What is dental calculus?

Calculus is a hard deposit that is formed by mineralization of dental plaque on the surface of natural teeth and dental prosthesis, generally covered by layer of unmineralised plaque.

What is dental plaque?

A sticky film that coats teeth and contains bacteria.Dental plaque is a sticky, colorless or pale yellow film that is constantly forming on your teeth. When saliva, food and fluids combine, plaque – which contains bacteria – forms between your teeth and along the gum line.

Calculus cannot be removed with a toothbrush; only a dental professional can remove it during an oral cleaning.

What are the effects of dental plaque and calculus?

  • Bleeding gums/Gingivitis
  • Dental caries/Tooth decay
  • Periodontal disease which may lead to loose/mobile teeth.
  • Halitosis/bad breath.

The best way to prevent these complications is to brush twice a day, to floss once a day, and to visit your dentist regularly for cleanings.

Article By: Dr. Mackatiani
Resident Dental Surgeon,
Imara Mediplus Hospital
Welcome to Imara for Quality Affordable Healthcare!




Deliberate provocation of an adaptive immune response by introducing antigen into the body.


Deliberate induction of an adaptive immune response to a pathogen by injecting a vaccine,a killed or attenuated form of the pathogen.


A substance used to stimulate the production of antibodies and provide immunity against one or several diseases, prepared from the causative agent of a disease, its products, or a synthetic substitute, treated to act as an antigen without inducing the disease


Given at birth

1. BCG (Bacillus Calmette-Guerin)

Given as an injection 0.05ml under the skin (intra-dermal) of the left fore arm.

It helps protect the child against Tuberculosis (TB)

2. Polio Vaccine: 2 drops per oral.

It helps protect the child against poliomyelitis (polio) to avert crippling in children.

Given at 6, 10 and 14 weeks of age

1. Polio Vaccine: Dose: 2 drops administered

Children can safely receive the polio booster any time before they are 5 years old.

2. Pentavalent Vaccine: Dose: 0.5mls Intra muscular left outer thigh

Contains a combination of five vaccines hence the name Penta.

It acts against diphtheria, pertussis, tetanus, Hepatitis B and Haemophilus Influenza.


  • Fever
  • Pain at injection site
  • Swelling or redness on injection site
  • Irritability


  • Injection site abscess

3. Pneumococcal Vaccine: Dose: 0.5ml Intra muscular right outer thigh

This vaccine helps to prevent pneumonia. Was added in 2012.

4. Rota Virus vaccine: 1.5mls administered orally

Given at 6 & 10 weeks

Helps prevent rotavirus infection which is the leading cause of diarrheal diseases in children worldwide.

At 6 Months

  1. Measles Rubella Vaccine

In event of a measles rubella outbreak or HIV exposed children

  1. Flu vaccine: Vitamin A 100000iu per Oral

At 9 Months

1st Dose Measles Rubella Vaccine: Dose 0.5ml subcutaneously right upper arm.

At 12 Months

  1. Vitamin A 200000 IU
  2. Deworming with Albendazole 200mg

At 18 Months

2nd Dose Measles Rubella Vaccine: Dose 0.5ml subcutaneous right upper arm

Vitamin A 200000 IU and deworming with Albendazole 200mg

At 9 Months – Only in the selected counties

Yellow Fever Vaccine: Dose 0.5mls Intra Muscular left upper deltoid

N/B: Vitamin A and Deworming is given to the child at 1 year and repeat after every 6 months till the child is 5 Years old.

At 10 Years

HPV – Human Papilloma Virus

Given in two doses 1st Dose then 2nd Dose after 6 months

N/B: For HIV exposed girls receive 3 doses 6 months apart



  • BCG
  • Oral polio
  • Hepatitis B 0.5mls Intra muscular

6, 10 & 14 WEEKS

  1. Hexaxim/infanrix
  2. Rotarix,
  3. Prevenar 13
  4. Oral polio


  1. Flu Vaccine
  2. Vitamin A 100000iu


Flu Vaccine


  1. MMR
  2. Yellow fever vaccine


Meningoccal ACY and W conjugate


  1. Vitamin 200000iu
  2. Hepatitis A
  3. Varicella,
  4. Dewormer 200mg.


  1. Meningoccal Vaccine
  2. MMR,


  1. Hexaxim/Infanrix Booster
  2. MMR
  3. Vitamin A 200000IU
  4. Dewormer


  1. Typhoid Vaccine
  2. Flu Vaccine
  3. Dewormer
  4. Vitamin 200,000iu



  1. IPV
  2. Typhoid Vaccine
  3. Flu vaccine


  1. HPV
  2. Flu vaccine


Flu vaccine


  1. Typhoid Vaccine – every 3 years
  2. Meningococcal Vaccine
  3. Cholera Vaccine
  4. Verorab/Antirabies.


Article by: Jilian M’kea
Immunization Nurse
Imara Mediplus Hospital


Welcome to Imara for Quality Affordable Healthcare!



