I work in Kisumu County Department of Health as a medical epidemiologist and also coordinate data to action for the CHAMPS mortality study in Kisumu, Kenya. Kisumu is one of 47 counties in Kenya with a population of over one million people. I work mostly on research and epidemiological investigations, conduct surveillance activities with the aim of linking findings to interventions and public health action. I am a member of various Technical Working Groups at the county management level that implement Universal Health Care, design and interrogate health activities, policies, and strategies. Together with fellow epidemiologists, we also design and conduct studies to inform public health interventions and policy at the community, facility and health systems level.
What challenges do you encounter in your work?
Kisumu County has a high burden of HIV. The prevalence is 16.3%, the third highest amongst the 47 counties in the country. A lot of research and effort has been invested to ensure we are able to identify those living with HIV, link them to care, and have them virally suppressed. We are also in a malaria endemic zone and we focus our activities towards prevention and treatment. We have a TB case notification rate slightly higher than the national average but with a fairly good cure rate.
We are currently piloting Universal Health Care across all public-owned health facilities and this is a learning curve for us in terms of supply chain management, human resources for health, healthcare financing, infrastructure, and decision making at all levels.
Water and sanitation hygiene is a challenge, especially in the urban informal settlements in the county. The county’s maternal mortality ratio is about 1.5 times higher than the national average. Despite working in a low resource setting, we continue to explore ways to reduce incidence of disease through cost effective interventions at all levels.
How has UpToDate impacted your work on a daily basis?
From the research perspective, UpToDate is convenient as it gives a summarized and well packaged narrative on the subject matter. The first bit is on epidemiology of the disease thus I can do a quick check on the literature and citations and this gives me a good head start on the research topic.
We conduct Maternal and Perinatal Death Surveillance and Review at the county level in order to identify deaths due to preventable causes and discuss strategies to avert such deaths in the future. In the process of doing this reviews, we need to build interventions based on evidence. I use UpToDate to keep abreast on the current guidelines for management of common obstetric conditions.
For the CHAMPS mortality study, part of my job is to abstract clinical information and package it for the determination of cause of death by a multi-disciplinary panel. UpToDate is a useful tool toreview the cases and package it in a proper format in preparation for Cause of Death determination. At this point, UpToDate also serves as an educational tool on this conditions that I encounter.
What makes UpToDate special?
I find UpToDate very useful in my research capacity. The packaging of information on UpToDate is quite user-friendly. It is all categorized in a way that is easy to follow, so, if you are looking for epidemiology, which is the first thing I would most likely turn to, I would easily find it there and know about the global epidemiology. Most of the time, I would go to UpToDate, look at the epidemiology quick and fast, and use the references and the citations to build to have a more detailed search probably on PubMed, or any other medical database that would be for research articles.
In terms also of clinical diagnosis and treatment, it is very well organized. It’s not just that it’s a certain proportion of these symptoms that would be in this condition, but it’s the discussion around that and what to expect for example. I find the content organized quite well more specifically in the epidemiology which I identified with, because that’s what I do daily. I find it very easy to digest and to just pick up a few points and run with them as I continue to build a case. The summary and recommendation section is also a great tool for a really quick and fast search on many topics. And really that the information is scrutinized behind the scenes and updated so that search results are accurate and reliable.
How will UpToDate continue to affect your career?
UpToDate adds onto my clinical knowledge and enables me to have rich discussions with these practicing colleagues in the frontline. I will continue to use this tool to add knowledge in diagnosis, management, prevention and control of various disease conditions.
It is a way to keep reading, keep learning and keep updating oneself, it is a journey of self-improvement.
I look forward to sharing this wonderful experience with my colleagues and have as many of them as possibly could be using UpToDate as a daily tool to influence patient management and decision making
In summary, I will continue to use UpToDate in order to stay up-to-date.