To determine the thirty-day mortality of open-heart patients at the Kenyatta National Hospital in... more To determine the thirty-day mortality of open-heart patients at the Kenyatta National Hospital in Nairobi from June 1973 to October 2000 and; to look at likely variables related to mortality. DESIGN: A retrospective analysis of data from the unit database. Data on this database were collected prospectively from September 1997 to the time of study. Data in respect of the period prior to this were collected retrospectively from patient files, ward and theatre records. SETTING: Kenyatta National Hospital (KNH), Nairobi. PATIENTS: A total of 563 open-heart patients operated at the KNH were included in the study. RESULTS: The thirty-day mortality rate calculated at 17.4% for the study period compared to a hospital mortality rate of 16.9%. Surgical repair for complex congenital pathology, surgery on patients with a left atrial (LA) dimension or a left ventricular end systolic dimension (LVESD) greater than 5 cm or/and a cross clamp time greater than 60 minutes all had a significantly greater risk of mortality on bivariate analysis. This is compared to surgery for simple hole in the heart, LA and LVESD dimensions less than 5 cm and cross clamp times less than 60 minutes (p < 0.05). The increased risk of mortality with these variables was 3.33, 3.95, 3.18 and 1.8 times greater than their counterparts, respectively. For patients having surgery for an acquired pathology, only a cross clamp time greater than 60 minutes and a left atrial size greater than 5 cm were independent risk factors for thirty day mortality using logistic regression analysis. For patients having surgery for correction of a congenital defect, only a cross clamp time of more than 60 minutes was an independent predictor of mortality (p < 0.05). CONCLUSIONS: The higher mortality rate is amongst others, probably related to the late presentation of our patients for surgery when their myocardial function is below the optimum for surgery. There is a need to bring down the mortality through more stringent patient selection, preoperative preparation and reduction of surgical ischaemic times, however without depriving the patients in need of surgery.
Appropriately designed elearning programmes (including Best or School for Surgeons) may allow mor... more Appropriately designed elearning programmes (including Best or School for Surgeons) may allow more efficient use of consultant teaching time. Using funding from Irish Aid, we piloted these existing elearning tools in a sub-Saharan African country (Zambia) where low specialist numbers and limited Consultant time for teaching limits expansion of surgical training programmes. Eight MMed trainees preparing for the Membership (COSECSA) examination in the University Department of Surgery, Lusaka acted as the study group and four from elsewhere served as controls. Each trainee was supplied with BeST (an RCSI elearning basic knowledge course) on a hand held computer and weekly online case based discussions were arranged using the RCSI School for Surgeons platform. Structured feedback, following an initial eight cases previously developed for Irish trainees, identified trainee preference for local cases and faculty involvement. Eight cases appropriate to the healthcare context of the region ...
After decades on the margins of primary health care, surgical and anaesthesia care is gaining inc... more After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. T...
To determine the incidence of valve morbidity associated with post-operative valve patients at th... more To determine the incidence of valve morbidity associated with post-operative valve patients at the Kenyatta National Hospital, Nairobi. A combined retrospective and prospective study. Restrospective period from 1973 to 31st July 1977 and prospective period from there on to 31st July 1998. Cardiothoracic outpatient clinic at Kenyatta National Hospital, Nairobi. All valve replacement patients attending the cardiothoracic outpatient clinic on follow up following discharge from the ward. Morbidity was assessed by incidence of: stroke, thromboembolism, valve thrombosis, bleeding episodes, valve endocarditis and re-operation for valve failure. For all valve surgery combined the overall follow up rate equalled 476.3 patient years. The linearised occurrence rate for thromboembolism for all valves was 1.04% per patient year. For the mechanical valves this incidence was 1.32% per patient year. The stroke free rate at one year and five years was 97.7% and 95.9% respectively. The linearised inc...
