Articles in the journal
Nyamu D.G. , Juma R , Mwangangi E.M , Maru S.M , Tele A. K , Gitonga I.Keywords:
Diabetes mellitus, patient knowledge, control measures, antidiabetic medication, diabetic affiliate organizationsAbstract:
Background: Good knowledge about diabetes and its management enhances the ability of patients to cope and adjust to their illness.
Objectives: To determine the knowledge on diabetes mellitus and its management among diabetic outpatients at Kenyatta National Hospital, Diabetic Clinic.
Methodology: This was a cross-sectional study involving 105 consenting diabetic outpatients, aged ≥18 years. Consecutive sampling was used to collect data using pre-designed semi structured interviewer administered questionnaires. Patients’ knowledge on diabetes mellitus including cause, symptoms, complications, medications, dietary control, importance of exercises and diabetes affiliate organizations was collected and analysed using IBM statistical package for social sciences version 21. Chi square tests were used to compute associations between participants’ sociodemographics and outcome variables at p≤0.05.
Results: The ratio of males to females was approximately 1:1. The mean age of the participants and duration of diabetes was 41.0±16.0 and 6.0±5.0 years, respectively. Knowledge on causes, signs and symptoms of diabetes mellitus was statistically significantly associated with the education level (p=0.0001) and was more common among males (p=0.01). Knowledge on dietary control (p=0.02), exercise (p=0.04) and complications (p=0.05) was more common among males and the more educated. Irrespective of sociodemographic variables (p>0.05), only 33.3% of the patients knew their medication and dosing schedules in relation to meals. A large proportion (90%) of the patients was unaware of the role of diabetes affiliate organizations.
Conclusion: Knowledge on diabetes among diabetic outpatients varies with level of education and gender. More health education is, however, advocated to diabetic patients in order to increase their knowledge on antidiabetic medication and diabetes affiliate organizations. Future work should, however, be carried out to correlate the patients’ level of knowledge and long term glycaemic control.
Medication use, Self-medication, Prescription, PregnancyAbstract:
Background: The study set out to establish drug use practices among mothers and prescribers at the Obstetrics and Gynaecology department of Kenyatta National Hospital. Since it is difficult to determine effects on the foetus before marketing new drugs due to ethical reasons, most drugs are contraindicated in pregnancy. However, pregnancy itself often necessitates medication. A careful balance between the risks of medications to the foetus and the benefits to the mother is therefore necessary. The study assessed patterns and predictors of drug use practices in pregnancy among women admitted to the labour wards of Kenyatta National Hospital. It was carried out as a cross sectional survey at the Obstetrics and Gynaecology wards of Kenyatta National Hospital. Data was analysed using STATA 13 computer software. Knowledge on medication use was measured by a score generated by combining ten variables of knowledge. Association between predictors and knowledge was done by chi square and logistic regression. Up to 70% of the respondents had practiced self-medication with at least one drug during pregnancy.
Paracetamol was the most used for self-medication (30%) while antibiotics were the most prescribed. FDA category B drugs were most prescribed (43.6%). Univariable analysis showed significant relationship between level of knowledge and age greater than 35 years, employment whether in the formal or informal sector compared to not being employed or self-employed and level of education. However, in the multivariable analysis which adjusted for other factors, only level of education was significant for having knowledge of drug use in pregnancy. These results provide sufficient evidence to conclude that level of knowledge of a mother on drug use in pregnancy significantly influences her self-medication practices while pregnant. This implies that a lot of effort should be put towards improving level of education of women as this will improve their reproductive health outcomes.
Odhiambo M.A. , Mwagiru P.M. , Mukindia G.Keywords:
NTI - drugs, tablet splitting, half tablets, uniformity in weight, carbamazepine 200mg scored tabletsAbstract:
Carbamazepine is an example of a drug with a narrow therapeutic index (NTI) whose dose response should be carefully titrated to avoid adverse effects associated with over- or under-dosages. Currently, there are no studies in Kenya that have investigated the accuracy of splitting tablets of such drugs. Carbamazepine tablets available in Kenya are scored, indicating suitability for splitting.
