Journal Article > ResearchFull Text
Public Health Action. 21 June 2022; Volume 12 (Issue 2); 58-63.; DOI:10.5588/pha.21.0051
Mbau L, Harrison RE, Kizito W, Timire C, Namusonge T, et al.
Public Health Action. 21 June 2022; Volume 12 (Issue 2); 58-63.; DOI:10.5588/pha.21.0051
BACKGROUND
Prevalence of hypertension in Africa is rising but it remains underdiagnosed and poorly controlled. In Kenya, only 22% of individuals known to have hypertension were on treatment, and only 51.7% were controlled. This study will assess screening outcomes, retention and blood pressure (BP) control of a hypertension programme in Kenya.
DESIGN
This was a retrospective cohort study using data routinely collected between 2015 and 2018. All patients aged >18 years screened and treated in the programme were included.
RESULTS
Of 663,028 screening encounters, 70.4% were female; the median age was 34 years. Overall, 19% of the study population, mainly males and older persons, had high BP higher rates. Of 66,981 patients started on treatment, the majority were females (71.2%); the median age was 55 years. Only 12% of patients were reported as having been retained after 12 months, and 48.6% of patients on treatment 10.5-13.5 months after enrolment had controlled BP. Older age and treatment at primary care level were associated with better retention and females had better BP control.
CONCLUSIONS
The programme screened primarily females and younger individuals at lower risk. Retention was poor and close to half of patients retained had controlled BP. Hypertension programmes should target high-risk individuals, decentralise treatment, incorporate retention strategies and improve longitudinal data management.
Prevalence of hypertension in Africa is rising but it remains underdiagnosed and poorly controlled. In Kenya, only 22% of individuals known to have hypertension were on treatment, and only 51.7% were controlled. This study will assess screening outcomes, retention and blood pressure (BP) control of a hypertension programme in Kenya.
DESIGN
This was a retrospective cohort study using data routinely collected between 2015 and 2018. All patients aged >18 years screened and treated in the programme were included.
RESULTS
Of 663,028 screening encounters, 70.4% were female; the median age was 34 years. Overall, 19% of the study population, mainly males and older persons, had high BP higher rates. Of 66,981 patients started on treatment, the majority were females (71.2%); the median age was 55 years. Only 12% of patients were reported as having been retained after 12 months, and 48.6% of patients on treatment 10.5-13.5 months after enrolment had controlled BP. Older age and treatment at primary care level were associated with better retention and females had better BP control.
CONCLUSIONS
The programme screened primarily females and younger individuals at lower risk. Retention was poor and close to half of patients retained had controlled BP. Hypertension programmes should target high-risk individuals, decentralise treatment, incorporate retention strategies and improve longitudinal data management.
Journal Article > CommentaryFull Text
Trop Med Int Health. 10 August 2011; Volume 16 (Issue 11); DOI:10.1111/j.1365-3156.2011.02863.x
Tayler-Smith K, Zachariah R, Manzi M, Kizito W, Vandenbulcke A, et al.
Trop Med Int Health. 10 August 2011; Volume 16 (Issue 11); DOI:10.1111/j.1365-3156.2011.02863.x
Journal Article > LetterFull Text
Trop Med Int Health. 30 May 2013; Volume 18 (Issue 8); DOI:10.1111/tmi.12133
Zachariah R, Reid AJ, Van der Bergh R, Dahmane A, Kosgei RJ, et al.
Trop Med Int Health. 30 May 2013; Volume 18 (Issue 8); DOI:10.1111/tmi.12133
Journal Article > ResearchFull Text
AIDS. 16 November 2018; Volume 33 (Issue 2); DOI:10.1097/QAD.0000000000002070
Loarec A, Carnimeo V, Molfino L, Kizito W, Muyindike WR, et al.