1. What is it?

It is also referred to as complete blood count (CBC), full blood count (FBC)

It is a group of tests performed on a sample of blood mainly the three components of the blood; Red Blood Cells, White Blood Cells and Platelets.

2. Why is it done?

By it being a broad screening panel it checks for the presence of a wide range diseases and infections in the body.

3. Which diseases can be detected by this test?

They include but not limited to;

  • Anemia (low hemoglobin)
  • Autoimmune disorders.
  • Bone marrow problems.
  • Cancer.
  • Dehydration.
  • Heart disease.
  • Infection.
  • Inflammation.

4. How do you prepare for the test?

No prior preparation is needed; you can eat and drink normally before the test but if the blood sample will be used for additional tests, you may need to fast for a certain amount of time before the test. Specific instructions are given at the hospital.


Technically referred to as Respiratory Protective Devices (RPD) The most common masks can be classified as follows:

  1. N-95 masks
  2. Surgical masks
  3. Homemade masks


CDC does not recommend public use of this masks.

It achieves a very tight fit.

Is very effective in filtration of airborne particles.

Has 95% filtration capacity for particles 0.3 micrometres or bigger.

However, doesn’t 100% eliminate risk of Infection.

Cannot be shared and has limited reuse.


Is a loose fitting disposable mask

Offers protection by creating a physical barrier with immediate environment

Protect against large-particle droplets, splashes, sprays, or splatter

Usually has 2-3 layers ie. 2 ply or 3 ply

Has a low filtration capacity and poor protection against particles < 2 micrometres

One cannot share or reuse.


Offers physical barrier for both inward and outward protection

Has a low filtration capacity

Has a low protective factor compared to other masks

Capacity of re-use


Protection of homemade masks can be increased by adding layers to the mask, proper fitting and adding a filter. We propose the use of a sanitary pad as a mask filter.

Filtration Capacity of a Sanitary Pad

Pads consist of 3 main layers

  1. Top- non-woven fabric
  2. Middle adsorbent material
  3. Outer impermeable back sheet with adhesive (Should be removed when using as a mask filter)

The super-fine inner fibers provide filtration capability for micro/nano-size particles

Masks offer protection in two ways:

  • Inward protection

Self-protection against transmission by reducing external exposure to particles

  • Outward protection

Retention of particles inside of masks to reduce spread of infection to others.

Protective Factors:

  1. N-95 Respirators – 99
  2. Surgical Masks – 5.3
  3. Homemade masks – 3.2

Our homemade masks are now available for online purchases. Visit:



Here’s everything you need to know about homemade masks preparation :

  • We recommend using a 3 layer home-made mask
  • Outer layer- Water resistant fabric e.g. Laminated cotton, nylon, polyester, microfiber
  • Inner layer- cotton
  • 3rd layer- Pouch with a disposable microfibre filter


  1. Hospital microfibre air filter (not readily available, expensive, stocks difficult to find)
  2. Items available at the supermarket i.e. Sanitary pad or diaper (readily available, affordable, stocks are in plenty)

3 layer olson mask, by Unitypoint Health://


Taking off mask wrongly or touching your face may lead to infection. Spend the time to get in-person training or at least watch a video on how to put on (“don”) and take off (“doff”)

PPE sample videos can be found on and

Wash your hands well before you touch the PPE involving your face.

When taking off your mask, handle the straps behind your ears and never touch the front of the mask.


After carefully taking off, dispose the filter . Soak reusable mask in 0.5% bleaching solution for at least 30mins.

Follow by washing with clean water & detergent ** You may additionally boil in water for 10-20mins – Addition of 0.3% washing soda enhances boiling**

Always inspect the mask for any tears and damage. Discard if damaged.

Insert new filter and reuse if no damage.



These are liquids/ gels that reduce levels of microorganisms by killing them chemically, just like disinfectants kill germs on environmental surfaces.

There are two main types of hand sanitizers: alcohol-based and alcohol-free.

Alcohol-based hand sanitizers contain varying amounts and types of alcohol, often between 60% and 95% and usually isopropyl alcohol, ethanol (ethyl alcohol) or n-propanol. Alcohol is known to be able to kill most germs. It attacks and destroys the envelope protein that surrounds some viruses, including coronaviruses. This protein is vital for a virus’s survival and multiplication. But a hand sanitizer needs to be at least 60% alcohol in order to kill most viruses.

