10 commonly asked questions about Urinary Tract Infections (UTI) in Kenya

  1. Is it a sexually transmitted infection? – Some UTIs are a result of sexually transmitted infections like gonorrhea and Chlamydia. However, most urinary tract infections are not due to a sexually transmitted organism!uti3
  2. If not sexually transmitted, then where did I get it from? – From ourselves! Or dirty toilets! A majority of UTIs are caused by a bacterial that is found in fecal material normally (E. Coli). This bacteria is resident in our colons without causing any harm to us. But, there are instances when this bacteria gets access into our urinary system and there causes an infection.
  3. What makes me vulnerable to getting a UTI? Or recurrent UTIs?
    1. Hygiene – Use of dirty toilets can lead to UTI because of the toilet bowl contents being splashed back onto one’s body. In addition, women wiping themselves after visiting the toilet should wipe from front to back and not the other way round. Wiping from front to back means that you’ll wipe the vaginal area, urethra and then anus last to avoid moving the E. Coli bacteria from the anus to the urethra.
    2. Diabetes – Diabetic patients get UTIs due to myriad reasons. Examples include sugar in the urinary system that encourages growth of bacteria and  injury to nerve tissues predispose to bladder infections.
    3. Immune suppression – Anything that suppresses one’s immunity will allow growth of any kind of organism in any part of the body. This may be due to illness or drugs.
    4. Abdominal masses – Anything that causes enlargement of the abdominal cavity has potential of compressing the other structures found in the abdomen and uti4pelvis. The bladder capacity is reduced with statis of urine which encourages bacteria to grow. Examples include pregnancy, fibroids, abdominal organ tumors.
    5. Sex – The frictional activity of sex can predispose one to a UTI due to the proximity of the vagina to the urethra with minute trauma to the urethra and displacement of organisms from the perineum to the urethra.
    6. Problems in the urinary system – like enlarged prostate, stones, congenital narrowing or secondary to some localized lesions
    7. Instrumentalization – Any instruments inserted into the urethra can predispose on to a UTI. These include urinary catheters.
  4. My child has pain passing urine; does that mean they have been abused? – Children can get a urinary tract infection especially if they are not taught proper hygiene or exposed to dirty toilets. Children also like to touch their private parts on occasion and can transmit organisms.UTI2However, care givers have to be on high alert for sexual abuse of children who then get infected with sexually transmitted organisms. Proper probing history must be sought from the child. But, a child with recurrent UTIs must be properly investigated for predisposing factors like diabetes, congenital or developmental problems or sexual abuse.
  5. What does the prostrate have to do with UTIs? – The prostate gland sits at the neck of the bladder for all men. In addition, every man’s prostrate starts to grow in size normally from puberty to death putting all men at risk of getting an enlarged prostrate (BPH). As the prostate enlarges, it compresses the bladder with poor emptying of the bladder and putting one at risk of getting a UTI.UTI1
  6. So what are the symptoms of UTI?
    1. Pain (dysuria) – Pain can be at the start of urination, during urination or after urination. It is usually a burning pain due to irritation of urethra and/or bladder.
    2. Frequency – this means passing urine more than usual. A person goes to the uti9toilet and shortly after they feel like going again.
    3. Urgency – This means that a person feels like they will urinate on themselves and they must run to the bathroom. Irony is that they may then pass very little urine.
    4. Blood (hematuria) – A person may notice blood in the toilet bowl or in the tissue when they wipe themselves.
    5. Lower abdominal pain – When the UTI has progressed into the bladder, a person may present with lower abdominal pain.
  7. What tests should I have done?
    1. Urinalysis – The routine test to confirm a UTI is a urine examination for microscopy and biochemistry.
    2. Urine for culture and sensitivity – This means that a urine specimen is grown on a medium to grow the exact bacteria causing an infection and to determine the antibiotics that it will respond to.uti6
    3. Urethral swab or High Vaginal Swab for culture and sensitivity – Anyone, especially men, reporting seeing any pus ooze from the urethra (penis) should have a sample taken and then grown on medium as above. It will also be checked under a microscope to see if specific organisms can be picked up. For women, the vaginal swab will be subjected to the same.
    4. Serology – Specific blood tests to look for organisms like Chlamydia can be done.
    5. Investigative – these are done for people with recurrent UTIs to look for what is predisposing them to the infections.
  8. Is an injection the best treatment for UTIs? – Many people believe that getting one injection of an antibiotic is enough to treat for UTIs. This is only true for some uti7Sexually Transmitted Infections which can only be suggested by history and confirmed by microscopy or culture. Other organisms that require treatment for longer periods can be missed and can lead to resistance to antibiotics, formation of strictures in the urethra and other complications.
  9. Should my partner get treated? – In reality, not everyone who gets exposed to an organism gets sick from it. Thus, it should then be prudent that we treat only the people who are symptomatic and advice them to abstain from sexual contact with their partners until they finish their treatment. We then treat their partners if they display symptoms. As mentioned earlier, not all UTIs are STIs. However, if an STI is confirmed, then all sexual partners should be treated.uti8
  10. Are there any regular measures one can take to prevent UTIs?
    1. Women should wipe themselves from front to back after urination
    2. Drink adequate water to allow frequent urination to “wash  out” the bladder
    3. Do not hold in urine, if you need to go, go.
    4. Ensure you empty the bladder completely when you go to the toilet
    5. Emptying bladder before and after intercourse may help.
    6. Treat all underlying problems.

 

 

 

 

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10 practical knowledge on weaning in Kenya.

Recommended age by most medical Institutions and in Kenya to start weaning is 6 months.

However, to live in the real world, many people start weaning as early as three months due to a myriad reasons like inadequate breast milk, cannot afford formula or child does not seem to get satisfied. These people should not be condemned at all but be encouraged to do it in a healthy step-by-step way.

This is an example of a practical way to wean a child. Please note that foods suggested are locally available and affordable foods. One can substitute with their locally available foods or culturally recommended food in the same food groups.

1) 1-3 months  

Try as much as possible to breastfeed exclusively.

If that is not possible, then buy infant formula up to 9 months to 1 year of age.food1

If cost is an issue, then discuss with your well baby clinic attendant or doctor on what to do.