In the past, the Kenyatta National Hospital heart unit policy has been to discourage pregnancy am... more In the past, the Kenyatta National Hospital heart unit policy has been to discourage pregnancy among patients following open heart surgery for valve replacement, in view of the adverse effects of warfarin. To review the occurrence of pregnancy in open heart patients following discharge from hospital, and to compare the incidence with national figures. Retrospective and prospective. Kenyatta National Hospital, Nairobi. Of the 239 female patients operated upon at the cardiothoracic unit of the KNH during the period June 1973 and September 1998, 108 met the inclusion criteria; 56 of them had valve replacement surgery. At the time of surgery, 31% of all the female patients were in the reproductive age group of 14 to 45 years. Only two per cent were older than 45 years. Follow up was 490 patient years for the entire group, and 318 patient years for all with valvulopathy. For the whole group, irrespective of age, pregnancy rate was 6% and 15% at five and ten years of follow up respectivel...
To determine the patient drop out to postoperative follow up for heart patients at the Kenyatta N... more To determine the patient drop out to postoperative follow up for heart patients at the Kenyatta National Hospital. The study analysed the postoperative attendance of heart patients to the surgical outpatient clinic at the KNH. Data on clinic attendance was collected over a one-year period from patient files and from clinic attendance. A total of four hundred and seventy-five open heart operations have been performed at the Kenyatta National Hospital over the last twenty-five years. The patients' mean age is 18.0 years. Clinic follow up rate over this period is 85% at one-year, 62% at five-years, 32% at ten-years and 13% at fifteen-years. A number of patients who had since fallen out to clinic follow up were traced during the study period, when included into the analysis the revised figures are 85%, 70%, 40% and 24% respectively. The difference is statistically significant (p = 0.019). There was no significant statistical difference in the follow up between males and females (p =...
On average, for every 100 patients with malignant dysphagia admitted into the Kenyatta National H... more On average, for every 100 patients with malignant dysphagia admitted into the Kenyatta National Hospital (KNH) in Nairobi, 28 will have their tumour resected. Seven in the tumour resected group will die during the postoperative period while there will be 12 deaths occurring in patients before surgery.
A 50-year-old female presented with a five months history of recurrent attacks of dizziness, swea... more A 50-year-old female presented with a five months history of recurrent attacks of dizziness, sweatiness, tremors and fainting with loss of consciousness. These were found to be due to hypoglycaemic episodes with blood sugars less than 1 mmol/l and were treated as such. A diagnosis of insulinoma was initially considered, but the patient turned out to have fibrosarcoma of the lung, a rare lung tumour. She also had finger and toe clubbing and features of hypertrophic pulmonary osteoarthropathy.
Eighty random patients were examined over a 9-month-period to determine the incidence of asymptom... more Eighty random patients were examined over a 9-month-period to determine the incidence of asymptomatic haemorrhoids at the Kenyatta National Hospital (KNH). The incidence of asymptomatic was found to be 21% all being first degree haemorrhoids, while in the age group 50 years and over, 29% had asymptomatic haemorrhoids. The mean age calculated as 44.3 years (+/- 18.3), with no statistical difference between the ages of the two sexes. Males however had a significant greater incidence of asymptomatic haemorrhoids than females.
Aims Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however... more Aims Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment. Methods and results This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%).
