The WEO Activities to Reach Africa (ARA) initiative has a strong emphasis on how to perform research as part of endoscopy training. The WEO-supported endoscopy center at Kenyatta Hospital, Nairobi, is a very active and progressive institution, headed by Professor Elly Ogutu. Trainees progress from novice to highly competent clinical gastroenterologists, well trained in basic endoscopy skills, who will then return to either their regional centers or continue to train in advanced endoscopy. As a part of this process, all trainees undertake a research project that is self-initiated and supervised by both local and international experts.

Dr Kefa Otieno, for example, completed a dissertation on the provision of pediatric endoscopy services in Kenyatta (KNH) and Gertrude Hospitals. A total of 110 patients were recruited, average  age was 7.3 years with equal numbers of boys and girls. He prospectively examined the presentations, procedures, and findings in this group of patients over a 5-month period. The most common indications for endoscopy were upper GI bleeding, dysphagia, recurrent abdominal pain, and hematochezia, with over 79% of patients undergoing gastroscopies, and 21% undergoing colonoscopies. According to Otieno’s study the major findings on upper GI endoscopy were gastritis and esophagitis, while the commonest colonoscopy findings were chronic ulcerative colitis, juvenile polyps, and lymphonodular hyperplasia, seen in 30.8%, 23.1% and 15.4% respectively. These data shed a valuable insight into several important questions regarding the need for pediatric endoscopy in Kenya as demonstrated by the disease burden. The relatively high rates of gastritis and esophagitis show the need for further studies into the specific etiologies of these conditions in children; studies that need to incorporate local factors including dietary habits and microbiology. The increasing rates of inflammatory bowel disease in Africa are reflected in this study, with a surprising burden of juvenile polyps. This cohort needed variceal bandings, polypectomies, and esophageal dilations. , This study also reflects the need for endoscopic training in basic interventions especially  in the pediatric population.

WEO congratulates Dr. Otieno for his successful study, under the excellent mentorship provided by his local supervisors, Ahmed Laving, Juliana Muiva, Elly Ogutu, and Stephen Onyango, and WEO collaborators, Lars Aabakken and Purnima Bhat.

For information on WEO-ARA research opportunities, visit the WEO website.

Author: Dr Purnima Bhat.