Use of Non-Formulary Medicines at a Kenyan Private Hospital

Background: Hospital formularies are used to encourage the use of safe, ef-fective and most affordable medications. Institutions need to make provi-sions for non-formulary medicines (NFM) due to the dynamic nature of dis-eases and their management. The aim of this study was to describe the pat-terns of non-formulary medicine prescriptions at the Nairobi Hospital, the reasons for their purchase as well as the duration taken to avail them. Methods: A descriptive review of all the non-formulary medicine prescrip-tions from January 2021 to June 2022. The medicines were listed and catego-rized according to the WHO Anatomical Therapeutic Chemical (ATC) classi-fication system. Correspondence between pharmacy and procurement was reviewed to understand the reason for the requests and the duration it took to avail the medicines. Results: A total of 183 NFM were purchased, with a general increase in the number from January 2021 to June 2022. Vitamins, Mineral supplements and General nutrients accounted for 41 (22.4%) of the NFM. Dermatologicals 27 (14.6%), Genito-urinary system drugs and sex hormones 20 (10.9%), Ophthalmologicals 14 (7.6%) and Antineoplastic and Immuno-modulating agents 12 (6.6%) were also frequently purchased out of formulary. The main reasons for NFM purchases were: having no therapeutic equivalents in the hospital formulary 72 (39.3%) and prescriber or patient preference 69 (37.7%). It took a median (IQR) of 4 (2 - 7) days for the phar-macy to avail these drugs;with 18.6% being availed in 1 day and 55.2% tak-ing more than 3 days. For the NFM where no alternative was available in the hospital formulary, sales amounted to USD 63,362 which was 79.1% of the value of all the NFM sales. Conclusion: There’s a need to regularly update the hospital formulary and to emphasize to the prescribers the importance of adhering to it, as much as possible.

Prevalence, Species Distribution and Antifungal Susceptibility Profile of <i>Candida</i>Species Isolated from Bloodstream of Critical Care Unit Patients in a Tertiary Care Hospital in Kenya

The upsurge of candidemia in the past years has been an immense encumbrance on public health and the number of deaths caused by candidemia particularly in critical care unit patients is devastating. Candida species harbor a 30% - 60% mortality rate and compared to stable people or those with less serious illnesses, this ranges from 60% to 80% of those who are chronically ill patients. Grounded on a recent report from a tertiary care hospital in Kenya showing the emergence of previously unobserved species: Candida auris, this study aimed to determine the prevalence, species distribution, and antifungal susceptibility profile of candidemia in critical care unit patients of the hospital. 378 Critical Care Unit patients were enrolled for the study from January 2019 to January 2020. Positive archived isolates were sub-cultured using Saboraud Dextrose Agar. Candida species were identified utilizing API20C AUX and Vitek-2. Antifungal susceptibility testing was conducted using the Liofilchem MIC Test strip. Out of 378 patients, thirty-one presented a positive culture for Candida species. The prevalence of Candidemia was 8.2% with 9 (29.03%) Candida auris, 8 (25.81%) Candida albicans, 6 (19.35%) Candida parapsilosis, 3 (9.68%) Candida famata, 3 (9.68%) Candida tropicalis, 1 (3.23%) Candida duobushaemolumonii, and 1 (3.23%) Candida lusitaniae. A resistance pattern to Fluconazole was observed among Candida auris and Candida parapsilosis, and resistance to Flucytosine was observed in Candida tropicalis, whereas susceptible MIC values were obtained for the other drugs. There is an increase in candidemia among critical care unit patients in the health facility posing a public health challenge. Moreover, the onset of new species Candida auris which is unprecedented in Kenya warrants enhanced infection control, and the uniform resistance of Candida auris, Candida parapsilosis, and Candida tropicalis towards Fluconazole and Flucytosine necessitate constant drug monitoring for empirical treatment regime. In contrast, the high potency of Echinocandins and Amphotericin-B demonstrate them as the drug of choice.

Application of Statistical Process Control for Setting Action Thresholds as Quality Assurance of Dose Verifications in External Beam Radiotherapy

Purpose: To test the concept of Statistical Process Control (SPC) as a Quality Assurance (QA) procedure for dose verifications in external beam radiation therapy in conventional and 3D Conformal Radiotherapy (3D-CRT) treatment of cervical cancer. Materials and Methods: A study of QA verification of target doses of 198 cervical cancer patients undergoing External Beam Radiotherapy (EBRT) treatments at two different cancer treatment centers in Kenya was conducted. The target doses were determined from measured entrance doses by the diode in vivo dosimetry. Process Behavior Charts (PBC) developed by SPC were applied for setting Action Thresholds (AT) on the target doses. The AT set was then proposed as QA limits for acceptance or rejection of verified target doses overtime of the EBRT process. Result and Discussion: Target doses for the 198 patients were calculated and SPC applied to test whether the action limits set by the Process Behavior Charts could be applied as QA for verified doses in EBRT. Results for the two sub-groups of n = 3 and n = 4 that were tested produced action thresholds which are within clinical dose specifications for both conventional AP/PA and 3D-CRT EBRT treatment techniques for cervical cancer. Conclusion: Action thresholds set by SPC were within the clinical dose specification of ±5% uncertainty for both conventional AP/PA and 3D-CRT EBRT treatment techniques for cervical cancer. So the concept of SPC could be applied in setting QA action limits for dose verifications in EBRT.