The Risk Adjustment in Congenital Heart Surgery (RACHS-1) system has been used as a benchmark to ... more The Risk Adjustment in Congenital Heart Surgery (RACHS-1) system has been used as a benchmark to compare surgical results in developed countries. Its ability to stratify postoperative mortality risk has been validated in several developed countries, however, this has not been examined in a developing country. To assess the ability of the RACHS-1 system to stratify postoperative mortality risk in a developing country Retrospective study over a five year period between 1st January 2002 and 31st December 2006. Kenyatta National Hospital, a teaching and referral hospital in Nairobi, Kenya. Three hundred and seventeen consecutive operations were performed on 313 patients aged between 0.25 and 204 months.Operations were performed in RACHS-1 categories 1, 2, 3 and 4 with hospital mortalities of 2.5%, 16.9%, 29.4% and 50% respectively. The difference in mortality between categories 1 and 2 was significant (p-value of 0.0003), however, the difference in mortality between categories 2 and 3 and categories 3 and 4 was not significant (p-values 0.193 and 0.67 respectively). The RACHS-1 system did not adequately stratify risk in a low case load setting. The use of the RACHS-1 method as a benchmark to compare surgical results of paediatric cardiac surgery services in developing countries may be limited
Objective: To determine the pattern of anticoagulation control for post heart-valve surgery for p... more Objective: To determine the pattern of anticoagulation control for post heart-valve surgery for patients on follow up at Kenyatta National Hospital(KNH). Design: A combined prospective and restrospective hospital-based study. Retrospective period from January 1991 to 31st August 1997, while the prospective period was from 1st September 1997 to 31st November 1999. Setting: Cardiothoracic surgery clinic, Kenyatta National Hospital, Nairobi. Patients: Post heart valve surgery patients on warfarin and attending the cardiothoracic surgery clinic at Kenyatta National Hospital. Main outcome measures: Clinic attendance intervals, average warfarin dosages, interval of dosage change, INR values and variations from accepted normal. Results: A total of 103 patients fulfilled the criteria for inclusion into the study consisting of 77 mitral valve replacements, 18 aortic valve replacements, seven double valve replacements and one mitral valve repair. The total follow up time for the study period is 316.9 patients years. On average, patients attended their anticoagulation clinic once every 59 days. The average dose of warfarin prescribed was 6.81mg daily(±2.67mg), with double valve replacement patients receiving a statistically significant lower dosage of 6.04 mg (±1.36mg), (95% confidence limits). On average, a warfarin dose change was made 1.48 times a year per patient. For all the patients, the mean INR was 2.50 (±1.18). The respective values for mitral, aortic, double valve replacement and the mitral repairs were 2.53(±1.21), 2.32 (±1.04), 2.5 (±1.05) and 2.02 (±0.53), respectively. Mitral valve repair patients maintained a significantly lower level of INR (95% confidence limits). Only during 18% of the follow up time was adequate anticoagulation maintained. During the study period only 6.9% of patients were able to maintain adequate anticoagulation for 50% or more of their follow up time. Conclusion: Anticoagulation control at the KNH still needs some improvements in clinic attendance and better dosage adjustments to achieve more appropriate INR values.
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failur... more Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failure, stroke and death among African women and children, despite being preventable and imminently treatable. From 21 to 22 February 2015, the Social Cluster of the Africa Union Commission (AUC) hosted a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, to develop a 'roadmap' of key actions that need to be taken by governments to eliminate ARF and eradicate RHD in Africa. Seven priority areas for action were adopted: (1) create prospective disease registers at sentinel sites in affected countries to measure disease burden and track progress towards the reduction of mortality by 25% by the year 2025, (2) ensure an adequate supply of high-quality benzathine penicillin for the primary and secondary prevention of ARF/RHD, (3) improve access to reproductive health services for women with RHD and other non-communicable diseas...
Background: Post oesophagectomy leakage is a common postoperative complication. This present revi... more Background: Post oesophagectomy leakage is a common postoperative complication. This present review was aimed at documenting the problem of post-oesophagectomy leakage and associated variables at Kenyatta National Hospital (KNH) between January 1998 and December 2004. Methods: All patients presenting with carcinoma of the oesophagus and who underwent an oesophagectomy were included into the study. Analysis of data was carried out to determine the leakage rate as well as determining the association of leaks with other preoperative and postoperative variables. Statistical analysis performed on Microsoft Excel (10.2614.2625), and Epinfo 2002. The Chi 2 test was used to determine statistical significance. Level of significance was achieved if the p value was < 0.05. Results: A total of 201 oesophagectomies were carried out in the period under review. The male to female sex ratio was 1.6:1. The average age was 57 years with a range of 24 years to 88 years. Two thirds (67.1%) of the anastomoses were fashioned within the thoracic cavity while the rest were fashioned within the cervical area. A total 16.4% of anastomoses leaked. The in-hospital mortality rate for all oesophagectomies was 28.9%. The in-hospital mortality for the post anastomotic leakage patients was 48.4% as compared to 27.2% among those patients who did not develop anastomotic leakage. Conclusion: Post oesophagectomy leakage remains common complication at Kenyatta National Hospital (KNH).
