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



Eye examination

If your child has myopia (nearsightedness), you’re probably wondering if there is a cure or at least something that can be done to slow its progression so your child doesn’t need stronger glasses year after year. For years, eye care practitioners and researchers have been wondering the same thing and there’s good news: A number of recent studies suggest it may indeed be possible to at least control myopia by slowing its progression during childhood and among teenagers.

What Is Myopia Control?

Although an outright cure for near-sightedness has not been discovered your eye doctor can now offer a number of treatments that may be able to slow the progression of myopia. These treatments can induce changes in the structure and focusing of the eye to reduce stress and fatigue associated with the development and progression of near-sightedness.

What is progressive myopia?

Progressive myopia is near-sightedness that continues to worsen year after year. This progression can result in severe myopia (also called high myopia) that may be associated with potentially serious side effects.

  1. Atropine Eye Drops
correct position to instill eyedrops
How to instill eye drops

Atropine eye drop have been used for myopia control for many years, with effective short-term result. Topical atropine is a medicine used to dilate the pupil thereby temporarily paralyze accommodation and completely relax the eyes’ focusing mechanism.

Because research has suggested near-sightedness in children may be linked to focusing fatigue, investigators have looked into using atropine to disable the eye’s focusing mechanism to control myopia.

Drawbacks of atropine treatment include discomfort and light sensitivity from prolonged pupil dilation, blurred near vision, and the added expense of the child needing bifocals or progressive eyeglass lenses during treatment to be able to read clearly, since his or her near focusing ability is affected.



  1. Orthokeratology

Orthokeratology is the use of specially designed gas permeable contact lenses that are worn during sleep at night to temporarily correct near-sightedness and other vision problems so glasses and contact lenses aren’t needed during waking hours.


  1. Multifocal Contact Lenses

Multifocal contacts are special lenses that have different powers in different zones of the lens to correct presbyopia as well as near-sightedness or farsightedness (with or without astigmatism).

  1. Multifocal Eyeglasses
Multifocal Glasses

Multifocal eyeglasses also have been tested for myopia control in children, but results have been less impressive than those produced with multifocal contacts.

Detecting Myopia Early

The best way to take advantage of methods to control myopia is to detect near-sightedness early. Even if your child is not complaining of vision problems (near-sighted kids often are excellent students and have no visual complaints when reading or doing other schoolwork), it’s important to schedule routine eye exams for your children, starting before they enter preschool. Early childhood eye exams are especially important if you or your spouse are near-sighted or your child’s older siblings have myopia or other vision problems.


  1. Holden, B. A., Fricke, T. R., Wilson, D. A., Jong, M., Naidoo, K. S., Sankaridurg, P., … & Resnikoff, S. (2016). Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology123(5), 1036-1042.
  2. Rusnak, S., Salcman, V., Hecova, L., & Kasl, Z. (2018). Myopia progression risk: Seasonal and lifestyle variations in axial length growth in czech children. Journal of ophthalmology2018.


Author: Jacob Onyango, Optometrist, Imara Mediplus Hospital



  1. What is a pregnancy ultrasound?

A pregnancy ultrasound is a test that uses high-frequency sound waves to image the developing baby as well as the mother’s reproductive organs. The average number of ultrasounds varies with each pregnancy. An ultrasound, also called a sonogram, can help monitor normal fetal development and screen for any potential problems.

  1. Reasons for a pregnancy ultrasound

An ultrasound can be used for a variety of reasons during pregnancy.

  1. During the first trimester of pregnancy

In the first trimester of pregnancy (weeks one to 12), ultrasounds may be done to:

confirm pregnancy  `

  • check the fetal heartbeat
  • determine the gestational age of the baby and estimate a due date
  • check for multiple pregnancies
  • examine the placenta, uterus, ovaries, and cervix
  • diagnose an ectopic pregnancy (when the fetus does not attach to the uterus) or miscarriage
  • look for any abnormal growth in the fetus


  1. During the second and third trimesters of pregnancy

In the second trimester (12 to 24 weeks) and the third trimester (24 to 40 weeks or birth), an ultrasound may be done to:

  • Monitor the fetus’ growth and position (breech, transverse, cephalic, or optimal)
  • Determine the baby’s sex
  • Confirm multiple pregnancies
  • Look at the placenta to check for problems, such as placenta previa (when the placenta covers the cervix) and placental abruption (when the placenta separates from the uterus prior to delivery)
  • Check for characteristics of down syndrome (normally done between 13 and 14 weeks)


  • Check for congenital abnormalities or birth defects



  • Examine the fetus for structural abnormalities or blood flow problems
  • Monitor the levels of amniotic fluid
  • Determine if the fetus is getting enough oxygen
  • Diagnose problems with the ovaries or uterus, such as pregnancy tumors
  • Measure the length of the cervix
  • Guide other tests, such as amniocentesis
  • Confirm an intrauterine death

Author: Plankington Menjah

Sonographer Imara Mediplus Hospital



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

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