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17th Annual Scientific Conference

KENYAASSOCIATION OF

PHYSICIANS(KAP)

Fatima Court [directly opposite Studio House]

Marcus Garvey Rd.

off Argwings Kodhek Rd.

Kilimani

Flat No. 15

P.O. Box 48397 Post Code: 00100 GPO

Tel: 0707-899-964

Tel: 0738-355-862

Website: [email protected]

[email protected]


WELCOME ADDRESS BY KAP NATIONAL CHAIRMAN

Dear colleagues and participants to the 17TH Annual Scientific Conference.

It is with great pleasure that I welcome you to this all important Conference. As the THEME: “TRAINING OF MEDICAL DOCTORS IN KENYA: THE WAY FORWARD” reads; it prudent upon us, as key players; to share our thoughts and be involved in shaping the future of young doctors we train in this country.

Kenya Association of Physicians (KAP) recognizes the fact that many Medical Schools have been established in Kenya in the recent past. This is a very positive move to bridge the gap of Doctor: Inhabitants Ratio. Cuba is ranked number 1 (2005-2010 statistics) the ratio is 67 doctors per 10,000 inhabitants. In Egypt (the leader in Africa but ranked number 40 world-wide) it is 28doctors per 10,000 inhabitants, USA ranked number 53 it is 24 doctors per 10,000 inhabitants, Nigeria ranked number 106 it is 4 doctors per 10,000 inhabitants, Djibouti ranked number 115 it is 2 doctors per 10,000 inhabitants. Kenya is not ranked, however, with a population of about 40 million with 8060 registered doctors as at March 2013 (MP&DB); the ratio would be 1/2 a doctor to 10,000 inhabitants, say 1 doctor to 5000 inhabitants.

The 8060 doctors registered by MP&DB as at March 2013, does take into account attrition rates i.e. colleagues who have passed away, those who have left the country for whatever reason and those who are in the country but are not directly involved in patient care (for example those who have turned to non medical businesses or have become administrators in various fields). This ratio, not withstanding; is grossly inadequate. This is further compounded by the unequal distribution of doctors, most of who are in urban centers.

The growing number of Medical Schools is a welcome move; however, there is need to work as cohesive teams sharing experiences to enable us come up with uniformly well trained doctors. The 21st Century doctor ought to be a critical thinker and a life-long learner, cognizant of the environment they working in.

It is my hope that by the end of this Conference we shall have made a contribution towards our goal, albeit, in a small way. The saying goes; “A Journey of a Thousand miles starts with one step”

Finally I express my sincere gratitude to all who worked tirelessly to make this Conference be. These include the KAP Council members, the various Conference committees, pharmaceutical firms and last but not least KAP secretariat very ably handled by Mrs. Pauline Kimonge. KARIBUNI.

With Thanks

National Chairman KAPProf. J.O.Jowi


KENYA ASSOCIATION of PHYSICIANS OFFICIAL

Prof. J. O. Jowi - National ChairmanDr. J. N. Walumbe - National Vice ChairmanDr. J. Kwasa - SecretaryDr. C. Kamotho - Asst. SecretaryDr. F. Otieno - TreasurerProf. G. Yonga - Council MemberDr. C. Muyodi - Council MemberProf. M.S. Abdullah - Ex-Officio


17TH ANNUAL SCIENTIFIC CONFERENCE ORGANIZING COMMITEE

Prof. J. O. Jowi - Chairman Organising CommitteeProf. E. N. Ogola - Chairman Scientific CommitteeDr. F. Otieno - MemberDr. C. Muyodi - MemberDr. J. N. Walumbe - Member

OFFICIAL GUESTS:

Prof. D. K. Some - Chief GuestDr. J. Mwanzia - Invited GuestDr. J. A. Aluoch - Keynote Address

KAP HONOURS:The Late Dr. G. A. Anjichi


17TH ANNUAL KAP SCIENTIFIC CONFERENCE

ABSTRACTS

AB-01

SHOULD DOCTOR TRAINING BE DECENTRALIZED?

Paul O. Ayuo – Moi University, Dean School of Medicine, Box 4606-030100 Eldoret

BACKGROUND

Until recently, there have been only two Doctor Training Schools in Kenya, based in Nairobi and Eldoret. The number of medical students and graduate students has continued to rise due to the great demand for doctor training. However, clinical teaching space has not expanded in tandem with student population. This has lead to congestion, rendering effective teaching and learning challenging in the wards and clinics. More schools have since been established but, unfortunately in urban areas.

On the other hand, the distribution of doctors has continued to be skewed towards towns and cities. This has resulted in a scenario where 78.7% of Kenyans who live in rural areas have access to fewer doctors than the 21.3% who live in urban settings. Given the shortage of doctors in the country this inequity s bound to get worse.

PROBLEM:

• How can we as doctor trainers address the congestion in the clinical areas in order to improve clinical teaching?

• How can the inequitable distribution of doctors be mitigated?

HYPOTHESIS:

Decentralized training can mitigate the disparity on distribution of doctors.

OBJECTIVE:

To review relevant literature with a view to proposing a mitigation to both the congestion in clinical teaching areas and inequity in the distribution of doctors in the country.

FINDINGS AND CONCLUSION

Published literature suggests that doctors tend to choose an environment similar to where they were trained. Thus establishing training sites in underserved areas may mitigate the unequal doctor distribution as well as ease the congestion in the current teaching institutions.


AB-02

DECENTRALIZATION OF RESIDENCY PROGRAMS IN KENYA

Dr. Sultani Matendechero-KMPDU

Kenya has an estimated population of 40 million people. Going by the WHO recommended doctor-people ratios; we are still very far from achieving internationally acceptable numbers of doctors in the country. This deficit is even more pronounced for specialists.

To reduce and eventually eliminate the deficit there is need to fast track the training of specialists by significantly increasing the number trained every year without compromising on the quality of training. We propose decentralization of residency programs in the country as one viable way of affecting this.

With only 16 year left before the realization of Vision 2030, the country needs to train and produce well over 1,500 specialists every year for the next 15 years in order to achieve the desired doctor-patient ratios. The doctors’ Union (KMPDU), in the Collective Bargaining Agreement (CBA) with the government, has proposed the creation of 400 new residency positions funded by the exchequer every year. The program will have defined qualification criteria and those admitted will be on a salary as they work and learn.

In order to accommodate the relatively larger numbers of trainees, we need to increase the number of training facilities without losing the prerequisite exposure and quality. Initially, all level five hospitals can be upgraded to residency centers and gradually, every county can have a residency centre.

To effect this, the minimum requirements for a residency centre should be set and potential hospitals upgraded within a year to suitable standards. Decentralization will also not be done for all specialties all at once but in staggered manner to enable capacity building for those specialties whose requirement will take longer to set up. For specialties that cannot be set up immediately, arrangements can be made to enable trainees to rotate in the current referral hospitals in turns.

The trainees shall also be required to sit a common standardized exam countrywide at all levels in order to ensure near uniformity in all centers. This shall be coordinated by the Kenya Medical Practitioners and Dentists Board (KMPDB) or a competent subcommittee.

This approach provides an opportunity to not only increase the number of specialists in the country but also provide better services to more citizens across the country.


AB-03

HARMONIZATION OF CURRICULA IN MEDICAL EDUCATION

Prof. Stephen Okeyo-FUNZO Kenya Project

Higher Education Institutions (HEI) in Africa are being forced to do more and more with less and less, in terms of infrastructure, faculty and equipments for teaching and research because of inequity in investment in higher education and brain drain. This has invariably impacted quality adversely and the capacity of graduates to compete in the global market1.

In Kenya there has been rapid expansion of medical education to meet the national economic and social development. The Government has reviewed the necessary laws and policies in the education system to facilitate the market demand. This has resulted in numerous new courses, additional educational providers and new approaches of delivery of these courses.

The entry of private education providers has been positive in bridging the gap created by limitation in public sector capacity. Additional benefits stem from the superior business and management concepts of the private sector facilitating efficiency and sustainability.

The downside of this is that the capacity to coordinate and regulate quality and standards has not grown half as fast, resulting in falling standards, poor coordination, of educational programs, and generally graduates with inadequate competencies to solve the health realities of the communities they are employed to serve. Another impediment is the attitudinal disposition of ‘medical’ graduates, who have been seen to lack the requisite ethics and professionalism required for effective health care.

Harmonization of curricula is therefore justified and rationale on the basis of facilitating efficient utilization of resources, which is critical in resource constrained settings. Harmonization also facilitates coordination, and has been shown to facilitate ‘deeper’ learning and student performance.

This paper is a synthesis of literature and stakeholder views in Kenya regarding harmonization. It was undertaken as a step in defining elements of a curriculum framework. It adopted a cross sectional design using literature review and focus group discussions.

The information generated suggests that there is unanimity in perceived need for harmonization and the commitment to act by a diverse array of stakeholders. And there is global and regional political will and commitment to harmonization.

1 Sawyerr A. (2002), “Challenges Facing African Universities”, Selected Issues, Retrieved January 10, 2007 from the Association of African Universities

website: http://www.aau.org/english/documents/asachallenges.pdf


DESIGN & METHOD

Synthesis of notes, lessons, and experiences generated during discussion with constituent groups and stakeholders in medical/health education sector to include academic institutions, regulatory bodies, professional associations, health programs and project leaders. This was undertaken through a series of four meetings during the course of June 2012 to March 2013 and which involved a diverse of health/medical cadres from across Kenya. The methodology was chosen based on utility reasons given the available time and financial resources, but it also represented an efficient and synergistic approach. This was supplemented with desk/literature review of program/project reports, scientific publications, and electronic databases.