 

6am                       –              milk

9am                       –              milk

12noon                 –              milk

3pm                       –              milk

6pm                       –              milk

9pm                       –              milk

12midnight         –              milk when child wakes

3a.m                      –              milk when child wakes

2) 4th month 

First 2 weeks, introduce infant porridge that is sold in most shops and supermarkets. Give it once a day for about 3-5 days then twice a day until food is well taken.food2

Alternatively, use well ground, easily digested flours bought in many shops or markets. Please be very careful with these flours as some tend to be mixed with things like omena (a type of fish) which are protein in nature and can set off allergies early in life.

6am                       –              milk

9am                       –              milk

12noon                 –              porridge

3pm                       –              milk

5pm                       –              milk

7/8pm                   –              porridge

9/10pm                 –              milk

Night time           –              milk when child wakes

Next 2 weeks, introduce a blended fruit like pawpaw. Give about half a small pawpaw once a day on alternate days.

6am                       –              milk

9am                       –              porridge

12noon                 –              milk

3pm                       –              milk/pawpaw

5pm                       –              milk

7/8pm                   –              porridge

9/10pm                –              milk

Night time           –              milk if child wakes

 

3) 5th month

1st 2 weeks introduce weetabix with formula milk food5

6am                       –              milk

9am                       –              porridge

12noon                 –              milk

3pm                       –              weetabix

5pm                       –              milk

7/8pm                   –              porridge/pawpaw

9/10pm                –              milk

Night time           –              milk when child wakes

 

Next 2 weeks introduce a 2nd fruit like blended mango.

6am                       –              milk

9am                       –              porridge

12noon                 –              milk

3pm                       –              weetabix

5pm                       –              milk

7/8pm                   –              pawpaw/mango

9/10pm                 –              milk

Night time           –              milk when child wakes

 

 4) 6th month

Introduce blended combination of boiled potatoes, pumpkin and spinach with a pinch of salt.food3

Give diluted fresh orange juice or pineapple juice three times a week. Alternate days give some water.

6/7am                   –              milk

9am                       –              porridge

12noon                 –              Blended food with diluted juice/water

3pm                       –              weetabix or fruit

5pm                       –              milk

7/8pm                   –              Blended food

9/10pm                –              milk

Night time           –              milk if child wakes

 

5) 7th month

Mash the food instead of blendingfood4

6/7am                   –              milk

9am                       –              porridge

12noon                 –              mashed food with diluted                                                   juice/water

3pm                       –              weetabix or fruit

5pm                       –              milk

7/8pm                   –              mashed food

9/10pm                –              milk

Night time           –              milk if child wakes

 

6) 8th month

Give rice or ugali – ensure that it is not huge chunks and child is chewing a little. Safe alternative is to mash it a little.

With mince meat or fish.food6

With spinach or other easy to eat vegetable including carrot.

Fry the food in a little oil and with a little salt to taste.

 

6/7am                   –              milk

9am                       –              porridge

12noon                 –              lightly mashed food with diluted juice/ water

3pm                       –              weetabix or fruit

5pm                       –              milk

7/8pm                   –              Rice (Ugali)/mince meat/spinach

9/10pm                 –              milk

Night time           –              milk if child wakes

 

7) 9th month

Child usually picks food off your plate and you can allow them to eat what the family is eating as long as the food is in small bits, moist enough and easy to eat.food7

Includes chapatti, spaghetti, fruits and many other things in family diet

8) Do’s and don’ts of Proteins

a. Don’t introduce eggs before one year of age.

b. Start with one egg per week maximum until about 2 years so that one can look out                    for allergies. Ideally give on alternate weeks and no more than three eggs per week                  should ever be consumed. By anyone!calcium6

d. Do not introduce proteins before 6 months of age to protect against allergies

e. Cow milk should ideally be introduced at 9 – 12 months. Anyone wishing to                                    introduce it earlier should discuss with their health care provider so as to ensure                      that all the nutrients found in breast milk are made available to the child.

f. Do not introduce two foods especially proteins in the same two weeks so that we                       can watch out for allergies and try and determine the culprit.

9.)Do’s and don’ts of fruits

a. Don’t give bananas before 8 months of age.

b. Give just a piece of a banana and not more than three times per week.

c. Children should not eat more than two bananas per week even when older due to                    constipation (See blog on causes of constipation in children)food8

d. Avoid sweet bananas (the small type of ripe bananas pictured above) in children less than two years.

10.) Important points to note

a. Avoid store bought juice concentrates for up two – three years to prevent recurrent                  throat infections. If they must be consumed, make them as dilute as possible.

          b. If an allergic reaction to a specific food occurs and it is not life threatening i.e rash                    on the body, withdraw the food, wait about 2-4 weeks before re-introducing it again                and start again slowly. (Check blog on allergies for the different ways in which                              allergy manifests.)

10 things that must be provided in diet; for successful weaning.

Weaning is the process of accustoming an infant to adult food. This is a process that is wean3usually complete, by and large, by the age of two years. By adult food, we are talking about the different types of foods in terms of different tastes, textures and consistencies.

This article will consider the food groups only. A subsequent blog will talk about important points to note when weaning and will include things like when to introduce what foods and what to avoid at certain ages.

Successful weaning means that the child will gain weight as recommended as well as avoid malnutrition conditions that are associated with deficiencies of micro-nutrients in diet.

Breast milk is rich in all required nutrients of infants and should be continued as long as possible. The recommended age is up to two years. After six months of age, an infant’s requirement of nutrients is more than breast milk alone can provide. In addition, their digestive system is better developed and that is why weaning is recommenced at this age.