To determine the thirty-day mortality of open-heart patients at the Kenyatta National Hospital in... more To determine the thirty-day mortality of open-heart patients at the Kenyatta National Hospital in Nairobi from June 1973 to October 2000 and; to look at likely variables related to mortality. DESIGN: A retrospective analysis of data from the unit database. Data on this database were collected prospectively from September 1997 to the time of study. Data in respect of the period prior to this were collected retrospectively from patient files, ward and theatre records. SETTING: Kenyatta National Hospital (KNH), Nairobi. PATIENTS: A total of 563 open-heart patients operated at the KNH were included in the study. RESULTS: The thirty-day mortality rate calculated at 17.4% for the study period compared to a hospital mortality rate of 16.9%. Surgical repair for complex congenital pathology, surgery on patients with a left atrial (LA) dimension or a left ventricular end systolic dimension (LVESD) greater than 5 cm or/and a cross clamp time greater than 60 minutes all had a significantly greater risk of mortality on bivariate analysis. This is compared to surgery for simple hole in the heart, LA and LVESD dimensions less than 5 cm and cross clamp times less than 60 minutes (p < 0.05). The increased risk of mortality with these variables was 3.33, 3.95, 3.18 and 1.8 times greater than their counterparts, respectively. For patients having surgery for an acquired pathology, only a cross clamp time greater than 60 minutes and a left atrial size greater than 5 cm were independent risk factors for thirty day mortality using logistic regression analysis. For patients having surgery for correction of a congenital defect, only a cross clamp time of more than 60 minutes was an independent predictor of mortality (p < 0.05). CONCLUSIONS: The higher mortality rate is amongst others, probably related to the late presentation of our patients for surgery when their myocardial function is below the optimum for surgery. There is a need to bring down the mortality through more stringent patient selection, preoperative preparation and reduction of surgical ischaemic times, however without depriving the patients in need of surgery.
Appropriately designed elearning programmes (including Best or School for Surgeons) may allow mor... more Appropriately designed elearning programmes (including Best or School for Surgeons) may allow more efficient use of consultant teaching time. Using funding from Irish Aid, we piloted these existing elearning tools in a sub-Saharan African country (Zambia) where low specialist numbers and limited Consultant time for teaching limits expansion of surgical training programmes. Eight MMed trainees preparing for the Membership (COSECSA) examination in the University Department of Surgery, Lusaka acted as the study group and four from elsewhere served as controls. Each trainee was supplied with BeST (an RCSI elearning basic knowledge course) on a hand held computer and weekly online case based discussions were arranged using the RCSI School for Surgeons platform. Structured feedback, following an initial eight cases previously developed for Irish trainees, identified trainee preference for local cases and faculty involvement. Eight cases appropriate to the healthcare context of the region ...
After decades on the margins of primary health care, surgical and anaesthesia care is gaining inc... more After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. T...
To determine the incidence of valve morbidity associated with post-operative valve patients at th... more To determine the incidence of valve morbidity associated with post-operative valve patients at the Kenyatta National Hospital, Nairobi. A combined retrospective and prospective study. Restrospective period from 1973 to 31st July 1977 and prospective period from there on to 31st July 1998. Cardiothoracic outpatient clinic at Kenyatta National Hospital, Nairobi. All valve replacement patients attending the cardiothoracic outpatient clinic on follow up following discharge from the ward. Morbidity was assessed by incidence of: stroke, thromboembolism, valve thrombosis, bleeding episodes, valve endocarditis and re-operation for valve failure. For all valve surgery combined the overall follow up rate equalled 476.3 patient years. The linearised occurrence rate for thromboembolism for all valves was 1.04% per patient year. For the mechanical valves this incidence was 1.32% per patient year. The stroke free rate at one year and five years was 97.7% and 95.9% respectively. The linearised inc...
