypothetical case history. Investigators from 6 centres within the International Clinical Epidemiology Network (INCLEN) in China, Thailand, India, Egypt, and Kenya. Doctors chosen to represent primary and secondary hospital practice in the regions of the study centres. Investigations and initial treatments which would be ordered for a hypothetical 60-year-old woman who develops pneumonia 5 days after hospital admission, whether local data on antibiotic sensitivities are available and where information would be obtained to guide management. Chest x-ray and sputum gram stain/culture were consistently the most commonly ordered investigations, there being much greater variation in the initial treatment choices with either penicillin, a third-generation cephalosporin or aminoglycoside being the most popular choice. Textbooks were the commonest form of information source, and access to a library, textbooks and journals were statistically significantly associated with appropriate choice of investigations, but not treatment. Access to local antibiotic sensitivities was associated with appropriate initial treatment choice. Improving access to information in the literature and to local data may increase the practice of evidence-based medicine in the developing world.

Effects of skin contactants on evolution of atopic dermatitis in children : a case control study

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 children with AD and 63 age and sex matched controls. Emollients had been used to lubricate the skin during early infancy in a similar proportion of children in both groups (odds ratio = 0.33; 95% CI = 0.14, 0.80). Similarly, no association was found between the use of toilet soaps or laundry detergents in early infancy and development of AD. These findings suggest that baby soaps and vaseline petroleum jelly can safely be used in the skin care of AD susceptible individuals.

Four-country surveillance of intestinal intussusception and diarrhoea in children.

Aim:  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.

Outcome For Hospitalized Road Trauma Patients at a Tertiary Hospital in Kenya

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 determined by calculating Injury Severity Scores (ISS) for each patient. Information on the care and treatment outcome was obtained from patient interviews, case notes and discharge summaries. Data analysis was performed using the SPSS version 10.0 statistical software.Results:Injury accounted for 48.8% of all emergency hospitalizations into the surgical units. Injury due to traffic comprised a third (31%) of trauma admissions. Injuries to the limbs were predominant (54%). Acuity ranged from ISS 1 to 43. The mean ISS was 8.78. Major injury (ISS > 15) constituted 13% of all the admissions. Operating room resources were utilized in 52% of the patients (major operations were performed in 12% of this group). The overall complication rate was 12.0%. Although the overall mortality amounted to 6%, mortality was 35.6% amongst those with major injury. It was also higher with associated head injury, pedestrian injury and weekend injury.Conclusion:The overall trauma acuity was moderate injury. Mortality escalated to 35% for major injury. There is need to explore the factors contributing to this high mortality and a system of care that can optimize outcome.

A systematic review of existing national priorities for child health research in sub-Saharan Africa

BackgroundWe systematically reviewed existing national child health research priorities in Sub-Saharan Africa, and the processes used to determine them.MethodsCollaborators 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, identified and located potentially eligible prioritisation documents. Included documents were those published between 1990 and 2002 from national or nationally accredited institutions describing national health research priorities for child health, alone or as part of a broader report in which children were a clearly identifiable group. Laboratory, clinical, public health and policy research were included. Two reviewers independently assessed eligibility for inclusion and extracted data.ResultsEight of 33 potentially eligible reports were included. Five reports focused on limited areas of child health. The remaining three included child-specific categories in reports of general research priorities, with two such child-specific categories limited to reproductive health. In a secondary analysis of Essential National Health Research reports that included children, though not necessarily as an identifiable group, the reporting of priorities varied markedly in format and numbers of priorities listed, despite a standard recommended approach. Comparison and synthesis of reported priorities was not possible.ConclusionFew systematically developed national research priorities for child health exist in sub-Saharan Africa. Childrens interests may be distorted in prioritisation processes that combine all age groups. Future development of priorities requires a common reporting framework and specific consideration of childhood priorities.