Prevalence of constipation among children referred to gastroenterology clinic with chronic abdominal pain at Kenyatta National Hospital

Background: Chronic abdominal pain is one of the most common presenting complaints to primary care providers and paediatricians. Studies in developed countries have shown that constipation is one of the most common diagnoses in children presenting with chronic abdominal pain.Objectives: To determine the prevalence of constipation in children 4-13 years presenting with chronic abdominal pain and to describe the pharmacological and non-pharmacological management of children with constipation at Kenyatta National Hospital.Design: A cross-sectional hospital based study.Setting: Paediatric Gastroenterology Clinic, Kenyatta National Hospital.Subjects: children aged 4 to 13 years attending the paediatric gastroenterology clinic at Kenyatta National Hospital between July to December 2014.Results: A total of 84 children with chronic abdominal pain were seen, 47 (55.95%) were girls and the median age was nine years. The prevalence of constipation in children with chronic abdominal pain with two or more Rome III criteria was 69 out of 84 (82%, 95%CI: 72%95%), out of which there were 37(53.62%) females and 32(46.3%) males. The difference among the boys and girls was not statistically significant. Pharmacological management was more commonly used than non-pharmacological management. The most common medication given to children with constipation was lactulose given to 63 (91.3%) of the children. The non-pharmacological management of constipation was education and dietary advice 53(76.8%), while behaviour change advice was given to 28 (40.6 %).Conclusion: The prevalence of constipation in children with chronic abdominal pain was 82%. Pharmacological management was more commonly used than non pharmacological

Short term clinical outcome of children with rotavirus infection at Kenyatta National Hospital, Nairobi

Background: Rotavirus infection is the single most common cause of acute gastroenteritis in children under five years of age. Rotavirus gastroenteritis has a high morbidity and mortality in children in Kenya. Objectives: To determine the short term clinical outcome for children admitted to Kenyatta National Hospital with rotavirus gastroenteritis and the correlates of poor outcome. Design: Short longitudinal survey. Setting: Kenyatta National Hospital from February to May 2008. Subjects: Five hundred children were screened using a rapid antigen detection kit and ELISA. Results: Of the 191 children who tested positive for rotavirus in stool; 172 children were recruited into the study. Eighty eight per cent of the patients were discharged within one week, 8.1% stayed for more than seven days while 4.1% died. Children who had co-morbidities such as malnutrition, rickets and pneumonia had worse outcomes. Conclusion: Rotavirus gastroenteritis has a long hospital stay and a high mortality. Children in shock on admission and those with co-morbid conditions should get priority for they have a poor outcome

Enhancing resistance against African weevils through development of transgenic sweetpotato cultivars (Ipomoea batatas (L.) Lam.) expressing cry7Aa1, cry3Ca1 and ET33-34 genes.

Sweetpotato (Ipomoea batatas) is one of the most important food crops in tropical and subtropical countries. In Sub-Saharan Africa, sweetpotato is mainly produced for consumption and as a source of income by resource-poor farmers. However, their production is limited by severe damage caused by pests and diseases. The African weevils Cylas puncticollis and C. brunneus are the main biological constraints that may cause losses between 50 and 100%. Biotechnological approaches to control weevils include the introduction of genes encoding Cry proteins found to be active against these pests. To that end, several protocols for sweetpotato regeneration and transformation by organogenesis or somatic embryogenesis have been developed but their efficiency remains largely genotype-dependent and time-consuming. In this study, 31 African sweetpotato cultivars from CIP genebank were screened for regeneration and transformation efficiencies by organogenesis and somatic embryogenesis. Additionally, “Jewel” and “Jonathan” cultivars were used as organogenic and embryogenic controls, respectively. Regeneration by organogenesis was conducted using a two-step protocol including 2,4-D then thidiazuron, zeatin or kinetin while regeneration by embryogenesis was performed using a three-step protocol, each one using a different hormone (2,4,5-T, ABA and AG3). Higher than 40% regeneration efficiencies were obtained for 8 cultivars (Jewel, Imby, Kawogo, Luapula, Mafutha, CIP440163, Zambezi and Ukerewe) with an organogenesis protocol and 8 cultivars (Jonathan, Imby, K51/3251, Bwanjule, CIP440163, SPK004, New Kawogo and KSP 11) with an embryogenesis protocol. Genetic transformation of sweetpotato with Jewel by organogenesis and Imby, CIP440163 and Jonathan by somatic embryogenesis has been achieved using chimerical genes coding for three of the most active proteins (Cry7Aa1, ET33-34, and Cry3Ca1) against African weevils. Transgenic events have been confirmed by kanamycin resistant calli test, PCR and Southern blot. Transcriptional activity and Cry protein accumulation are being tested in leaves and storage roots by Real time PCR and DAS-ELISA respectively

