East African medical journal最新文献

{"title":"THE INCIDENCE AND RISK FACTORS FOR INTRA-OPERATIVE HYPOTHERMIA AMONG PAEDIATRIC PATIENTS UNDERGOING GENERAL ANAESTHESIA AT THE KENYATTA NATIONAL HOSPITAL.","authors":"P. M. Kioko, P. Olang, C. Mwangi, T. Chokwe","doi":"10.4314/EAMJ.V90I8","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I8","url":null,"abstract":"OBJECTIVE\u0000To determine the incidence and risk factors for intra-operative hypothermia in paediatric patients undergoing general anaesthesia at the Kenyatta National Hospital.\u0000\u0000\u0000DESIGN\u0000A prospective observational study.\u0000\u0000\u0000SETTING\u0000The Kenyatta National Hospital main operating theatres and affiliated satellite operating theatres.\u0000\u0000\u0000SUBJECTS\u0000A total of 100 paediatric patients (range; three days to 12 years, mean; 4.1 ± 3.3 years) were enrolled in the study.\u0000\u0000\u0000RESULTS\u0000Thirty out of 100 patients developed hypothermia defined as a core temperature < 36 °C recorded at least once during provision of general anaesthesia. Ninety percent of those developing hypothermia were male compared to 63% who remained normothermic (p = 0.006). Proportionally, more than twice as many hypothermic patients had a caudal block (43% versus 20%, p = 0.016) and received 121 ml more of fluid (p = 0.002) compared to the normothermic group. The patients who became hypothermic tended to be colder at induction of anaesthesia (36.6 ± 0.5°C versus 37.0 ± 0.5 °C, p = < 0.0001) but there was no significant difference in the waiting time, time of induction, environmental temperatures or theatre temperatures compared to those not developing hypothermia. There was no significant difference in the BMI between the two groups (14.0 ± 2.9 kg/ m2 versus 15.2 ± 3.5 kg/m2, p = 0.101).\u0000\u0000\u0000CONCLUSION\u0000The incidence of intra-operative core hypothermia in paediatric patients undergoing general anaesthesia at the Kenyatta National Hospital is 30%. Gender (male), lower body temperature at induction, use of caudal block and the volume of intravenous fluids infused were significant independent predictors of core hypothermia. The most significant predictor was body temperature at the time of induction of general anaesthesia.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"90 8 1","pages":"241-7"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4314/EAMJ.V90I8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPACT OF CLINICAL OFFICER ANAESTHETIST TRAINING PROGRAMME AT THE KENYA MEDICAL TRAINING COLLEGE, NAKURU, ON TRAINEE SATISFACTION, QUALITY OF PRACTICE, AND CADRE SHORTFALL ALLEVIATION.","authors":"Titus Mutwiri, J. Magambo, E. Zeyhle, G. Mkoji, C. N. Wamae, E. Mulinge, H. Wassermann, P. Kern, T. Romig","doi":"10.4314/EAMJ.V90I7","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I7","url":null,"abstract":"Objective : To determine the impact of Clinical Officer (C.O) Anaesthetist Training programme at Kenya Medical Training College (KMTC) Nakuru, on Trainee satisfaction, quality of practice and cadre shortfall alleviation. Design : Cross-sectional descriptive study Setting : Kenya Medical Training College, Nakuru. Subjects : All thirty one Clinical Officer Anaesthetist graduates from KMTC Nakuru, since the training programme started 8 years ago. Results : Twenty nine of the 31 C.O Anaesthetist graduates responded. Twenty six of the 29 respondents (89.7%) passed in the final qualifying examination in the first sitting. Twenty one (72.4%) are working in Public health facilities. All graduates are distributed in 16 out of the 47 counties in Kenya. Twenty six (89.7%) are satisfied with the training. Their average working week is 54 hours, with a median of 45 working hours a week. They recommend an improvement in peripheral nerve blocks and epidural training in the 2005 curriculum. Conclusion : C.O Anaesthetist training in KMTC Nakuru over the last eight years has produced self reported satisfied, adequately trained graduates and has had an impact in alleviating shortage of this cadre in Kenya. Improvement in peripheral nerve blocks and epidural training is needed.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"90 1","pages":"226-234"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of hypertensive emergencies.","authors":"Jaya R Mallidi, S. Penumetsa, A. Lotfi","doi":"10.4172/2167-1095.1000117","DOIUrl":"https://doi.org/10.4172/2167-1095.1000117","url":null,"abstract":"Hypertension is a common problem encountered in everyday clinical practice. Patients with poorly controlled hypertension may present to the emergency room with “hypertensive emergency” - severely elevated blood pressure (>180/120 mmHg) associated with end organ damage, involving neurological, cardiovascular or renal systems. There is a paucity of literature regarding the preferred rate of decline of blood pressure, while treating these patients, as well as the appropriate medications to be used. Based on expert opinion and anecdotal data, it is recommended that the initial management should focus on promptly identifying impending or established end organ damage and decreasing the blood pressure by about 25% in the first 2 hours, except in aortic dissection where rapid lowering of blood pressure is recommended. This review provides a focused approach to the management of hypertensive emergencies.