So, what are the foods that every care giver should factor in as they plan their weaning menus and schedules?wean1

  1. Proteins
    1. Sources – Proteins are sourced from animal foods like beef and chicken as well as plant sources like beans and nuts.
    2. Importance – Proteins are the building block of all cells and as children are growing both in size and complexity, they required adequate amounts of protein for normal growth. Lack of adequate proteins leads to reduced growth or stunted growth as well as conditions like kwashiorkor.
  2. Carbohydrates
    1. Sources – Carbohydrates are the sources of energy for the body and mind and thus it is essentially for all children to allow them to grow and explore the world around them. Carbohydrates are sourced from maize, rice, wheat, pumpkins, sweet potatoes and others.
    2. Importance – Lack of carbohydrates means that children are dull and not able to interact well with others and their environment hence resulting in reduced growth and development and conditions like Marasmus.wean4
  3. Vitamin A
    1. Sources – Vitamin is sourced from foods that have reddish pigment in them. These include carrots, pumpkins, pawpaw, tomatoes and many others. Also found in liver, milk and egg York.
    2. Importance – Vitamin A is essential for proper development of the eyes and lack of it results in a preventable illness like night blindness and xerophthalmia. Night blindness is one of the top causes of preventable childhood blindness in developing countries.
  4. Vitamin C
    1. Sources – Vitamin C is sourced from citric fruits and these include oranges and tangerines, cabbage, cauliflower amongst others.
    2. Importance – Vitamin C is essential in the development of soft tissues like gums as well as in maintaining a healthy immune system. Lack of it causes scurvy which is characterized commonly by wide spread bleeding gums in children. It also makes one prone to recurrent colds as well as development of ulcers in the mouth.wean8
  5. Vitamin Bs
    1. Sources – There are many subtypes of vitamins in the B group and these are found in varying proportions in most meats and vegetables. Thus a balanced diet containing the foods mentioned in the other categories will ensure an adequate supply of vitamin Bs.
    2. Importance – Vitamin Bs have many uses in the body that include being components of enzymes, necessary in the development and maintenance of hair, skin, mucous membranes, metabolism, brain and nervous system and the hematological (blood) system.
  6. Iodine
    1. Sources – Iodine is mostly found in seafoods but trace amounts are also found in soil, water and most foods. However, due to the efforts of WHO, salt used in the homes is fortified with iodine. Some other foods as well are fortified with iodine.
    2. Importance – Iodine is essential in the functions of the thyroid gland and a person with a thyroid that is not functioning well is predisposed to many problems as thyroxine (hormone produced by the thyroid gland) is used in almost all parts of the body. Severe lack of iodine will lead to dwarfism, mental problems and poor learning.wean12
  7. Calcium
    1. Sources – Calcium is sourced from animal milk like cow milk, infant formula, eggs, soy sources, sesame seeds, spinach and many others. (Check blog on sources of calcium.)
    2. Importance – Lack of calcium in diet of children will lead to poorly developed bones (rickets) as well as poorly developed teeth. Calcium is also necessary in development of other tissues in the body as well as controlling many functions of the body.
  8. Iron
    1. Sources – Iron is available from meats like chicken, beef, fish and chicken. It is also available from green vegetables.
    2. Importance – Lack of iron leads to anemia which will result in a child who is dull, lacks energy and predisposed to repeated minor infections. Chronic anemia can also lead to heart failure as the heart is forced to work harder to ensure that oxygen gets to tissues.wean11
  9. Zinc
    1. Sources – Zinc is available in meats like beef, wholemeal wheatflour and bread, nuts, cereals and some types of fish.
    2. Importance – Zinc is an important contributor to a well maintained immune system, preventing and treating diarrheas, having good skin and stimulating healthy appetite.
  10. Roughage
    1. Sources – Roughage is sourced from fruits like pawpaw and mango, green vegetables like kales and spinach as well as cereals like weetabix.
    2. Importance – Roughage is essential for proper bowel movement to prevent constipation in children which can be severe enough to cause intestinal obstruction. Constipation in children is way too common and yet it is so easily avoided. (Check blog on constipation in children)wean6

 

 

10 Things to know about Typhoid in Kenya

  1. If you have no fever you do not have typhoid – Fever is a cardinal symptom of Malaria fevertyphoid. The classical fever of typhoid rises gradually over 4 to 5 days and ends up as a high grade fever.
  2. What causes typhoid? – Typhoid is caused by a bacteria of the Salmonella group. One can be infected by;
    1.  Salmonella typhi
    2. Salmonella paratyphi  – which causes a less serious illness.
  3. Salmonella typhi causes a very serious illness – A person suffering from typhoid typhoid3due to Salmonella typhi will very likely be admitted in a hospital for proper management. My rule of thumb is that if you walk into a medical facility by yourself in your usual happy way then you most likely do NOT have typhoid. If you are carried by two or more people then you may have typhoid. A person suffering from typhoid is generally unwell for 2-4 weeks even with treatment. It takes a while to recover from an acute infection of typhoid.
  4. How does one get typhoid? – Typhoid is acquired when one ingests food or water that is contaminated with the salmonella bacteria. A person who is a carrier of the organism or suffering from the disease who comes into contact with their faecal material and does not wash their hands properly, will spread the bacteria to others when they touch food or water.
  5. Symptoms of typhoid – The  symptoms of typhoid include;
    1. Fever
    2. Initial constipation then followed by diarrhea +/- vomiting
    3. Malaise, muscle and joint pains
    4. Other symptoms that may occur include skin rash, cough and epistaxis (nose bleeding).
  6. How do we diagnose typhoid?
    1. The gold standard for diagnosis of typhoid is blood culture in order to grow the bacteria.typhoid 8
    2. Widal test – This is now obsolete in many centers due to its unreliability
    3. Salmonella antigen or antibody test – This is now widely in use as the test can either be positive or negative and does not require any other interpretation.typhoid8
  7. What is the treatment of typhoid? – Treatment of typhoid involves;
    1. typhoid1Fluid and electrolyte replacement – As noted earlier, serious vomiting and diarrhea occurs with typhoid and this can be fatal if not properly managed. This is why most patients end up in the hospital.
    2. Fever and pain management
    3. Antibiotics for 10-14 days minimum.
  8. Complications of typhoid
    1. Intestinal complications – untreated infection can lead to perforation of the intestines or bleeding from the intestines and this can be fatal.
    2. Septicemia – Presence of actively dividing bacteria in blood is septicemia. These bacteria can then find their way to any organ causing illness. These may be to the bones, lungs, kidneys, heart or gall bladder.
  9. Healthy carriers of typhoid – These are people we refer to as chronic carriers of typhoid. Once infected by typhoid, about 5% of people become chronic carriers of typhoid4typhoid. They usually show no symptoms but continue to shed the organism through their fecal matter. These people will then continue to have on and off positive test results without showing actual symptoms of typhoid. They may have on/off abdominal discomfort and should then be checked for gall bladder disease. The most famous chronic carrier is Typhoid Mary.typhoid2
  10. How do we control transmission of typhoid?
    1. Maintaining high hygiene standards is the most important way to control transmission of the disease. This means that we should all ensure that the food we eat and the water we drink has not been contaminated with human fecal material. This means that toilets and latrines are away from kitchen areas, we wash our hands well after visiting the toilet and we eat at establishments that maintain high hygiene standards.typhoid5
    2. Screening and treatment of food handlers – It is mandatory in many countries, including Kenya, for food handlers to undergo annual screening for salmonella. As we said earlier, there are chronic carriers of salmonella who show no symptoms but who can transmit disease. Food handlers, refers to people working in the kitchens as well as anyone selling fresh meats, fruits and vegetables.
    3. Vaccination – There are vaccines available against Salmonella typhi and these are given once every 3 years. This can be given to high risk individuals or people travelling to high risk areas if deemed necessary.

