Aggrey Wasunna | University of Nairobi, Kenya (original) (raw)
Papers by Aggrey Wasunna
East African Medical Journal, May 12, 2004
Background: Meningitis occurs in up to one third of neonates with septicaemia. Diagnosis is diffi... more Background: Meningitis occurs in up to one third of neonates with septicaemia. Diagnosis is difficult due to its non-specificity of signs and symptoms. While neonatal septicaemia is a common problem at Kenyatta National Hospital (KNH), there are no recent data on the incidence and clinical characteristics of neonatal meningitis at the hospital. Objective: To evaluate the prevalence and the bacterial aetiology of meningitis in neonates at the Newborn Unit (NBU) of KNH. Design: Descriptive cross-sectional study.
East African Medical Journal, Oct 1, 2002
East African Medical Journal, Oct 1, 2002
Background: Neonatal deaths, especially among the Low Birth Weight (LBW) babies, are of major con... more Background: Neonatal deaths, especially among the Low Birth Weight (LBW) babies, are of major concern in the Newborn Unit (NBU) of Kenyatta National Hospital (KNH). Several instruments have been developed to predict initial mortality risk among the LBW babies. Among them is the scoring system Clinical Risk Index for Babies also known as CRIB II score.Objective: To evaluate the use of CRIB II score as a tool to predict the risk for neonatal mortality among the LBW babies at KNH.Design: A prospective cohort study.Setting: Newborn Unit of Kenyatta National Hospital.Subject: A total sample of 135 low birth weight babies were followed up from admission till discharge, the 28th day of life or death whichever came first.Results: One hundred and thirty five newborns were enrolled into the study. Birth weight ranged from 600 – 2500g, with a median of 1600g. Total CRIB II score ranged from 1 – 15, with a median of 5.5. Gestational age ranged from 26 – 38 weeks. Total mortali...
East African medical journal, 1999
Reports of osteopaenia/rickets of prematurity are on the increase due to improved survival rates ... more Reports of osteopaenia/rickets of prematurity are on the increase due to improved survival rates of low birthweight infants. To establish the incidence of rickets of prematurity by the age of six months in premature infants born at Kenyatta National Hospital, Nairobi. Prospective cohort study. Newborn unit and paediatric outpatient follow up clinic of Kenyatta National Hospital. Successive surviving infants of birthweight less than 2000 g residents in Nairobi. Incidence of rickets of prematurity by six months of age was 58.8%. Rickets appeared more commonly in male infants compared to female infants. Rickets of prematurity is a common problem in the premature infants seen at Kenyatta National Hospital. Routine vitamin D supplements to premature infants in adequate doses of at least 400iu per day should be adopted in our centre.
East African medical journal, 1984
East African medical journal, 1985
A study of 125 children aged 0-6 months who were seen at Kenyatta National Hospital for acute dia... more A study of 125 children aged 0-6 months who were seen at Kenyatta National Hospital for acute diarrhea was conducted between 1982-1983 to determine the benefits of oral rehydration therapy (ORT) in treatment of diarrheal illness. At admission, specimens of stool, blood and urine were collected and examine for bacterial, parasitic, and viral agents (including malaria), serum electrolytes, urea, white cell counts and hematocrit. Children were started on oral rehydration solution (ORS) unless severly dehydrated, in which case intravenous therapy was initiated. 84% of the children were successfully treated with ORS alone regardless of etiological agent found; 15% required IV therapy initially, then were placed on ORS. Average hospital stay was 56.2 hours. Cost of treatment by ORT is less than 20% the cost of IV therapy. When investigators surveyed other health institutions, they found that ORT was used alone in less than 10% of all children seen with diarrhea. A side benefit of ORT is the utilization of mothers in preparation and administration of solution, reducing the demand on hospital staff. Since 20% of all pediatric admissions at Kenyatta are due to acute diarrheal disease, use of ORT would reduce costs tremendously. Initiation of ORT at home may prevent development of dehydration altogether.
East African Medical Journal, 2004
Archives of Disease in Childhood, 1987
One hundred and twenty five measurements of arterial oxygen saturation (Stcao2) obtained with a t... more One hundred and twenty five measurements of arterial oxygen saturation (Stcao2) obtained with a transcutaneous pulse oximeter were compared with direct arterial oxygen tension (Pao2) in 13 preterm infants with predominantly fetal haemoglobin. Stcao2 of 86-92% corresponded to Pao2 of 5-13 kPa. Stcao2 above 92%, however, was sometimes associated with Pao2 above 13 kPa.
Tropical Medicine & International Health, 2009
objective To assess the availability of resources that support the provision of basic neonatal ca... more objective To assess the availability of resources that support the provision of basic neonatal care in eight first-referral level (district) hospitals in Kenya.
