Aga Khan Hospital, Mombasa

Background: Antimicrobial stewardship (AMS) programs have implemented various surveillance interventions, such as profiling bacterial resistance patterns and developing economic cases for effective management. However, there has been comparatively less focus on evaluating the Drug Resistance Index (DRI). The DRI serves as a crucial instrument for evaluating the efficacy of antimicrobial therapies and examining the patterns of bacterial resistance. Evaluating the efficacy of antibiotics and effectively communicating the issue of antimicrobial resistance are crucial components in developing AMS programs within hospital environments. Objective: This study utilised the DRI to analyse the distribution of multidrug-resistant organisms (MDROs) associated with widely prescribed antimicrobials at Benjamin Mkapa Hospital (BMH), focusing on their application in treating both Gram-positive and Gram-negative infections. Methods: A retrospective descriptive study was conducted using combined data on total bacterial isolates, resistance isolates, and antibiotic usage to calculate the DRI over the years 2020, 2021, and 2022. Results: The three-year DRI for the priority pathogens Escherichia coli and Klebsiella pneumoniae isolated from urine samples is 46%. The average three-year DRIs for pathogens isolated from blood samples were as follows: Acinetobacter baumannii (37%), Escherichia coli (65%), Klebsiella pneumoniae (62%), Streptococcus pneumoniae (60%), and Staphylococcus aureus (63%). Additionally, the DRIs for bacteria isolated from pus and wound swabs were: Acinetobacter baumannii (60%), Escherichia coli (57%), Klebsiella pneumoniae (66%), Pseudomonas aeruginosa (34%) and Staphylococcus aureus (75%). Conclusion: All evaluated priority pathogens displayed multidrug resistance, with DRI values surpassing 25%, a clear indicator of escalating antimicrobial resistance (AMR). These findings underscore the necessity for robust antibiotic stewardship programs within healthcare institutions, alongside the regular dissemination of antibiotic consumption data to the BMH. Additionally, the formulation of comprehensive policies and treatment guidelines is essential to regulate antibiotic prescriptions effectively, thereby preserving their long-term efficacy. These initiatives are pivotal in the fight against AMR, facilitating the restoration of antimicrobial susceptibility and mitigating the DRI.

IntroductionSeeking legal redress for sexual violence (SV) is a daunting process for survivors. They must navigate their personal trauma societal stigma, and flawed systems, creating an arduous path to justice. This study was conducted to assess patterns of SV within Mombasa County, Kenya, and details the legal follow-up post-SV care.MethodsA retrospective cross-sectional study was conducted using data from SV survivors attending the Gender-Based Violence and Recovery Centre (GBVRC) at the Coast General Teaching and Referral Hospital (CGTRH) between 2017 and 2023. Data sources include post-rape care (PRC) forms, clinician notes, quarterly reports, police reports, counsellor reports, and paralegal follow-up records. A legal cascade for SV cases was created detailing SV survivors' referral patterns between police and GBVRC attendees who proceeded to court, and judgments rendered.ResultsThe total number of survivors at GBVRC between 2017 and 2023 was 3122; 2738 girls/women and 384 boys/men, with the majority of perpetrators known to the survivors, 2764/3122 (89%). The median age for survivors was 15 years, ranging from less than one year to 63 years with a male median age of 9 and a female median age of 15. Fewer males reported their cases, with 238 out of 384 males (62%) and 2,020 out of 2,738 females (74%). Ninety-three per cent (2906/3122) of cases referred from GBVRC arrived at the police station, though 62% (1864/3022) of these cases were successfully recorded and filed at the police station after follow-up. Additionally, 29% (535/1864) of cases reported did not proceed with investigation. Overall, of the 3022 cases that were referred to and reported, 1746 (57.7%) proceeded to court. Among these, judgments were pronounced in 372 cases (21%) and 85 out of these 372 cases (23%) were either withdrawn or acquitted.DiscussionLack of evidence, poor witness testimonies, or failure of witnesses to present themselves in court were likely causes for withdrawal and acquittal of cases. Sexual violence remains a prevalent concern and should be prioritized as a national agenda. Systems should be strengthened to enhance access to justice while exploring alternatives for legal support, such as paralegal networks that can improve case follow-up.

At the International Gynecologic Cancer Society (IGCS) Global Meeting in 2023 held in Seoul, South Korea, we held a Presidential Plenary Session focusing on palliative care (https://www.youtube.com/watch?v=TBDIoQ50xgI). We hereby reaffirm the significance of this session, express the Palliative Care Declaration made by the IGCS, and describe our action plan for the future.