This was undertaken as part of the Funzo Kenya background information development to facilitate development of a generic harmonization framework. Analysis was undertaken through simple data count from excel worksheet for quantitative data. Analysis was aided by the fact that the information to be collected was simple and not extensive. Qualitative information was grouped into thematic areas and again lent itself to simple manual count to expose a pattern.

FINDINGS

There is an international push for medical education reforms to be better aligned to the Concept of ‘Competency based learning’ in contrast to ‘problem based learning’ as is the case today. This is because the basic knowledge, skills and competencies to best serve a patient need to be uniform across different cadres, this is a justification/rational for harmonizing teaching/instruction and learning activities to build those core skills/competencies.

Literature review has revealed that A 20 member Global committee of experts constituted to spearhead higher education reforms articulated curriculum harmonization as one of the key elements of reform2.

Further, International as well as regional political transitioning provides another impetus for harmonization of higher education as a means of facilitating free movement of workforce by ensuring that training is of comparable standards and quality. Educational harmonization that existed in East Africa before the breakup of the east African Community has been initiated since 2008 with the East and Central Africa economic integration through the Inter-University Council of East Africa3. The executive secretary of the Inter-University Council of East Africa (IUCEA) making a presentation, earlier on in the year in Nairobi, to a high level forum of 46 participants comprising Deputy Vice Chancellors responsible for Academic Affairs, Principals of university institutions/university colleges, and Deans of Faculties/Schools, stressed the necessity of national commissions and councils for higher education

2 Julio Frenk, Lincoln Chen, Zulfiqar A Bhutta, Jordan Cohen, Nigel Crisp. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lance (2010) Volume: 376, Issue: 2, Publisher: The Lancet, Pages: 337-341Also available from http://www.mendeley.com/research/health. And www.ncbi.nlm.nih.gov

3 Haberler. Harmonisation of Education & Training Curricula in East Africa. Available at http://www.eac.int/education/index.php?id=53%3Acurricula-harmonisation&format=pdf&option=com_content&Itemid=106


4 http://www.iucea.org/component/content/article/1-latest-news/241-high-level-qa-forum

5 http://www.africa-union.org/comedaf3.htm

6 Beckers S,Fries M,Bickenbach J, Hoffmann N,Classen-Linke I,Killersreiter B,Wainwright U,Rossaint R,Kuhlen R, Evaluation of a new approach to implement structured, evidence-based emergency medical care in undergraduate medical education in Germany. 2005 Jun;65(3):345-56. Epub 2005 Apr 18. http://www.keepthefaith1296.com/parkinsons/evaluation-of-a-new-approach-to-implement-structured--evidence-based-emergency-medical-care-in-undergraduate-medical-education-in-germany-MTU5MTk1NzM=.htm.

7 Dahle LO, Brynhildsen J, Behrbohm Fallsberg M, Rundquist I, Hammar M. Pros and cons of vertical integration between clinical medicine and basic science within a problem-based undergraduate medical curriculum: examples and experiences from Linköping, Sweden. Med Teach. 2002 May; 24(3):280-5.

8 Karl Kingsley, Susan O’Malley, Tanis Stewart and Katherine M Howard. Research enrichment: evaluation of structured research in the curriculum for dental medicine students as part of the vertical and horizontal integration of biomedical training and discovery. BMC Medical Education 2008, 8:9 doi: 10.1186/1472-6920-8-9. Also available at http://www.biomedcentral.com/1472-6920/8/9

and higher education institutions to continuously engage in dialogue with IUCEA for the purpose of addressing harmonization of higher education systems in the region, which is the critical agenda of IUCEA4.

The Africa Union, also in recognition of the need to facilitate free movement of human resources in the continent, is also pursuing curriculum harmonization initiatives5.

In the global arena, evidence basis for harmonization of curriculum is also contained in several publications. One of these reports effectiveness in a German experience in introducing reforms in undergraduate medical education incorporating systems integration6. Another experience of curriculum integration in dentistry training from Sweden extols the virtues of vertical and horizontal integration in improving knowledge retention, ‘profound learning’ and lifelong learning7, and another experience with integration in dental education is derived from a Texas report detailing research integration into dental curriculum8.

Synthesis of views generated during discussions with various stakeholders comprising academic institutions, regulatory bodies, professional associations, health programs and project leaders indicates that there is unanimity in desire for harmonization of training and the commitment to engage in a harmonization intervention. On the question of perceived feasibility of such an intervention, the majority asserted that it was feasible though a handful were not so positive probably feeling that not enough time and money would be allocated for the same.

DISCUSSION

The literature review and synthesis of views of stakeholders provides overwhelming evidence that there is sound basis for harmonization in medical training and there is sufficient readiness and commitment to action.What may be the sticky point, and which was not appraised in the study, is the process of going about harmonization.


It is proposed that for starters, stakeholders establish concurrence on key concepts and principles of harmonization.

This paper thus proposes a definition and approach

DEFINITION OF HARMONIZATION

Harmonization or Integration? Sometimes used synonymously depending on context. In practice integration may be the more appropriate term in one instance and Harmonization in another. Harmonization as derived from Dictionaries:

• The process and/or results of adjusting differences or inconsistencies to bring significant features into agreement.

• To bring things into harmony, or to make things compatible

Susan Drake and Rebecca Burns provide a simple but useful definition of integration as “making connection”9. Connection of ideas, experiences, and practices

APPROACHES TO HARMONIZATION

A report by Susan and Rebecca is useful in making decision related to the above questions of ‘what’ and ‘how’. They cite from their experiences and review of work done by other educators since the thirties defining three approaches as Multidisciplinary, Interdisciplinary and trans-disciplinary.

• In Multidisciplinary approach the focus is on the discipline, where subjects are organized around a theme. When sub disciplines are integrated within a subject area this is called Intra-disciplinary. Service learning, learning centers and theme based units are examples of Multidisciplinary approaches.

• Interdisciplinary approach involves identifying common learning across disciplines. A good example would be learning on counseling, or professional ethics.

• Trans-disciplinary approach is centered on the learner, and the teacher organizes learning around questions and concerns posed by students. The most powerful example of this approach is project based learning. Another example, which is more common in developed countries, is negotiation of curriculum. In this situation student questions form the basis of the curriculum

CONCLUSION

If there is concurrence on harmonization then follow on action can borrow from the four phased approach of the Inter-university Council of East Africa and standard curriculum cycle:

1. Undertake situational analysis

9 Susan M. Drake and Rebecca C. Burns. Meeting Standards through Integrated Curriculum


2. Synthesis of findings on curricula and approaches of delivery to identify gaps/overlaps and areas to be harmonised

3. Develop relevant harmonized curriculum

4. Facilitate reforms/review of structures/adjustments necessary for implementation of the harmonised curricula.

This can then be merged with the standard curriculum review/development cycle shown in annex

AB-04

HEALTH SYSTEMS MANAGEMENT TRAINING: THE NEW FACE OF SPECIALIZATION IN PHYSICIAN PRACTICE

Rachel Waireri – Onyango, Lecturer in Health Systems Management, Kenya Methodist University, Nairobi Campus

BACKGROUND:

In developing countries, strong and efficient health systems are the backbone of effective healthcare delivery. In order to achieve this, training in health systems management is critical. Consequently, Kenya Methodist University launched the Master of Science in Health Systems Management (MSc HSM) and Bachelor of Science in Health Systems Management (BSc HSM) programs in 2008. Among those that unquestionably need this training are physicians who play a vital role in the six pillars of a health system.

SETTING:

This case study was conducted among graduate students enrolled in the MSc HSM program course at Kenya Methodist University from 2009 to 2011.

METHODS:

Convenience sampling technique was used among students taking HSMG 513 Introduction to Health Systems course. A focused group discussion was the tool used to ask students to give reasons for taking the MSC HSM program as part of the course activity. The researcher then observed student’s growth in their professional areas.

RESULTS:

About 80% of respondents indicated promotion or change to management positions as the main motivator for undertaking a management program. A similar proportion indicated the need for management training in order to cope with their current job responsibilities.


At least 2 out of 5 students have positively progressed in the careers by taking on managerial and/or policy roles. It was also noted that in an average class of 20 students, about 3 out of 5 are physicians.

CONCLUSION:

In reference to the medical fraternity, health system management training paves the way for physicians to fully participate in decision-making arenas, thereby integrating medical perspectives to health system management; bridge the pathways between clinical and managerial processes within health institutions; and produces physicians who are able to comprehend healthcare beyond the clinical setting.

AB-05

OVERVIEW OF MENTORSHIP IN MEDICAL EDUCATION

Dr. Nobert Rakiro-FUNZO Kenya Project

While Mentorship is mentioned or inferred in multiple and a diverse setting even outside knowledge institutions, available reports and experience suggests that there is lack of uniformity in understanding and usage of the term mentorship. The mentoring models and goals of the existing programs in the wider global context vary considerably. Mentorship evolved from business enterprises, later finding favor within the nursing profession and later in the medical academics. Its goal is to promote career development and enhanced performance, and several reports have documented benefits. One study by Gerard Roche (1979) in the settings of the Harvard business school, found that respondents who are mentored were on the average better paid and attained career development faster than comparable group who were not mentored10. Kram (1986) of Boston University reported that mentoring facilitates the socialization of new staff, reduce turnover, minimize mid-career adjustments, enhance transfer of knowledge and values, and facilitate the adjustment of retirement11.

An important element of leadership is to establish a mechanism for nurturing young and emerging leaders, of which mentorship is an important approach. In a national medical training reform, such as the IntraHealth supported Kenya national training mechanism, mentorship is critical in developing sustainable institutional faculties, but is as equally important in strengthening service delivery by ensuring that service providers keep pace with technological advances ion diagnosis, treatment, surgery, and of course evolving epidemiological transitions.