Alcohol-free hand sanitizers contain something called quaternary ammonium compounds (usually benzalkonium chloride) instead of alcohol. These can reduce microbes but are less effective than alcohol. Alternatively, 0.05% hypochlorite may be used as hand sanitizer. This compound is commonly known as jik. When diluted correctly, its stronger than alcohol-based hand sanitizers, as it also destroys fungi which is not destroyed by alcohol sanitizers.

With the recent pandemic of COVID 19 and sanitizers stocks running out, it is necessary for one to know of how to make theirs. However, note that all extemporaneous preparations, should be made by qualified pharmacists only.


So what ingredients are needed to make alcohol-based sanitizer

  1. isopropyl alcohol/ ethanol/ surgical spirit
  2. glycerin/ aloe-vera gel
  1. Peroxide
  2. Boiled/ distilled water
  3. Measuring bottle

Ingredients for non-alcohol-based sanitizer

  1. 5% hypochlorite/ jik
  1. Boiled/ distilled water
  2. Measuring bottle



  • Make the hand sanitizer in a clean space. Wipe down counter tops with a diluted bleach solution beforehand.
  • Wash your hands thoroughly before making the hand sanitizer.
  • To mix, use a clean spoon and whisk. Wash these items thoroughly before using them.
  • Make sure the alcohol used for the hand sanitizer is not diluted.
  • Mix all the ingredients thoroughly until they are well blended.
  • Do not touch the mixture with your hands until it is ready for use.
  • Transfer the liquid in appropriate containers.

REMEMBER: Always clean your hands

  • Before touching your face or eyes
  • After touching doors or other surfaces
  • After using the bathroom
  • After handling paper and other public material
  • After greeting or touching others

Contact us for further assistance:


We also supply and assist in preparation of hand sanitizer for all our clients and partners.


  1. Pharmaceutical Society of Kenya





Aspirin has been in use over the years for primary prevention of major adverse cardiovascular events (MACE) a composite of non-fatal stroke, non-fatal myocardial infarction and cardiovascular death.

In a metanalysis on comparison of contemporary versus older studies it was noted aspirin had a significant reduction on MACE and a significant increase in the risk of major hemorrhage and intracranial hemorrhage

It was also noted that aspirin has no mortality benefit when used for primary prevention.

Statins use has however reduced the risk of non-fatal MI when used for primary cardiovascular prevention.

All over the world different guidelines are in use on aspirin for primary prevention of cardiovascular events.

In conclusion more, studies need to be done to come up with one guideline on who and when aspirin should be used for primary prevention of MACE, however as for the metanalysis recommendation made was not to use aspirin for primary prevention.


Family Practice, 2019,1_7 doi:10.1093/fampra/cmz080



What is breast cancer?

Breast cancer is an abnormal growth of malignant cells (cancer cells) in the breast. It can occur in both men and women, but it’s far more common in women impacting over 2.1 million women each year.

In order to improve breast cancer outcomes and survival, early detection is critical. There are two early detection strategies for breast cancer: early diagnosis and screening.


How is it diagnosed?

Early diagnosis strategies focus on providing timely access to cancer treatment by reducing barriers to care and/or improving access to effective diagnosis services.

Screening consists of testing women to identify cancers before any symptoms appear. Breast cancer screening tools include:

  1. Mammography-is the process of using low-energy x-rays to examine the human breast for
    A mammogram image of a breast with cancer

    diagnosis and screening. Helps in early detection of breast cancer.

2. Clinical breast exam-it’s done by the healthcare provider. The provider visually checks your breasts while you are sitting up and physically examine your breast while you are lying down.

3. Breast self –exam-it involves checking your breasts for lumps or changes.

What are early warning signs of breast cancer?

Symptoms of breast tumors vary from person to person. Some common, early warning signs of breast cancer include:

  • Skin changes, such as swelling, redness, or other visible differences in one or both breasts
  • An increase in size or change in shape of the breast(s)
  • Breast Pain image

    Changes in the appearance of one or both nipples

  • Nipple discharge other than breast milk
  • General pain in/on any part of the breast
  • Lumps or nodes felt on or inside of the breast.



How does breast cancer develop?

Breast cancer occurs when some breast cells begin to grow abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. Cells may spread (metastasize) through your breast to your lymph nodes or blood to other parts of your body.


What factors are associated with increased risk of breast cancer?