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"66 4 1","pages":"241-2"},"PeriodicalIF":0.0,"publicationDate":"2013-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2167-1095.1000117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70816942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RISK OF RED BLOOD CELL ALLOIMMUNISATION IN RWANDA: ASSESSMENT OF PRETRANSFUSION CROSSMATCH TECHNIQUES USED IN DISTRICT HOSPITALS.","authors":"E. Ndahimana, A. Gothot, C. Gérard, F. Senyana, S. R'Zik, O. Mukabayire, L. Mutesa","doi":"10.4314/EAMJ.V90I4","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I4","url":null,"abstract":"BACKGROUND\u0000Screening of alloantibodies in patients is not yet done in district hospitals of Rwanda. The practice is to transfuse ABO/D compatible blood following an immediate spin crossmatch (IS-XM) or indirect antiglobulin test crossmatch (IAT-XM).\u0000\u0000\u0000OBJECTIVES\u0000To assess the risk of red blood cell (RBC) alloimmunisation associated with the use of IS-XM compared to the IAT-XM in patients receiving blood transfusions in district hospitals in Rwanda.\u0000\u0000\u0000DESIGN\u0000A cross-sectional comparative descriptive study.\u0000\u0000\u0000SETTING\u0000Four Rwandan district hospitals. Kirehe and Nyanza hospitals used IS-XM while Muhima and Ruhengeri hospitals used IAT-XM.\u0000\u0000\u0000SUBJECTS\u0000Blood samples were obtained from 187 patients (101 with IS-XM and 86 with IAT-XM) transfused in January, February, October, and November of 2012.\u0000\u0000\u0000RESULTS\u0000The median age of blood recipients was 31 years (7 - 80) and 36% of them were male. Sixteen specific antibodies were identified in 12 patients: anti-RH1/D (2),anti-RH2/C (2), anti-RH3/E (2), anti-RH4/c (1), anti-RH5/e (2),anti-LE1/Lea (2),anti-JK1/Jka (1), anti-JK2/Jkb (1), anti-KEL1/K (1), anti-MNS1/M (1), and autoantibody (1).The global prevalence of redblood cell (RBC) alloimmunisationwas 6.4% (12/187). Thatprevalence was significantly higher in the IS-XM group (10.4%) than in the IAT-XM group (2.3%) with an odds ratio of 4.8; [95% CI=1.2-19.8]; and a p-value of 0.031.\u0000\u0000\u0000CONCLUSION\u0000The prevalence of red blood cell (RBC) alloimmunisation in 187 patients receiving blood transfusions was 6.4% and was higher in recipients from hospitals using IS-XM, with Rhesus (RH) system antibodies widely predominant (56.2%).We recommend that IAT-XM be used in all district hospitals in Rwanda to minimise this risk.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"90 4 1","pages":"124-9"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes and acceptance of Nigerians towards vasectomy--A comparison of married men and women in Lagos.","authors":"K. Tijani, R. Ojewola, GL Yahya, A. Oluwole, B. Odusanya","doi":"10.4314/EAMJ.V90I3","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I3","url":null,"abstract":"Background : Nigeria with a growth rate of 28%, accounts for over two thirds of the West African population. It also has one of the highest maternal mortality rates in the world with contraceptive prevalence among married couples less than 10%. Despite its safety and efficacy vasectomy appears to be unpopular in our environment. Objective : To assess the perception and acceptance of married men and women towards vasectomy and the influence of the spouse on the man’s decision to accept or reject vasectomy. Design : A cross sectional questionnaire based study. Setting : With an estimated population of 20 million, Lagos is the most cosmopolitan and urbanised city in Nigeria and accounts for 65% of all commercial activities in the country. Virtually all the tribes in Nigeria are represented in the city. Subjects : Literate pregnant women recruited from the antenatal clinics and literate new fathers. All subjects were recruited from three health facilities in the Lagos metropolis. Results : Twenty seven point five and twenty one percent of the men and women respectively had a good Knowledge of vasectomy while 49.1% and 19% of all men and women respectively with good knowledge would accept vasectomy (or agree for their spouses to have the procedure). Overall acceptance rates for men and women were 26 and 13.5% respectively while 92% of men who can opt for vasectomy will only do so if their spouses agree. Knowledge about vasectomy was the strongest single factor  influencing the acceptance of vasectomy (p= 0.013) with stronger  correlation among men than women (p=0.005 vrs p=.0.023). Conclusion : Knowledge and acceptance of vasectomy is significantly better in males than female Nigerians living in Lagos.