AIDS. 16 November 2018; Volume 33 (Issue 2); DOI:10.1097/QAD.0000000000002070
: A multicentric, retrospective case-series analysis (facility-based) in five sites across Kenya, Malawi, Mozambique, and Uganda screened HIV-positive adults for hepatitis C virus (HCV) antibodies using Oraquick rapid testing and viral confirmation (in three sites). Results found substantially lower prevalence than previously reported for these countries compared with previous reports, suggesting that targeted integration of HCV screening in African HIV programs may be more impactful than routine screening.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0.
Journal Article > ReviewFull Text
East Afr Med J. 1 October 2016; Volume 93 (Issue 10); S55-S57.
Gituma KS, Hussein S, Mwitari J, Kizito W, Edwards JK, et al.
East Afr Med J. 1 October 2016; Volume 93 (Issue 10); S55-S57.
Journal Article > ResearchFull Text
Public Health Action. 21 June 2013; Volume 3 (Issue 2); 149-55.; DOI:10.5588/pha.12.0105
Nakanwagi-Mukwaya A, Reid A, Fujiwara PI, Mugabe F, Kosgei RJ, et al.
Public Health Action. 21 June 2013; Volume 3 (Issue 2); 149-55.; DOI:10.5588/pha.12.0105
SETTING
Three regional referral hospitals in Uganda with a high burden of tuberculosis (TB) and human immunodeficiency virus (HIV) cases.
OBJECTIVE
To determine the treatment outcomes of TB retreatment cases and factors influencing these outcomes.
DESIGN
A retrospective cohort study of routinely collected National Tuberculosis Programme data between 1 January 2009 and 31 December 2010.
RESULTS
The study included 331 retreatment patients (68% males), with a median age of 36 years, 93 (28%) of whom were relapse smear-positive, 21 (6%) treatment after failure, 159 (48%) return after loss to follow-up, 26 (8%) relapse smear-negative and 32 (10%) relapse cases with no smear performed. Treatment success rates for all categories of retreatment cases ranged between 28% and 54%. Relapse smear-positive (P = 0.002) and treatment after failure (P = 0.038) cases were less likely to have a successful treatment outcome. Only 32% of the retreatment cases received a Category II treatment regimen; there was no difference in treatment success among patients who received Category II or Category I treatment regimens (P = 0.73).
CONCLUSION
Management of TB retreatment cases and treatment success for all categories in three referral hospitals in Uganda was poor. Relapse smear-positive or treatment after failure cases were less likely to have a successful treatment outcome.
Three regional referral hospitals in Uganda with a high burden of tuberculosis (TB) and human immunodeficiency virus (HIV) cases.
OBJECTIVE
To determine the treatment outcomes of TB retreatment cases and factors influencing these outcomes.
DESIGN
A retrospective cohort study of routinely collected National Tuberculosis Programme data between 1 January 2009 and 31 December 2010.
RESULTS
The study included 331 retreatment patients (68% males), with a median age of 36 years, 93 (28%) of whom were relapse smear-positive, 21 (6%) treatment after failure, 159 (48%) return after loss to follow-up, 26 (8%) relapse smear-negative and 32 (10%) relapse cases with no smear performed. Treatment success rates for all categories of retreatment cases ranged between 28% and 54%. Relapse smear-positive (P = 0.002) and treatment after failure (P = 0.038) cases were less likely to have a successful treatment outcome. Only 32% of the retreatment cases received a Category II treatment regimen; there was no difference in treatment success among patients who received Category II or Category I treatment regimens (P = 0.73).
CONCLUSION
Management of TB retreatment cases and treatment success for all categories in three referral hospitals in Uganda was poor. Relapse smear-positive or treatment after failure cases were less likely to have a successful treatment outcome.
Journal Article > ResearchFull Text
Public Health Action. 21 June 2016; Volume 6 (Issue 2); 105-10.; DOI:10.5588/pha.15.0081
Mchunu G, van Griensven J, Hinderaker SG, Kizito W, Sikhondze W, et al.
