Journal of the Kenya Association of Physicians

The emerging burden of autoimmune and rheumatic diseases in Africa

2026-04-06T13:42:46+00:00

No abstract

Review Article - Pharmacological management of diabetic retinopathy: Current trends and emerging therapies

2026-04-06T13:56:37+00:00

Background: Diabetic Retinopathy (DR) is a leading cause of preventable vision loss worldwide. Over the past decade, pharmacological therapies have revolutionized management, shifting emphasis from laser photocoagulation to intravitreal agents.
Objective: This review summarizes current pharmacological treatments, evaluates evidence from pivotal clinical trials, and discusses emerging therapeutic strategies in DR management.
Methods: A narrative synthesis of recent guidelines, clinical trial data, and regulatory updates was undertaken, emphasizing anti-VEGF therapy, dual-pathway inhibition, corticosteroid implants, systemic agents, and emerging therapies.
Results: Anti-VEGF therapy remains the gold standard for Diabetic Macular Edema (DME) and Proliferative DR (PDR), with aflibercept 8mg (Eylea HD) and faricimab (vabysmo) offering improved durability. Corticosteroid implants provide alternatives in refractory or pseudophakic cases. Panretinal photocoagulation remains relevant where adherence is uncertain. Systemic agents, notably fenofibrate, reduce DR progression. Emerging therapies include sustained-delivery systems, gene therapy, integrin inhibitors, and Artificial Intelligence (AI)-assisted screening.
Conclusion: Pharmacological management of DR is in a transition toward extended-dosing, dualmechanism inhibition, and systemic adjunctive therapies. Integration of AI-enabled screening and next-generation therapeutics promises to reduce treatment burden and improve visual outcome.

Glycaemic trajectories and the role of interleukin 18 as a surrogate biomarker for cardiovascular risk in persons with tuberculosis

2026-04-06T14:23:43+00:00

Background: Diabetes Mellitus (DM) and tuberculosis (TB) interact synergistically. However, glycaemic trajectories in TB are not extensively investigated. TB increases the risk of developing dysglycaemia and while the latter may resolve at the end of treatment, the risk of developing DM for good persists. A diagnosis of DM triples to quadruples the risk of developing TB and the outranks that of TB-HIV co-infection. Most deaths post-TB treatment are cardiovascular (CV) in origin but long-term follow-up for glycaemic monitoring and control in TB, and surrogate biomarkers for CV risk in the context of TB are lacking. Interleukin 18 (IL-18) presents a potential role both as a surrogate biomarker for glycaemia and CV risk prediction. It is a strong predictor of CV risk and death and increase in IL-18 is associated with an increase in risk of CV mortality.
Objectives: To evaluate the performance of markers of glycaemia; glycated haemoglobin (HbA1C) and interleukin 18 (IL 18) as a surrogate biomarker in predicting glycaemic trajectories in patients newly diagnosed with drug-sensitive TB and identify patient factors associated with worsening or persistent trajectories.
Methods: Prospective, nested longitudinal study in Nairobi County, Kenya. Sample size of participants was n=261. Adults with newly diagnosed TB had baseline, month 6 and month 12 HbA1C measured. IL18 was also measured at month 6 and 12 in a subset of participants.
Results: Persons with tuberculosis undergo individualized glycaemic trajectories from diagnosis of TB to the end of treatment that change with time; at month 6 and post-treatment at month 12. The overall rate of diabetes, prediabetes and normoglycaemia at baseline was 28 (10.7%), 102 (39.1%) and 131 (50.2%) respectively. Hyperglycaemia is highest at baseline or start of treatment and begins to decline at the end of treatment and resolves or morphs into a worsening trajectory at month 12. Interleukin-18 levels remain high at the end of treatment at month 6 and at month 12 even in people with a normal HbA1C.
Conclusion: Measurement of IL 18 levels may be a useful surrogate for prediction of CV risk given that people treated with TB have 3 times as much risk of dying than those who have not been treated for it and glycaemic monitoring is needed even after TB treatment.
Recommendation: Multi-disciplinary, longer term follow-up post end of treatment at 6 months in drug sensitive tuberculosis is needed to establish those at risk for a worsening glycaemic trajectory and offer personalized glycaemic care for those who persist at diabetes or pre-diabetes. I L-18 level measurement may be a useful surrogate to HbA1C in follow-up of people with TB post-treatment.