Pan African Medical Journal
... This article aims to provide a preliminary assessment of the NHIS to date. ... district schem... more ... This article aims to provide a preliminary assessment of the NHIS to date. ... district schemes, funded from members' contributions and a levy on the value-added tax (VAT) charged on goods and services, from which a broad minimum package of care could be funded. Methods ...
ABSTRACT To assess the availability of resources that support the provision of basic neonatal car... more ABSTRACT To assess the availability of resources that support the provision of basic neonatal care in eight first-referral level (district) hospitals in Kenya. We selected two hospitals each from four of Kenya's eight provinces with the aim of representing the diversity of this part of the health system in Kenya. We created a checklist of 53 indicator items necessary for providing essential basic care to newborns and assessed their availability at each of the eight hospitals by direct observation, and then compared our observations with the opinions of health workers providing care to newborns on recent availability for some items, using a self-administered structured questionnaire. The hospitals surveyed were often unable to maintain a safe hygienic environment for patients and health care workers; staffing was insufficient and sometimes poorly organised to support the provision of care; some key equipment, laboratory tests, drugs and consumables were not available while patient management guidelines were missing in all sites. Hospitals appear relatively poorly prepared to fill their proposed role in ensuring newborn survival. More effective interventions are needed to improve them to meet the special needs of this at-risk group.
Background: In developing countries referral of severely ill children from primary care to distri... more Background: In developing countries referral of severely ill children from primary care to district hospitals is common, but hospital care is often of poor quality. However, strategies to change multiple paediatric care practices in rural hospitals have rarely been evaluated. Methods and Findings: This cluster randomized trial was conducted in eight rural Kenyan district hospitals, four of which were randomly assigned to a full intervention aimed at improving quality of clinical care (evidence-based guidelines, training, job aides, local facilitation, supervision, and face-to-face feedback; n = 4) and the remaining four to control intervention (guidelines, didactic training, job aides, and written feedback; n = 4). Prespecified structure, process, and outcome indicators were measured at baseline and during three and five 6-monthly surveys in control and intervention hospitals, respectively. Primary outcomes were process of care measures, assessed at 18 months postbaseline. In both g...
Quality of hospital care for sick newborns and severely malnourished children in Kenya: A twoyear... more Quality of hospital care for sick newborns and severely malnourished children in Kenya: A twoyear descriptive study in 8 hospitals
East African Medical Journal, May 12, 2004
Background: Meningitis occurs in up to one third of neonates with septicaemia. Diagnosis is diffi... more Background: Meningitis occurs in up to one third of neonates with septicaemia. Diagnosis is difficult due to its non-specificity of signs and symptoms. While neonatal septicaemia is a common problem at Kenyatta National Hospital (KNH), there are no recent data on the incidence and clinical characteristics of neonatal meningitis at the hospital. Objective: To evaluate the prevalence and the bacterial aetiology of meningitis in neonates at the Newborn Unit (NBU) of KNH. Design: Descriptive cross-sectional study.
East African Medical Journal, Oct 1, 2002
East African Medical Journal, Oct 1, 2002
Background: Neonatal deaths, especially among the Low Birth Weight (LBW) babies, are of major con... more Background: Neonatal deaths, especially among the Low Birth Weight (LBW) babies, are of major concern in the Newborn Unit (NBU) of Kenyatta National Hospital (KNH). Several instruments have been developed to predict initial mortality risk among the LBW babies. Among them is the scoring system Clinical Risk Index for Babies also known as CRIB II score.Objective: To evaluate the use of CRIB II score as a tool to predict the risk for neonatal mortality among the LBW babies at KNH.Design: A prospective cohort study.Setting: Newborn Unit of Kenyatta National Hospital.Subject: A total sample of 135 low birth weight babies were followed up from admission till discharge, the 28th day of life or death whichever came first.Results: One hundred and thirty five newborns were enrolled into the study. Birth weight ranged from 600 – 2500g, with a median of 1600g. Total CRIB II score ranged from 1 – 15, with a median of 5.5. Gestational age ranged from 26 – 38 weeks. Total mortali...
East African medical journal, 1999
Reports of osteopaenia/rickets of prematurity are on the increase due to improved survival rates ... more Reports of osteopaenia/rickets of prematurity are on the increase due to improved survival rates of low birthweight infants. To establish the incidence of rickets of prematurity by the age of six months in premature infants born at Kenyatta National Hospital, Nairobi. Prospective cohort study. Newborn unit and paediatric outpatient follow up clinic of Kenyatta National Hospital. Successive surviving infants of birthweight less than 2000 g residents in Nairobi. Incidence of rickets of prematurity by six months of age was 58.8%. Rickets appeared more commonly in male infants compared to female infants. Rickets of prematurity is a common problem in the premature infants seen at Kenyatta National Hospital. Routine vitamin D supplements to premature infants in adequate doses of at least 400iu per day should be adopted in our centre.