Public Health Action. 21 June 2016; Volume 6 (Issue 2); 105-10.; DOI:10.5588/pha.15.0081
SETTING
All health facilities providing tuberculosis (TB) care in Swaziland.
OBJECTIVE
To describe the impact of human immunodeficiency virus (HIV) interventions on the trend of TB treatment outcomes during 2010-2013 in Swaziland; and to describe the evolution in TB case notification, the uptake of HIV testing, antiretroviral therapy (ART) and cotrimoxazole preventive therapy (CPT), and the proportion of TB-HIV co-infected patients with adverse treatment outcomes, including mortality, loss to follow-up and treatment failure.
DESIGN
A retrospective descriptive study using aggregated national TB programme data.
RESULTS
Between 2010 and 2013, TB case notifications in Swaziland decreased by 40%, HIV testing increased from 86% to 96%, CPT uptake increased from 93% to 99% and ART uptake among TB patients increased from 35% to 75%. The TB-HIV co-infection rate remained around 70% and the proportion of TB-HIV cases with adverse outcomes decreased from 36% to 30%. Mortality remained high, at 14-16%, over the study period, and anti-tuberculosis treatment failure rates were stable over time (<5%).
CONCLUSION
Despite high CPT and ART uptake in TB-HIV patients, mortality remained high. Further studies are required to better define high-risk patient groups, understand the reasons for death and design appropriate interventions.
All health facilities providing tuberculosis (TB) care in Swaziland.
OBJECTIVE
To describe the impact of human immunodeficiency virus (HIV) interventions on the trend of TB treatment outcomes during 2010-2013 in Swaziland; and to describe the evolution in TB case notification, the uptake of HIV testing, antiretroviral therapy (ART) and cotrimoxazole preventive therapy (CPT), and the proportion of TB-HIV co-infected patients with adverse treatment outcomes, including mortality, loss to follow-up and treatment failure.
DESIGN
A retrospective descriptive study using aggregated national TB programme data.
RESULTS
Between 2010 and 2013, TB case notifications in Swaziland decreased by 40%, HIV testing increased from 86% to 96%, CPT uptake increased from 93% to 99% and ART uptake among TB patients increased from 35% to 75%. The TB-HIV co-infection rate remained around 70% and the proportion of TB-HIV cases with adverse outcomes decreased from 36% to 30%. Mortality remained high, at 14-16%, over the study period, and anti-tuberculosis treatment failure rates were stable over time (<5%).
CONCLUSION
Despite high CPT and ART uptake in TB-HIV patients, mortality remained high. Further studies are required to better define high-risk patient groups, understand the reasons for death and design appropriate interventions.
Journal Article > ResearchFull Text
PLOS One. 26 January 2016; Volume 11 (Issue 1); e0145634.; DOI:10.1371/journal.pone.0145634
Some D, Edwards JK, Reid AJ, Van der Bergh R, Kosqei RJ, et al.
PLOS One. 26 January 2016; Volume 11 (Issue 1); e0145634.; DOI:10.1371/journal.pone.0145634
BACKGROUND
In sub-Saharan Africa there is an increasing need to leverage available health care workers to provide care for non-communicable diseases (NCDs). This study was conducted to evaluate adherence to Médecins Sans Frontières clinical protocols when the care of five stable NCDs (hypertension, diabetes mellitus type 2, epilepsy, asthma, and sickle cell) was shifted from clinical officers to nurses.
METHODS
Descriptive, retrospective review of routinely collected clinic data from two integrated primary health care facilities within an urban informal settlement, Kibera, Nairobi, Kenya (May to August 2014).
RESULTS
There were 3,554 consultations (2025 patients); 733 (21%) were by nurses out of which 725 met the inclusion criteria among 616 patients. Hypertension (64%, 397/616) was the most frequent NCD followed by asthma (17%, 106/616) and diabetes mellitus (15%, 95/616). Adherence to screening questions ranged from 65% to 86%, with an average of 69%. Weight and blood pressure measurements were completed in 89% and 96% of those required. Laboratory results were reviewed in 91% of indicated visits. Laboratory testing per NCD protocols was higher in those with hypertension (88%) than diabetes mellitus (67%) upon review. Only 17 (2%) consultations were referred back to clinical officers.