User satisfaction with Voice Recognition Systems (VRS): Insights from a Kenyan Tertiary Teaching Hospital

2026-04-06T15:12:48+00:00

Background: The healthcare landscape is rapidly evolving, with a growing shift towards more efficient documentation methods, including the integration of Electronic Health Records (EHR). Among these advancements, Voice Recognition Systems (VRS) have emerged as a valuable tool, enabling real-time transcription of speech into text. Despite their potential to streamline clinical workflows and reduce documentation burden, the adoption of VRS in Low- and Middle-Income Countries (LMICs) remains limited.
Objective: To evaluate the adoption/uptake of VRS and the end-user satisfaction among physicians at a tertiary care hospital in Kenya.
Methods: A cross-sectional study was conducted between October 1, 2023 and January 31, 2024 at the Aga Khan University Hospital, Nairobi involving physicians who actively use the EHR system. Data were collected using a structured, anonymous online questionnaire adapted from the Michigan Public Health Institute’s EHR End-User Survey. The survey assessed key domains including ease of use, functionality, efficiency, and overall user satisfaction with the VRS..
Results: The study involved 124 physicians of which 57 (46.0%) reported the use of VRS. The majority of participants in this investigation expressed satisfaction with their experiences with VRS (96.4%) with almost all reporting ease of use when employi g VRS technology (98.2%). The participants stated that the integration of VRS into their workflow enhanced their efficiency (85.7%) and required them to do less work following the integration of VRS (91.1%).
Conclusion: Although adoption of the VRS was moderate, physicians who used the technology reported overwhelmingly positive experiences, including presumed improved efficiency. These findings highlight the strong potential for scaling VRS in hospital settings within LMICs particularly if key infrastructural and training barriers are effectively addressed.

Evaluating of machine learning models in predicting COVID-19 vaccine uptake in Kenya

2026-04-06T15:56:53+00:00

Background: Machine learning algorithms are employed to create prognostic and diagnostic models, aiding in public health decision-making and intervention strategies.
Objective: This study aimed to explore predictive models for the COVID-19 vaccination uptake using machine learning algorithms.
Methods: Supervised machine learning algorithms were utilised to predict accuracy. We employed an evaluation framework to assess the performance of Random Forest (RF), Support Vector Machine (SVM) and Extreme Gradient Boost (XGB) models in predicting COVID-19 vaccine hesitancy. The data used was based on a cross-sectional study conducted between November 2021 and January 2022 among the general adult public seeking care at six different healthcare facilities in Kenya. The survey, in English, consisted of questions based on demographics, knowledge, and attitudes, including knowledge towards the COVID-19 vaccine. Model effectiveness was evaluated by comparing accuracy, F1 score, sensitivity, specificity and AUROC.
Results: Of the 3996 surveys collected, approximately 68.8% reported being vaccinated with at least one dose. Three models were established using 56 predicting features. Among the three models, RF and XGB yielded better overall performance, with an equal AUROC of 0.88, compared to SVM, which achieved an AUROC of 0.82. Additionally, protection against COVID-19 variables had the highest importance to vaccine uptake, and the following features were healthcare facility and recommendation to the family respectively.
Conclusion: The study findings underscore the potential of leveraging machine learning algorithms in public health strategies to address vaccine hesitancy. Our results indicated that random forest could be a useful predictive tool to identify vaccine uptake which may facilitate effective strategies and further optimize resources. These algorithms were selected for their widespread use, transferability, and proven performance in healthcare prediction tasks, aiming to enhance the predictive accuracy and offer actionable insights into combating vaccine hesitancy.