In the past, the Kenyatta National Hospital heart unit policy has been to discourage pregnancy am... more In the past, the Kenyatta National Hospital heart unit policy has been to discourage pregnancy among patients following open heart surgery for valve replacement, in view of the adverse effects of warfarin. To review the occurrence of pregnancy in open heart patients following discharge from hospital, and to compare the incidence with national figures. Retrospective and prospective. Kenyatta National Hospital, Nairobi. Of the 239 female patients operated upon at the cardiothoracic unit of the KNH during the period June 1973 and September 1998, 108 met the inclusion criteria; 56 of them had valve replacement surgery. At the time of surgery, 31% of all the female patients were in the reproductive age group of 14 to 45 years. Only two per cent were older than 45 years. Follow up was 490 patient years for the entire group, and 318 patient years for all with valvulopathy. For the whole group, irrespective of age, pregnancy rate was 6% and 15% at five and ten years of follow up respectivel...
To determine the patient drop out to postoperative follow up for heart patients at the Kenyatta N... more To determine the patient drop out to postoperative follow up for heart patients at the Kenyatta National Hospital. The study analysed the postoperative attendance of heart patients to the surgical outpatient clinic at the KNH. Data on clinic attendance was collected over a one-year period from patient files and from clinic attendance. A total of four hundred and seventy-five open heart operations have been performed at the Kenyatta National Hospital over the last twenty-five years. The patients' mean age is 18.0 years. Clinic follow up rate over this period is 85% at one-year, 62% at five-years, 32% at ten-years and 13% at fifteen-years. A number of patients who had since fallen out to clinic follow up were traced during the study period, when included into the analysis the revised figures are 85%, 70%, 40% and 24% respectively. The difference is statistically significant (p = 0.019). There was no significant statistical difference in the follow up between males and females (p =...
On average, for every 100 patients with malignant dysphagia admitted into the Kenyatta National H... more On average, for every 100 patients with malignant dysphagia admitted into the Kenyatta National Hospital (KNH) in Nairobi, 28 will have their tumour resected. Seven in the tumour resected group will die during the postoperative period while there will be 12 deaths occurring in patients before surgery.
A 50-year-old female presented with a five months history of recurrent attacks of dizziness, swea... more A 50-year-old female presented with a five months history of recurrent attacks of dizziness, sweatiness, tremors and fainting with loss of consciousness. These were found to be due to hypoglycaemic episodes with blood sugars less than 1 mmol/l and were treated as such. A diagnosis of insulinoma was initially considered, but the patient turned out to have fibrosarcoma of the lung, a rare lung tumour. She also had finger and toe clubbing and features of hypertrophic pulmonary osteoarthropathy.
Eighty random patients were examined over a 9-month-period to determine the incidence of asymptom... more Eighty random patients were examined over a 9-month-period to determine the incidence of asymptomatic haemorrhoids at the Kenyatta National Hospital (KNH). The incidence of asymptomatic was found to be 21% all being first degree haemorrhoids, while in the age group 50 years and over, 29% had asymptomatic haemorrhoids. The mean age calculated as 44.3 years (+/- 18.3), with no statistical difference between the ages of the two sexes. Males however had a significant greater incidence of asymptomatic haemorrhoids than females.
Aims Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however... more Aims Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment. Methods and results This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%).