  • Family history of breast cancer-if you have a 1st degree relative who has had breast cancer you could be at a higher risk of getting breast cancer.
  • Personal history of breast cancer-if you have already been diagnosed with your risk of developing it again on the same or the other breast is higher.
  • Gender-women are more at risk of developing breast cancer than men.
  • Age-chances of getting breast cancer increases with age.
  • Pregnancy and breastfeeding-women who have not had or had a full-term pregnancy after the age 30 have an increased risk of breast cancer. Women who have children breastfeeding may slightly lower their breast cancer risk
  • Obesity-being overweight is associated with increased risk of breast cancer because the extra fat cells makes estrogen which can cause extra breast cell growth. This extra cell growth increases the risk of breast cancer.
  • hormone replacement therapy drugs
  • Postmenopausal hormone therapy-women who take hormonal therapy combined with estrogen and progesterone to treat signs and symptoms of menopause have an increased risk of breast cancer.
  • Alcohol consumption-alcohol can limit your livers ability to control blood levels of hormone estrogen which in turn increases risk of breast cancer.
  • Menstrual history – women who started menstruating (having periods) younger than 12 years have a higher risk of breast cancer. Same is true for women who through menopause when they are older than 55 years.
  • Smoking cigarettes -it’s linked to a higher risk of breast cancer in younger and premenopausal women.


 How can we reduce your risk of breast cancer?

  1. Exercise –inactivity can raise breast cancer risk. Aim for at least 30 minutes of exercise on most days of the week.
  2. Limit postmenopausal hormone therapy– To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time. Talk with your doctor about the benefits and risks of hormone therapy.
  3. Maintain a healthy weight-if you need to lose weight, ask your doctors about healthy strategies to accomplish this. Healthy weight helps to reduce the risk of breast cancer.
  4. Limit alcohol intake –drink alcohol in moderation; limit the amount of alcohol intake to no more than 3 to 4 drinks per week, if you choose to drink.
  5. Choose a healthy diet– it’s best to eat a highly plant dominated diet such as fruits and vegetables, whole grains, legumes and nuts. Choose healthy fats such as olive oil, over butter and fish instead of red meat. Avoid processed food.
  6. Pregnancy and Breastfeeding-Studies have shown that breastfeeding, especially for more than 18 months can reduce breast cancer risk.
  7. Breast self-exam making changes in your daily life help reduce your risk of breast cancer. Ask your doctor about breast cancer screening and when to begin. If there is a new change, lump or other unusual signs in your breast, talk to your doctor promptly


Breast awareness can’t prevent breast cancer, but it may help you to better understand the normal changes that your breasts undergo and identify any unusual signs and symptoms.


  1. Medical-surgical nursing textbook by Brunner and Suddarth 12th edition.
  2. WHO. Https://>preventionbreastcancer-who.
  3. Mayo clinic.



Veronica Wanja – Nursing Officer, Imara Mediplus Hospital


1. What is ANC?

ANC is an acronym for Ante Natal Care. This is the clinical and psychological care and support given to pregnant mothers from conception up to delivery.

2. When can I start ANC care?

An expectant lady displaying an ultrasound image

ANC care varies from patient to patient depending on the dynamics of the pregnancy. For mothers with normal non-high-risk pregnancies, the 1st clinic should be before 16 weeks gestation (4 months). As for those with high-risk pregnancies, ANC clinics may start as earlier than this.

  1. What does ANC entail?

ANC basically ensures a smooth and safe pregnancy and where complications are noted, timely intervention is instituted.

It entails a full history and physical examination for the mother, laboratory investigations for the mother to check for hemoglobin levels, blood group and Rhesus factor, syphilis, HIV, and TB screen, malaria screen, Hepatitis B screen, and urinalysis.

An ultrasound image showing the foetus

Ultrasounds may be done to assess fetal development, placenta location, and adequacy of the amniotic fluid, the number of fetuses in the womb and weight of the baby.

Iron and folic acid are supplemented throughout the pregnancy period, tetanus vaccine is administered, deworming is done in the second trimester and treated mosquito nets are issued.


Thereafter at least 3 more visits are recommended during which fetal development is monitored as well the mother’s health.

  1. Does Imara Mediplus Hospital offer these services and what makes them different from other facilities?

Imara Mediplus Hospital runs a dedicated ANC clinic every Wednesday and Thursday from 2pm to 5pm by a resident medical officer.

During delivery, Imara provides a comprehensive service package where we have our resident doctor admitting patients in one of the local hospitals under his care for normal or caesarian delivery, doing daily reviews as well post-discharge follow-up.


