School of Medicine

Confronting the TB-HIV syndemic in adolescents and young adults: a call to action in a time of Ccrisis

2026-03-17T00:00:00Z

Confronting the TB-HIV syndemic in adolescents and young adults: a call to action in a time of Ccrisis A. Enane, Leslie; Leonard, Adam; Diero, Lameck; Marcy, Olivier; Marcel Yotebieng, Marcel

Adequacy of analgesic practices among adult patients undergoing Laparotomy at Moi Teaching and Referral Hospital, Eldoret, Kenya.

2026-01-01T00:00:00Z

Adequacy of analgesic practices among adult patients undergoing Laparotomy at Moi Teaching and Referral Hospital, Eldoret, Kenya. Njue, Gladys Kezziah M Background: The prevalence of moderate to severe postoperative pain is estimated to be up to 100% in sub-Saharan Africa. Undertreatment is associated with physiological and psychological complications which can prolong recovery, lengthen hospitalization and add economic strain to patients and health care system. Adequate analgesia following surgery is generally considered when the visual analogue pain score (VAS) is ≤ 3. Faced with rising laparotomy rate at MTRH, lack of published data and absence of a procedure specific pain management guideline, the magnitude of acute postoperative pain and adequacy of analgesia practices remained unknown. Objective: To determine the adequacy of analgesia practices used in management of acute postoperative pain among adult patients who undergo laparotomy at MTRH, Eldoret, Kenya by establishing acute pain severity, identifying and evaluating the adequacy of pain-relieving modalities. Methods: The descriptive study was conducted among 241 participants who underwent laparotomy during the study period. The sample size was 241 people enrolled systematically. Participants were followed at different intervals including, at the postanesthetic care unit (PACU), at 24- and 48-hours. Data was collected through patients’ interviews, review of anesthetic charts and treatment sheets, to complete a structured questionnaire. The independent variables were demographic and clinical data (Elective/Emergency), types of analgesics and techniques of administration. The dependent variable of interest was pain severity. STATA version 16 software was used for analysis. Categorical data was summarized and findings presented in figures, corresponding percentages and tables. The study was conducted at 0.05 α level of significance. Pertinent ethical approvals were obtained. Results: The mean age of participants was 45.4 years with a female predominance. Majority of laparotomies were performed emergently (97.1%), with most common abdominal procedure being, exploratory laparotomy (41.9%). The proportion of patients with moderate or severe pain at PACU, 24 hours and 48 hours intervals, was 56%, 17% and 6.2%, respectively. The Conchran – Armitage test showed a statistically significant (P< 0.001) linear trend in pain score across the assessment periods. Paracetamol and tramadol were the most used combination at both 24 (31.1%) and 48 (28.9%) hours intervals. Conclusion: Postoperative pain management at MTRH is inadequate, as evidenced by many patients experiencing acute moderate to severe pain. A narrow range of opioid based systemic analgesics are used. Recommendation: Incorporation of additional interventions (such as adjuvant analgesics) and techniques (such as nerve blocks, epidural analgesia, cognitive behavioral therapy) with the goal of achieving VAS ≤ 3 post-operatively. Further research is needed to explore factors influencing post-operative pain management (comorbidities, anesthesia used, health care provider or system related factors).

Substance use among older adults attending outpatient clinics at the Moi Teaching and Referral Hospital Eldoret, Kenya

2026-01-01T00:00:00Z

Substance use among older adults attending outpatient clinics at the Moi Teaching and Referral Hospital Eldoret, Kenya Chemutai, Winnie Background: National Authority for the Campaign against Alcohol and Drug Abuse (NACADA) in 2022 reported that over the past ten years, substance use has considerably increased throughout Kenya. However, there is limited literature regarding substance use among specific populations particularly older adults (50 years and above) as the national estimates do not disaggregate substance use by older age groups. Objectives: The objectives of this study were: to determine the prevalence of substance use, to assess factors associated with substance use, and to establish the preferred interventions to substance use among older adults attending the Outpatient Clinics at the Moi Teaching and Referral Hospital (MTRH). Methods: The study adopted a cross-sectional design that employed a quantitative approach. Stratified sampling was used to select five Outpatient Clinics at MTRH. Within the Clinics, consecutive sampling was used to select 402 consenting older adults. A questionnaire and the WHO Alcohol, Smoking and Substance Involvement Test (ASSIST) tools were used to collect data. The University of California Brief Assessment of Capacity to consent (UBACC) was used to assess participants’ capacity to consent. Data was analyzed using descriptive analyses including: mean, frequencies and percentages to summarize data and analyze the prevalence. Chi- square and logistic regression were used to measure associations. Results: The life prevalence of substance use among older Adults attending Outpatient Clinics at MTRH was 80% and the prevalence based on the past three months was 66.7% (95% CI; 1.53%-1. 63%). The Commonly used substances in order of prevalence were; alcohol (42%), tobacco (16.8%), cannabis (6.7%) and inhalants (1.2%). Factors associated with substance use were; Age 55-59 years (36.8%, p=0.001), married people (37.0%, p=0.001), religion (Christians) (40.5%, p=0.001), income of below 9,999 Kenyan shillings (21.5%, p=0.001), those not working (31.4%, p=0.001), those with chronic illness (43.7%, p=0.001) and those with a history of substance use (54.8%, p=0.000). From logistic regression model family history of substance use and chronic illness were significantly associated with substance use. Professional counselling taking a longer time; above six weeks (p=.002), Peer Support Group (p=.003) and pharmacological treatment (p=.001) were the preferred inteventions for substance use. Conclusion: There was a high prevalence of substance use among older adults attending Outpatient Clinics at MTRH. The most commonly used substance was alcohol. Factors associated with substance use were: being married, low monthly income, family history of substance use, and having a chronic illness. Most preferred interventions were: professional counseling, peer support group and pharmacological treatment. Recommendations: The study recommends individualized interventions to address substance use among older adults. MTRH need to screen for substance use and focus counseling services on adults attending the clinics; and NACADA needs to enhance programs specific to older adults to facilitate prevention and minimize substance use.

