13 research outputs found
Incidence and severity of respiratory syncytial virus pneumonia in rural Kenyan children identified through hospital surveillance
Background.Although necessary for developing a rationale for vaccination, the burden of severe respiratory syncytial virus (RSV) disease in children in resourceāpoor settings remains poorly defined.
Methods.We conducted prospective surveillance of severe and very severe pneumonia in children aged <5 years admitted from 2002 through 2007 to Kilifi district hospital in coastal Kenya. Nasal specimens were screened for RSV antigen by immunofluorescence. Incidence rates were estimated for the wellādefined population.
Results.Of 25,149 hospital admissions, 7359 patients (29%) had severe or very severe pneumonia, of whom 6026 (82%) were enrolled. RSV prevalence was 15% (20% among infants) and 27% during epidemics (32% among infants). The proportion of case patients aged 3 months was 65%, and the proportion aged 6 months was 43%. Average annual hospitalization rates were 293 hospitalizations per 100,000 children aged <5 years (95% confidence interval, 271ā371 hospitalizations per 100,000 children aged <5 years) and 1107 hospitalizations per 100,000 infants (95% confidence interval, 1012ā1211 hospitalizations per 100,000 infants). Hospital admission rates were double in the region close to the hospital. Few patients with RSV infection had lifeāthreatening clinical features or concurrent serious illnesses, and the associated mortality was 2.2%.
Conclusions.In this lowāincome setting, rates of hospital admission with RSVāassociated pneumonia are substantial; they are comparable to estimates from the United States but considerably underestimate the burden in the full community. An effective vaccine for children aged >2 months (outside the age group of poor responders) could prevent a large portion of RSV disease. Severity data suggest that the justification for RSV vaccination will be based on the prevention of morbidity, not mortality
Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya
Background
Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with
the greatest burden falling on young children living in less-developed countries. Vaccines
directed against this virus have shown promise in recent trials, and are undergoing
effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are
available on the incidence and clinical characteristics of severe group A rotavirus disease.
Advocacy for vaccine intervention and interpretation of effectiveness following implementation
will benefit from accurate base-line estimates of the incidence and severity of rotavirus
paediatric admissions in relevant populations. The study objective was to accurately define the
incidence and severity of group A rotavirus disease in a resource-poor setting necessary to
make informed decisions on the need for vaccine prevention.
Methods and Findings
Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus
infection at Kilifi District Hospital in coastal Kenya. Children < 13 y of age were eligible as
"cases" if admitted with diarrhoea, and "controls" if admitted without diarrhoea. We calculated
the incidence of hospital admission with group A rotavirus using data from a demographic
surveillance study of 220,000 people in Kilifi District. Of 15,347 childhood admissions 3,296
(22%) had diarrhoea, 2,039 were tested for group A rotavirus antigen and, of these, 588 (29%)
were positive. 372 (63%) rotavirus-positive cases were infants. Of 620 controls 19 (3.1%, 95%
confidence interval [CI] 1.9ā4.7) were rotavirus positive. The annual incidence (per 100,000
children) of rotavirus-positive admissions was 1,431 (95% CI 1,275ā1,600) in infants and 478
(437ā521) in under-5-y-olds, and highest proximal to the hospital. Compared to children with
rotavirus-negative diarrhoea, rotavirus-positive cases were less likely to have coexisting
illnesses and more likely to have acidosis (46% versus 17%) and severe electrolyte imbalance
except hyponatraemia. In-hospital case fatality was 2% among rotavirus-positive and 9%
among rotavirus-negative children.
Conclusions
In Kilifi > 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first
5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across
Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is
associated with acute life-threatening metabolic derangement in otherwise healthy children.