This article invites museum and art gallery professionals to reflect on the potential of an artwork or museum object to act as a launchpad for a multitude of stories and voices that not only allow for different perspectives to connect with diverse audiences across time and space, but that may also serve as unique conversation starters for inclusive contemporary encounters around topics and issues of universal concern - with the ultimate aim of fostering intercultural dialogue, pluralism, and peacemaking. At the Aga Khan Museum, with its mandate of fostering pluralism and contributing to a more peaceful, inclusive world through the arts, experimental work is underway to encourage alternative mindsets and approaches when interpreting objects, using the tangible and intangible arts of Muslim cultures – be it objects, exhibition and art installations, or film, spoken word and performances, with the ultimate aim of building bridges across differences in the name of peace.

Objectiveto describe clinical, management and outcome features of critically ill patients admitted to intensive care units (ICUs) and high dependency units (HDUs) in Kenya.Designprospective registry-based observational study.Settingthree HDUs and eight ICUs in Kenya.Patientsconsecutive adult patients admitted between January 2021 and June 2022.Interventionsnone.Measurements and main resultsdata was entered in a cloud based platform using a common data model. Study endpoints included case mix variables, management features and patient centred outcomes. Patients with Coronavirus disease 2019 (COVID-19) were reported separately. Of the 3892/4546 patients without COVID-19, 2445 patients (62.8%) were from HDUs and 1447 (37.2%) from ICUs. Patients had a median age of 53 years (interquartile range [IQR] 38-68), with HDU patients being older but with a lower severity (APACHE II 6 [3-9] in HDUs vs 12 [7-17] in ICUs; p<0.001). One out of four patients were postoperative with 604 (63.4%) receiving emergency surgery. Readmission rate was 4.8%. Hypertension and diabetes were prevalent comorbidities, with a 4.0% HIV/AIDS rate. Invasive mechanical ventilation (IMV) was applied in 3.4% in HDUs vs. 47.6% in ICUs (P<0.001), with a duration of 7 days (IQR 3-21). There was a similar use of renal replacement therapy (4.0% vs. 4.7%; P<0.001). Vasopressor use was infrequent while half of patients received antibiotics. Average length of stay was 2 days (IQR 1-5). Crude HDU mortality rate was 6.5% in HDUs versus 30.5% in the ICUs (P<0.001). Of the 654 COVID-19 admissions, most were admitted in ICUs (72.3%) with a 33.2% mortality.ConclusionsWe provide the first multicenter observational cohort study from an African ICU national registry. Distinct management features and outcomes characterise HDU from ICU patients.Study registrationClinicaltrials.gov (reference number NCT05456217, date of registration 07 Nov 2022)

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The coronavirus disease 2019 (COVID-19) is one of the most severe global health uncertainties to date. Although significant global effort has been put into implementing COVID-19 pandemic control measures such as lockdowns, travel restrictions, and hygiene precautions, the transmission is expected to resurface once these efforts are discontinued. We aimed to determine the prevalence and factors associated with compliance with presidential 53-day lockdown measures in June-July 2021 in northern Uganda. In this cross-sectional study, 587 adult participants (≥18 years old) from northern Uganda were selected using a systematic sampling method. Data collection involved interviewer-administered questionnaires with an internal validity of Cronbach’s α = .72. Socio-demographic characteristics of participants were described, and multivariable modified Poisson regressions were performed to assess prevalence ratios between dependent and selected independent variables, with respective P values at 95% confidence intervals. All analyses were conducted using Stata 17.0. Participants’ compliance with the presidential lockdown directives was high at 88%(95% CI: 85%-90%). Compliance with the presidential directives was more likely among participants who agreed to the lockdown measures [adjusted Prevalence Ratio, aPR = 1.28 (95% CI: 1.10-1.49; P = .001)] compared to those who did not, and more likely among those who were afraid of death from COVID-19 [aPR = 1.08 (95% CI: 1.01-1.15; P = .023)] than those who did not. However, compliance was less likely among males [aPR = 0.91 (95% CI: 0.86-0.97; P = .002)] compared to females, those aged 35 to 44 years [aPR = 0.87 (95% CI: 0.79-0.97; P = .013)] compared to those less 25 years; and unmarried [aPR = 0.89 (95% CI: 0.82-0.97; P = .011)] compared to the married. Compliance with the COVID-19 presidential lockdown measures in northern Uganda was high. The factors associated with compliance were the fear of death and agreement with presidential lockdown measures. However, compliance was less likely among males, unmarried persons, and persons aged 35 to 44. The authors recommend more community engagements, participation, sensitization, mobilization, and simultaneous application of multiple public health approaches to improve compliance and control of COVID-19.

