Seroprevalence of varicella zoster antibodies among children with malnutrition, malignancies and HIV infection

Objective: To determine the seroprevalence of varicella zoster in paediatric patients at a high risk of developing complications. Design: A cross-sectional study. Setting: Paediatric general wards at Kenyatta National Hospital. Subjects: Children with malignancies, severe malnutrition and were HIV positive. Interventions: The sample size was calculated at 147 subjects. Venous samples were tested for varicella zoster virus (VZV) antibodies using enzyme immunosorbent assay (ELISA) technique at Kenya Medical Research Institute (KEMRI) laboratories, The data were anaIysed using the SPSS software and presented in form of tables and graphs. The prevalence of VZV antibodies was determined and 95% confidence interval computed. Results: The overall seroprevalence of VZV antibodies in the three groups of children studied was 23.6% (95% CI= 17.4, 29.8), The seroprevalence of VZV antibodies in those with malignancies and severe malnutrition was 24.1 and 25.0% respectively. About 22% of HIV positive children had protective levels of VZV antibodies. Though the seroprevalence increased with age, it was not significantly associated with area of residence, size of residence, family size or income. Conclusions: The low prevalence of protective VZV antibodies among children with severe malnutrition, malignancies and HIV infection children at Kenyatta National Hospital warrants routine immunisation of the high-risk population

Urine neutrophil gelatinase-associated lipocalin in asphyxiated neonates: a prospective cohort study

Background: Acute kidney injury (AKI) is the most common complication of perinatal asphyxia. Recent research indicates that urine neutrophil gelatinase-associated lipocalin (NGAL) is an early marker for AKI; yet, there is a paucity of data about its use in term neonates with perinatal asphyxia. Methods: A prospective cohort study was conducted on 108 term babies in the new-born unit of Pumwani Maternity Hospital and Kenyatta National Hospital. Urine NGAL and serum creatinine were measured in 108 term asphyxiated neonates on days 1 and 3 of life. Results: One-hundred and eight patients were recruited (male:female 1.4:1). At a cut-off of 250 ng/ml, urine NGAL had an acceptable discriminative capability of predicting AKI (area under the curve 0.724). The sensitivity, specificity, positive and negative predictive value and likelihood ratios were 88, 56, 30, 95%, 2 and 0.2 respectively. Urine NGAL levels were significantly higher in patients with AKI compared with those without AKI. An NGAL level greater than 250 ng/ml on day 1 was significantly associated with severe hypoxic ischaemic encephalopathy (HIE); odds ratio = 8.9 (95% CI 1.78-37.69) and mortality; odds ratio = 8.9 (95% CI 1.78-37.69). Conclusion: Urine NGAL is a good screening test for the early diagnosis of AKI. It is also a predictor of mortality and severity of HIE in asphyxiated neonates

Prevalence and outcomes of acute kidney injury in term neonates with perinatal asphyxia

Background: The kidney is the most damaged organ in asphyxiated full-term infants. The severity of its damage is corre­lated with the severity of neurological damage. We determined the prevalence of perinatal asphyxia-associated acute kidney injury (AKI). Methods: We conducted a prospective cohort study including 60 full-term neonates admitted at the Kenyatta National Hospital newborn unit (NBU) in Nairobi with hypoxic ischaemic encephalopathy (HIE) from June 2012 to November 2012. Renal function was assessed by measuring serum creatinine on day 3 of life. AKI was defined by a level of creatinine above 133 μmol/l. The degree of neurological impairment was determined daily until patient discharge, death or day 7 of life. Results: Of the 60 infants 36.6% had HIE I, 51.6% HIE II and 11.8% HIE III. The prevalence of AKI was 11.7 %. There was a 15 fold increase risk of developing AKI in HIE III versus HIE I, p=0.034. Mortality rate in perinatal asphyxia associ­ated AKI was 71.4 % with a 24 fold increase risk of death in neonates with AKI, p=0.001. Conclusions: AKI is common and associated with poorer outcomes in perinatal asphyxia. Larger studies need to be done to correlate maternal factors and perinatal asphyxia-associated A

