In developing countries, sciatic nerve injury following gluteal intramuscular injection is a persistent problem. A study over 6 months involving 133 children seen in Mulago hospital with acute flaccid paralysis revealed 124 (93%) children with injection-induced sciatic nerve injury. The identity of the drug in 79 cases (59.4%) was quinine. It is recommended that the gluteal region should not be used as an intramuscular injection site in children.

Background: The pattern of organisms found in open fractures is important in the selection of antibiotics for prophylaxis and empirical treatment. So far, there is paucity of data on local patterns of bacteria contaminating and infecting open fractures and their antibiotic susceptibility profile. Objective: To describe the pattern and antibiotic susceptibility of bacterial isolates obtained within 24 hours of injury from open fractures and to compare these to bacterial isolates from fractures that subsequently develop infection. Methods:A prospective study of 98 patients with open fractures seen at Kenyatta National Hospital (KNH) within 24 hours of injury between November 2015 and March 2016 was conducted. Swabs for culture and sensitivity were taken from the wounds and antibiotics initiated.Surgical debridement was subsequently carried out witha 14 day follow up for wound infection. Wounds thatbecame infected were sampled for cultures And sensitivity. Results: Fifty-one (52.2%) pre debridement wound samples had positive cultures. Staphylococcus aureus and (Coagulase Negative) CON Staphylococci were the predominant gram positive isolates. At 14 days' follow-up, the infection rate was58.9 %. The predominant gram positive isolate was Staphylococcus aureus. Only 5.7% of the predebridement isolates were similar to the post debridement isolates. Conclusions: The contaminating organisms are not similar to the organisms isolated from injuries that later develop infection.

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We are presenting a case report of a 10-year-old male with a 1 year history of bilateral heel pain. Sever disease is self limiting condition of calcaneal apophysis. It is the most common cause of heel pain in the growing child. There is no documented case of this condition in this region. This case highlights the clinical features of this self limiting disorder as seen in this patient and reviews the current literature.

Background: Assessing people's knowledge and beliefs about osteoporosis is fundamental to the formulation of preventive strategies for this condition. To our knowledge, no randomized community survey has been conducted using Facts on Osteoporosis Quiz (FOOQ) and Osteoporosis Health Belief Scale (OHBS) exclusively in the postmenopausal women in Kenya. This study aimed to assess postmenopausal women's knowledge and beliefs concerning osteoporosis in semirural Kiambu County, Kenya. Methods: A cross-sectional study involving face-to-face interviews with 254 African postmenopausal women was conducted between October 2017 and February 2018. The questionnaire explored the socio-demographic characteristics; FOOQ was used to evaluate the knowledge these women had about osteoporosis, while OHBS was used to assess their beliefs. Results: The mean age of the participants was 64.6±10.7 years. About 26.4% (67/254) of the participants had no formal education, while 3.1% (8/254) were in formal employment. About 54.3% (138/254) of the women were married, and 51.2% (130/254) were in the lowest and lower wealth quintile. FOOQ had a mean score of 8.6 (standard deviation±1.8; range, 0-17). OHBS revealed a low level of perceived susceptibility to osteoporosis. Perceived benefits of exercising and calcium intake as well as perceived seriousness of osteoporosis as a disease were at moderate levels. The level of health motivation was also moderate. Conclusions: The women in this study demonstrated limited knowledge about osteoporosis. The low susceptibility score makes the prevention and treatment of osteoporosis in this population challenging. We recommend public health education for all postmenopausal women in this setting.