10 Roche, Gerard R., (1979). Much Ado About Mentors. Harvard Business Review, January/February 1979, 14-28.

11 Kram, K. E. (1986). Mentoring in the Workplace. In Hall, D. T. and associates (eds.), Career Development in Organizations (pp. 160-201). San Francisco: Jossey-Bass (1988).


12 Standards to support learning and assessment in practice. NMC standards for mentors, practice teachers and teachers. UK. http://www.nmc-uk.org/Documents/Standards/nmcStandardsToSupportLearningAndAssessmentInPractice.pdf

13 Meinel FG, Dimitriadis K, von der Borch P, Störmann S, Niedermaier S, Fischer MR.

More mentoring needed? A cross-sectional study of mentoring programs for medical students in Germany. BMC Med Educ. 2011 Sep 24; 11:68.

Funzo Kenya, the operational term of the Kenya NTM, is keen to incorporate and strengthen mentorship within the project mandate as means of ensuring quality and sustainability. Based on the principle of evidence based practice, Funzo Kenya is generating best available evidence in designing the mentorship model, which provides the genesis of this study

An important goal of mentorship is achieving professional growth to the level that one is able to make credible independent (technical) decisions. An example of this is the United Kingdom (UK) Nurse Midwife Council (NMC) concept of sign-off mentor attaining competence to make judgments about whether a nursing student has achieved the required standards of proficiency for safe and effective practice12.

A study in Germany concludes that outcome data from controlled studies are needed to compare the efficiency and effectiveness of different forms of mentoring for medical students13. In general, the number of studies with strong evidence on effectiveness of mentorship is limited. A few reports from South Africa were generated from the internet, but their utility in making judgment on effectiveness is equally limited.

This paper asserts that the utility of mentorship is critical in advancing medical professional practice, and is increasingly significant in modern times to keep pace with rapid phase of technological, social, and even epidemiological transition. However failure to gain wide consensus on key mentorship concepts and principles, probably contributing to poor documentation of mentorship experiences has failed to generate strong evidence on which to base more rigorous policy and program strategy advocacy.

This study was undertaken to build the knowledge base around mentorship by synthesizing evidence/experiences in literature as well as experiences from one mentorship program in an academic setting in Kenya and draw learning lessons that can facilitate the improved utility of any future mentorship intervention.

This was a rapid cross sectional study using mainly literature review and interview of members of an institutional mentorship program.

Three important elements of the mentorship program include the act of commissioning, the ‘360 degree’ mentorship ‘cell’ concept and clear targets and linkage to career development. The importance of mentorship is affirmed by the respondents, but gaps are identified in contact time, regularity of interaction, linkage to job description, regularized evaluation, and induction of mentors. Other areas of weakness include networking between mentees and mentors, as well as weak mentor support. Institutionalization of mentorship is mentioned repeatedly as in need of attention.


Findings from the study provide useful insights into the design of more robust mentorship models, including comprehensive evaluation frameworks, but also actionable gaps that can be addressed in any new mentorship program.

CONCEPTUAL FRAMEWORK

A conceptual framework brings together related ideas and theories to facilitate visualization of their interaction and the effect thereof. For purposes of this study a simple framework linking program aspects, mentee aspects and mentor aspects and simple outcome as perceived by mentor was used. A simple M&E framework shown below captures this interaction.

Conceptual frameworks: Classical M&E framework

→ → → →Inputs (Resources) Processes/procedures,

Activities

Outputs Outcomes Intended

Results/Impac tsProgram

Components

Courses

Workshops

Tutors-Mentors

Materials

Management

System

Monitoring

&assessment system

Professional learning

Learning

Knowledge

Attitudes

Skills

development

Attitudes

Aspirations

Behavior,

Practice

Goals

DESIGN & METHOD

This was a rapid cross sectional design using an electronic questionnaire. Synthesis of notes, lessons, and experiences generated during discussion with some leaders of constituent groups and stakeholders in medical/health education sector. This was supplemented with desk/literature review of program/project reports, scientific publications, and electronic databases. This was undertaken as part of the Funzo Kenya background information, and linkage with institutions collaborating in the Funzo Kenya regional hubs.

FINDINGS

The tool was emailed to 30 respondents identified from institutional records and through electronic and physical networks and two follow up reminders, out of which 18 respondents returned the completed form. The 30 represents just under half of the 76 members available in the records, and were those whose contacts were in the electronic mailing list and showed regular responsiveness to communication, and were pointed out by other active members on the list.

Most of the questions were adequately responded to.


DESCRIPTION OF THE TICH MENTORSHIP PROGRAM (TMP)

The TMP was launched eight years ago with the purpose of providing a platform to attract and develop faculty by inspiring them to undertake conduct, publish and dissemination of scientific research while engaging in teaching, supervision and community program work. The study could not discern any specific stimulus for the program other than simply as an academic professional development intervention. It is structured around regularized writing and capacity building workshops/retreats. Participants are encouraged to take charge of incrementally complex tasks in research and consultancy work, and are given time off for proposal writing, research and external attachments.

Upon graduation from the masters in community health and development program, on an annual basis, graduates are invited to apply and join the mentorship program. This invitation is also extended to teaching staff who join the faculty during the index year, and some of who are alumni. Invitation is also extended to students who have registered for PhD. A minimum subscription fee is levied for facilitation of administrative activities. Once application is processed, which basically involves paying the subscription fee and being registered, applicants await invitation to the immediate succeeding commissioning retreat.

During the initial period of program launch, when there was available funding. This retreat had a regular scheduled date/period. However more recently, the dates have become variable as it is built on to other funded retreats or workshops. This means that the process is not regularized and indeed there is no guarantee of a mentorship retreat over a twelve month period. The program description prescribes interactions outside the retreats, but experience indicates that while this may take place among members within the campus, those members who are not formally in the staff establishment do not have this opportunity for regular interaction.

The commissioning entails sworn personal commitment to community and public service.

The new mentee joins a ‘cell’ that is structure through a ‘360 degree’ concept meaning that in the cell there will be other mentees at the same level, and who will be guided by a mentor, who is a senior member of faculty (part time or full time). The mentee is in turn expected to supervise students undertaking masters training within the institution.

During the period of mentorship the mentee is encouraged to plan and achieve seven key deliverable targets listed in the table 1 below.


Table 1: Mentee deliverable targets

TARGET SCORE

Design two successful funded proposals 2

Develop and implement two successful technical evaluation proposals 2

Publish one paper in peer reviewed journal 1

Develop and manage one program 1

External attachment at any collaborating institution, community site 1

Present four scientific seminars 4

Presentation of two scientific papers in conferences 2

Total 13

In addition the mentee is expected to teach and supervise students entering master degree program

Upon attainment of the above deliverables, usually lasting around three years, the mentee graduates, and if a member of staff gets promotion to a higher professional position accompanied by raised remuneration package. Those who are within the TICH faculty are expected, though not forced to remain as part of the TMP with mentor’s role but in association with a senior mentor. Those ‘graduating’ mentee outside the institute are awarded certificates with which they can apply for promotion in their organizations.

Regularization of meetings is dependent on having adequate funding After initial funding dried up, the meetings have became rather infrequent since they have to be linked to other funded activities. This also may have the consequence of diminishing the adequacy of time devoted specifically to mentoring.

CHARACTERIZATION OF MENTORSHIP (MENTEES PERSPECTIVE)

Mentorship is overall rated as important and beneficial

Gaps identified include: challenges in time investment; lack of regularization of mentorship; lack of incorporation of mentorship in the Job description. These as per the questionnaire design, were simply listing without attempt to determine their strengths.

There is good participation of mentee in decision making on mentee-mentor pairing, and the mentorship pairing is satisfactory to most.


Only 61% of respondents rate the technical guidance as above average.

Fig 1: Rating on Technic al guidance

Clear gaps are also identified in limited networking among mentee, and among mentors, as well as lack of induction for mentors. This is summarized in table 2 below.

Table 2: Adequacy of mentorship elements

Elements of mentorship Inadequate % Adequate %

Networking between mentees 6 33.3 12 66.7

Networking between mentors 6 33.3 12 66.7

Induction of mentors 6 33.3 12 66.7

Shared Information about the mentor 4 22.2 14 77.8

Support for mentors 4 22.2 14 77.8

Interaction with the mentorship program 4 22.2 14 77.8

coordinator

Shared Information about the mentee 3 16.7 15 83.3

Information about the mentorsh ip program at the 3 16.7 15 83.3

initial recruitment session

Encouraged work ethics 2 11.1 16 88.9

Encouraged balance social ethics/Good citizenry 2 11.1 16 88.9

Some strengths of the mentorsh ip program include good structuring, target setting, exposure, trust building and room for innov ation as listed in table 3 below


Fig 1: Rating on Technical guidance

Clear gaps are also identified in limited networking among mentee, and among mentors, as well as lack of induction for mentors. This is summarized in table 2 below.

Table 2: Adequacy of mentorship elementsElements of mentorship

Networking between mentees Networking between mentors Induction of mentors Shared Information about the mentorSupport for mentors Interaction with the mentorship program coordinator Shared Information about the menteeInformation about the mentorship program at the initial recruitment session Encouraged work ethics Encouraged balance social ethics/Good

Some strengths of the mentorship program include good structuring, target setting, exposure, trust building and room for innovation as listed in table 3 below

0.020.040.0

Very poor


Fig 1: Rating on Technical guidance

gaps are also identified in limited networking among mentee, and among mentors, as well as lack of induction for mentors. This is summarized in table 2 below.