Dr. Erick Musyima Musau, MBChB (UoN)

Stanford Seed Alumni (Cohort 3)



Hepatitis refers to an inflammatory condition of the liver commonly caused by a viral infection. Other possible causes include autoimmune hepatitis and hepatitis secondary to medication, drugs, toxins, and alcohol. Autoimmune hepatitis is a disease that occurs when your body makes antibodies against your liver tissue.


  1. Hepatitis A-caused by hepatitis A virus(HAV) through consuming food or water contaminated by feces from a person infected with hepatitis A.
  2. Hepatitis ­B –it’s transmitted through contact with infectious blood, vaginal secretions or semen containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner or sharing razors with an infected person increase your risk of getting hepatitis B.
  3. Hepatitis C- Caused by hepatitis C virus. It’s transmitted through direct contact with infected body fluids through injection drug use or sexual contact.
  4. Hepatitis D- is a serious liver disease caused by Hepatitis D virus (HDV). it’s contracted through direct contact with infected blood. HEP D is a rare form of hepatitis that only occurs in conjunction with hepatitis B
  5. Hepatitis E- is a waterborne disease caused by the hepatitis E virus (HEV). Mainly found in areas with poor sanitation. Transmitted through ingestion of contaminated water with fecal matter from an infected person.

Common signs and symptoms of hepatitis

Signs and symptoms of acute hepatitis appear quickly. They include fatigue, flu-like symptoms, dark urine, pale stool, and abdominal pain or discomfort especially on the upper right side beneath lower ribs, loss of appetite, unexplained weight loss, yellow skin and eyes which may be signs of jaundice.

Chronic hepatitis develops slowly, so these signs and symptoms may be too subtle to notice.

How is it diagnosed?

  • History and physical exam-the doctor will ask you some questions to determine any risk factors you may have for infectious or noninfectious hepatitis. During a physical examination, your doctor may press down gently on your abdomen to see if there’s pain or tenderness. Your doctor may also feel to see if your liver is enlarged. If your skin or eyes are yellow, your doctor will note this during the exam.
  • Liver function test-blood sample is obtained to determine how efficiently your liver is working. Abnormal results will indicate there is a problem
  • Other blood tests- If your liver function tests are abnormal, your doctor will likely order other blood tests to detect the source of the problem. These tests can check for the viruses that cause hepatitis.
  • Ultrasound-This test allows your doctor to take a close at your liver and nearby organs to detect anomalies.
  • Liver biopsy-it’s an invasive procedure that involves taking a small sample of liver tissue through your skin using a needle using an ultrasound guide in which the sample will be used to detect any anomalies in your liver.

How is hepatitis treated?

Treatment options are determined by the type of hepatitis and whether the infection is acute or chronic.

Hepatitis A

Bed rest may be recommended if symptoms cause a great deal of discomfort. If you experience vomiting or diarrhea, follow your doctor’s orders for hydration and nutrition.

Hepatitis B

Acute hepatitis B doesn’t require specific treatment. Chronic hepatitis is treated with antiviral medications for several months or years.

Hepatitis C

Antiviral medications are used to treat both acute and chronic forms of hepatitis C.

People who develop cirrhosis (scarring of the liver) or liver disease as a result of chronic hepatitis C may be candidates for a liver transplant.

Hepatitis D

No antiviral medications exist for the treatment of Hep D at this time.

Hepatitis E

adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol. However, pregnant women who develop this infection require close monitoring and care.

How can it be prevented?

  1. Hygiene

Practicing good hygiene is one key way to avoid contracting hepatitis A and E.

Hepatitis B, C, and D contracted through contaminated blood can be prevented by Not sharing drug needles, not sharing razors, not using someone else’s toothbrush, not touching spilled blood.

Practicing safe sex by using condoms can help decrease the risk of infection by hepatitis B and c.

   2. Vaccines

The use of vaccines is an important key to preventing hepatitis. Vaccinations are available to prevent the development of hepatitis A and B. The CDCTrusted Source recommends hepatitis B vaccinations for all newborns. The vaccine is also recommended for all healthcare and medical personnel.

Hepatitis D can be prevented by getting the vaccination for Hep B, as infection with Hep B is necessary for hepatitis D to develop

The hepatitis A vaccine is available to prevent this infection. Most children begin vaccination between the ages of 12 and 18 months. It’s a series of two vaccines

What are the possible complications?

People with chronic hepatitis B or C are at risk of chronic liver disease, cirrhosis, and liver cancer

  • Liver failure can occur when the liver stops functioning completely. Complications of liver failure include bleeding disorders, kidney failure, and a buildup of fluid in your abdomen known as ascites.

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