 

 

10 things every man should know about their health

 

  1. Blood Pressure – Every man should know his baseline blood pressure. Blood Bppressure can never be exactly the same as the value is influenced by normal body mechanisms like beating of the heart and normal physical activity.  Apart from protecting oneself from the known side effects of high blood pressure, B.P monitoring is essential for other reasons. From my experience, few men take time to know their normal or recommended health parameters until they develop a symptom that will make them seek medical treatment. They thus tend to suffer from adverse effects of blood pressure for a longer time before it is managed. Black men also tend to suffer from high blood pressure more commonly.
  2. BMI – Body mass Index is a figure that basically correlates one’s height with one’s BMIweight. It is a universally accepted way of determining if one’s weight is acceptable for their height. One can then determine if their weight is normal, overweight or underweight. Maintaining one’s weight within normally accepted levels helps one to prevent or manage symptoms of diabetes, hypertension, heart problems, arthritis and joint pains.
  3. Blood sugar – It would be good practice for every person to measure their bloodBlood sugar sugar levels at least once in their lives but preferably once a year as general health vigilance. Blood sugar monitoring becomes essential in people who are overweight and people with family history of diabetes in blood relatives.
  4. PSA (Prostatic Specific Antigen) level– PSA is a hormone that is derived from the prostate gland. It is measured by Hbtaking a blood specimen and sending it for assay. It should be done once a year for all healthy men above the age of forty years. PSA levels can increase due to benign prostatic hypertrophy (BPH), handling of the prostate gland during prostrate exam or catheterization. More importantly, PSA levels rise in cancer of the prostate. In our Country, prostate cancer is very common (in the top ten cancers) and if detected early, one can achieve 100% cure rate since it is a slow growing cancer.
  5. Dyspepsia can be a warning – Anyone can suffer dyspepsia symptoms due to poor diet, drugs, GERD, alcohol and cigarette smoking (check out our blog on hyperacidity).  But, any man, especially above 40 men2 years of age, with persistent or recurrent dyspepsia symptoms should be thoroughly investigated for cancer of the stomach. In addition, they may suffer from esophageal cancer or liver cancer especially in our Country where these three cancers are in the top ten cancers encountered. Dyspepsia symptoms include heartburn, acidity pain, abdominal bloatedness, belching a lot and many other nonspecific subjective complains.
  6. Central obesity is a health risk– In many cultures, a man with central obesity is considered a mark of prestige and wealth. It portrays a man who is able to utilize his wealth in living the men1good life unlike a thin man or one with a flat stomach. Men should first and foremost be aware that unlike women who primarily store fat under the skin, men tend to store fat around their organs like heart and kidneys. That is the reason they are able to develop a well rounded, firm girth. Fat deposited around organs is much harder to loose and studies have shown that a wide girth is a risk factor for diabetes and heart diseases.
  7. H.I.V status – Every person should know their H.I.V status for their own health HIVbeing.  The essence of knowing one’s H.I.V status is so that one can ensure that their immunity remains as high as possible in order to pre-empt opportunistic infections that are the menaces to deal with.
  8. STD status – Every man must know his STD status because of the adverse effects associated with acquiring an STD. Some STDs can lead to infertility like Chlamydia which unfortunately is often asymptomatic when acquired. Others can be transmitted to their female sexual partners and then to unborn babies while in the uterus or during delivery including syphilis, herpes and gonorrhea. Papillomas are also transmitted by men to women and these in term predispose to cervical cancer and penile cancer.STD
  9. Uric acid levels – Every man above forty years should ideally do an annual uric acid grout managementlevel as part of normal health vigilance. This can be started earlier if one’s diet involves excessive consumption of alcohol and proteins. (For more detail, check out our blog on gout.) Excess uric acid is deposited in joints and in the kidney and a person may represent with gouty arthritis, high blood pressure symptoms or renal failure.
  10. Normal male genitalia – All men (and this time I would like to include male children, teenagers and young adults) should know their normal genital. They should know their penile look as well as the look and feel of their testicles. For young children, parents must ensure that both testicles are descended by two years of age. Undescended testicles are a big concern for future infertility as well as risk of development of testicular cancer. For children and teenagers, they must be advised about testicular pain. Many cases of testicular torsion (twisting of the testicle) are missed or diagnosed late because the boys do not tell the health care provider of testicular pain. Some report it a day or two later and the sad fact is that it is usually too late to save the testicle. Testicular cancer can also occur and usually presents with a painless, enlarged testicles.men3

 

