Department of Pathology

Telemedicine in Africa: Applications, Opportunities, and Challenges

2024-08-05T12:36:37Z

Telemedicine in Africa: Applications, Opportunities, and Challenges Onsongo, Simon; Kagotho, Elizabeth Telemedicine is the delivery of healthcare services remotely through information and communication technology (ICT) devices. Telemedicine offers a promising solution to address unmet healthcare needs across the African continent. This review explores the current state, opportunities, and challenges of telemedicine in this context. While growth has been significant in recent decades, access remains limited in many rural and underserved regions due to numerous barriers. Despite these limitations, telemedicine has demonstrated its great potential to improve healthcare delivery, particularly in primary care, chronic disease management, specialist consultations, and remote education and training. As new technologies emerge, the scope of services will expand. When used effectively, telemedicine not only improves patient outcomes and healthcare efficiency but also enables collaboration among healthcare professionals, fostering knowledge sharing, and capacity building across geographical barriers. To increase effective utilization across African states, access barriers such as limited internet connectivity, inadequate infrastructure, regulatory hurdles, cultural beliefs, and individual (patient/provider) concerns must be addressed. This requires a multifaceted approach involving various stakeholders supporting healthcare service delivery in the continent.

Effects of improved on-farm crop storage on DNA methylation of mothers and their infants: evidence from a randomized controlled trial in Kenya

2024-08-05T12:28:34Z

Effects of improved on-farm crop storage on DNA methylation of mothers and their infants: evidence from a randomized controlled trial in Kenya Eichenauer, Heike; Fischer, Susanne; Gardini, Elena; Onsongo, Simon; Ehlert, Ulrike Stress during pregnancy can lead to adverse maternal and infant health outcomes through epigenetic changes in the hypothalamic–pituitary–adrenal axis. Among farmers in low-income countries, one important stressor is food insecurity, which can be reduced using hermetic storage bags. This study aimed to determine, for the first time, whether a hermetic storage bag intervention during pregnancy positively affects maternal and infant DNA methylation of the hypothalamic–pituitary–adrenal axis-related genes FKBP5 and NR3C1. We further analyzed whether anthropometrics, stress, and mental health were associated with DNA methylation.

Experiences on the Utility and Barriers of Telemedicine in Healthcare Delivery in Kenya

2023-10-15T09:28:13Z

Experiences on the Utility and Barriers of Telemedicine in Healthcare Delivery in Kenya Onsongo, Simon; Kamotho, Charles; Rinke de Wit, Tobias F; Lowrie, Kinga Telemedicine is the provision of health services over a distance using information communication technology devices. Telemedicine is emerging as a promising component of healthcare care delivery worldwide, accelerated by the COVID-19 pandemic. This study assessed the factors promoting uptake, barriers, and opportunities for telemedicine among doctors in Kenya. Methodology. A semiquantitative, cross-sectional online survey was conducted among doctors in Kenya. During a month, between February and March 2021, 1,200 doctors were approached by email and WhatsApp, of whom 13% responded. Findings. A total of 157 interviewees participated in the study. The general usage of telemedicine was 50%. Seventy-three percent of doctors reported using a mix of in-person care and telemedicine. Fifty percent reported using telemedicine to support physician-to-physician consultations. Telemedicine had limited utility as a standalone clinical service. The inadequate information communication technology infrastructure was the most reported barrier to telemedicine, followed by a cultural resistance to using technology to deliver healthcare services. Other notable barriers were the high cost of initial setup limited skills among patients, limited skills among doctors, inadequate funding to support telemedicine services, weak legislative/policy framework, and lack of dedicated time for telemedicine services. The COVID-19 pandemic increased the uptake of telemedicine in Kenya. Conclusion. The most extensive use of telemedicine in Kenya supports physician-to-physician consultations. There is limited single use of telemedicine in providing direct clinical services to patients. However, telemedicine is regularly used in combination with in-person clinical services, allowing for continuity of clinical services beyond the physical hospital infrastructure. With the widespread adoption of digital technologies in Kenya, especially mobile telephone technologies, the growth opportunities for telemedicine services are immense. Numerous mobile applications will improve access capabilities for both service providers and users and bridge the gaps in care. https://doi.org/10.1155/2023/1487245

A patient with leishmaniasis presenting with longstanding pancytopenia and hepatosplenomegaly