Table 2: Adequacy of mentorship elements Inadequate % Adequate

6 33.3 12 6 33.3 12 6 33.3 12

Shared Information about the mentor 4 22.2 14 4 22.2 14

Interaction with the mentorship program 4 22.2 14

Shared Information about the mentee 3 16.7 15 Information about the mentorship program at the 3 16.7 15

2 11.1 16 Encouraged balance social ethics/Good citizenry 2 11.1 16

Some strengths of the mentorship program include good structuring, target setting, exposure, trust building and room for innovation as listed in table 3 below

poor Average Good Very good

%

%

Page 13

gaps are also identified in limited networking among mentee, and among mentors, as well

Adequate %

66.7 66.7 66.7 77.8 77.8 77.8

83.3 83.3

88.9 88.9

Some strengths of the mentorship program include good structuring, target setting, exposure,

%


Table 3: Strengths of the mentorship program

Enhances learning and networking if well-structured and everyone is actively involved It is practical and allows

detailed discussion with a mentorSelf decision oriented and one sets targets and works towards achieving them voluntarily. The program exposure

to higher learning teaching and researchMostly gives one all round experienceCollective action planning, giving room for innovations and consensus buildingThe trust building between the mentor and the mentee and the room to choose the mentor Mentors were very

flexible and approachable/mentees shared freely with peersThe interaction between the mentors and mentees and the training content

Some weaknesses of mentorship program are identified as inadequate identification of needs, poor institutional prioritization, inadequate time commitment and poor tracking as listed in Table 4 below.

Table 4: Weakness of the mentorship program

Inadequate identification of mentees needs

Some mentor feels he/she is an authority in the area or line of professionalism Most of the institutions do not recognise the need for mentoring (Mention X2)Most of the mentors are always very busy and do not commit adequate time to mentees (Mentioned X2)

Lack of international exposure to higher learning teaching Inadequate tracking of progress of the mentees

Lack of long term networking and relationship between the mentees and mentors Inconsistency in follow-up of mentees, interaction concentrating only during main meetings

Recommendations for improving mentorship include establishing policy guidance, better structuring, and clearer target setting, regularize induction of mentors and mainstream mentorship in workplace as listed in table 5 below. The questionnaire was designed to produce simple listing of recommendations without assigning any strength value.


Table 5: Recommendations for improving mentorship

Need for better mentorship structure with more experienced mentors in Academic institution as set out in policy guidelines (Mentioned X2

Establish mechanisms to ensure maintenance of relationships between the mentors and mentees beyond work places (mentioned X2)

The mentors should as well improve on sharing of personal experiences and lessons in life. Establish clear and achievable goals set by the mentees with close supervision by the mentors. Encouraging scientific writing and publishing of research work

The Government should have mentors as cadre and establish policy for training institutions have courses for mentorship

Regularize Induction of both mentor and mentee (Mentioned X3)

Establish Policy guidelines that include induction of mentors and mentees, as well as structured framework for follow up mentees (Mentioned X3)

Mainstream Mentorship culture in professional bodies and workplace (Mentioned X3)

DISCUSSION

Three important elements of the TMP include the act of commissioning, the ‘360 degree’ mentorship ‘cell’ concept and clear targets and linkage to career development.

It is difficult from the study tool to identify the specific drivers of the conceptualization and initiation of the TMP other than simply as a faculty or professional development intervention. The study was not well designed to measure exactly how many members have since graduated in terms of attaining the set 13 points, and it is likely that many members drop out, possibly on account of physical relocation or pressure for time. But even that conclusion may be erroneous because they are still in the register, because there is no stated maximum period for being in the program.

The importance of mentorship is affirmed by the respondents. However it is evident that certain elements of structure and quality of mentorship could be improved. These include: contact time, regularity of interaction, linkage to job description, regularized evaluation. Additionally attention needs to be given to induction of mentors. The assumption here that good experience practitioners are automatically good mentors is akin to the mistake made in the medical training field where assumption is made that a good experienced clinician is a good educator.

More need to be done in terms of networking between mentees and mentors. The study provides indication that even mentors need support. And institutionalization of mentorship is mentioned repeatedly.


The gaps in mentorship identified by respondents in the TMP are similar to those identified by Nakanjako et al in a program needs assessment at Makerere College of Health Sciences14.

Committing time for mentorship has to be weighed against other competing tasks and responsibilities. A significant factor in activity of mentorship program resides within the mentor and mentee individually and collectively. There is a limit to which organizations can push a mentorship program, which some people consider need to be mentee driven.

Scholarly study of mentorship remains a challenge in large part due to the nature of mentorship itself. Several methodological issues remain to be addressed, and it is a long way before exacting research repertoire will be available to build the methodologies from current concentration in qualitative methodologies to experimental designs. In this regard this study inspires the need to design a robust, credible and valid mentorship assessment and evaluation framework and use in a control or cohort study design. Another dimension would be to clearly describe different mentorship types and compare their effectiveness. Underlying all these is the need to identify and define clearly the measurable outcomes and how they are to be measured.

EMERGENT CONCEPTUAL FRAMEWORK

Experience from the study inspires need to consider a more comprehensive conceptual framework to strengthen the evidence base of further illumination work on mentorship.

The elements to be considered in strengthening the conceptual framework are summarized in the figure below. Conceptual framework is structured from a number of broad principles, theories and ideas that facilitate identification of the problem/issue, and framing of the question15. This in turn facilitates focusing on search for evidence or literature review16. Sometimes it is useful, or even necessary to use more than one set of ideas, in which case a researcher may need to use more than one framework. Put another way, a conceptual framework identifies the important elements and their connectedness to the issue of concern, the potential interventions and the desired outcome/effect. In developing the conceptual framework it is useful to remember that flexibility enables one to take on board new ideas that may emerge as one expands search for evidence.

14 Damalie Nakanjako, Pauline Byakika-Kibwika, Kenneth Kintu, Jim Aizire, Fred Nakwagala, Simon Luzige, Charles Namisi, Harriet Mayanja-Kizza and Moses R Kamya. Mentorship needs at academic institutions in resource-limited settings: a survey at Makerere University College of Health Sciences. BMC Medical Education 2011, 11:53 doi: 10.1186/1472-6920-11-53

15 Robert Smyth (2004). Exploring the usefulness of a conceptual framework as a research tool: A researcher’s reflections., Issues In Educational Research (IIER), Vol 14, 2004. Available at http://www.iier.org.au/iier14/smyth.html

16 Sociology: Themes and Perspectives; M. Haralambos and M. Holborn; 2008.


In the framework above it is envisaged that contextual or macro level factors have broad ranging implication for most undertakings, including educational systems to which mentorship can be considered to belong. The policies of a country or a program or organization influence the availability of necessary resources, but also the working environment. Broad ranging educational or industrial policies may require or incentivize employers who institutionalize mentorship, while institutional Leadership, Governance and Management may have visions and missions which embrace mentorship. Also considered under contextual factors are social and economic factors because social norms may provide incentives or disincentives, or influence the direction of social interactions. The financial environment of course influences institutional/program priorities especially when the mentorship program has significant financial implications.

The organizational description provides the structure and system (processes/procedures) necessary for operationalizing the mentorship program and have much to do with securing the right inputs at the right time in the right place to facilitate mentor-mentee interaction. Based on the volume and quality of these management interventions the interaction may be effective or ineffective, and may be value added and efficient, or a usual uninspiring routine. One may ask: Who drives the mentorship? In practice some mentorship programs are driven by institutional program mandates, but there are those who assert that a true mentorship program should be driven by the mentee. Synthesis of literature reviewed and the program experience suggests that whichever way you look at in, the interaction between the mentor and mentee is crucial to the success of any mentorship intervention. And within that interaction there are those that are considered as ‘software’ such as trust, and those considered as ‘hardware’ such as technical interaction. The former is hardly covered in evaluations and yet is critical to success going by the mentorship definition.

Page 17

In the framework above it is envisaged that contextual or macro level factors have broad ranging implication for most undertakings, including educational systems to which mentorship can be considered to belong. The policies of a country or a program or organization influence the availability of necessary resources, but also the working environment. Broad ranging educational or industrial policies may require or incentivize employers who institutionalize mentorship, while institutional Leadership, Governance and Management may have visions and missions which embrace mentorship. Also considered under contextual factors are social and economic factors because social norms may provide incentives or disincentives, or influence the direction of social interactions. The financial environment of course influences institutional/program priorities especially when the mentorship program has significant financial implications. The organizational description provides the structure and system (processes/procedures) necessary for operationalizing the mentorship program and have much to do with securing the right inputs at the right time in the right place to facilitate mentormentee interaction. Based on the volume and quality of these management interventions the interaction may be effective or ineffective, and may be value added and efficient, or a usual uninspiring routine. One may ask: Who drives the mentorship? In practice some mentorship programs are driven by institutional program mandates, but there are those who assert that a true mentorship program should be driven by the mentee. Synthesis of literature reviewed and the program experience suggests that whichever way you look at in, the interaction between the mentor and mentee is crucial to the success of any mentorship intervention. And within that interaction there are those that are considered as ‘software’ such as trust, and those considered as ‘hardware’ such as technical interaction. The former is hardly covered in evaluations and yet is critical to success going by the mentorship definition.

Mentee perspectives Mentor perspectives Mentee-Mentor

dynamics

Organisational/program

Content Process Strategies,

Activities

Context Policy Structure/System Social

Attitudes Aspirations Skills (Soft,

hard) Practice Behaviour


The information available from the review and interview with mentees provide a rich source for developing a comprehensive framework which can drive the design of a comprehensive assessment/evaluation tool. It is proposed that an enumeration be made of several identified mentorship programs and application be made to apply the framework and tool(s) in studying those programs, generating useful comparisons in time and space. The knowledge and learning generated can then be disseminated widely beyond national and regional boundaries

The documented experiences from the TMP however highlight important gaps especially related to process, such as induction, training and support of mentors, which can be addressed right away in any new mentorship initiative without need to wait for more evidence.

