Browsing by Author "Kussin, Peter S"

Background: Cardiovascular diseases form a large part of a growing pandemic of non-communicable diseases afflicting Sub-Saharan Africa(1–3) Heart failure is one of the most debilitating of these diseases. The global 5-year life expectancy of patients afflicted by heart failure is less than 50%(4–6). Cardiac rehabilitation (CR) has been demonstrated to improve functional status, quality of life, and reduce depression in patients with heart failure(7,8). Even though CR is a simple and comparatively low-cost intervention, adherence rates of CR remains poor and are estimated at 20% in the US(9–11). In Western Kenya, CR is non-existent. We sought to establish the feasibility of two different models of cardiac rehabilitation for heart failure in Western Kenya and to identify potential barriers to participation.

Methods: This was a feasibility study using mixed methods to describe characteristics and changes in a cohort of patients with heart failure. Study participants were prospectively recruited and allocated by convenience into an institution based cardiac rehabilitation (IBCR) arm, a home based cardiac rehabilitation (HBCR) arm and an observational arm (OA). At completion of 3 month follow up period, participants were invited to take part in focus group discussions exploring perspectives on heart failure and cardiac rehabilitation. The primary measure of feasibility was the ability of study participants to attain a mean adherence rate of at least 25%, of prescribed rehabilitation sessions.

Results: This study found that cardiac rehabilitation is a feasible intervention for patients with heart failure in Western Kenya with an adherence rate of 46% for institutional based cardiac rehabilitation and an adherence rate of 28% for home based cardiac rehabilitation. All study arms demonstrated significant change in depression screening and quality of life scores. Participants in focus group discussions identified competing interests, distance to the facility and forgetfulness as barriers to cardiac rehabilitation.

Conclusions: Cardiac rehabilitation is a feasible treatment intervention for heart failure in Western Kenya. However, the barriers to delivery of care are similar to barriers in other health systems around the world(12). There is need for further research to evaluate the efficacy of cardiac rehabilitation and development of innovative ways to improve treatment adherence.

Background: This study aimed to describe sepsis related intervention practices among health care providers within a referral center in Kenya. Methods: Knowledge Attitude and Practice (KAP) surveys assessing sepsis related activities were distributed to health care providers at the Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. The target population was physicians, clinical officers, and nurses working in the Intensive Care Unit (ICU), casualty (emergency) and medicine wards in July 2014. Results: The response rate was 100% (86/86). Crystalloid fluids were the most common resuscitation fluids. About 80% of the providers in the medicine wards and casualty department utilized the drop count method. Fifty percent of providers at the ICU reported using intravenous fluid pumps. The most common reported cause of sepsis was respiratory infections. The most common reported antibiotics were ceftriaxone and metronidazole. All providers at casualty reported having access to these antibiotics, while only 75% of providers at the ICU indicated that they had access to antibiotics (p = 0.018). Only 43% of providers reported ordering blood cultures as the initial investigation in patients with sepsis. Invasive catheters were mostly unavailable in the ICU and casualty departments. Common reported barriers to providing care included advanced patient presentation, lack of antibiotics, and lack of sufficient staff. Conclusion: Providers reported a severe lack of invasive critical care equipment across all departments. Participant reported that lack of broad-spectrum antibiotics, lack of staff and lab test and equipment severely hinder optimal management of sepsis in this setting.

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Background: Fractional exhaled nitric oxide (FeNO) is a novel biomarker that is utilized as a tool to assist with the diagnosis and management of asthma in developed countries. Little data exists from sub-Saharan Africa to understand the role for exhaled nitric oxide in subjects suspected of having asthma. In this study, we aim to elucidate if a relationship exists between elevated FeNO levels and symptoms of asthma.

Methods: Using a cluster randomized stratified sampling strategy, 154 subjects age 12 and above in Uasin Gishu County, Kenya were enrolled. Questionnaires including ISAAC written and video questionnaires and the St George’s Respiratory Questionnaire for COPD were completed. Subjects were tested for FeNO, pre-and post-bronchodilator spirometry, and exhaled carbon monoxide. Odds ratios for the presence of asthma symptoms based on FeNO levels above or below a cutoff point of 71 ppb were generated.

Results: Overall, 5.8% of subjects were identified with asthma symptoms by video questionnaires, and 17.5% by written questionnaires. Median FeNO levels were significantly higher in subjects with wheezing compared to those without. The odds ratio for wheezing in individuals with FeNO levels greater than 71 ppb compared to less than 71 ppb was 7.8 (video questionnaire) and 11.3 (written questionnaire).

Conclusions: A statistically significant relationship exists between elevated levels of FeNO and symptoms of asthma in this western Kenyan population. Further work is needed to explore this link for clinical and research purposes.