2023-04-24T16:27:13Z

A patient with leishmaniasis presenting with longstanding pancytopenia and hepatosplenomegaly Onsongo Simon, Mulwa Evelyne, Mutiso Bonface Leishmaniasis is a common cause of pancytopenia and hepatosplenomegaly in tropical and subtropical regions. A high index of suspicion is required to diagnose and manage patients with leishmaniasis. Travel history should always be elicited in a patient with suggestive clinical presentation. https://doi.org/10.1002/ccr3.6940

Linking private health sector to public COVID-19 response in Kisumu, Kenya: Lessons Learnt

2022-05-20T08:03:48Z

Linking private health sector to public COVID-19 response in Kisumu, Kenya: Lessons Learnt Mevis Omollo, Isdorah A Odero, HC Barsosio, Simon Karuki, F Ter Kuile, SO Okello, K Oyoo, AK K'Oloo, K Otieno, SV Duijn, N Houben, E Milimo, R Aroka, SN Onsongo, TF Rinke de Wit COVID-19 is overwhelming health systems universally. Increased capacity to combat the epidemic is important, while continuing regular healthcare services. This paper describes an innovative Public Private Partnership (PPP) against COVID-19 that from the onset of the epidemic was established in Kisumu County, Western Kenya. https://doi.org/10.1101/2022.03.29.22271489

Performance of a rapid antigen test for SARS-CoV-2 in Kenya

2022-02-16T07:35:30Z

Performance of a rapid antigen test for SARS-CoV-2 in Kenya Simon N.Onsongo, KephasOtieno ,Shannenvan Duijn,EmilyAdams,Mervis Omollo,Isdora A.Odero,AlloysK'Oloo,Nathalie Houbene,Emmanuel ,Milimo RobertAroka,Hellen C.Barsosiob,Fredrick Oluoch,Albert Odhiambo,Simon Kariuki,Tobias F. Rinkede Witce Testing for SARS-CoV-2 in resource-poor settings remains a considerable challenge. Gold standard nucleic acid tests are expensive and depend on availability of expensive equipment and highly trained laboratory staff. More affordable and easier rapid antigen tests are an attractive alternative. This study assessed field performance of such a test in western Kenya. We conducted a prospective multi-facility field evaluation study of NowCheck COVID-19 Ag-RDT compared to gold standard PCR. Two pairs of oropharyngeal and naso pharyngeal swabs were collected for comparative analysis. With 997 enrolled participants the Ag-RDT had a sensitivity 71.5% (63.2-78.6) and specificity of 97.5% (96.2-98.5) at cycle threshold value <40. Highest sensi tivity of 87.7% (77.2-94.5) was observed in samples with cycle threshold values ≤30. NowCheck COVID-19 Ag-RDT performed well at multiple healthcare facilities in an African field setting. Operational specificity and sensitivity were close to WHO-recommended thresholds https://doi.org/10.1016/j.diagmicrobio.2021.115591

Vitamin D status in healthy black African adults at a tertiary hospital in Nairobi, Kenya: a cross sectional study

2022-02-01T07:47:18Z

Vitamin D status in healthy black African adults at a tertiary hospital in Nairobi, Kenya: a cross sectional study 31. Kagotho E. , Omuse G., Okinda N. , Ojwang P. Background: Vitamin D has been known since the twentieth Century for its benefits in bone health. Recent observational studies have demonstrated its benefits in infectious diseases such as tuberculosis and non-communicable diseases such as diabetes mellitus, cardiovascular diseases and cancer. This has led to a dramatic increase in testing among adults. The cut-offs for vitamin D deficiency have been debated for decades and the current cut off is derived from a Caucasian population. Studies done among black African adults in Africa are few with vitamin D deficiency ranging from 5 to 91%. A few cut- offs have correlated vitamin D deficiency to physiological markers such as parathyroid hormone (PTH), calcium and phosphate with varying results. Methods: This was a cross sectional study carried out among blood donors at Aga Khan University hospital, Nairobi (AKUHN) from March to May 2015. Vitamin D (25(OH)D) levels were assayed and correlated with PTH, calcium and phosphate. Results: A total of 253 individuals were included in the final analysis. The proportion of study participants who had a 25(OH) D level of < 20 ng/ml thus classified as vitamin D deficient was 17.4% (95% C.I 12.73–22.07). The 25(OH) D level that coincided with a significant increase in PTH was 30 ng/ml. Males were less likely to be vitamin D deficient (O.R 0.48 (C.I 0.233–0.993) p 0.04). Sunshine exposure for ≥3 h per day reduced the odds of being Vitamin D deficient though this was not statistically significant after multivariate regression analysis. Conclusions: We found a much lower prevalence of Vitamin D deficiency compared to many similar studies carried out in sub-Saharan Africa possibly due to the recruitment of healthy individuals and the proximity of Nairobi to the equator which allows for considerable exposure to sunshine. Vitamin D levels below 30 ng/mL was associated with a significant rise in PTH levels, suggesting that this cut off could be appropriate for defining Vitamin D deficiency in the population served by our laboratory https://doi.org/10.1186/s12902-018-0296-5