Efficacy of Mobile phone use on adherence to Nevirapine prophylaxis and retention in care among the HIV-exposed infants in prevention of mother to child transmission of HIV: a randomized controlled trial

Background: HIV is a major contributor to infant mortality. A significant gap remains between the uptake of infant and maternal antiretroviral regimens and only a minority of HIV-exposed infants receives prophylaxis and safe infant feeding. Losses to follow-up of HIV-exposed infants are associated with shortcomings of facility-based PMTCT models with weak community support of linkages. Use of mobile phones offers an opportunity for improving care and promoting retention assessed by timely attendance of scheduled appointments for the mother-baby pairs and achievement of an HIV-free generation. The objective of this study was to compare self-reported adherence to infant Nevirapine (NVP) prophylaxis and retention in care assessed by timely attendance of scheduled appointments over 10 weeks in HIV exposed infants randomized to 2-weekly mobile phone calls (intervention) versus no phone calls (control). Methods: In this open label randomized controlled study, one hundred and fifty HIV infected women drawn from 3 health facilities in Western Kenya and their infants were randomly assigned to receive either phone-based reminders on PMTCT messages or standard health care messages (no calls) within 24 h of delivery. Women in the intervention arm continued to receive fortnightly phone calls. At 6- and 10-weeks following randomization we collected data on infant adherence to Nevirapine, mode of infant feeding, early HIV testing and retention in care in both study arms. All analyses were intention to treat. Results: At 6 weeks follow-up, 90.7% (n = 68) of participants receiving phone calls reported adherence to infant NVP prophylaxis, compared with 72% (n = 54) of participants in the control group (p = 0.005). Participants in the intervention arm were also significantly more likely to remain in care than participants in the control group [78.7% (n = 59) vs. 58.7% (n = 44), p = 0.009 at 6 weeks and 69.3% (n = 52) vs. 37.3% (n = 28), p \u3c 0.001 at 10 weeks]. Conclusions: These results suggest that phone calls are potentially an important tool to improve adherence to infant NVP prophylaxis and retention in care for HIV-exposed infants. Trial registration: PACTR202007654729602. Registered 6 June 2018 - Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=344

Short Term Outcomes in Neonates with Acute Kidney Injury on Peritoneal Dialysis in Renal Unit at National Referral Hospital in Low Income Country

Background: Acute Kidney Injury is commonly seen in neonates and is associated with mortality. Peritoneal dialysis is the preferred modality of renal replacement therapy for neonatal acute kidney injury. This study sought to determine short-term outcomes of neonates on peritoneal dialysis and factors associated. Method: This was a retrospective study on neonates who underwent peritoneal dialysis for AKI in the pediatric renal unit at Kenyatta National Hospital between January 2016 and December 2017. The outcome was determined within 14 days of admission in the pediatric renal unit. Results: A total of 92 records were reviewed, included in the study and analyzed. The mortality rate was found to be at 9.8% (n=9). Complications were found in 33.7% (n= 31) of the patients and the most common was catheter leakage in 25 patients (80.6%). The mean time spent on PD in patients who died was three days and five days in those who survived. Neonates who died were older (16 days) at the start of PD compared to those who survived (11 days). Conclusion: The mortality rate in neonates was low at 9.8% with a median of 5 days on PD. The complication rate was acceptable at 33.7% with the commonest being catheter leakage (80.6%)

Prevalence of abnormal aminoglycoside trough levels in children with clinically suspected gram negative infections at a tertiary level hospital In Kenya-a cross sectional study