Do clinicians adhere to practice guidelines? A descriptive study at a referral hospital in Kenya

Background: Clinical guidelines when implemented correctly have shown to improve disease outcomes. This study describes utilization of Kenya National guidelines in managing ante partum haemorrhage (APH) in 3rd trimester.Objective: To describe adherence to clinical guideline in management of antepartum haemorrhage at Garissa Provincial General Hospital Design: Crossectional mixed methods studySetting: Garissa Provincial General HospitalSubjects: Medical records of patients managed for APH between 2002 and 2012 and Key Informant Interviews (KIIs) of Health workers.Results: 36.1% of the cases assessed were managed with strict adherence to guidelines. 90% of health care workers had high levels of awareness of the existence of guidelines and sited utilization challenges attributed to resource inadequacies.Conclusion: Clinicians are skilled on APH guidelines, but adherence levels are still low. Therefore, continuous appraisal of clinical practices, availing equipment, facilities and supplies to reinforce adherence is recommended

2D-Galactic chemical evolution: The role of the spiral density wave

© 2019 The Author(s). Published by Oxford University Press on behalf of the Royal Astronomical Society. We present a 2D chemical evolution code applied to a Milky Way type Galaxy, incorporating the role of spiral arms in shaping azimuthal abundance variations, and confront the predicted behaviour with recent observations taken with integral field units. To the usual radial distribution of mass, we add the surface density of the spiral wave and study its effect on star formation and elemental abundances. We compute five different models: one with azimuthal symmetry which depends only on radius, while the other four are subjected to the effect of a spiral density wave. At early times, the imprint of the spiral density wave is carried by both the stellar and star formation surface densities; conversely, the elemental abundance pattern is less affected. At later epochs, however, differences among the models are diluted, becoming almost indistinguishable given current observational uncertainties. At the present time, the largest differences appear in the star formation rate and/or in the outer disc (R ≥ 18 kpc). The predicted azimuthal oxygen abundance patterns for t ≤ 2 Gyr are in reasonable agreement with recent observations obtained with VLT/MUSE for NGC 6754

Utility of total lymphocyte count as a surrogate marker for CD4 counts in HIV-1 infected children in Kenya

<p>Abstract</p> <p>Background</p> <p>In resource-limited settings, such as Kenya, access to CD4 testing is limited. Therefore, evaluation of less expensive laboratory diagnostics is urgently needed to diagnose immuno-suppression in children.</p> <p>Objectives</p> <p>To evaluate utility of total lymphocyte count (TLC) as surrogate marker for CD4 count in HIV-infected children.</p> <p>Methods</p> <p>This was a hospital based retrospective study conducted in three HIV clinics in Kisumu and Nairobi in Kenya. TLC, CD4 count and CD4 percent data were abstracted from hospital records of 487 antiretroviral-naïve HIV-infected children aged 1 month - 12 years.</p> <p>Results</p> <p>TLC and CD4 count were positively correlated (r = 0.66, p < 0.001) with highest correlation seen in children with severe immuno-suppression (r = 0.72, p < 0.001) and children >59 months of age (r = 0.68, p < 0.001). Children were considered to have severe immuno-suppression if they met the following WHO set CD4 count thresholds: age below 12 months (CD4 counts < 1500 cells/mm³), age 12-35 months (CD4 count < 750 cells/mm3), age 36-59 months (CD4 count < 350 cells/mm³, and age above 59 months (CD4 count < 200 cells/mm³). WHO recommended TLC threshold values for severe immuno-suppression of 4000, 3000, 2500 and 2000 cells/mm³for age categories <12, 12-35, 36-59 and >59 months had low sensitivity of 25%, 23%, 33% and 62% respectively in predicting severe immuno-suppression using CD4 count as gold standard. Raising TLC thresholds to 7000, 6000, 4500 and 3000 cells/mm³for each of the stated age categories increased sensitivity to 71%, 64%, 56% and 86%, with positive predictive values of 85%, 61%, 37%, 68% respectively but reduced specificity to 73%, 62%, 54% and 68% with negative predictive values of 54%, 65%, 71% and 87% respectively.</p> <p>Conclusion</p> <p>TLC is positively correlated with absolute CD4 count in children but current WHO age-specific thresholds had low sensitivity to identify severely immunosuppressed Kenyan children. Sensitivity and therefore utility of TLC to identify immuno-suppressed children may be improved by raising the TLC cut off levels across the various age categories.</p

Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort

<p>Abstract</p> <p>Background</p> <p>Among children, early mortality following highly active antiretroviral therapy (HAART) remains high. It is important to define correlates of mortality in order to improve outcome.</p> <p>Methods</p> <p>HIV-1-infected children aged 18 months-12 years were followed up at Kenyatta National Hospital, Nairobi after initiating NNRTI-based HAART. Cofactors for mortality were determined using multivariate Cox regression models.</p> <p>Results</p> <p>Between August 2004 and November 2008, 149 children were initiated on HAART of whom 135 were followed for a total of 238 child-years (median 21 months) after HAART initiation. Baseline median CD4% was 6.8% and median HIV-1-RNA was 5.98-log₁₀copies/ml. Twenty children (13.4%) died at a median of 35 days post-HAART initiation. Mortality during the entire follow-up period was 8.4 deaths per 100 child-years (46 deaths/100 child-years in first 4 months and 1.0 deaths/100 child-years after 4 months post-HAART initiation). On univariate Cox regression, baseline hemoglobin (Hb) <9 g/dl, weight-for-height z-score (WHZ) < -2, and WHO clinical stage 4 were associated with increased risk of death (Hb <9 g/dl HR 3.00 [95% C.I. 1.21-7.39], p = 0.02, WHZ < -2 HR 3.41 [95% C.I. 1.28-9.08], p = 0.01, and WHO clinical stage 4, HR 3.08 [1.17-8.12], p = 0.02). On multivariate analysis Hb < 9 g/dl remained predictive of mortality after controlling for age, baseline CD4%, WHO clinical stage and weight-for-height z-score (HR 2.95 (95% C.I. 1.04-8.35) p = 0.04).</p> <p>Conclusion</p> <p>High early mortality was observed in this cohort of Kenyan children receiving HAART, and low baseline hemoglobin was an independent risk factor for death.</p

ECONOMIC INTEGRATION FOR DEVELOPMENT IN EASTERN AND SOUTHERN AFRICA: ASSESSMENT AND PROSPECTS

Summary Eastern and Southern Africa has a long history of efforts to achieve operational economic integration and a complex set of overlapping institutional frames. The gains from successful cooperation are agreed ? the basic issues turn on how to attain them. In this context the experiences of the two key actors, PTA (Preferential Trade Area) and SADC (Southern African Development Community), offer insights into the strengths and weaknesses of a broad, secretariat?led trade barrier reducing organization and a narrower (geographically), key sector production coordination, country?led one (SADC). The divergences ? as well as history ? have hampered attempts to coordinate or to merge them and their responses to the opportunities and challenges posed by the re?entry of South Africa into Africa. The latter raises rather more complex issues (and ones less threatening ? or promising in some respects ? to its Eastern and Southern African region potential partners) than is sometimes supposed. Resumé efforts pour d'obtenir l'intégration économique et de rendre celle?ci opérationnelle dans le contexte d'une série complexe de cadres institutionnels parfois superposés. Les gains résultant des réussites dans la coopération ne sont pas contestés: les questions fondamentales tournent autour des moyens d'y parvenir. Dans ce contexte l'expérience de deux acteurs principaux (la PTA – Preferential Trade Area ou Zone commerciale privilégiée et la SADC – Southern African Development Community ou Communauté de développement de l'Afrique australe) offrent des aperçus quant aux avantages et désavantages de l'existence d'une organisation de grande envergure et fondée sur secrétariat, consacrée à la réduction des barrières douannières, et d'une autre organisation, cette fois limitée en termes de sa superficie géographique et menée par des pays, qui cherche à coordiner la production dans les secteurs clef: la SADC. Leurs divergences, et l'histoire même, ont servi d'entrave aux efforts de les coordiner ou de les faire fusionner, surtout en ce qui concerne les nouvelles possibilités et le challenge même de la réintégration de l'Afrique du Sud dans la grande Afrique. Cette réintégration soulève des questions un peu plus complexes (et moins menaçantes) et aussi, moins promettrices sous certains jours pour ses éventuels partenaires dans les régions orientales et australes de l'Afrique) qu'on ne le supposerait parfois. Resumen El Africa oriental y el Africa austral tienen un largo historial de esfuerzos para alcanzar la integración económica operacional y un complejo grupo de estructuras institucionales superpuestas. Los beneficios de una cooperación exitosa no están en discusión ? el punto básico es cómo obtenerlos. En este contexto las experiencias de dos actores clave, (la PTA?Preferential Trade Area o Zona de Comercio Privilegiado, y la SADC ? Southern Africa Development Community o Comunidad para el Desarrollo de Africa Austral), ofrecen interesantes revelaciones sobre los puntos fuertes y débiles de una amplia y burocrática barrera comercial que reduce la organización, y la coordinación de la producción en sectores clave de un área geográfica más reducida, de orientación nacional. Las divergenias ? así como la historia ? han estorbado intentos de combinar o coordinar estos dos aspectos y sus respuestas a las oportunidades o desafíos que presenta el reingreso de Sudafrica al Africa. Esto último plantea más asuntos complejos de los que a veces se suponen (y menos amenazantes ? más prometedores en alugunos aspectos) para sus socios comerciales en potencia en Africa oriental y Africa del sur