Metabolic syndrome and its predictors in an urban population in Kenya: A cross sectional study

2022-01-29T09:50:55Z

Metabolic syndrome and its predictors in an urban population in Kenya: A cross sectional study Geoffrey Omuse, Daniel Maina, Mariza Hoffman, Jane Mwangi, Caroline Wambua, Elizabeth Kagotho, Angela Amayo, Peter Ojwang, Zulfiqarali Premji, Kiyoshi Ichihara & Rajiv Erasmus The metabolic syndrome (MetS) is a clustering of interrelated risk factors which doubles the risk of cardio-vascular disease (CVD) in 5–10 years and increases the risk of type 2 diabetes 5 fold. The identification of modifiable CVD risk factors and predictors of MetS in an otherwise healthy population is necessary in order to identify individuals who may benefit from early interventions. We sought to determine the prevalence of MetS as defined by the harmonized criteria and its predictors in subjectively healthy black Africans from various urban centres in Kenya. DOI 10.1186/s12902-017-0188-0

Determination of reference intervals for common chemistry and immunoassay tests for Kenyan adults based on an internationally harmonized protocol and up-to-date statistical methods

2022-01-21T13:46:02Z

Determination of reference intervals for common chemistry and immunoassay tests for Kenyan adults based on an internationally harmonized protocol and up-to-date statistical methods Geoffrey Omuse, Kiyoshi Ichihara, Daniel Maina, Mariza Hoffman, Elizabeth Kagotho, Alice Kanyua, Jane Mwangi, Caroline Wambua, Angela Amayo, Peter Ojwang, Zul Premji, Rajiv Erasmus Due to a lack of reliable reference intervals (RIs) for Kenya, we set out to determine RIs for 40 common chemistry and immunoassay tests as part of the IFCC global RI project. URL: https://doi.org/10.1371/ journal.pone.0235234

A Review of 74 Patients with Newly Diagnosed Multiple Myeloma at A Tertiary Referral Hospital in Nairobi, Kenya

2021-01-12T05:56:27Z

A Review of 74 Patients with Newly Diagnosed Multiple Myeloma at A Tertiary Referral Hospital in Nairobi, Kenya G Kiraka, Mbayah Etabale, M Riyat Introduction Multiple myeloma is a neoplastic disorder characterized by clonal proliferation of plasma cells. We aimed to carry out a retrospective audit to describe clinical and laboratory features of patients newly diagnosed with multiple myeloma. Materials and Methods Records of all patients initially diagnosed with multiple myeloma at the haematology clinic of Aga Khan University Hospital, Nairobi, from January 1, 1999 to December 31, 2011 were reviewed. Diagnosis of multiple myeloma was based on (1) increased numbers of abnormal, atypical or immature plasma cells in a bone marrow aspirate or trephine, (2) presence of monoclonal protein or free light chains in serum or urine and (3) bone lesions consistent with multiple myeloma. Results Seventy-four patients were diagnosed with multiple myeloma. The median age at diagnosis was 59 years. Males comprised 53%. The most common presenting complaints were bone pain in 56 (76%), recurrent infections in 11 (16%) and fatigue in 24 (33%) patients. Anaemia (Hb < 10 g/dl) was present at diagnosis in 47% of patients while 25 (34%) presented with hypercalcaemia (serum calcium > 2.6 mmol/l) and 38 patients (52%) had renal failure at diagnosis (serum creatinine > 110μmol/l). A monoclonal band was demonstrated in 56 patients (76%). Nine patients (12%) had light chain myeloma while only 4 patients had nonsecretory myeloma. One patient was found to have biclonal myeloma. Conclusion The median age of patients at diagnosis is lower than that reported in other populations [59 years versus 66–68 years] and may indicate a younger age of incidence of the pre-malignant monoclonal gammopathy of undetermined significance (MGUS) in African patients.