10 things every woman should know about their health

  1. Blood Pressure – Every woman should know their baseline blood pressure. Blood pressure can never be exactly the same as the value is influenced by normal body mechanisms like beating of the heart and normal physical activity.  Apart from protecting oneself from the known side effects of high blood pressure, B.P monitoring is essential for other reasons. Firstly, it influences your choice of contraceptives as hormone based contraceptives can cause an increase in one’s blood pressure. Secondly, blood pressure can also increase in pregnancy and maintaining a normal baseline blood pressure may mean that a pregnancy associated increase in blood pressure is not very significantly felt.
  2. BMI – Body mass Index is a figure that basically correlates one’s height with one’s BMIweight. It is a universally accepted way of determining if one’s weight is acceptable for their height. One can then determine if their weight is normal, overweight or underweight. Maintaining one’s weight within normally accepted levels helps one to prevent or manage symptoms of diabetes, hypertension, heart problems, arthritis and joint pains. It is also minimizes some of the negative effects or complications that affect overweight women in pregnancy.
  3. Blood sugar – It would be god practice for every person to measure their blood Blood sugarsugar levels at least once in their lives but preferably once a year as general health vigilance. Blood sugar monitoring becomes essential in people who are overweight, people with family history of diabetes in blood relatives, pregnancy especially with weight gain over and above what is medically recommended.
  4. Hemoglobin (Hb) level – Hemoglobin levels are determined by doing a blood test that can measure just the hemoglobin level or more ideally a total blood count that Hbwill look at other blood parameters as well as suggest the type of anemia one may have if they have. Many women are at risk of being anemic because of excess blood loss and/or increased need for iron during normal periods, abnormal vaginal bleeds due to things like fibroids, breastfeeding, ectopic pregnancies, miscarriages, normal delivery or caesarean sections. In addition, some women may have diets that exclude meats or vegetables which are essential in providing iron which is used in maintaining one’s Hb. Teenagers and college students are usually a risk group for unhealthy diets.
  5. Normal periods (menses) – Every woman should know roughly at what age their periods began, how many days of flow they have, pattern of flow and how often their
    Menstrual cycle
    28 day cycle

    periods come. Every woman should know whether they fall in the 21 day, 28 day or 35 day cycle. They should also make a note of when the periods end. This information is essential so that if there is any change in their periods, they should be the first ones to notice at the earliest time possible. Changes may include heavier periods than normal, newly painful periods, bleeding in-between periods, delayed or absent periods. Things we look out for in women include fibroids, Polycystic Ovarian Disease, Cancer of the cervix, Endometrial (Uterus) cancer, side effects of hormones, pregnancy and its complications amongst other things.

  6. Normal breasts – Every woman should be doing self breast exam at least once a month. If one tends to forget then as often as one remembers. Breast changes associated with breast cancer can be picked early if one is keen enough to note any changes in their normal breasts. These include changes in the skin color or texture, puckering of nipples, inversion of nipples, breast pain or discharge and of course any lumps in the breasts. If there is family history of breast cancer, family members must be extra vigilant in self breast examinations.

    Breast exam
    Breast exam
  7. Pap smear result – Any woman who is sexually active should have a regular pap pap smearsmear done to pick on any early changes of the cervix that could lead to cervical cancer. Sometimes endometrial cancers are picked from pap smears. Regular exam should be annually or every two years depending on factors that your health care provider will determine for you. Early diagnosis of cervical cancer can have 100% cure rate.
  8. H.I.V status – Every person should know their H.I.V status for their own health being. HIVFor women, due to pregnancy, deliveries and breastfeeding, this becomes compulsory as part of Ante Natal Care as well as admissions for delivery in some centers. The essence of knowing one’s H.I.V status is so that one can ensure that their immunity remains as high as possible in order to pre-empt opportunistic infections that are the menaces to deal with.
  9. STD status – Every woman must know their STD status because of the adverse effects associated with acquiring an STD. Some STD’s can lead to infertility like Chlamydia which unfortunately is often asymptomatic when acquired. Others can be transmitted to unborn babies while in the uterus or during delivery including syphilis, herpes and gonorrhea.STD
  10. Normal bowel habits – Every woman should know what is their normal bowel movement in terms of frequency, amounts and consistency. This becomes essential Bowel movementin being on the look-out for colorectal cancer which is a cancer that is pretty common especially in Kenya and affects more women than men. Early symptoms are nonspecific and include changes in bowel movement with constipation or diarrhea, abdominal bloating and blood in stool which may be easily seen or microscopic. Thus, any woman, especially above 40 years with sudden changes in bowel habits should have occult blood checked in stool as well as colonoscopy done to check for cancer of the colon/rectum.

10 things to know about too much acidity

1. Definition of terms

Hyper-acidity – Basically means increased production of acid in the stomach or increased effects of acid presence on the stomach. This is the term most commonly used to describe symptoms and it will be used in the write-up to represent both superficial irritations and ulcers.

Heartburn – Feeling of burning sensation in the chest due to indigestion.Hyper1

Esophagitis – Irritation and inflammation of the lining of the esophagus (food pipe).

Gastritis – Irritation and inflammation of the lining of the stomach.

Duodenitis – Irritation and inflammation of the lining of the duodenum which is the first part of the small intestine.

GERD (Gastro-Esophageal Reflux Disease) – A condition whereby acid produced in the stomach finds its way back to the esophagus due to ineffective control of the lower esophageal sphincter that ideally should ensure that stomach contents do not move back to the esophagus.

Ulcer – A wound that has formed on the inner lining of the esophagus, stomach or duodenum.

2. Demographics

Gender – Symptoms of acidity affects both women and men.

Age – Can occur in children or adults though commoner in adults.

Role of genetics? – There are various studies to support the role of genetics especially in GERD and other conditions. Hyper-acidity symptoms tend to run in families and it is common to hear of generations suffering from symptoms, that is, a mother may have symptoms as well as her children.

3. Risk factors for the above

Foods – Different people develop symptoms due to different foods and each person must determine which foods cause or worsen their symptoms. Common culprits include citric fruits like lemons and oranges, vegetables like kales (sukuma wiki), fatty foods, chocolate and beans. In addition, some people get symptoms when they eat a lot of food regardless of type and especially when they try to lie down afterwards.Hyper2

Drinks – Coffee, alcohol and caffeinated soft drinks may lead to symptoms in predisposed individuals.

Cigarette smoking – This is associated with symptoms due to its effect on the lining of the stomach and the normal protective mechanisms of the stomach and other organs.

Pregnancy – In early pregnancy, it is due to effects of progesterone which slows down peristalsis and movement of food. It is the same reason that constipation occurs in pregnancy. Subsequently, as the pregnancy progresses, the increase in abdominal girth due to the growing baby, displaces the intestines and stomach and this allows for acidic stomach contents to reflux to the esophagus.

Skipping meals – All people are encouraged to eat every 3 hours when they are awake. This is because acid production and digestion is a continuous process. Thus, people with tendency to skip meals continue to produce acid that has no food to work on and consequently works on the lining of the stomach and other organs.

Drugs – Drugs interfere with motility of the intestines as well as interfere with the pump that deals with acid production. Many drugs can cause hyper-acidity symptoms but common ones include some pain killers (NSAIDS) and antibiotics.