Current Status of Radiotherapy Services in Kenya

Purpose: Owing to the missing recent data regarding cancer case volumes in Kenyan hospitals since 2012, the aim of the study was to fill the gap by providing data for two hospitals in Nairobi, the post year 2012. The general situation of radiation oncology and recommendation for improvement of radiotherapy services in the country were also highlighted. Further assessment was to investigate and determine the relationship between age, different types of cancer, and gender for cancer patients undergoing radiotherapy treatment. Materials and Methods: A data compilation, analysis, and evaluation process were conducted at two cancer treatment centers in Kenya followed by an assessment of radiotherapy cancer treatment facilities in the country. The number of the patients treated for cervical, breast prostate, esophagus, rectum, and lung cancer against their ages and gender were also compiled for assessment. Results: The number of cancer patients treated by radiotherapy continuously increased annually and he trends of the graphs in both centers were similar. Cervical cancer was the most common cancer treated by radiotherapy at the two centers, followed by breast and prostate cancer. Different types of cancer assessed were dependent on age and that cancer appeared at younger ages in female cervical and breast cancer patients as opposed to the male prostate cancer. Conclusion: The results indicate a continuous annual increase in cancer patients treated by radiotherapy in Kenya radiotherapy centers. The increase may be attributed to the rising population, limited access to cancer awareness, and the growing adoption of unhealthy lifestyles, among other factors. Female cervical and breast cancer patients contracted the disease at younger ages (46 - 50 years) compared to the male prostate cancer patients with a mean age of 61 - 65 years. Socio-economic factors, the organization of healthcare systems, and a limited workforce have been identified as some of the barriers to the provision of proper radiotherapy services in the country.

Hepatitis A Antibody Seroprevalence in a Selected Kenyan Pediatric Population

The incidence of infection by Hepatitis A virus shows regional variation being highest in developing countries. Determination of age specific Hepatitis A virus (HAV) seroprevalence and the associated risk factors would help better plan for national preventive strategies including vaccination. We carried out a cross-sectional study on 300 children from Nairobi city, Kenya during the years 2003-2004. The age range of the children was 2 - 14 years and were from low and high socioeconomic status (SES) families. The indicators of SES included employment status, residence, number of children per patient’s household, parents’ level of education and source of drinking water. SES was encoded and analysed using Statistical Program for Social Sciences (SSPS) version 16.0. Seroprevalence increased significantly with advancing age. Seropositivity of HAV antibodies was significantly higher among children of low SES, 77.6% by the age of 14 years compared to children of high SES, 38.9% by the same age. Crowded household and parental education were significantly associated with high seropositivity and seronegativity respectively. There is significant rate of seronegativity amongst the studied population especially those from richer backgrounds making them more susceptible to severe infection in future with concomitant complications. We propose that revision of national vaccination program should be considered to include Hepatitis A vaccination.

A Comparative Study of Smugel and KY Jelly Vaginal Lubricating Gels

Objective To assess the safety of Smugel compared with KY Jelly vaginal lubricating gel in baboon （Papio anubis） vagina. Methods Ten sexually mature olive female baboons were used in this study. Vaginal pH, blood chemistry, vaginal flora, vaginal and cervical histology were evaluated at baseline and after administration of15 ml of either Smugel or KY Jelly gel twice a week for 5 weeks to each randomized treatment group. Results Basal vaginal pH was 5.8± 0. 8. There was no significant difference in the vaginal pH of Smugel compared with KY Jelly treated animals or baseline data （P〉0. 05）. Similarly, analysis of blood chemistry parameters revealed no significant differences. The most frequently isolated microorganisms both at baseline and during treatment included Corynebacterium glucuronolyticum, C. renale group, Lactococcus raffinolactis, Leuconostoc lactis, Lactobacillus acidophilus, L. fermentum, L. salivarius, Staphylococcus aureus, S. xyloxus, S. hyicus, Aerococus viridians, Escherichia coli and Candida albicans. No detectable histological changes were observed in the vaginal or cervical sections examined. Conclusion Smugel, compared with KY Jelly did not induce any adverse event that may facilitate transmission of sexual transmitted infection （STI） pathogens including HIV.