Prevalence of depression and its associated risk factors among patients with Type 2 Diabetes Mellitus at Chumbuni District Hospital, Zanzibar

2026-04-06T16:20:55+00:00

Background: Depression is a significant comorbidity among patients with Type 2 Diabetes Mellitus (T2DM), negatively impacting treatment adherence, quality of life, and clinical outcomes. However, data on its prevalence and associated risk factors remain limited in Zanzibar.
Objective: This study aimed to assess the prevalence and severity of depression and identify its associated risk factors among patients with T2DM attending Chumbuni District Hospital (CDH).
Methods: A descriptive cross-sectional study was conducted among 246 adult T2DM patients at CDH. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Sociodemographic and clinical data were collected and analyzed using descriptive statistics, t-tests, ANOVA, and multiple linear regression.
Results: The prevalence of depression was 51.2%, with mild depression being most common (41.9%). No cases of severe depression were recorded. Depression was significantly associated with older age (p<0.001), longer duration of diabetes (p<0.001), and presence of comorbidities such as diabetic foot ulcers, diabetic retinopathy, kidney disease, stroke and hypertension (p<0.001).
Conclusion: Depression is highly prevalent among patients with T2DM at CDH, particularly in those with comorbidities and advanced complications. Routine depression screening and integrated mental health interventions should be considered for patients with diabetes in our settings.

Awareness and acceptability of pre-marital screening for sickle cell among university students in Kenya

2026-04-06T16:35:04+00:00

Background: Sickle cell disease is a severe autosomal recessive disorder most prevalent in people of African descent. It is associated with significant morbidity and premature death. Premarital screening for sickle cell is a costeffective strategy intended to minimize high risk couplings. Premarital screening for sickle cell is yet to be adopted in Kenya.
Objective: This study sought to assess awareness and acceptance of premarital screening for sickle cell among a young Kenyan population.
Methods: A descriptive cross-sectional research design utilizing an online, self-administered, questionnaire was conducted among 314 university students selected by multistage sampling technique. Statistical analysis was done using descriptive methods. The following domains were assessed: Students demographics, knowledge of inheritance patterns, attitude and perception towards premarital screening for sickle cell and, acceptance of premarital screening. Chi square test was used to determine significance of association between the study variables and the two groups.
Results: A total of 314 unmarried students were recruited with 134 (43%) medical students and 180 (57%) non-medical students. Males were 172 (55%) and females 142 (45%). Majority; 191 (61%) were between ages 21~25 years. Overall good knowledge was 241 (77%). Sickle cell was identified as a heritable disorder by 123 (92%) of medical students and 98 (54%) non-medical students. Diagnosis of sickle cell via blood test was correctly identified by 121 (90%) medical and 92 (51%) non-medical students. Premarital screening was identified as beneficial by 124 (93%) medical and 136 (76%) non-medical students. Of all respondents, 196 (62%) were willing to undergo premarital screening for sickle cell (medical students 69%; non-medical students 57%).
Conclusion: Sickle cell is the commonest monogenic disorder in Kenya. Kenyan youths demonstrated significant gaps on knowledge on inheritance patterns, attitude and perception towards premarital screening for sickle cell. There was also limited acceptability to undergo individual premarital screening and genetic counselling. Health education on premarital screening and genetic counselling is an important intervention at reducing burden and prevalence of sickle cell disease.

Haemoptysis as a rare presentation of Aortic Arch Aneurysm: A case report

2026-04-06T16:54:29+00:00

Haemoptysis is a very rare but possible complication of Aortic Arch Aneurysm (AAA) and usually is due to an erosion of the aneurysm into the trachea or rupture of the aneurysm into the lungs. Rupture of an aortic aneurysm is a catastrophic event associated with a very high mortality of >30%. Globally the incidence of AAA is 5-10 per 100,000 person-years. Approximately 15,000 people in the United States and 30,000 in Europe are diagnosed with AAA each year. The disorder is more common in men than in women, with prevalence rates estimated at 1.3– 8.9% in men over the age of 60 years.
In sub–Saharan Africa the data on the prevalence rate of aortic arch aneurysm is scanty and not up to date. In Kenya, statistics mean age was 56 years. Two hundred and twenty-three (83%) aneurysm occurred in the abdominal aorta ,7.5% descending aorta and 3.8% and 1.9% on ascending and arch of aorta respectively 2.3% of cases both abdominal and thoracic were affected. They do not directly cause death, complications arising from it such as dissection and rupture cause deaths annually.
This case report is a retrospective study design based on the data collected through documents review and data analysis of cases from The Karen Hospital repository.