Effect of prophylactic ondansetron on spinal anaesthesia - induced hypotension during caesarean section at Moi Teaching and Referral Hospital, Eldoret, Kenya.

2026-01-01T00:00:00Z

Effect of prophylactic ondansetron on spinal anaesthesia - induced hypotension during caesarean section at Moi Teaching and Referral Hospital, Eldoret, Kenya. Omondi, Pauline Awili Background: Spinal anaesthesia (SA) technique is widely preferred for caesarean sections due to its safety and effectiveness. However, spinal anaesthesia-induced hypotension (SAIH) remains a common and serious complication, with global incidence rates between 50–80% and local rates around 64%. SAIH can lead to adverse maternal effects like cardiovascular collapse, and fetal risks such as hypoxia and acidosis. Existing prevention methods, such as fluid loading and prophylactic vasopressors, are inadequate when used individually. Ondansetron, a 5-HT3 receptor antagonist, may mitigate SAIH by inhibiting serotonin-mediated activation of the Bezold-Jarisch reflex via vagal cardiac receptors. While international data on its efficacy is controversial, its role at Moi Teaching and Referral Hospital (MTRH) also remains unexplored. This study investigates ondansetron’s potential to reduce SAIH and enhance maternal outcomes within the MTRH setting. Objectives: This study aimed to determine the effect of prophylactic ondansetron on the incidence of spinal anaesthesia-induced hypotension and bradycardia, and vasopressor requirements in pregnant women undergoing elective caesarean sections at MTRH. Methods: A randomized, double-blind, control trial was conducted at Moi Teaching and Referral Hospital (MTRH) involving 194 pregnant women undergoing elective caesarean sections under spinal anaesthesia. Block randomization and consecutive sampling were employed. Participants were assigned to two groups (97 each): one received 4 mg intravenous ondansetron (Group O), and the other received saline (Group S), both administered 15 minutes prior to anaesthesia. To minimize bias, blinding was applied to both the anaesthetists administering the intervention and the study participants. Data on demographics, clinical and surgical outcomes, vasopressor usage, and neonatal results were collected and analyzed using STATA version 16. Statistical tests included the two proportions z-test and Mann-Whitney U test, with significance set at P < 0.05. Results: SAIH incidence proportion was 85.6%. Group O had lower SAIH occurrence (77.3%, n=75) compared to group S (93.8%, n=91), P=0.001. Bradycardia was observed in 14.4% (n=14) of Group S and 8.2% (n=8) of Group O participants, with no significant difference (P=0.17). Ephedrine was administered more frequently in Group S (92.8%, n=90) than in Group O (75.3%, n=73), (P<0.001). However, the median total dose was comparable between the groups; 18.0 mg (IQR: 12.0–24.0) in Group S and 18.0 mg (IQR: 12.0–30.0; P ˃0.99). Phenylephrine was administered at almost similar frequencies in Group S (10.3%, n=10) and Group O (7.2%, n=7; P=0.446), though the total dose was significantly higher in Group S (200 mcg) than Group O (100 mcg; P=0.023). In addition, occurrence of nausea, vomiting, and shivering was significantly less in Group O (P<0.05). Conclusion: Prophylactic 4mg IV ondansetron is effective in reducing the occurrence of SAIH, the vasopressor requirement, and the total dose of vasopressors. Prophylactic ondansetron has no effect on the occurrence of bradycardia. Recommendations: Prophylactic administration of 4 mg IV ondansetron 15 minutes before spinal anaesthesia should be considered for elective caesarean sections at MTRH to reduce the incidence of SAIH and vasopressor requirement. The Anaesthesia Department should consider adding ondansetron in the prevention and management protocol of SAIH.