CONCLUSION

Some of the gaps identified in synthesized information above arise from contextual realities and lack of policy guidance or policy implementation enforcement. Beyond internship most health/medical practitioners do not have an accountable structure that houses a mentorship program. Along with this naturally is lack of resource allocation. Little wonder then that lack of structure is a repeated complaint in mentorship program evaluation. Medical personnel who are lucky to work in discerning institutions have CPD/CME programs, which some people erroneously call mentorship, but which in many instances also suffer from inadequate resource and time allocation because of competing interest with regular tasks that are written in job descriptions.

One may ask: Who is best suited to spearhead an accountable mentorship program? This paper posits that Professional associations have legal mandate but also a professional and social responsibility to do so!


Annex 1: Curriculum cycle blended with curriculum stages/steps

NB: For curriculum review step 7 is the starting point

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Annex 1: Curriculum cycle blended with curriculum stages/steps

NB: For curriculum review step 7 is the starting point

7M&E 1 Needs

Assessment

2Policy

Dvp, Review

3Curriculum Dvp, Review

Syllabus Dvp, Review

Dvp, Review of curriculum support materials

4Preparation for

curriculum Implementation

5Pre-Test,

Piloting, Phasing

6National

Implementation


AB-06

MENTORING MEDICAL STUDENTS:

A CASE STUDY OF KENYATTA UNIVERSITY SCHOOL OF HEALTH SCIENCES

Francisca A. O. Ongecha, MBChB, M.Med (Psych) (Nrb), Kenyatta University

Mentoring is a reciprocal relationship between an experienced, highly regarded, empathetic person and a less experienced student member aimed at fostering the professional and personal development of the student member. Mentoring is acknowledged as a key to successful and satisfying careers in medicine, Kenyatta University included.

Kenyatta University is one of the new medical schools established recently and will be graduating its first group of medical doctors (interns) end of this year. The University has a formal mentoring programme which was rolled in 2006 under the Directorate of Mentoring Programmes for all its students with 250 mentors and a total population of 11000 mentees currently. This programme incorporates four modes of delivery which contribute to a positive university experience and provide student mentees with the support needed to succeed at Kenyatta University. The School of health sciences being part of this programme however does not seem to have mentees in the programme though a few of its staff are mentors.

This paper will describe the objectives, the various modes of delivery of the programme at Kenyatta University; the experiences, challenges and activities undertaken by the School of Health Sciences to integrate and benefit medical students and thus training of doctors.

AB-07

RHEUMATOLOGY WORKFORCE IN AFRICA: THE CHALLENGES OF PROVIDING CARE WITH LIMITED RESOURCES INCLUDING WORKFORCE

Omondi Oyoo FACR FRCP (Edin)

Life threatening communicable diseases, inadequate and over-burdened public health systems, and struggling economies place a tremendous strain on health systems with very limited resources in sub-Saharan Africa.

Poverty, political instability and unemployment compound these challenges and further contribute to the main disparity between the developed and developing world. The health workforce is alarmingly scarce both in numbers and training.

Musculoskeletal conditions though prevalent in Africa remain largely orphan diseases because of fierce competition for scarce resources.


Health professionals, administrators and government officials need to work together and identifythe burden of rheumatic diseases as an important health focus. Partnership between the international community and Africa could be instrumental in achieving this success.Collaboration and funding from international musculoskeletal institutions and the wider community towards the growth and development of rheumatology care in Africa is vital to develop and improve services.

How can you help?

AB-08

NURTURING NEUROLOGY AND NEUROSCIENCE IN KENYA AND EAST AFRICA:SOME REFLECTIONS

Dr. Juzar Hooker-Aga Khan University Hospital, Nairobi

AB-09

HEALTH CARE WORKER TRAINING PROGRAMMES: SHARING THE KENYANEXPERIENCE

Omondi Oyoo FACR FRCP (Edin)

Despite what seems to be a significant burden of rheumatic diseases in East Africa, huge deficiencies in education and training of health professionals exist. World health organization recommends that there should be at least one rheumatologist per 100,000 people. However in sub-Saharan Africa(excluding south Africa), there are less than 20 rheumatologists for over 8000 million people and only four for a population of over 100 million in East Africa.

Appropriate training of suitably qualified staff could help rectify this. Unfortunately, a lack of well -developed curricula for teaching rheumatology in East Africa has resulted in inadequate teaching in medical schools.

Primary care physicians, internists and middle-level care medical careers such as nurses and clinical officers in Kenya currently play a major role in managing these patients .Despite inadequate training, they have to recognize, diagnose and treat patients with MSK conditions. With few functioning rheumatology clinics, patient management is haphazard and without guidelines or adequate intervention strategies.


Bridging the gap between patients and rheumatologists can be achieved by giving basic training to the nurses, clinical officers and primary care physicians who are often the first point of contact for patients. This method is already being used for managing diabetic patients in Kenya and has been successful.

AB-10

EMERGING ROLES OF ICT IN MEDICAL TRAINING AND PRACTICE IN KENYA.

Dr. Okell Julius, Physician. MP Shah Hospital Nairobi.

Kenya has seen an exponential rise of medical training colleges and schools. This has brought challenges in provision of both human and other financial resources required for training of doctors.

Despite the rise in training opportunities Kenya still has acute shortage of doctors to offer both general and specialized care especially in rural areas. There is that need to offer innovative and cost effective solutions to these emerging challenges in training of medical doctors and provision of care.

Information and communication technology (ICT) has brought many changes in medical education and practice in the last couple of decades. Teaching, learning and practice of medicine particularly has gone under profound changes in the developed countries.

In order to catch up with the rest of the world, developing countries need to research their options, design the necessary processes, and implement essential changes in adapting to new ICT technologies to solve challenges medical education and practice.

AB-11

THE CURRENT STATUS OF CPD COMPLIANCE AND REGULATION IN KENYA,FROM KMPD PERSPECTIVE

Dr. T. J. Ochola- KMP&DB


AB-12

WHY DO PATIENTS CONSENT TO PARTICIPATE IN CLINICAL TRIALS?

EXPERIENCES OF CLINICAL RESEARCH PARTICIPANTS IN ELDORET, KENYA

Fatuma F. Some1, 2, Violet Naanyu 3, Abraham M. Siika1, 2

1 Department of Medicine, Moi University School of Medicine, Eldoret, Kenya

2 Moi University Clinical Research Centre, Eldoret, Kenya

3 Department of Behavioral Sciences, Moi University School of Medicine, Eldoret, Kenya

BACKGROUND:

Obtaining informed consent from participants in resource-limited settings is a great challenge. Perceived benefits may encourage enrolment in trials, especially where individuals live in poverty, carry a great burden of disease, and are semi-literate or illiterate.

OBJECTIVES:

To identify reasons why participants in Eldoret consent to take part in a clinical trial and find out their trial participation experiences.

METHOD:

In-depth interviews were conducted on 21 participants from an HIV/TB clinical trial, after completion of their clinic visit. Field notes and audio recording data were stored and analyzed. Emerging themes were logically connected to provide a description of trial participants’ reasons for participating, experiences and thoughts.

RESULTS:

Popular reasons for consenting to participate include access to healthcare and financial support. Some were desperate to get any care because they were HIV infected and very ill, while others were motivated by the anticipated communal good from the clinical trials. A few hoped their participation would result in better understanding of their HIV status and being part of a medical discovery. Others felt they might get employed as community health promoters. Further, advice from their relatives and trust in clinic staff encouraged participation. As regards experiences, the trial was described as “very good” and no one regretted consenting to it. They felt that the staff members conducting the study were friendly, and provided high quality services. All participants enjoyed improved health status and supportive compensatory services.


CONCLUSION:

Popular motivations to participate in clinical trials in Eldoret include access to general care and drugs, and monetary support. Intended benefits and positive study experiences are bound to influence volunteerism. Future studies should explore the association between study benefits, reimbursements, trust in providers, and volunteerism in resource-limited settings.

Key words: Informed consent; clinical trial benefits; clinical trial experiences; Kenya

Corresponding author: F. F. Some, Department of Medicine, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya.

Email: [email protected] Tel +254 722 726199

AB-13

CLINICAL GUIDELINES: THE TIME IS NOW

Dr George Moturi. Nephrologist, Aga Khan University Hospital - Nairobi Kenya

Clinical guidelines are recommendations based on the best available evidence for the care of people by healthcare and other professionals. Tools that guide best clinical practice are antiquity. In fact, ‘’in the 4th century BC, Plato explored the difference between skills grounded in practical expertise and those based solely on following instructions or obeying rules’’. With the exponential growth of technology in the 21st century, there is increased demand on institutions, agencies and governments to provide best clinical practices while maintaining cost-efficiency. Guidelines are relevant to clinicians, health service managers and commissioners as well as patients, their families and care givers. Hence, protocols, policies, recommendations for practice and clinical guidelines have been, and continue to be, developed to offer direction to clinicians - both novice and seasoned. Good clinical guidelines change the process of healthcare, improve outcomes for patients and ensure efficient use of scarce healthcare resources. Kenya is a lowincome country that needs to carefully, and when possible, critically evaluate before adopting, guidelines developed and customized for developed countries. Local guidelines are lacking in almost all areas of clinical practice. Ministry of health policy statements is often mistaken as clinical guidelines to guide patient care. Now is the time for clinicians, government and other stake holders in the health sector to come together and formulate guidelines for local use. Such guidelines will not only be guided by best available clinical practice but also the socioeconomic situation of the country.