East African medical journal, 1984
East African medical journal, 1985
A study of 125 children aged 0-6 months who were seen at Kenyatta National Hospital for acute dia... more A study of 125 children aged 0-6 months who were seen at Kenyatta National Hospital for acute diarrhea was conducted between 1982-1983 to determine the benefits of oral rehydration therapy (ORT) in treatment of diarrheal illness. At admission, specimens of stool, blood and urine were collected and examine for bacterial, parasitic, and viral agents (including malaria), serum electrolytes, urea, white cell counts and hematocrit. Children were started on oral rehydration solution (ORS) unless severly dehydrated, in which case intravenous therapy was initiated. 84% of the children were successfully treated with ORS alone regardless of etiological agent found; 15% required IV therapy initially, then were placed on ORS. Average hospital stay was 56.2 hours. Cost of treatment by ORT is less than 20% the cost of IV therapy. When investigators surveyed other health institutions, they found that ORT was used alone in less than 10% of all children seen with diarrhea. A side benefit of ORT is the utilization of mothers in preparation and administration of solution, reducing the demand on hospital staff. Since 20% of all pediatric admissions at Kenyatta are due to acute diarrheal disease, use of ORT would reduce costs tremendously. Initiation of ORT at home may prevent development of dehydration altogether.
East African Medical Journal, 2004
Archives of Disease in Childhood, 1987
One hundred and twenty five measurements of arterial oxygen saturation (Stcao2) obtained with a t... more One hundred and twenty five measurements of arterial oxygen saturation (Stcao2) obtained with a transcutaneous pulse oximeter were compared with direct arterial oxygen tension (Pao2) in 13 preterm infants with predominantly fetal haemoglobin. Stcao2 of 86-92% corresponded to Pao2 of 5-13 kPa. Stcao2 above 92%, however, was sometimes associated with Pao2 above 13 kPa.
Tropical Medicine & International Health, 2009
objective To assess the availability of resources that support the provision of basic neonatal ca... more objective To assess the availability of resources that support the provision of basic neonatal care in eight first-referral level (district) hospitals in Kenya.
Pan African Medical Journal
... This article aims to provide a preliminary assessment of the NHIS to date. ... district schem... more ... This article aims to provide a preliminary assessment of the NHIS to date. ... district schemes, funded from members' contributions and a levy on the value-added tax (VAT) charged on goods and services, from which a broad minimum package of care could be funded. Methods ...
ABSTRACT To assess the availability of resources that support the provision of basic neonatal car... more ABSTRACT To assess the availability of resources that support the provision of basic neonatal care in eight first-referral level (district) hospitals in Kenya. We selected two hospitals each from four of Kenya's eight provinces with the aim of representing the diversity of this part of the health system in Kenya. We created a checklist of 53 indicator items necessary for providing essential basic care to newborns and assessed their availability at each of the eight hospitals by direct observation, and then compared our observations with the opinions of health workers providing care to newborns on recent availability for some items, using a self-administered structured questionnaire. The hospitals surveyed were often unable to maintain a safe hygienic environment for patients and health care workers; staffing was insufficient and sometimes poorly organised to support the provision of care; some key equipment, laboratory tests, drugs and consumables were not available while patient management guidelines were missing in all sites. Hospitals appear relatively poorly prepared to fill their proposed role in ensuring newborn survival. More effective interventions are needed to improve them to meet the special needs of this at-risk group.
Background: In developing countries referral of severely ill children from primary care to distri... more Background: In developing countries referral of severely ill children from primary care to district hospitals is common, but hospital care is often of poor quality. However, strategies to change multiple paediatric care practices in rural hospitals have rarely been evaluated. Methods and Findings: This cluster randomized trial was conducted in eight rural Kenyan district hospitals, four of which were randomly assigned to a full intervention aimed at improving quality of clinical care (evidence-based guidelines, training, job aides, local facilitation, supervision, and face-to-face feedback; n = 4) and the remaining four to control intervention (guidelines, didactic training, job aides, and written feedback; n = 4). Prespecified structure, process, and outcome indicators were measured at baseline and during three and five 6-monthly surveys in control and intervention hospitals, respectively. Primary outcomes were process of care measures, assessed at 18 months postbaseline. In both g...
Quality of hospital care for sick newborns and severely malnourished children in Kenya: A twoyear... more Quality of hospital care for sick newborns and severely malnourished children in Kenya: A twoyear descriptive study in 8 hospitals