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"22 1","pages":"89-94"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EFFECTS OF STANDARD AND/OR GLUTAMINE DIPEPTIDE AND/OR OMEGA-3 FATTY ASCID-SUPPLEMENTED PARENTERAL NUTRITION ON NEUTROPHIL FUNCTIONS, INTERLEUKIN-8 LEVEL AND LENGTH OF STAY--A DOUBLE BLIND,CONTROLLED, RANDOMISED STUDY.","authors":"T. Aliyazicioglu, N. Z. Cantürk, T. Simsek, F. Kolaylı, M. Çekmen","doi":"10.4314/EAMJ.V90I2","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I2","url":null,"abstract":"BACKGROUND AND AIMS\u0000Protein calorie malnutrition for cancer patients is related with altered cellular and humoral immunity. Standard TPN and glutamine and lipid emulsion with omega 3 fatty acids were given to colorectal cancer patients and the effects of these to neutrophil functions and IL-8 levels are compared.\u0000\u0000\u0000METHODS\u0000Consecutive 36 patients with colorectal cancer diagnosed with endoscopic biopsy and with malnutrition determined by subjective global assessment were enrolled to study. The patients are randomly divided into four groups. Standard TPN to control group, TPN with glutamine solution to S-D group, TPN with omega 3 fatty acid solution to S-O group and TPN with omega 3 fatty acids solution and glutamine to S-D-O group were given for seven days after the operation. At the preoperative, postoperative first day and 7th day, neutrophil phagocytosis index, neutrophil adhesivity index and IL-8 levels were determined.\u0000\u0000\u0000RESULTS\u0000In all groups compared to control group neutrophil phagocytosis index were increased significantly (p<0.05). The most increasing was in group 3. There wasn't significant difference between groups about postoperative first day neutrophil adhesiveness index (p>0.05). At the 7th day the neutrophil adhesivity index for study groups were increased compared with control group, but there was no significant differences between groups. There was no significant difference between groups for IL-8 levels.\u0000\u0000\u0000CONCLUSIONS\u0000As a result of the study, altered cellular immunity in colorectal cancer patients with malnutrition can be corrected with omega 3 fatty acid emulsions and glutamine added to TPN so the ratio of morbidity and mortality can be decreased.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"59 1","pages":"59-66"},"PeriodicalIF":0.0,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CAPITATION IN HEALTHCARE FINANCING IN GHANA.","authors":"A. Aboagye","doi":"10.4314/EAMJ.V90I5","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I5","url":null,"abstract":"OBJECTIVE To analyse implementation of the pilot study of the per capita system of healthcare financing in Ghana in 2012 for a determination of the likelihood of realising the inherent theoretical benefits when the system is rolled out nationally. DESIGN AND SETTING First, publicly available information on how the pilot unfolded is presented, followed by the reaction of the health authorities to these developments. We then analysed accrued evidence on costs and developments vis-à-vis the theoretical benefits. RESULTS It would appear that preparation for the pilot exercise could have been handled better. Concerns include i) the low level of both education and awareness of the capitation system among healthcare subscribers and primary care providers; ii) confusion about service provider to whom subscribers had been assigned for the capitation period; and iii) service providers not understanding differences between capitation financing and financing under the Ghana diagnostic Related Grouping; and iv) some indication of cost savings. CONCLUSION Cost savings may be available nationally. This is important because cost containment is the driving force behind the introduction of the capitation system.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"90 5 1","pages":"156-63"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A COMPARATIVE STUDY ON THE EFFICACY OF TWO REGIMENS OF SINGLE- SHOT SPINAL BLOCK FOR PAIN RELIEF IN WOMEN PRESENTING IN ESTABLISHED LABOUR.","authors":"P N Tshibuyl, P O R Olang, Omondi Ogutu, T M Chokwe","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Most women experience moderate to severe pain during labour and delivery, often requiring some form of pharmacologic analgesia. The lack of proper psychological preparation combined with fear and anxiety can greatly enhance the patient's sensitivity to pain and further add to the discomfort. Skillfully conducted obstetric analgesia, in addition to relieving pain and anxiety, may benefit the mother by increasing self esteem and improving bonding with the baby.</p><p><strong>Objective: </strong>To assess and compare the satisfaction and efficacy of two regimens of single-shot spinal blocks for the relief of labor pain in women who present in active phase of labour.