AB-14

HYPERTENSION GUIDELINES: THE TIME IS NOW

Dr Mzee Ngunga Interventional Cardiologist, Aga Khan University Hospital Nairobi Kenya

BACKGROUND:

As the country forges forward in the 21st century, the complexity of medicine and medical care continues to change. The spectrum of disease is changing too. By the year 2030, heart disease will be the number one killer. One of the ways we can win the battle against heart disease is widespread awareness and an all-inclusive approach in the delivery of health care to the community. We need to decentralize the treatment of the major risk factors for heart disease.

Hypertension is a chief driver of heart disease, stroke and kidney failure. By developing hypertension guidelines and making sure that these guidelines reach each practicing clinician in this country, we can all prevent stroke, heart disease and kidney failure. These guidelines shall go beyond the traditional approach of prescribing the pill but will form a major framework through which communities will effectively screen, treat and monitor the hypertensive patient to prevent cardiovascular morbidity and mortality.

METHODS:

Through an all-inclusive approach, we need to develop hypertension guidelines. Physicians and notably cardiologists, diabetologists, nephrologists and neurologists should be the drivers of this process with other stake holders providing necessary support.

CONCLUSION:

It is hoped that physician involvement in this noble activity will steer the country to a new path in medicine that will help the medical community forge new ground to fight the oncoming epidemic of cardiovascular disease. We shall embark on a path where the primary doctor is empowered to conduct primary and secondary prevention of CVD. The benefits of such guidelines will be immense to this country in terms of efficiency in health care delivery and cost savings.


AB-15

THROMBOLYSIS (TENECTEPLASE) IN ACUTE ISCHEMIC STROKE

Dr. Sanjeev Parmar Aga Hospital Kisumu

Intravenous Alteplase is the only approved treatment for acute ischemic stroke. Tenecteplase, a genetically engineered mutant tissue plasminogen activator, is an alternative thrombolytic agent. Alteplase is far from ideal, with incomplete and often delayed reperfusion in many patients.Tenecteplase, a genetically engineered mutant tissue plasminogen activator, has some pharmacokinetic advantages over Alteplase. A balance between efficacy and risk of bleeding in the treatment of stroke appears to be achieved at a lower dose of Tenecteplase than the dose used for myocardial infarction.Availability of Alteplase is an issue. Since April 2012, I have three cases of Acute Ischemic stroke who fulfilled the Criteria and did not have contraindication for Thrombolysis were Thromboloysed with Tenecteplase which we have used for other indications (Myocardial Infarction and Pulmonary Embolism). This is the First ever use of Tenecteplase in Stroke patients in Kenya and probably in Africa.Use and success of Tenecteplase in relation to Stroke will be presented.

AB-16

CARDIOVASCULAR RISK FACTORS IN RENAL TRANSPLANT RECIPIENTS ATTENDING NEPHROLOGY CLINICS IN NAIROBI, KENYA

Wagude JA, Kayima JK, Ogola EN, Mcligeyo SO, Were JO

OBJECTIVE:

To determine prevalence of established cardiovascular risk factors in renal transplant recipients in Nairobi, Kenya and to analyze for any associations with age, gender, duration of dialysis pretransplant, medications, immunosuppressant’s, cause of CKD, pre-existent diabetes or hypertension, and type and number of renal allografts

DESIGN:

Cross-sectional clinic based descriptive study

Setting:Nephrology clinics at Renal Unit, Kenyatta National Hospital (KNH), KNH Doctors Plaza, Nairobi Hospital Doctors Plaza and Parklands Nephrology Centre

SUBJECTS:

Adult renal allograft recipients attending nephrology clinics in Nairobi


MAIN OUTCOME MEASURES:

Hypertension, obesity, decreased glomerular filtration rate (GFR), smoking, hypertension, diabetes mellitus, impaired fasting glucose, anemia, dyslipidemia, proteinuria, immunosuppressant agents

RESULTS:

Ninety one (91) renal allograft recipients were evaluated with male to female ratio of 2.1 to 1 and mean age of 44.2 years (SD12.44). Hypertension, dyslipidemia and abdominal obesity by waisthip ratio were the most prevalent risk factors at 95.6%, 73.6% and 68.1% respectively. Statistically significant associations noted included presence of a second renal allograft and NODAT (P = 0.011) as well as history of pre-transplant diabetes mellitus and use of insulin with impaired graft function (P = 0.026 and P = 0.004 respectively). Most allograft recipients were on Prednisolone, Cyclosporine and Mycophenolate mofetil combination therapy with those on Azathioprine having the longest duration of exposure (142.0 months) while those on Everolimus had the shortest duration (7.5 months).

CONCLUSIONS:

There is a high burden of cardiovascular risk factors among renal transplant recipients who should be prioritized as a high risk cohort for cardiovascular mortality. Adaptation of international guidelines on cardiovascular risk factors control is a priority and larger studies should be done to assess the control of diabetes mellitus and hypertension

AB-17

PATTERN OF COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) USE AMONG INDIVIDUALS WITH DIABETES IN A TERTIARY CARE HOSPITAL IN KENYA

Duncan Matheka1, 2, Jeremiah Munguti1, 3, Cecilia Munguti2, Peter Waweru2

1Fifth year Medical Students, University of Nairobi; 2Department of Medical Physiology, University of Nairobi; 3Department of Human Anatomy, University of Nairobi

Correspondence: [email protected]

AIM:Complementary and alternative medicine (CAM) is common in patients with chronic diseases such as diabetes mellitus. The role of CAM in the management of diabetes is an emerging health issue given the potential side effects and benefits associated with the use of this kind of medicine.The purpose of the current study was therefore to establish the pattern of use of CAM in patients with diabetes.


METHOD:

One hundred and ninety eight (198) patients visiting the Diabetes outpatient clinic of Kenya’s main referral hospital (Kenyatta National Hospital), over a 2-month period in 2012, were interviewed regarding use of CAM in the past. Information was gathered on the patients’ demographics, type(s) of CAM used, sources of recommendation, reasons for opting for CAM and areas of satisfaction and dissatisfaction associated with the use of CAM.

RESULTS:

Overall, 60.1% of patients had used CAM alongside or as a complement to conventional health care service. Herbal medicine, dietary supplements and prayer were the most frequently used CAM modalities. The most commonly cited reason by patients for using CAM was recommendations by family and friends (67.2%). Other reasons were: the need for patients’ better control of their diabetes and also dissatisfaction with conventional medicine. However, more than half of the patients eventually became dissatisfied after using CAM.

CONCLUSION:CAM was widely used among Type 2 diabetics as an adjunct to their conventional therapy. The self-administration of both conventional medicines and CAM without disclosure of CAM use to healthcare professional’s results in ineffective diabetes management and adverse effects. The findings highlight the need for further research on the role of CAM in the prevention and management of diabetes.

AB-18

BASIC CANCER SCREENING: AN UNMET NEED

Dr Sitna Mwanzi. Aga Khan University Hospital, Nairobi

BACKGROUND:

Data from the World Health Organization estimates that 70% of all global cancers deaths occur in middle and low income countries with the overall incidence expected to continue rising. According to the draft National Cancer Control Strategy, it is estimated that cancer is the third leading cause of death in Kenya although robust data on cancer incidence and its related mortality is lacking. Late presentation is still prevalent due to lack of awareness, screening, diagnostic tests and access to cancer care for a majority of our patients. This report also states that approximately 40% of all cancers are preventable.

Screening and early diagnosis have been shown to reduce the incidence and mortality of various cancers as well as increase the rate of cure in some cancers such as breast and cervical cancer.

Some cancer screening methods are easy to perform even in resource limited areas and may be easy to implement and integrate into already existing services such as maternal child health clinics and HIV clinics.


METHODS:

A review of current literature on the screening for several cancer types mainly breast, cervical, prostate and colon cancer among others was done to establish current guidelines of screening and benefits of screening. Basic cancer screening methods easily applicable regionally were identified

EXPECTED PRESENTATION:

A summary of the current cancer trends and effective screening tools will be presented. Basic cancer screening techniques and appropriate follow up of abnormal results will also be discussed.Integration of screening with other medical services will be emphasized.

AB-19

MANAGEMENT OF LYMPHOMAS: CHALLENGES AND RECOMMENDATIONS

Dr. Chite Asirwa MOI University, School of Medicine

Despite global improvements in diagnosis and management of lymphomas, majority of patients in Kenya, like most sub-Saharan Africa have not benefited. There have been numerous advances in basic, clinical and translational research in understanding the molecular biology of lymphomas leading to development of high number of therapeutic agents with targeted mechanisms of actions that have ultimately improved overall survival. Unfortunately in our settings, we have not been able to translate the said gains into improved patient outcomes due to challenges in diagnostics, workforce, treatment protocols, cost, survivorship care, outcomes data, referral patterns and appropriate local-based research. This paper will attempt to enumerate these challenges and offer some recommendations for improvement in the quality of care in the management of Lymphomas.


AB-20

CASE REPORT: AGGRESSIVE CANCER OF THE LOWER THIRD OF ESOPHAGUSIN A 16 YEAR OLD BOY.

Dr. Amos Ayunga

HISTORY:

A 16 year old presents with a one year history of progressive dysphagia. He did not have fever, cough or poor appetite. There is no history of ingestion of caustic substances. There was no history of gastro esophageal reflux disease, peptic ulcer disease and no history of trauma to the neck. There was no history of hoarseness of voice or difficulty in breathing.

When examined he was found to be extremely wasted, dehydrated but had no pallor, lymphadenopathy. He was sent for an endoscopy in which a huge obstructing tumor was found in the lower third of the esophagus. A biopsy was removed and taken for histology which revealed a adenocarcinoma of the esophagus.

Treatments: Patient was referred for cardiothoracic surgery review in which esophagectomy was done. The patient had a stormy post-operative period in which he developed sepsis, bilateral and recurrent pleural effusions. He died while undergoing treatment.