This study set out to determine the uniformity in weight of half tablets of a number of brands of carbamazepine 200mg tablets, the loss in mass upon splitting, and the accuracy of splitting tablets by hand and by means of a knife.
Twenty tablets each of 5 different brands were split by hand and using a knife. The uniformity in weight of the halves obtained was compared as well as the accuracy of the splitting method.
It was found that none of the half tablets passed the adopted United States Pharmacopeia (USP) test for Uniformity in Weight, whether split by hand or using a knife. Eighty-seven (87%) half tablets obtained from splitting by hand passed the European Pharmacopeia (Ph. Eur.) test for Subdivision of Tablets while only 52 half tablets passed the USP test for Uniformity of Dosage Units. When tablets were split by means of a knife, 81 (81%) half tablets passed the Ph. Eur. test while only 34% of the half tablets passed the USP test. Loss in mass for majority of the products was less than 3%.
Splitting of tablets results in variations in weight of half tablets. The USP test is stricter compared to the Ph. Eur. Test with the majority of the half tablets satisfying the Ph. Eur. requirements. Splitting by hand gave better results than using a knife. However, due to weight variation of halves, splitting of carbamazepine tablets is not recommended.
P.N.Karimi , A.N. Guantai , C. Kigondu , T. OgaroKeywords:
Adherence, Anti tuberculosis drugs, Adverse drug eventsAbstract:
Tuberculosis is a global health problem and Kenya is among the countries with high burden of the disease. The disease is curable but the drugs used have several adverse effects which increase the morbidity and mortality. They also affect adherence to treatment.
To determine the prevalence of adverse drug events of first line anti-tuberculosis therapy and their impact on adherence to treatment in Nairobi City County.
The study was carried out in nine health facilities in Nairobi City County. A cross-section study design was used targeting adult patients on first line anti-tuberculosis drugs. A sample of 190 participants was selected using simple random sampling. Eligible respondents were taken through a consenting process and those who concurred were included in the study. Data was collected using a researcher-administered questionnaire. The participants were interviewed and their responses entered accordingly. Analysis of the data was done using STATA version 13 and both inferential and descriptive analysis were used to generate the report.
115(60.53%) respondents were males and 48(25.26%) had HIV coinfection. The most common adverse drug events were; nausea, vomiting, anorexia, tiredness and weakness, numbness and burning sensation in the limbs, clumsiness or unsteadiness, depression, skin rash, arthralgia, blurred vision and eye pain. The majority (51.58%) of the respondents had high adherence to anti-tuberculosis drugs. There was a statistically significant relationship between the level of adherence and duration of treatment (p=0.05); alcoholism (p=0.002); depression (p=0.026).
Males are more predisposed to tuberculosis than females and adverse drug events are common in patients on treatment.
P.N.Karimi , A.N. Guantai , C. Kigondu , T. OgaroKeywords:
MDR-tuberculosis, Adverse drug reactionsAbstract:
Increased incidence of Multidrug-resistant tuberculosis (MDR-TB) is eroding the gains made in controlling the disease. The drugs used to treat MDR-TB have several side effects which enhance morbidity and mortality associated with the disease.
To determine the prevalence of adverse drug events among patients on MDR-TB therapy in Nairobi City County.
A longitudinal study was carried out in four health facilities within Nairobi City County. It involved twenty- three participants who were on MDR-TB treatment selected through universal sampling. Eligible respondents were taken through a consenting process and those who concurred were included in the study. Data was collected using a researcher-administered questionnaire. The participants were interviewed and their responses entered accordingly. Analysis of the data was done using STATA version 13 and both inferential and descriptive analyses were used to generate the report.
Among the patients who were on therapy for drug-resistant tuberculosis, the main adverse drug events involved disturbances of the nervous system (91.3%), gastrointestinal (87%), musculoskeletal (73.9%), cardiovascular (43.5%) and endocrine (43.5%) systems. The other less common but serious adverse drug events were nephrotoxicity (6, 21.6%), hepatotoxicity (5, 21.7%) and rash (5, 21.6%). All the participants suffered from many adverse events and 12(52.2%) had experienced ten and below while 11(47.8%) had more than ten adverse events.
MDR –TB therapy causes several adverse events involving most body systems.