</p><p><strong>Design: </strong>A prospective randomised single-blind observational study</p><p><strong>Setting: </strong>Labour ward of Kenyatta National Hospital, Nairobi.</p><p><strong>Subjects: </strong>All consenting primiparous women presenting in active phase of labor with uncomplicated singleton pregnancy at term (> 37 weeks) and in cephalic presentation, who reported a > 70 mm VAS (Visual Analog Scale) pain score at cervical dilatation ≥ 5 cm at the time of request for labour analgesia.</p><p><strong>Results: </strong>Effective labour analgesia lasting up to 120 minutes was observed in the fentanyl-bupivacaine group but with high incidence of breakthrough pain. The fentanyl-bupivacaine-morphine group had labour analgesia lasting up to 180 minutes or even more with a lower incidence of breakthrough pain. The one-minute and five- minute Apgar scores in the morphine group were significantly lower (p = 0.026 and 0.044 respectively) than in the fentanyl group but the difference in neonatal outcome had no clinical significance, and there were no significant differences in adverse effects, sensory levels, and motor power between the two groups.</p><p><strong>Conclusion: </strong>Effective analgesia for about 120 minutes was observed in the fentanyl-bupivacaine group with high incidence of breakthrough pain while the fentanyl-bupivacaine-morphine group had labour analgesia prolonged up to more than three hours. The difference in fetal outcome had no clinical significance for the morphine group, and there were no significant difference in adverse effect, sensory levels, and motorpowerbetween the two groups. These findings show that intrathecal analgesia is safe and the use of the combination of fentanyl-bupivacaine-morphine gives adequate and safe analgesia during labour and delivery.</p>","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"90 1","pages":"12-8"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PRESENCE OF CRYPTOCOCCUS SPECIES IN DOMESTIC CHICKEN (GALLUS GALLUS) DROPPINGS AND THE POSSIBLE RISK IT POSED TO HUMANS IN KABIGERIET VILLAGE, NAKURU COUNTY, KENYA.","authors":"E. K. Kemoi, P. Okemo, Christine C Bii","doi":"10.4314/EAMJ.V90I6","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I6","url":null,"abstract":"OBJECTIVE To isolate and identify Cryptococcus from domestic Chicken dropping. DESIGN cross sectional study. SETTING Kabigeriet village, Olenguorone Division, Nakuru county, approximately 282 km from Nairobi, Kenya. SUBJECTS Sixty four domestic chicken droppings were sampled in thirty two homesteads after obtaining the farmers consent. RESULTS Two species of Cryptococcus were isolated. CONCLUSION Domestic chicken (Gallus gallus) harbor Pathogenic Cryptococcus in their dropping and their close proximity to human habitation poses a risk of AIDS to immunocompromised persons.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"90 6 1","pages":"202-6"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cryptococcus Meningitis in a Cohort of HIV Positive Kenyan Patients: Outcome after Two Weeks of Therapy","authors":"A. Otedo, C. Otieno, J. Jowi, G. Oyoo, E. Omonge","doi":"10.4314/EAMJ.V90I12","DOIUrl":"https://doi.org/10.4314/EAMJ.V90I12","url":null,"abstract":"Background : Cryptococcus meningitis is the most lethal meningitis in patients with HIV/AIDS. It is invariably fatal if not treated appropriately and promptly. In sub-Saharan Africa with the highest prevalence of HIV/AIDS, response to treatment of cryptococcal meningitis has seldom been assessed. Objective : To describe the clinical features, laboratory findings, CD4+ cell counts and clinical outcome after a two-week treatment course of patients having cryptococcal meningitis. Design : Longitudinal, prospective, consecutive entry study. Setting : Kisumu District Hospital, Nairobi Rheumatology Clinic and Mater hospital between July 2001 and May 2007. Subjects : One hundred and forty one patients with cryptococcus meningitis. Main outcome measures :CD4+cellcount,cerebrospinalfluid(CSF)  biochemistry/microbiology, morbidity and mortality. Results : One hundred and forty one patients (80 males and 61 females) with cryptococcus meningitis were included. Mean age and CD4+ cell counts was 36.12 ± 9.1 years (15-75) and 66.9 ± 102.8 cells/µl (1-1058) respectively. One hundred and forty one (83%) patients had CD4 + cell counts 350 cells/µl and 22 (15.6%) patients had CD4+ cell counts between 100-350 cells/µl. Ten (six males and four females) died within one week (four amphotericin B, three fluconazole, three no treatment). Eighty one patients were simultaneously initiated on HAART. Conclusion : Cryptococcal meningitis has a good clinical outcome when promptly and appropriately managed despite the low CD4+ cell count. Measures to avail amphotericin B and fluconazole at the mid level  healthcare facilities must be enhanced.","PeriodicalId":11399,"journal":{"name":"East African medical journal","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70520205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}