AB-21

TTP/HUS IN ADULTS: 3 CASE REPORTS

Dr. Jonathan Wala. Aga Khan University Hospital, Nairobi

TTP/HUS is a group of thrombotic microangiopathic disorders characterized by thrombocytopenia, microangiopathic hemolytic anemia and micro vascular occlusion, often resulting in brain and kidney ischemia. Although rare, it should always be considered in any patient presenting with acute kidney injury associated with thrombocytopenia. Therapeutic plasma infusion (including plasmapharesis) is an effective treatment modality. 3 case reports are presented to heighten the index of suspicion regarding this catastrophic disorder and to illustratethe challenges faced in its diagnosis and management.


AB-22

CASE PRESENTATION: ADULT STILL’S DISEASE, AN ELUSIVE DIAGNOSIS

Dr. Amos Ayunga. Garissa Hospital, Kenya

A 23 year old gentleman of African descent presents with a skin rash, joint pains and fever for a duration of 3 weeks. The fever was high grade but the patient was not sick looking. Temperature ranged from 38-40 C0. He had generalized joint pains but had no joint effusions. The patient had evanescent salmon-colored non pruritic rash that was mainly on the chest and abdomen. A full hemogram revealed a white blood cell count of 27x109 with 90% being neutrophils. A blood culture was negative .A bone marrow aspirate and peripheral blood film excluded leukemia as it reported a normal marrow. Anti-Cyclic citrullinated antibodies (Anti-CCP) were negative at 2.0 EU/ml (0-10).

Management:

Patient was initially treated for septicemia with strong antibiotics despite a negative blood culture but without improvement. Patient was then sent for a consultation in which Adult Still’s disease was suspected because of the spiking fevers, elevated WBC, the rash on the trunk and the arthritis. The patient was put on high-dose aspirin at 900mg 1 g tid, hydroxychloquine 200mg bid and prednisone at 15 mg tid. The patient responded quite well but the condition has been recurrent on stopping the treatment.

AB-23

NEW ORAL ANTICOAGULANTS IN VENOUS ARTERIAL THROMBOEMBOLISM (VAT)

Dr Wala Elizabeth

Thrombosis is the formation of a blood clot inside a blood vessel, blocking a vein (venous thrombosis) or artery (arterial thrombosis). Venous Arterial Thromboembolism (VAT) is caused when some or all of a clot detaches and is moved within the blood stream until it obstructs a smaller vessel.

VAT is responsible for a number of serious and life threatening conditions:Venous Thromboembolism (VTE) occurs when part of a clot formed in a deep vein, for example in the leg (known as deep vein thrombosis, or DVT), is carried to the lung, via the heart, preventing the uptake of oxygen. This is known as a pulmonary embolism (PE), an event which can be rapidly fatal Arterial Thromboembolism occurs when oxygenated blood flow from the heart to another part of the body (via an artery) is interrupted by a blood clot.


If this occurs in a vessel supplying blood to the brain, it can lead to a stroke, an event that can be severely debilitating or fatal. If it occurs in a coronary artery, it can lead to acute coronary syndrome (ACS), a complication of coronary heart disease which includes conditions such as myocardial infarction (heart attack), and unstable angina.

TREATMENT OF DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM

The most effective and economical approach to decreasing the burden of VTE is to prevent the development of DVT and PE in patients at high risk.

However, DVT and PE continue to be a common problem in hospitalized patients, and in some cases this may be attributable to underutilization of thromboprophylaxis. DVT and PE also develop spontaneously in non hospitalized patients. Prompt diagnosis and treatment of DVT are essential to decrease the risk of recurrence and also a potentially fatal PE.

The goals of DVT and PE treatment are:• Prevention of thrombus growth• Symptomatic relief• Prevention of DVT and PE recurrence

Traditionally, initial treatment of DVT and PE begins with a parenteral anticoagulant, transitioning to longer-term vitamin K antagonist (VKA) therapy, often with Warfarin. Because VKAs have a delayed onset of action, the transition requires close monitoring of the international normalized ratio (INR), which should be in the therapeutic range (INR 2.0–3.0) before discontinuation of the parenteral agent

The direct Factor Xa inhibitor rivaroxaban is the first novel oral anticoagulant approved in the EU for the treatment of DVT, PE and prevention of recurrent DVT and PE in adult patients. It can be used for the initial and longer-term treatment of DVT, PE and recurrent VTE. This singledrug approach removes the need for overlapping administration of heparin and a VKA, which can be complex owing to the requirement for coagulation monitoring and dose-adjustment of the VKA.

ATRIAL FIBRILLATION-RELATED STROKE: A MAJOR HEALTHCARE BURDEN

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia seen in clinical practice. AF is primarily a condition of the elderly. Diagnosis of AF is confirmed by electrocardiography.

AF is a major risk factor for stroke:Thrombi form in the fibrillating left atrium of the heart in patients with AF – most commonly in a small pocket in the left atrium called the left atrial appendage. These can embolize and travel to the brain, resulting in ischemic stroke Consequently, patients with AF have an approximately fivefold increased risk of stroke.


Strokes that occur in patients with AF are generally more severe and are associated with greater mortality and morbidity than those in patients without AF. Stroke in patients with AF results in longer hospital stays and greater healthcare resource use and costs for the healthcare system than in those without AFThe objectives of treating AF are to relieve symptoms (when present) and to optimize cardiac function. In addition to restoring heart rhythm or controlling heart rate, another goal of treatment is to minimize the risk of stroke by preventing thrombus formation in the heart.

A crucial part of AF management is the prevention of thromboembolism and AF-related stroke, which can be achieved by using anticoagulants and less effectively by using antiplatelet agents. Currently, the most widely used medications for preventing thrombosis in patients with AF are Vitamin K antagonists (VKAs). VKAs have proven efficacy but lack many of the properties of an ideal anticoagulant. Novel oral anticoagulants that meet most of these criteria – such as those with a wide therapeutic window, that lack a requirement for routine coagulation monitoring or frequent dose adjustments, that have predictable pharmacokinetics and pharmacodynamics andlow risk for drug–drug or drug–food interactions (resulting in more predictable anticoagulation) – have the potential to improve the quality of care. For these reasons, the 2012 European Society of Cardiology (ESC) guidelines on the management of AF recommend new oral anticoagulants rather than adjusted-dose VKA (INR 2–3) for most patients with non-valvular AF, based on their net clinical benefit.

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ADVERSE EVENTS IN A PATIENT WITH MIXED CONNECTIVE TISSUE DISORDER RECEIVING TUBERCULOSIS TREATMENT

Dr. Gordon Peter Yossa Aga Khan Hospital, Pandya Memorial, Mewa Hospital – Mombasa

Email : [email protected] [email protected]

INTRODUCTION:

In the immune compromised patient having systemic Rheumatoid disease requiring immune suppressive therapy, tuberculosis presentation is protean and prone to multiple adverse drug reactions which can be fatal. This coupled with Rheumatology services being in infancy, impacts negatively on adherence. Expertise in management of adverse drug reaction is often lacking in the team.


CASE REPORT:

35 years old married female (Kenyan resident in Italy – 7 years), known case of “Mixed Connective tissue disorder” since 2004 remaining in stable remission on Hydroxychloroquine 100mgms, Prednisone 5mgms, Losec 20mgms – all daily, with Nimesulide 100mgms prn.Diagnosed with Ileacaecal TB (30th May 2011) initiation of TB drugs twice was not successful up to 9th July, 2011, developing severe idiosyncratic reactions: rashes, headaches, orbital eodema and severe neutropenia.Returned to Kenya, seen on 25th July 2011 and admitted. Discharged on 14th August, 2011 with follow up on 8th

September, 2011.Remained HIV 1&11 Sero non reactive. Routine Rheumatic drugs continued.

Methods applied:Monitoring – clinical, renal and hepatic profiles, eudiometry, ophthalmological examination, nurses and patient education. An experienced Dermatologist consulted.Reinstitution of TB drugs done with small doses escalated every 3rd day, taking with food split if gastrointestinal symptoms experienced.

OUTCOME:Medication tolerated: Klacid, Ciproxin, Amikin, Ethambutol, PZA and Zyloric. Adverse events with Avelon and Streptomycin no consent for INH/ RIF reciting the worst experience before.Improved remarkablyAdverse events are then discussed.

CONCLUSION:Adverse events are common in this subset of patients. Thorough consultation is necessary, Patient education is most important and team work is emphasized. There is need for more research and public education.

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RHEUMATOID ARTHRITIS: CURENT MANAGEMENT CONCEPTS

Dr Paul Etau Ekwom. Medical Specialist (Physician and Rheumatologist); Department of Medicine, Kenyatta National Hospital.

INTRODUCTION:

Rheumatoid arthritis (RA) is a chronic inflammatory arthritis associated with functional decline and early mortality. There are recent advances in diagnosis, treatment and management of comorbidities.

METHODS:

Literature search of past 5 years on recent advances in the diagnosis and management of rheumatoid arthritis.


RESULTS:

Diagnostic: advances in laboratory tests: anti-CCP (ELISA anti CCP 2 and 3), anti-SA antibodies, and new classification criteria, recognition of early RA and very early RA and use of musculoskeletal ultrasound.

Treatment: Treatment of early and very early rheumatoid arthritis; treatment to target and concept of personalized therapy and new and emerging biologics.

Co-morbidities; recognition and management of cardiovascular risk factors in RA.

CONCLUSION:

Rheumatoid arthritis is a complex chronic inflammatory arthritis. Early treatment and treatment to target is now the accepted treatment modality. Recognition and management of cardiovascular risk factor is important.