Although mortality is low in this clinical research setting this may not be generally true in
African hospitals lacking rapid and appropriate management
Evaluation of a measles vaccine campaign by oral-fluid surveys in a rural Kenyan district: interpretation of antibody prevalence data using mixture models
We evaluated the effectiveness of a measles vaccine campaign in rural Kenya, based on oral-fluid surveys and mixture-modelling analysis. Specimens were collected from 886 children aged 9 months to 14 years pre-campaign and from a comparison sample of 598 children aged 6 months post-campaign. Quantitative measles-specific antibody data were obtained by commercial kit. The estimated proportions of measles-specific antibody negative in children aged 0ā4, 5ā9 and 10ā14 years were 51%, 42% and 27%, respectively, pre- campaign and 18%, 14% and 6%, respectively, post-campaign. We estimate a reduction in the proportion susceptible of 65ā78%, with ~85% of the population recorded to have received vaccine. The proportion of āweakā positive individuals rose from 35% pre-campaign to 54% post-campaign. Our results confirm the effectiveness of the campaign in reducing susceptibility to measles and demonstrate the potential of oral-fluid studies to monitor the impact of measles vaccination campaigns
The malaria testing and treatment landscape in Kenya: results from a nationally representative survey among the public and private sector in 2016
Abstract Background Since 2004, Kenyaās national malaria treatment guidelines have stipulated artemisinin-based combination therapy (ACT) as first-line treatment for uncomplicated malaria, and since 2014, confirmatory diagnosis of malaria in all cases before treatment has been recommended. A number of strategies to support national guidelines have been implemented in the public and private sectors in recent years. A nationally-representative malaria outlet survey, implemented across four epidemiological zones, was conducted between June and August 2016 to provide practical evidence to inform strategies and policies in Kenya towards achieving national malaria control goals. Results A total of 17,852 outlets were screened and 2271 outlets were eligible and interviewed. 78.3% of all screened public health facilities stocked both malaria diagnostic testing and quality-assured ACT (QAACT). Sulfadoxineāpyrimethamine (SP) for intermittent preventive treatment in pregnancy was available in 70% of public health facilities in endemic areas where it is recommended for treatment. SP was rarely found in the public sector outside of the endemic areas (<Ā 0.5%). The anti-malaria stocking private sector had lower levels of QAACT (46.7%) and malaria blood testing (20.8%) availability but accounted for majority of anti-malarial distribution (70.6% of the national market share). More than 40% of anti-malarials were distributed by unregistered pharmacies (37.3%) and general retailers (7.1%). QAACT accounted for 58.2% of the total anti-malarial market share, while market share for non-QAACT was 15.8% and for SP, 24.8%. In endemic areas, 74.9% of anti-malarials distributed were QAACT. Elsewhere, QAACT market share was 49.4% in the endemic-prone areas, 33.2% in seasonal-transmission areas and 37.9% in low-risk areas. Conclusion Although public sector availability of QAACT and malaria diagnosis is relatively high, there is a gap in availability of both testing and treatment that must be addressed. The private sector in Kenya, where the majority of anti-malarials are distributed, is also critical for achieving universal coverage with appropriate malaria case management. There is need for a renewed commitment and effective strategies to ensure access to affordable QAACT and confirmatory testing in the private sector, and should consider how to address malaria case management among informal providers responsible for a substantial proportion of the anti-malarial market share
Implementing facility-based kangaroo mother care services : lessons from a multi-country study in Africa
BACKGROUND : Some countries have undertaken programs that included scaling up kangaroo mother care. The aim
of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care
services in four African countries: Malawi, Mali, Rwanda and Uganda.
METHODS : A cross-sectional, mixed-method research design was used. Stakeholders provided background information at
national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied
in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the
four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress.
RESULTS : Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo
mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had
been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed
in the quality of implementation between facilities and across countries. Important factors identified in implementation are:
training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of
care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care.
CONCLUSION : The integration of kangaroo mother care into routine newborn care services should be part of all maternal
and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the
outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services.
Mechanisms for monitoring these services should be integrated into existing health management information systems.http://www.biomedcentral.com/bmchealthservreshb201
Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya
Background: Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with the greatest burden falling on young children living in less-developed countries. Vaccines directed against this virus have shown promise in recent trials, and are undergoing effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are available on the incidence and clinical characteristics of severe group A rotavirus disease. Advocacy for vaccine intervention and interpretation of effectiveness following implementation will benefit from accurate base-line estimates of the incidence and severity of rotavirus paediatric admissions in relevant populations. The study objective was to accurately define the incidence and severity of group A rotavirus disease in a resource-poor setting necessary to make informed decisions on the need for vaccine prevention. Methods and Findings: Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus infection at Kilifi District Hospital in coastal Kenya. Children , < 13 y of age were eligible as āācasesāā if admitted with diarrhoea, and āācontrolsāā if admitted without diarrhoea. We calculated the incidence of hospital admission with group A rotavirus using data from a demographic surveillance study of 220,000 people in Kilifi District. Of 15,347 childhood admissions 3,296 (22%) had diarrhoea, 2,039 were tested for group A rotavirus antigen and, of these, 588 (29%) were positive. 372 (63%) rotavirus-positive cases were infants. Of 620 controls 19 (3.1%, 95% confidence interval [CI] 1.9ā4.7) were rotavirus positive. The annual incidence (per 100,000 children) of rotavirus-positive admissions was 1,431 (95% CI 1,275ā1,600) in infants and 478 (437ā521) in under-5-y-olds, and highest proximal to the hospital. Compared to children with rotavirus-negative diarrhoea, rotavirus-positive cases were less likely to have coexisting illnesses and more likely to have acidosis (46% versus 17%) and severe electrolyte imbalance except hyponatraemia. In-hospital case fatality was 2% among rotavirus-positive and 9% among rotavirus-negative children. Conclusions: In Kilifi > 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first 5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is associated with acute life-threatening metabolic derangement in otherwise healthy children. Although mortality is low in this clinical research setting this may not be generally true in African hospitals lacking rapid and appropriate management