Tertiary hospitals in resource-limited countries treat patients referred but in most cases are the first level of care for the vast majority of patients. As a result, the tertiary facility effectively functions as a primary health care facility. The urban phenomenon of widespread self-referral is associated with low rates of formal referral from peripheral health facilities. Study Objective: To determine the patterns of orthopaedic and trauma admissions to Kenyatta National Hospital. Methodology: This was descriptive study design. Sample size was 905 patient charts for 2021 Findings The mean age was 33.8 years (SD 16.5) with range of 1 - 93 years. Majority 66.3% were between 25 – 64 years with those above 65 years being 40 (4.4%). Children 0-14 years comprised 10.9% of the admissions. Of the 905 admissions, 80.7% were accident and trauma-related admissions while 17.1% were non-trauma related admissions. About 50.1% were facility referrals while 49.9% were walk-ins. Majority of admissions were through Accident and Emergency Department 78.1%, Corporate Outpatient Care 14.9% and Clinic 7.0%. About 78.7% were emergency admissions while 20.8% were elective admissions. Approximately admissions 48.5% were due to Road Traffic Accidents, 20.9% due to falls and non-trauma related conditions represented 17.1%. Close to 44.8% were casual workers and 20.2% unemployed. Education level was also reviewed with 34.0% having primary education and 35.0% having secondary education. A significant proportion of female admissions (33.2%) were due to non-trauma conditions as compared to male admissions (12.8%) (p<0.001). Aadmissions for those aged 25 – 64 years were 3.5 more likely to have emergency admission as compared to those aged 0 – 14 years. Male were 65.1% less likely to have elective admissions compared to female (p<0.001). Those unemployed were 3.9 more likely to have emergency admission compared to businessmen/women. Vast majority (89.2%) of admissions were within Nairobi Metropolitan region

Inappropriate utilization of higher-level health facilities and ineffective management of referral processes in resource-limited settings is increasingly becoming a concern in health care management in developing countries. This is characterized by self-referral and frequent bypassing of the nearest health facilities coupled with low formal referral mechanisms. This scenario lends itself to a situation where uncomplicated medical conditions are unnecessarily managed in a high-cost health facility. On July 1, 2021, Kenyatta National Hospital (KNH) did enforce the referral guidelines that required patients have a formal referral letter to KNH to reduce the number of walk-ins and allow KNH to function as a referral facility as envisioned by Kenya 201 constitution and KNH legal statue of 1987. Study Objective: To determine the effect of referral guidelines on patterns of orthopaedic and trauma admissions to KNH. Methodology: This was a quasi – experimental design. Data abstraction was done for 459 and 446 before and after enforcement of referral guidelines. Findings enforcement of the referral guidelines reduced the proportion of walk-in admissions from 54.9% to 45.1%, while facility referrals increased from 46.6% to 53.4%. The Non-trauma orthopaedic admissions doubled from 12.0% to 22.4% after enforcement of the referral guidelines (p<0.001). The mean age was 33.8 years with mean age rising among females from 32.2 years to 38.0 years after the enforcement of the referral guidelines. There was a significant increase in the proportion of female admissions after the enforcement of the referral guidelines. The enforcement of the referral guidelines was associated with a statistically significant increase in the number of orthopaedic admissions with active insurance cover. Conclusion: the enforcement of the referral guidelines reduced the proportion of walk-ins. The enforcement of the guidelines was also associated with orthopaedic and trauma admissions with more non-trauma cases, tertiary education level, and more active insurance cover.

Tertiary hospitals in resource-limited countries should treat referred patients but in reality, are the first level of care for the vast majority of patients. As a result, the tertiary facility effectively functions as a primary health care facility. The urban phenomenon of widespread self-referral is associated with low rates of formal referral from peripheral health facilities. The study objective was to determine the patterns of orthopaedic and trauma admissions to Kenyatta National Hospital. This was descriptive study design. 905 patient charts were reviewed in 2021. The mean age was 33.8 years (SD 16.5) with range of 1–93 years. Majority 66.3% were between 25–64 years with those above 65 years being 40 (4.4%). Children 0–14 years comprised 10.9% of the admissions. Of the 905 admissions, 80.7% were accident and trauma-related admissions while 17.1% were non-trauma related admissions. About 50.1% were facility referrals while 49.9% were walk-ins. Majority of admissions were through Accident and Emergency Department 78.1%, Corporate Outpatient Care 14.9% and orthopedic Clinic 7.0%. About 78.7% were emergency admissions while 20.8% were elective admissions. Approximately 48.5% were due to Road Traffic Accidents and 20.9% due to falls. Close to 44.8% were casual workers and 20.2% unemployed. About 34.0% attained primary education and 35.0% secondary education. About 33.2% of female admissions were due to non-trauma conditions as compared to male admissions (12.8%) (p<0.001). Admissions for those aged 25–64 years were 3.5 more likely to have emergency admission as compared to those aged 0–14 years. Male were 65.1% less likely to have elective admissions compared to female (p<0.001). Whereas lower limb injuries and non-trauma related conditions were the most commonly admitted conditions, Lower limb injury and spine cases were mostly facility referred while non-trauma conditions were walk-in patients. Vast majority (89.2%) of admissions were from Nairobi Metropolitan region.