Hiv Seroprevalence in Orthopaedic Trauma Inpatients at a Tertiary Referral Hospital in Kenya

Abstract

Human immunodeficiency virus (HIV) is a major health problem in Kenya and worldwide. Trauma is a big public health problem in Kenya and the world at large. It is associated with high morbidity and mortality both in developed and developing countries. With the high prevalence of HIV in Kenya and sub-Saharan Africa at large, infected orthopaedic trauma patients pose significant danger of occupationally acquired infections to health care workers. The orthopaedic surgeon is at a higher risk due to the frequent exposure to blood and other body fluids and handling of sharp instruments and sharp bone fragments that increase chances of sustaining needle stick injuries (NSIs). Objectives: To determine the prevalence of HIV infection amongst orthopaedic trauma patients in Kenyatta National Hospital. Study design: cross sectional study. Setting: Kenyatta National Hospital: A National Teaching and Referral Hospital in Nairobi, Kenya. The study was conducted in the orthopaedic surgery wards. Methodology: This study was conducted in the orthopaedic wards (6A, 6C and 6D) at Kenyatta National Hospital (KNH).Patients 18 years and above who were fully conscious and being managed for orthopaedic trauma conditions were randomly recruited into the study. Demographic details (age, gender, marital status, occupation and level of education) and whether or not they were aware of their HIV status was recorded. Widows, widowers, divorced and the ones who were single were regarded as unmarried. The orthopaedic trauma condition and mechanism/circumstances of injury was also recorded after viewing their radiographs. Pre-counseling was done. Those who tested positive were counseled again and referred to the Comprehensive Care Centre (CCC) for follow up. x Results: A total of 277 orthopaedic trauma patients were randomly selected. The mean age was 36.0. The male to female ratio was 6.9:1. 27(9.7%) tested positive. 10(37%) of the patients who tested positive were 40-49yrs old, 9(33.3%) were 30-39years, 3(11.1%) were 50-59years, 2(7.4%) were above 59 years, 2(7.4%) 20-29 years and 1(3.7%) was below 20 years. 19(70.4%) of the seroreactive patients were males and 8(29.6%) were females. 17(63%) of the patients were married and 10(37%) were unmarried. 13(48.1%) had primary level of education, 11(40.7%) had secondary level of education and 3(11.1%) had Tertiary level of education.1(3.7%) of the patients who tested positive was in formal employment while 26(96.3%) were in the informal sector. Majority of the patients (59.3% had injuries on the lower limb, 18.5% had pelvic injuries, 14.8% had multiple fractures while 7.4% had upper limb injuries. 16(59.3%) were involved in a road traffic accident, 8(29.6%) had a history of a fall and 3(11.1%) were hit by an object. Of those involved in a road traffic accident 10(62.5%) were pedestrians, 3(18.8%) were motorbike riders and 3(18.8%) were vehicle passengers. Out of the 277 patients who were recruited, 247(89.2%) were aware of their HIV status prior to the test and 30(10.8%) were unaware of their HIV status. Conclusion and recommendations: The HIV seroprevalence amongst orthopaedic trauma patients in our setup and sub-Saharan Africa at large is higher than that in the general population. Despite the awareness of the HIV status of majority of the orthopaedic trauma patients, they pose potential danger of exposure of the HIV virus to the health care workers attending to them due to the nature of risk of contact with the blood and other body fluids containing the virus. It is recommended that all orthopaedic trauma patients be tested for HIV serostatus and that the HCWs should be provided with protective measures like orthopaedic gloves and protective eye wear while attending to this patients to help minimize the risk of seroconversion