TB or not TB? That is the question: A complex case with potential TB involvement: A case report

2026-04-07T10:43:30+00:00

Background: Tuberculosis (TB) and septic arthritis are common infectious diseases in Lowand Middle-Income Countries (LMICs). Septic embolism is rare but can complicate these infections. We present a challenging case of a 13-year-old boy with septic arthritis and septic embolism, highlighting diagnostic complexities and multidisciplinary management in a resource-constrained setting. The patient initially presented with a painful, swollen right lower limb, later developing respiratory symptoms. Imaging showed popliteal Deep Vein Thrombosis (DVT), cellulitis, and multiple lung opacities. Lab findings indicated Methicillin-Resistant Staphylococcus Aureus (MRSA), acute kidney injury, and extensive antibiotic resistance. Despite multiple antibiotic regimens and surgical interventions, his condition worsened, culminating in tension pneumothoraxes and cavitary lung lesions. Owing to financial constraints and persistent clinical deterioration, empirical anti-TB therapy was started despite negative TB investigations. He improved rapidly, was weaned off oxygen, and eventually discharged. This case presented diagnostic challenges, with negative TB tests despite a strong clinical suspicion. Multidisciplinary collaboration was pivotal in decision-making, emphasizing the necessity of adaptive treatment strategies. The patient’s atypical presentation and potential environmental factors, such as chronic smoke exposure, raised additional queries. Financial constraints impacted diagnostic choices necessitating frequent antibiotic regimen changes. This complex case underscores the significance of a multidisciplinary approach and adaptive treatment strategies particularly in resource-limited settings. It emphasizes the importance of considering all factors influencing the initiation of anti-TB treatment when faced with recurrent negative TB results. Furthermore, it highlights the influence of financial constraints on diagnostic methods and medication regimens in managing such cases.

Beyond abdominal pain: Acute intermittent porphyria as a rare cause of hyponatremia: A case report

2026-04-07T11:03:55+00:00

Acute intermittent porphyria (AIP) is a rare, inherited metabolic disorder resulting from partial deficiency of porphobilinogen deaminase, an enzyme involved in heme biosynthesis. It often presents with nonspecific neurovisceral symptoms that delays diagnosis.
A 50-year-old African female presented with severe low back pain and diffuse abdominal pain, hyponatremia (Na⁺ 122 mmol/l), and otherwise unremarkable investigations. AIP was suspected, and porphyrin studies were requested. She was managed with analgesics, physiotherapy, lactulose, and gradual sodium correction, leading to full recovery within five days. At one-month follow-up, she remained asymptomatic with normal sodium (137.9 mmol/l). Urinary porphobilinogen was elevated (0.78 mg/dl), confirming AIP. She received nutritional counseling and was advised to avoid known triggers. Genetic testing was deferred due to financial constraints.
This case underscores the importance of recognizing atypical presentations of metabolic disorders and integrating biochemical testing early to prevent misdiagnosis and repeated hospitalizations.
This case highlights the diagnostic challenge of AIP and the importance of considering it in patients with unexplained pain and hyponatremia. To our knowledge, it represents the first reported case of AIP in Kenya.

Unmasking the spectrum of Adult-Onset Still’s Disease: A case series from Zanzibar

2026-04-07T11:29:03+00:00

Adult-Onset Still’s Disease (AOSD) is a rare systemic autoinflammatory condition with highly variable presentations. Early recognition is often hindered by nonspecific symptoms that mimic infections or malignancies.
To describe two contrasting clinical presentations of AOSD in Zanzibar and highlight diagnostic challenges in a resource-limited setting.
Two adult patients diagnosed with AOSD at a tertiary referral hospital in Zanzibar were evaluated using the Yamaguchi criteria after
systematic exclusion of infectious, malignant, and autoimmune mimickers.
One patient presented with atypical serositis-dominant disease, while the other had classical systemic features. Both had markedly elevated serum ferritin levels and responded to corticosteroids and methotrexate.
AOSD presents variably in Zanzibar. Early recognition using established criteria and accessible inflammatory markers is essential to
improve outcomes.

In memorium: Professor Bill Lore

2026-04-08T05:15:15+00:00

No abstract