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SUCCESSFUL TREATMENT OF NEUROPSYCHIATRIC LUPUS ERYTHEMATOSUS WITH INTRATHECAL METHOTREXATE.

Dr Philip Simani, Dr Shabbir Hussein, Prof. Kioy

Neuropsychiatric abnormalities occur frequently (14-75%) in patients with systemic lupus Erythematosus. Immunosuppressive with or without high dose steroids are the mainstay of treatment. We report a successfully treated case of neuropsychiatric systemic lupus Erythematosus presenting as psychosis, organic brain syndrome and flaccid paraplegia with Intrathecal Methotrexate.

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BELIMUMAB FOR THE TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS(SLE) IN NAIROBI: A CASE REPORT.

Dr Paul Etau Ekwom. Medical Specialist (Physician and Rheumatologist); Department ofMedicine, Kenyatta National Hospital.

INTRODUCTION

Belimumab is a fully human recombinant IgG1λ monoclonal antibody that binds to soluble B lymphocyte stimulator (BLYs) with high affinity. It exerts its activity by preventing the binding of BLyS to its receptors. It is approved by the Food and drug administration for use in SLE.


CASE PRESENTATION:

I.W.N a 43 year old female SLE for past 20 years. She has positive anti-nuclear antibodies with also persistent anti-dsDNA positivity.

Current meds: prednisone 10 mg daily, Azathioprine 150 mg daily, Hydroxychloroquine 400 mg daily, Amitriptyline, Tramadol and paracetamol combination and sunscreen.She presented with muscle pains, increasing fatigue, oral ulcers, muscle weakness and joint pains. She also has sleeping difficulties. Her examination revealed oral ulcers, tender wrists and pleural rub with proximal muscle weakness.

Laboratory tests carried out revealed erythrocyte sedimentation rate of 28 mm/hr; C-reactive protein (CRP) of 13 mg/dl, Anti-ds DNA 690/iu/ml. urine: pyuria (25/ hpf), and low C3 and C4 SLE disease activity index (SLEDAI) score: 14Treatment

1. I.M triamcinolone2. Work up for Belimumab : mantoux, HIV, HBsAg and HCV3. Belimumab at 10mg/k administered as per schedule.

CONCLUSION:

Belimumab is a new addition in the treatment of patients who have SLE who are ANA positive,anti-dsDNA positive with moderate to high disease activity score.

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HIV AND INFLAMMATION: A NEW THREAT

J.A. Aluoch

Traditionally, it was thought that the natural course of HIV included a period of latency – a time when the virus was inactive, often for years. This seemed to be a respite from the harsh effects that HIV can have on the body. But according to recent studies, this “latency period” may not be what it was originally thought to be – in fact, HIV may have a greater impact on the body and immune system than we ever imagined. Previously, it was assumed that the higher the CD4 count, the greater the level of protection. When CD4 counts were high, the risk for AIDSdefining opportunistic infections and other diseases was thought to be quite low, perhaps even nonexistent. But now we’re seeing serious conditions like heart, liver, and kidney disease in people with higher CD4 counts. And we’re also seeing more deaths in people whose CD4 counts are above 200.


It appears that during this period of “latency” HIV is not silent, that CD4 levels may not indicate what is happening inside the body, and that inflammation may be affecting many organ systems. So the question is, how is this happening? To answer this, we can look at the SMART study, one of the first to reveal this effect. In this study, people who stopped their HIV meds when their CD4 count rose above 350 had higher rates of AIDS-defining opportunistic infections and non-AIDS conditions, as compared with those who stayed on HIV therapy. They had higher amounts of virus in their blood, and those higher levels were associated with inflammation.

WHAT IS INFLAMMATION?

When the body fights invaders like viruses or bacteria, or repairs injured tissues, fluid and cells get transported to the site of injury. As the body heals, the cells can become sore. One theory is that as HIV chronically infects the body, cells and tissues are destroyed and then heal, activating the immune system. That leads to an over stimulated immune system that can become burned out or weakened.

So, even though a lab result may show a high CD4 count, the amount of inflammation in the body may be causing damage on a cellular level. And that can lead to heart, liver, kidney disease, and greater levels of bone loss. Evidence shows that while HIV medications may play a role, they are not the only culprit. During the SMART trial, when people who stopped their HIV meds restarted them, levels of inflammation decreased but never became normal.

There remained a residual level of inflammation and a greater number of cardiovascular events occurred, especially in people who started the study with undetectable viral loads. Because high levels of inflammation are thought to increase atherosclerosis and heart disease even in people who don’t have HIV. In the SMART trial, there were higher rates of heart, liver, and kidney disease among people with HIV at younger ages, even after controlling for differences in age and gender.

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OBESITY TREATMENT WITH BARIATRIC SURGERY AND PSYCHOLOGICAL METHODS OF WEIGHT CORRECTION, CONTRARY TO ROUTINE USE OF COUNSELING.

Dr. Lyudmyla Shchukina

BACKGROUND.

This presentation was designed to demonstrate a new approach in obesity treatment. We combine2 methods: Psychological methods of weight correction invented by Ass. Prof. - I. Varaksin (Ukraine) and Bariatric Surgery or gastric balloon. Since 2003 Psychological methods of weight correction with long term psychotherapy we us in Kenya.


For the past 4 years we combine Bariatric surgery/gastric balloon with Psychotherapy. We would like to share our observations in:

1. Psychological methods of weight correction of Ass. Prof. - I. Varaksin.

2. Benefits of combining bariatric surgery with psychotherapy, contrary to Bariatric surgery with counseling.

METHODS.

Group A.Ninety seven (97) patients were treated with psychotherapy and right the food diary. 88 patients completed the treatment (2010-2012). Method is based on targeting social, subconscious psychological and homeostatic factors, while using techniques of auto training, psychotherapeutic tranquilization, NLP, persuasion and encoding, psychoanalysis...Attention was to compliance, effective weight loss and maintenance for min 2 years.

Group B.15 patients treated by combination of gastric balloon with psychotherapy (2011-2013).

RESULTS

Follow up data was collected on 88 patients, in group A, and 15 patients in group B.

In group A 14.5% weight loss achieved in obesity class 1, and 10.6% - in obesity class 2, with no complications.

In group B all patients had a balloon for 6 month, except of one who requested to remove it the next day due to discomfort.

5 patients only had gastric balloon (subgroup B1), while 9 other had gastric balloon with psychotherapy (subgroup B2).

11.2% mean weight loss achieved in obesity class 2 & 3, subgroup B1. 21% mean weight loss recorded in obese class1, and 24% - in class 3, subgroup B2. In subgroup B2 we had 2 diabetic cases: 43 yr old lady, on 62 units of insulin with BMI 46. In 6 month she lost 35 kg and now she is off insulin. 58 yr old man, on 56 units of insulin after losing 16 kg his insulin was reduced in half. Both patients got excellent control of BP.


CONCLUSIONS:

Role of Social, Subconscious Psychological factors is underestimated in non-surgical and bariatric treatment for obesity. To control psychological factors in eating habits is not easy, that is why long term psychotherapy is beneficial in contrary to routinely used counseling.

Dr. Varaksin’s Psychotherapeutic methods can be a treatment of choice for class 1 & 2 obesity.4.Weight loss will give possibilities to obese Type 1 diabetic patient to reduce medications andType 2 diabetic - to recover from diabetes.

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MAGGOT DEBRIDEMENT THERAPY IN THE TREATMENT OF NON–HEALING CHRONIC WOUNDS IN KENYA REPUBLIC

Peter Takáč1,2; Milan Kozánek2; Phoebe Mukiria3; Grace Murilla3

1Scientica,Ltd., Bratislava, Slovakia2Institute of Zoology, Slovak Academy of Sciences, Bratislava, Slovakia

3Kenya Agricultural Research Institute-Trypanosomiasis Research Centre (KARI-TRC); Muguga; Kenya

Maggot therapy (MT) is the therapeutic use of sterile medical grade larvae ofnecrophagic/coprophagic flies to treat chronic wounds. The maggots act by feeding only on necrotic tissue that covers the wounds. The maggots are produced in a sterile manner in the laboratory and the fly most commonly used is Luciliasericata (or green bottle fly) but other species have been used with similar efficacy. MT has also been called biosurgery or larval therapy (larval debridement therapy) and can be described as a carefully controlled process where an artificial therapeutic myiasis is induced. The health care professional makes use of the natural ability of maggots to ingest necrotic or infected tissue without affecting healthy tissue, reducing bacterial burden locally and promoting wound healing.Thismethodisapplicable to both humans and livestock suffering from chronic wounds.

A new facility has been built at the KARI- Trypanosomiasis Research Centre, Muguga, with support from Kenya Government, Slovak Aid, Government National Programme, Scientica, Ltd. And the Institute of Zoology, Slovak Academy of Sciences, to produce sterile maggots for use in Kenyan hospitals. The staffs from the centre have been trained at the Institute of Zoology, Bratislava and in the facility of Scientica, Ltd., where a similar biolab has beenoperatingsince2005, supplying sterile maggots to more than 15 hospitals in Slovakia. KARITRC is able to introduce the same technique in Kenya, with a view to collaborating with local hospitals to introduce an alternative method of managing wounds in the country. This is in appreciation of the fact that where they occur, they cause considerable morbidities and loss of productivity, especially when the wounds lead to loss of limbs through amputations and long term medical care.


“Maggots are the world’s smallest surgeons. In fact they are better than surgeons- they are much cheaper and work 24 hours a day……”

This work had been funded by the Operational Program of Research and Development and cofinanced with the European Fund for Regional Development (EFRD). Grant: ITMS 26240220030: Research and development of new bio-therapeutic methods and its application in some illnesses treatment.


NOTES