Infections – Food poisoning which we medically call gastro-enteritis means that the infective organism causes one to have stomach (gastro) symptoms like nausea, vomiting, anorexia and upper stomach pains on its own or in conjunction with small intestine (enteritis) symptoms of middle and lower abdominal pain and diarrhea.

Obesity – Increased abdominal girth as well as peri-organ fat leads to displacement of Hyper4abdominal content especially on lying down predisposing to acidity as well as GERD.

 

Abdominal masses – once again due to increased abdominal size.

4. Signs and symptoms of hyper-acidity

  • Pain – Pain is one of the cardinal symptoms of hyper-acidity at whatever stage of development. However, there are some characteristics of the pain that are crucial for suspicion.

Epigastric – This means that pain is in the upper mid                                                   Hyper5                                  section of the abdomen.

Hunger pain – This means that when one is hungry,            they develop or worsen the pain.

Night pains – This is very characteristic as the pain               tends to be worse at night and many people report             being woken up by the pain.

Pain relief – The pain is relieved by eating something,                                                                                   drinking milk or taking an OTC antacid.

Episodic/periodic – Once pain is established and without                                                                            treatment, the pain tends to last for a few days to weeks                                                                              and then disappears. It then recurs when risk factor is                                                                                  exposed again.

  • Belching – Belching is nature’s way of encouraging release of excess gas that accumulates and it makes the person feel better.
  • Persistent/recurrent sore throat – People with recurrent episodes of sore throat with no obvious infections should be put on an antacid and see whether the symptoms disappear.
  • Erosion of teeth – Reflux of acid into the mouth can lead to erosion of teeth.
  • Nausea and anorexia – Presence of epigastric pain and discomfort makes one lose their appetite and people report being unable to eat. Others experience persistent nausea that worsens inability to eat which then worsens the epigastric pain
  • Vomiting – When the stomach lining is sufficiently irritated, it protects itself by trying to remove the offending substance and this result in people vomiting. Once a person vomits the contents which are bitter, acidic and burns the throat, they usually feel much better.
  • Waterbrash effect – This means that a person has sour saliva accumulating in their mouths and they have to keep spitting it out. Swallowing this saliva leaves one nauseated and some people end up throwing up.

5. Association with H. Pylori infection

Prevalence – According to Davidson’s Principles and Practice of medicine, the prevalence of H. Pylori in adults in the U.K is about 50%. It is thought to be as high as 90% in adults in developing countries. Around 90% of patients with duodenal ulcers and 70% of patients with stomach ulcers are infected with H. Pylori.subglacial_lakes_1

Diagnosis – H. Pylori is diagnosed using an antigen or antibody kit which uses specimen of blood or stool. There are instances when tests done on stool or blood samples are negative but the bacteria is discovered on staining of specimen collected during endoscopy.

Hyper 11 Hyper 12

Eradication – Eradication of H.P ylori is done using “triple therapy.” This is accomplished using two antibiotics (amoxicillin and clarithromycin/metronidazole) and an antacid (omeprazole or other PPI) for 7 to 14 days. The antacid is usually continued after that until adequate healing is achieved.

6. Complications

Bleeding – Erosion of the lining of the esophagus, stomach or duodenum can continue until it erodes a blood vessel. This leads to massive bleeding and many patients present with vomiting blood (hematemesis). Others present with black stool which contains altered blood that’s been digested. Massive, repeated bleeding can be fatal.

Obstruction – Recurrent erosion with healing leads to healing with formation of fibrous tissue which leads to narrowing of the lumen of the organs. This can result in total occlusion of the lumen with features of obstruction.

Cancer – Recurrent inflammation of the inner lining of the duodenum, stomach and esophagus can lead to abnormal changes of the cells of these organs leading to development of cancer.

7. Diagnosis

Barium exam – This is a type of X-ray that is taken after one has been given a substance toHyper6 consume. X-ray is taken as the patient is swallowing and/or after the substance has settled in the stomach.

 

 
Endoscopy – This involves insertion of a tube with a camera downHyper7 one’s throat into the esophagus, stomach and duodenum. This enables the doctor to visualize the inner linings of the organs, take photographs as well as take biopsy samples for histology (which is how cancer is diagnosed) as well as staining to check for H. Pylori.

8. Drug treatment

Acute – A patient presenting with the first case of the above especially if it is associated with an obvious cause should be treated for 1-6 weeks as determined by the practitioner so as to allow for total healing of the lining of the organs.

Chronic – Patients with recurrent or persistent symptoms should be adequately investigated for any underlying issues. They usually require much longer treatment and may even be years. Some schools of thought advocate for treatment for life for those who cannot or will not change lifestyles that predispose to symptoms like taking alcohol or prescription medications.

9. Drugs used in treatment

Children – Children are usually managed with liquid antacids but stronger medications can be prescribed by health practitioners depending on severity of conditions.

Pregnant/lactating mothers – These individuals are usually managed with liquid antacids or H2 receptor antagonists like ranitidine.

Adults – A wide range of treatment options are available and include liquid antacids, H2 receptor antagonists and PPIs like omeprazole/esomeprazole/rabeprazole.

10. Lifestyle modification to manage hyper-acidity symptoms

  •  Elevation of one’s head by  (15cm) when lying down by either physically elevating the bed or using pillows
  • Moderate ingestion of foods that cause symptoms
  • Special care with “risk” medications
  • Do not lie down for at least two hours after meals
  • Avoid large meals
  • Reduce or stop intake of alcohol, coffee and other caffeinated drinks especially if they cause symptoms.
  • Do not skip meals
  • Stop smoking
  • Loose weight if overweight