The Risk Adjustment in Congenital Heart Surgery (RACHS-1) system has been used as a benchmark to ... more The Risk Adjustment in Congenital Heart Surgery (RACHS-1) system has been used as a benchmark to compare surgical results in developed countries. Its ability to stratify postoperative mortality risk has been validated in several developed countries, however, this has not been examined in a developing country. To assess the ability of the RACHS-1 system to stratify postoperative mortality risk in a developing country Retrospective study over a five year period between 1st January 2002 and 31st December 2006. Kenyatta National Hospital, a teaching and referral hospital in Nairobi, Kenya. Three hundred and seventeen consecutive operations were performed on 313 patients aged between 0.25 and 204 months.Operations were performed in RACHS-1 categories 1, 2, 3 and 4 with hospital mortalities of 2.5%, 16.9%, 29.4% and 50% respectively. The difference in mortality between categories 1 and 2 was significant (p-value of 0.0003), however, the difference in mortality between categories 2 and 3 and categories 3 and 4 was not significant (p-values 0.193 and 0.67 respectively). The RACHS-1 system did not adequately stratify risk in a low case load setting. The use of the RACHS-1 method as a benchmark to compare surgical results of paediatric cardiac surgery services in developing countries may be limited
Objective: To determine the pattern of anticoagulation control for post heart-valve surgery for p... more Objective: To determine the pattern of anticoagulation control for post heart-valve surgery for patients on follow up at Kenyatta National Hospital(KNH). Design: A combined prospective and restrospective hospital-based study. Retrospective period from January 1991 to 31st August 1997, while the prospective period was from 1st September 1997 to 31st November 1999. Setting: Cardiothoracic surgery clinic, Kenyatta National Hospital, Nairobi. Patients: Post heart valve surgery patients on warfarin and attending the cardiothoracic surgery clinic at Kenyatta National Hospital. Main outcome measures: Clinic attendance intervals, average warfarin dosages, interval of dosage change, INR values and variations from accepted normal. Results: A total of 103 patients fulfilled the criteria for inclusion into the study consisting of 77 mitral valve replacements, 18 aortic valve replacements, seven double valve replacements and one mitral valve repair. The total follow up time for the study period is 316.9 patients years. On average, patients attended their anticoagulation clinic once every 59 days. The average dose of warfarin prescribed was 6.81mg daily(±2.67mg), with double valve replacement patients receiving a statistically significant lower dosage of 6.04 mg (±1.36mg), (95% confidence limits). On average, a warfarin dose change was made 1.48 times a year per patient. For all the patients, the mean INR was 2.50 (±1.18). The respective values for mitral, aortic, double valve replacement and the mitral repairs were 2.53(±1.21), 2.32 (±1.04), 2.5 (±1.05) and 2.02 (±0.53), respectively. Mitral valve repair patients maintained a significantly lower level of INR (95% confidence limits). Only during 18% of the follow up time was adequate anticoagulation maintained. During the study period only 6.9% of patients were able to maintain adequate anticoagulation for 50% or more of their follow up time. Conclusion: Anticoagulation control at the KNH still needs some improvements in clinic attendance and better dosage adjustments to achieve more appropriate INR values.
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failur... more Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain major causes of heart failure, stroke and death among African women and children, despite being preventable and imminently treatable. From 21 to 22 February 2015, the Social Cluster of the Africa Union Commission (AUC) hosted a consultation with RHD experts convened by the Pan-African Society of Cardiology (PASCAR) in Addis Ababa, Ethiopia, to develop a 'roadmap' of key actions that need to be taken by governments to eliminate ARF and eradicate RHD in Africa. Seven priority areas for action were adopted: (1) create prospective disease registers at sentinel sites in affected countries to measure disease burden and track progress towards the reduction of mortality by 25% by the year 2025, (2) ensure an adequate supply of high-quality benzathine penicillin for the primary and secondary prevention of ARF/RHD, (3) improve access to reproductive health services for women with RHD and other non-communicable diseas...
Background: Post oesophagectomy leakage is a common postoperative complication. This present revi... more Background: Post oesophagectomy leakage is a common postoperative complication. This present review was aimed at documenting the problem of post-oesophagectomy leakage and associated variables at Kenyatta National Hospital (KNH) between January 1998 and December 2004. Methods: All patients presenting with carcinoma of the oesophagus and who underwent an oesophagectomy were included into the study. Analysis of data was carried out to determine the leakage rate as well as determining the association of leaks with other preoperative and postoperative variables. Statistical analysis performed on Microsoft Excel (10.2614.2625), and Epinfo 2002. The Chi 2 test was used to determine statistical significance. Level of significance was achieved if the p value was < 0.05. Results: A total of 201 oesophagectomies were carried out in the period under review. The male to female sex ratio was 1.6:1. The average age was 57 years with a range of 24 years to 88 years. Two thirds (67.1%) of the anastomoses were fashioned within the thoracic cavity while the rest were fashioned within the cervical area. A total 16.4% of anastomoses leaked. The in-hospital mortality rate for all oesophagectomies was 28.9%. The in-hospital mortality for the post anastomotic leakage patients was 48.4% as compared to 27.2% among those patients who did not develop anastomotic leakage. Conclusion: Post oesophagectomy leakage remains common complication at Kenyatta National Hospital (KNH).
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