Background: Aminoglycosides are used to treat severe gram-negative infections. The associated risk of nephro toxicity necessitates therapeutic drug level monitoring. Objectives: This study attempted to determine prevalence of abnormal aminoglycoside trough levels in children below the age of 12 years and to determine if glomerular filtration rate (GFR) estimation using Schwartz formula correlates with drug trough levels. Materials and Methods: This was a cross sectional study enrolling children aged one day to 12 years on aminoglycosides, at a private tertiary facility in Nairobi. Aminoglycoside drug trough levels and serum creatinine measurements were analyzed for a calculated sample size of 81 patients. GFR was estimated using Schwartz formula. The Pearson correlation coefficient was calculated between the drug trough levels and estimated GFR. Results: Median age of participants was 3 days (IQR 19). The prevalence of abnormal aminoglycoside trough levels was 4.9% (95% CI 1.4% to 12.2%). The Pearson correlation coefficient between aminoglycoside trough levels and GFR was -0.342. The area under the receiver operating characteristic (ROC) curve was 0.6185 Conclusion: The prevalence of abnormal aminoglycoside trough levels was low and therefore the routine screening of patients on aminoglycoside therapy for toxicity using drug trough levels may not be justified

Hyperlipidemia Among Children on Follow up for Idiopathic Nephrotic Syndrome at Kenyatta National Hospital

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Missed opportunities for immunization among children attending a Paediatric Outpatient Clinic at Juba Teaching Hospital

Background: Immunization prevents child morbidity and mortality through the universal access to routinely recommended childhood vaccines. Objectives: To determine the prevalence and factors associated with missed opportunities for immunization (MOI). Method: An out-patient paediatric clinic-based study conducted in May - June 2012 using the standard World Health Organization (WHO), Expanded Programme on Immunization (EPI) protocol for assessing MOI. The study involved client exit interviews with caregivers of children aged less than 2 years, reviews of immunization cards and parental recall of immunization history, and interviews with health workers. Results: Data were collected on 448 children aged 0-23 months and from 18 health workers. The prevalence of MOI was most common among children older than 12 months. As the age of administration of the vaccine increased so did the number of MOI. MOI were more common for DPT3 (22.1%) OPV3 (24.4%), and measles (31.2%) compared to other vaccines. Factors associated with MOI included home births, inadequate antenatal care, lack of information, and, among health workers, poor knowledge of immunization schedules and contraindications. Conclusion: The high prevalence of MOI could be reduced by defaulter tracing, encouraging antenatal visits and hospital deliveries, and education of caregivers and health workers

Patient- And parent proxy-reported outcome measures for life participation in children with chronic kidney disease: a systematic review

BACKGROUND: The burden of chronic kidney disease (CKD) and its treatment may severely limit the ability of children with CKD to do daily tasks and participate in family, school, sporting and recreational activities. Life participation is critically important to affected children and their families; however, the appropriateness and validity of available measures used to assess this outcome are uncertain. The aim of this study was to identify the characteristics, content and psychometric properties of existing measures for life participation used in children with CKD. METHODS: We searched MEDLINE, Embase, PsychINFO, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Kidney and Transplant register to August 2019 for all studies that used a measure to report life participation in children with CKD. For each measure, we extracted and analyzed the characteristics, dimensions of life participation and psychometric properties. RESULTS: From 128 studies, we identified 63 different measures used to assess life participation in children with CKD. Twenty-five (40%) of the measures were patient reported, 7 (11%) were parent proxy reported and 31 (49%) had both self and parent proxy reports available. Twenty-two were used in one study only. The Pediatric Quality of Life Inventory version 4.0 generic module was used most frequently in 62 (48%) studies. Seven (11%) were designed to assess ability to participate in life, with 56 (89%) designed to assess other constructs (e.g. quality of life) with a subscale or selected questions on life participation. Across all measures, the three most frequent activities specified were social activities with friends and/or family, leisure activities and self-care activities. Validation data in the pediatric CKD population were available for only 19 (30%) measures. CONCLUSIONS: Life participation is inconsistently measured in children with CKD and the measures used vary in their characteristics, content and validity. Validation data supporting these measures in this population are often incomplete and are sparse. A meaningful and validated measure for life participation in children with CKD is needed