10 Common manifestations of allergies

  1. Itchy eyes – Affected people are constantly rubbing their eyes in order to ease the allergy3itchy feeling. Associated with reddening of the eyes and sometimes sensation of something foreign in the eye. They also tend to have dark skin below the eyes and others may even have puffiness (bags swollen) under their eyes. These people react to all manner of things that could be dust, allergens in the air and others. Secondary eye infections are common due itch with dirty hands.
  2. Itchy nose – These people tend to rub the edge of the noses repeatedly to ease the allergy10itch. May or may not be associated with a runny nose. These people may be reacting to many things like strong smells or allergens in the air like dust and animal fur.
  3. Itchy ears – These are people who experience an intense itch in allergy6the ear and it is common to find them sticking things into their ears to relieve the itch. Sometimes they itch to the extent of causing pain in the ear canal and sometimes infections also follow. They are also culprits of leaving foreign bodies in the ears and usually cotton buds that were dislodged from ear buds.
  4. Itchy throat – These are people who are constantly using their tongues to scratch allergy13the back of their throats and the roof of their mouths due to a feeling of intense itchiness. Usually associated with discomfort or itchiness of the ears. Some people complain of having secretions dripping at the back of the throat. Others are always clearing their throats to ease a nagging irritation.
  5. Itchy rash – Itchy rash usually in the folded surfaces of skin like front of elbow joint, allergy2back of knees, front of neck, cheeks of infants are common manifestations of eczema. This is an allergic skin reaction one is born with. These people experience flare ups with intense itchiness and moments of complete disappearance of the rash. Others develop a rash with drier, tougher skin that does not completely disappear or takes time to clear.
  6. Pimples – These can manifest either as small raised red itchy red lesions on the skinallergy 17 or big itchy pimples on the body. These tend to result from a reaction to something that has been consumed like milk, meat or eggs. They tend to occur in different parts of the body at the same time.
  7. Contact dermatitis– This means that a person reacts to allergy 15something their skin has come into contact with and the reaction is usually localized to that one spot. One can react to metals, plastics, latex, chemicals or even cold. These people either develop a rash over the contact area or redness with intense itching over the area. The reaction occurs only with exposure to these substances and recurs with repeated exposure.
  8. Sneezing, runny/blocked nose – These refers to people who go into an episode of Allergy1repeated sneezing due to exposure to an item their body cannot tolerate. Can be a strong smell or exposure to tiny particles like dust mites or animal fur. Some people react to the cold environment so that a few minutes after they leave their beds they start sneezing until the body adapts to the weather. People reacting chronically to something have continuous runny or blocked noses and tend to develop a nasal speech.
  9. Cough – People experience a dry, irritating cough that is usually worse at night, inallergy 16 the early morning and when exposed to a cold environment. It is one of the symptoms of asthma and it results due to temporary narrowing of the small airways to the lungs. This result in build-up of secretions and these people will cough continuously until they expel some secretions then they feel better. Chronic irritation can lead to permanent narrowing of airways.
  10. Diarrhea and/or constipation – This is usually a manifestation of allergy to a type of food. Some people react to proteins while others react to wheat based products like bread, mandazi and chapati. Consumption of these foods then results in diarrhea or constipation and in some instances alternation between the two.allergy5

10 Things you must know about malaria in Kenya

  1. You cannot have malaria without fever – High grade fever is one of the most Malaria feverimportant diagnostic criteria for malaria. Unless one has taken some fever medication like paracetamol or have partly self medicated with malaria drugs, one must have a fever to even consider malaria as a cause of their illness. This, in conjunction with other symptoms, makes one feel really terrible. Anyone coming to a health facility smiling and being their usual happy self does not have malaria.
  2. Headache, fever and joint pains do not equate malaria – These are symptoms that can be attributed to malaria. But, there are many other illnesses that cause the above symptoms including a cold, flu, food poisoning, urinary tract infection and many other non-infective causes. So, if you wake up with a headache, runny nose and joint pains and have not traveled to a malaria endemic zone, you are very unlikely to be suffering from malaria. Do a malaria test before buying medicines over the counter.
  3. Being beaten by mosquitoes does not cause malaria – Malaria is caused by malaria mosquitoexposure to a parasite (plasmodium) which is carried by mosquitoes (of the anopheles type) and injected into your blood stream when the mosquito bites you. Thus, even if you are bitten by 100 mosquitoes that do not have the parasite, you will not contract malaria. Many people buy over the counter malaria medication just on the basis of the fact that they or their child were beaten by many mosquitoes.
  4. There is no malaria in Nairobi – A study that looked at malaria infection in urban informal settlement in Nairobi and conducted by KEMRI and other notable institutions in 2008 declared Nairobi a malaria free zone with zero prevalence.  So, if you have mosquitoes in your house in Nairobi and are beaten repeatedly and develop pimples on your body, you will not contract malaria. Yet, malaria drugs are some of the fastest selling medications over the counter in this Country even in non-malaria zones like Nairobi.
  5. Malaria prevalence in Kenya;

a)      Endemic areas – Coastal areas and Western Kenya. Endemic areas means that these                areas have malaria cases all year round and a person can get malaria if they travel to              these areas at any time of the year.Malaria

 

b)      Seasonal transmission areas – Northern Kenya and Southeastern Kenya. These areas            have seasons when malaria is high and seasons when it is low. This means that one                  can travel to these areas repeatedly and not get infected with malaria but when the                  person travels there during malaria peak seasons, they can contract malaria.

  1. Inappropriate use of antimalarials causes resistance – One should never take antimalarial drugs without a malaria test being done to confirm suspicion. Many people wake up, feel a bit of joint pains and buy malaria drugs. The day these people are unfortunate enough to actually contract malaria, they will have one rough time treating the illness as the body is accustomed to this regular medication.
  2. There are two main tests for malaria;
    1. Blood slide for malaria – This is user dependent and can only be relied on if malaria slideone is sure that the institution they have visited has staffs that are competent in preparing and reading the slide correctly.
    2. Malaria antigen test – This is not user dependent as itmalaria antigen test looks for antigens to malaria rather than physical detection of the parasites in blood. It is like the HIV test meaning than one will get a result that is either positive or negative.
  3. You can get malaria despite taking prophylaxis – This sounds ironic but the problem is that people take prophylaxis inappropriately. Prophylaxis for malaria must be started BEFORE travel to endemic zone, continued throughout the stay and continued for a few weeks after one returns from travel. It is becoming more advisable to allow for residents to travel without prophylaxis, practice barrier methods against malaria and do a test for malaria if they develop fever. But for visitors from outside the Country, they must take their prophylaxis as they tend to suffer more severe forms of malaria.
  4. Malaria takes time to develop – Malaria has an incubation period of at least 1 week. This means that if you went to a malaria area two days ago for one day, you are unlikely to have malaria. Seven days must have elapsed from the first day that the traveler arrived in the malaria endemic zone.
  5. Barrier methods for malaria – These include dressing in clothes that cover as much of one’s body parts as possible. In addition, use of mosquito repellent jelly, sprays, coils and mosquito nets is very important. Mosquitoes mostly bites at night so be more vigilant during the dark hours of the night.malaria barriers

10 things to know about meningitis in Kenya

Meningitis can be a life threatening illness if not quickly diagnosed and managed appropriately. The bigger part of this write up will cover bacterial meningitis since it is the one that is contagious and causes outbreaks. Other causes will be mentioned in brief.