CONCLUSIONS
Nurses are able to adhere to protocols for managing stable NCD patients based on clear and standardized protocols and guidelines, thus paving the way towards task shifting of NCD care to nurses to help relieve the significant healthcare gap in developing countries.
In sub-Saharan Africa there is an increasing need to leverage available health care workers to provide care for non-communicable diseases (NCDs). This study was conducted to evaluate adherence to Médecins Sans Frontières clinical protocols when the care of five stable NCDs (hypertension, diabetes mellitus type 2, epilepsy, asthma, and sickle cell) was shifted from clinical officers to nurses.
METHODS
Descriptive, retrospective review of routinely collected clinic data from two integrated primary health care facilities within an urban informal settlement, Kibera, Nairobi, Kenya (May to August 2014).
RESULTS
There were 3,554 consultations (2025 patients); 733 (21%) were by nurses out of which 725 met the inclusion criteria among 616 patients. Hypertension (64%, 397/616) was the most frequent NCD followed by asthma (17%, 106/616) and diabetes mellitus (15%, 95/616). Adherence to screening questions ranged from 65% to 86%, with an average of 69%. Weight and blood pressure measurements were completed in 89% and 96% of those required. Laboratory results were reviewed in 91% of indicated visits. Laboratory testing per NCD protocols was higher in those with hypertension (88%) than diabetes mellitus (67%) upon review. Only 17 (2%) consultations were referred back to clinical officers.
CONCLUSIONS
Nurses are able to adhere to protocols for managing stable NCD patients based on clear and standardized protocols and guidelines, thus paving the way towards task shifting of NCD care to nurses to help relieve the significant healthcare gap in developing countries.
Journal Article > ResearchFull Text
Public Health Action. 25 April 2018; Volume 8 (Issue 1); DOI:10.5588/pha.17.0076
Nghipumbwa MH, Ade S, Kizito W, Takarinda KC, Uusiku P, et al.
Public Health Action. 25 April 2018; Volume 8 (Issue 1); DOI:10.5588/pha.17.0076
Setting: Kavango, a 'moderate' transmission risk region located in north-eastern Namibia, borders Angola, a country with higher malaria transmission levels. Objective: To determine 1) the trends in malaria incidence between 2010 and 2014 in Kavango, 2) the socio-demographic and clinical characteristics of confirmed cases in 2014, and 3) associated risk factors of cases classified as imported. Design: This was a retrospective study of malaria case investigation forms conducted in all 52 public health facilities in 2014. Incidence was derived from aggregate routine surveillance data from the Health Information System (HIS). Results: During the 5-year study, incidence fell from 53.6 to 3.6 cases per 1000 population, then increased again to 47.3/1000. Fifty-five per cent of cases were males, and 49% were aged between 5 and 17 years. Of the 2014 cases, 23% were imported, and were associated with higher odds of severe malaria (adjusted odds ratio [aOR] 1.8; 95%CI 1.01-3.29), not having long-lasting insecticide treated nets (aOR 2.1, 95%CI, 1.3-3.4) and not receiving insecticide residual spraying (aOR 3.2, 95%CI, 2.1-5.1). Conclusion: Sporadic outbreaks in the 5-year period posed a threat to malaria elimination. Better targeting of vector control interventions, strong cross-border collaboration and robust health promotion will be key to achieving malaria elimination.
Journal Article > ResearchFull Text
Trends of reported outpatient malaria cases to assess the Test, Treat and Track (T3) policy in Kenya
East Afr Med J. 1 October 2016
Mbuli CW, Waqo E, Owiti P, Tweya H, Kizito W, et al.
East Afr Med J. 1 October 2016