Objective: Internet and development of digital media as a tool for online promotions provides avenues for early recruitment of college students into risky drinking. The objective of the study was to examine prevalence of alcohol promotions on web-based media and its possible effects on alcohol drinking by sex among college students in Kenya. Participants and Methods: A sample of 836 out of 1354 (61.7%) second and final year students in the school of education of a public urban university in Kenya participated in this online cross-sectional survey using awareness of online alcohol marketing and TWEAK questionnaires. Results: Facebook attracted most alcohol post per day (χ=3.6) and other apps collectively had least alcohol post per day (χ=0.8). Spearman’s correlation show significant association between online alcohol promotions and risky drinking (0.37; p < 0.001). At the overall level of exposure to online alcohol promotions on web-based media and risky drinking, we perceived a statistical significance difference (p < 0.001) in favor of male respondents. The regression model was successful in explaining approximately 56% of the adjusted variance in risky drinking habits. Conclusion: This significant level presence of online liquor promotions suggest that the youth had fairly open access to the mixed beverage creator’s items through web-based media stages which could impact youth to take part in early liquor drinking propensity. There was substantial presence of online alcohol promotions via web-based media scene that was related to risky drinking. Lastly, sex and online alcohol promotions could contribute to risky drinking among college students in Kenya.

Background Incidental prostate cancer is detected by histological examination of resected biopsy tissue that has been previously diagnosed as benign. It has the potential for progressing to become a disease necessitating active treatment. There is paucity of data on detection of incidental prostate cancer in Tanzania. A study done in northern Tanzania among the urban public sector revealed an alarming detection rate of 21.71%. We aimed to establish the prevalence of incidental prostate cancer among men surgically treated for benign prostate enlargement with considered normal range of prostate specific antigen. Methods This was a retrospective hospital-based cross-sectional study conducted to establish the prevalence of incidental prostate cancer among men who underwent transurethral resection of prostate with considered normal range of prostate-specific antigen from 2010 to 2019 at Aga Khan Hospital Dar es salaam, Tanzania. To find the prevalence of incidental prostate cancer with 95% confidence level, 5% tolerable error, minimum of 195 participants’ data was reviewed, and factors associated with incidental prostate carcinoma were evaluated by binary regression analysis. Results Total of 195 men were included in the study. The prevalence of incidental prostate cancer among men with prostate-specific antigen levels of less than 5.5ng/mL was 7.2% (95% CI, 4.0 to 11.8%). More than half of the patients had high-grade cancer and three quarters had T1b histological subtype making up the clinically significant category. For every 1-year increase in age from age of 65 years, risk of incidental prostate cancer increased by 1.6 (95% CI, 1.054 to 23.38; P&lt;0.05) and for every unit increase in prostate specific antigen, incidental prostate cancer increased by 2.2 (95% CI, 1.953 to 42.28; P&lt;0.05). Conclusion The Incidental prostate cancer detection rate of 7.2% in our settings is within the range found internationally.

Abstract BackgroundAfrican neurosurgical practice is faced with numerous challenges. Although there have been improvements in recent years, some problems persist. Research can help identify these problems and propose solutions for the growth of African neurosurgery. In this study, we decided to evaluate the landscape of African research.MethodsPubMed, Embase, and Web of Science were searched from inception to April 24, 2020. Duplicate articles were excluded, and at least two authors reviewed non-duplicate articles on Rayyan. After data had been extracted, they were analyzed to generate descriptive statistics (number of articles and articles per local neurosurgeon). The Kruskal Wallis test and Spearman's correlation were used for bivariate data analyses.ResultsThe authors reviewed 667 articles on neurosurgery in 34 (63%, n=54) African countries. Malawi (4.50), South Africa (3.33), and Benin (2.33) had the highest number of articles per local neurosurgeon (after excluding articles by foreign researchers). Foreign researchers published 1.0 (IQR=2.5) articles per country. Articles were published in World Neurosurgery (120, 18.0%), South African Medical Journal (44, 6.6%), and Journal of Neurosurgery Pediatrics (34, 5.1%). The articles were on pediatric neurosurgery (167, 25.0%) and neurotrauma (129, 19.3%). Also, the majority (411, 61.6%) of studies were cross-sectional.ConclusionAfrican neurosurgeons produce a median of 0.4 articles and publish in well-established journals. Collaboration with foreign researchers significantly increases local research output. In the future, we should assess the impact of this research.