  1. What is meningitis? – Meningitis means infection of the covering of the brain. As meningitis4seen in this diagram of the head, we move from the skin to the bone, to the meninges (covering the brain) and then finally to the brain itself.
  2. What causes Meningitis? – Meningitis can be caused by very many things. These include;
    1. Bacteria – The commonest bacteria that causes meningitis is of the Neisseria group. This is the bacteria that causes the contagious form of meningitis and is responsible for outbreaks. Other common bacteria include Streptococcal pneumoniae, Hemophilus influenza and other Gram-negative bacilli.
    2. TB (Tuberculosis) – TB is technically a bacteria but it deserves a category of its own because in our country, TB is pretty common. One can get the common lung TB which then spreads through the blood to multiple sites that can include the meninges.
    3. Viruses – commonly encountered viruses can give rise to meningitis. These include Varicella that causes chicken pox, Herpes, Influenza and HIV.
    4. Fungus – More rarely, funguses can cause meningitis especially among immunocompromised people and commonly involves the Cryptococcal type.
    5. Parasites – Some parasites can gain access to the meninges causing meningitis and include malaria, amoeba, toxoplasma and others.
    6. Non-infective causes – Meningitis can also be due to other causes and these include cancers, drugs, Systemic Lupus Erythematosus (SLE), vasculitis and other conditions.
  3. How can one get bacterial meningitis?
    1. Inhale it – Bacterial meningitis organisms are accessed through inhalation of the bacteria from the secretions of an infected individual. These bacteria access the nose and pharynx and then access the blood. This may proceed to rapidly multiplying infective organisms in blood which is known as septicemia. These organisms then gain access to any organ which may include the brain covering to cause meningitis.
    2. Direct injury to the head – This is due to penetrating injuries to the head, face, eye, nose or ears from Road Traffic Accidents, fights or accidents. A recent case I came across was of a high school student who fell off a bed and hit his nose on a hard desk. The boy developed a nose bleed that stopped after a short while. Days later, he developed severe headache and fever and was subsequently discovered to have developed meningitis.
    3. Progression of disease from organs that communicate with the brain – Poorly managed infections of organs communicating with the brain can also lead to infection of the meninges through direct extension of the disease either through bone or following a nerve. Example is that of people who have runny, blocked noses go on to develop sinusitis and then progress to meningitis. Others have poorly managed eye infections that lead to orbital cellulitis and then to meningitis or middle ear infections (otitis media) leading to meningitis.
    4. Septicemia – This means that any infection from a different part of the body (e.g. lung, skin, ear, bone e.t.c.) spreads to the blood and then finds its way to the meninges.
  4. Symptoms of meningitis – Commonest triad of symptoms of meningitis include meningitis3fever, severe headache and neck stiffness. They are all usually present in only about 70% of patients.Other common symptoms include photophobia (fear of bright light), phonophobia (fear of loud noises), drowsiness or loss of consciousness
  5. Risk factors for meningitis.
    1. Poorly ventilated, crowded, living areas
    2. Very young and very old by virtue of their age.
    3. Immunosuppression – HIV, cancer, drugs, alcoholics, pregnancy
    4. Direct trauma to head – can be major RTA or even a small injury that causes an open communication path to the brain e.g. fracture nasal bones or middle ear or penetrating injury to the eye.
    5. Poorly managed infections of the eye, nose and ears.
    6. Septicemia secondary to infection from any other site in the body.
  6. Treatment of meningitis;
    1. Bacterial               – Antibiotics given intravenously is the mainstay of treatment.
    2. T.B                          – Anti TB drugs
    3. Viral                       – Usually self limiting but some anti-virals can be given for specific viruses.
    4. Parasitic               – Anti-parasitic medications
    5. Fungal                   – Antifungal medications.
  7. Complications of meningitis
    1. Brain damage – Infection and inflammation of the meninges causes fibrous tissue to form which then compresses the brain and this can lead to brain damage. The damage can be localized where a person recovers but a part of their brain is damaged like speech or vision.
    2. Encephalitis – A big term to mean that the infection has spread from the covering of the brain into the brain itself.
    3. Septicemia – As stated earlier, once infected material has found its way into the blood, it can be lodged at any organ causing organ damage. This is usually to the kidneys, heart, bones and joints.
    4. Death – Usually due to a combination of some of the above.
  8. Is there a vaccine to prevent bacterial meningitis? – There are various vaccines for the different causes of meningitis.
    1. Meningococcal Vaccine – This is not given routinely as any part of our immunization programs. First and foremost, it does not cover all types of the Neisseria bacteria that cause meningitis. This means that one can still get meningitis from the same bacteria they were vaccinated against but a specific subtype. Secondly, the effectivity of the vaccine is only about three years. This would suggest that one gets vaccinated every three years but the irony is that studies have shown that booster vaccines actually lower your immunity not increase it.
    2. Streptococcal pneumonia Vaccine – Newly introduced in Kenya as part ofpentavalent our KEPI program (Kenya Expanded Program on Immunization).
    3. Hemophilus influenza Vaccine – Given in children (pentavalent) as part of our KEPI program (Kenya Expanded Program on Immunization).
  9. What if there is an outbreak of meningitis? What happens?
    1. High risk people get vaccinated – This means people living in the vicinity of the person affected as well as medical personnel who will be involved in the management of the outbreak.
    2. Affected people are managed in isolation. In addition there is Isolation and monitoring of people who have been in direct contact with affected persons.
    3. Prophylaxis treatment can also be given to people who have been exposed. This can only be effective if the cause of meningitis has been determined with certainty.
  10. How common is meningitis in Kenya? – Unfortunately, there are no easily available studies to show the epidemiology of meningitis in Kenya. Single cases of meningitis are common in Kenya especially in immunocompromised individuals, in children and the elderly. This is usually due to any of the organisms mentioned above. However, outbreaks are rare in this country and only a small part of the country is considered to be in the Meningitis belt.meningitis belt