Antimicrobial Susceptibility of Bacteria that cause Wound Sepsis in the Paediatric Surgical Patients at Kenyatta National Hospital

Background: Despite improvement in the practice of medicine and attempts to provide aseptic conditions in the surgical wards, the incidence of wound infection is increasing.  Management of wound infection remains a challenge in the surgical areas with the increasing resistance to antimicrobials. Local bacterial sensitivity data is therefore an important guide for antibiotic selection. Objective: To determine the aetiology and antimicrobial sensitivity patterns of bacteria that cause wound sepsis in the paediatric surgical wards at the Kenyatta National Hospital. Methodology: A cross- sectional study was carried out on 150 paediatric patients admitted in the surgical wards from mid April 2014 to mid June, 2014.  The patients were selected by convenient sampling.   Data was abstracted from patient files and specimens from the infected wounds were identified and analyzed for antibiotic susceptibility. Results: The prevalence of wound infection was 82%.   Staphylococcus aureus (52.7%) was the most prevalent infective agent followed by Pseudomonas aeruginosa (17.3%). Staphylococcus aureus was the most resistant organism with susceptibility of less than 50% to most drugs.  About 50.6% of the Staphylococcus isolates were methicillin resistant.  Streptococcus was less resistant with more than 80% susceptibility to all tested drugs except cefuroxime. Escherichia coli were sensitive to ciprofloxacin.  All gram negative bacteria were highly sensitive to ciprofloxacin with the following susceptibilities: Pseudomonas aeruginosa (92.3%), Proteus mirabilis (71.4%) and others 100%.  Imipenem which is a new and relatively expensive monobactam demonstrated reduced activity with the following susceptibilities: Staphylococcus aureus (38%), Streptococcus (80%) and all the gram negative bacteria (70%). Conclusion: The most common causative agent was Staphylococcus aureus and less than 50% of the isolates were susceptible to all tested antibiotics. Key words: Antibiotic, antibiotic resistance, antibiotic susceptibility, wound infection

Effect of Pesticide Exposure on Serum Cholinesterase Levels among Asthmatic Children in Naivasha Sub-County, Kenya

Background: Pesticide exposure is a risk factor for asthma exacerbations in flower farm regions in the world.  Data on levels of serum cholinesterase among asthmatic children exposed to pesticides in Kenya is scanty. Objectives: To compare and identify variables which affect the concentration of serum cholinesterases in children who are exposed and unexposed to pesticides. Methodology: The design was a comparative cross-sectional study that involved exposed and unexposed children.  The study was conducted between May and July, 2014 in Naivasha, Kenya.  Patients were interviewed and serum samples were analysed for cholinesterase levels.  Multi-linear regression was done to identify variables that affected cholinesterase activity. Results: Children who were exposed to pesticides had a lower median ChE activity of 5828 [IQR 4863, 6443] compared to the unexposed arm whose median was 7133 [IQR 6063, 8179].  Five predictor variables were found to be significantly associated with depression of serum cholinesterase levels.  The most important predictor variable for the levels of ChE in children, was not using protective clothing by the parent [adjusted β -1457.0 (95% CI - 2594, 1319.8)].  Others were not using household pesticides [adjusted β 96.3, (95% CI 22.6, 170.0)], female sex [adjusted β -695.7 (95% CI -1296.2, - 95.3)], non school attendance [adjusted β -1676.8 (95% CI -3371.6, 18.1)] and not taking a break after spraying [adjusted β 1105.5 (95% CI (315.0, 1895.2)]. Conclusion: Children who were exposed to pesticides had low cholinesterase levels. Parents should therefore be encouraged to wear protective gear as this conferred protection of children from the effects of pesticide exposure. Key words: asthma, exposure, children, pesticides, cholinesterase

Near-Complete SARS-CoV-2 Seroprevalence among Rural and Urban Kenyans despite Significant Vaccine Hesitancy and Refusal

Considering the early inequity in global COVID-19 vaccine distribution, we compared the level of population immunity to SARS-CoV-2 with vaccine uptake and refusal between rural and urban Kenya two years after the pandemic onset. A population-based seroprevalence study was conducted in the city of Nairobi (n = 781) and a rural western county (n = 810) between January and February 2022. The overall SARS-CoV-2 seroprevalence was 90.2% (95% CI, 88.6–91.2%), including 96.7% (95% CI, 95.2–97.9%) among urban and 83.6% (95% CI, 80.6–86.0%) among rural populations. A comparison of immunity profiles showed that >50% of the rural population were strongly immunoreactive compared to 75%), inadequate information (26%), and concern about vaccine effectiveness (9%). Less than 2% of vaccine refusers cited religious or cultural beliefs. These findings indicate that despite vaccine inequity, hesitancy, and refusal, herd immunity had been achieved in Kenya and likely other African countries by early 2022, with natural infections likely contributing to most of this immunity. However, vaccine campaigns should be sustained due to the need for repeat boosters associated with waning of SARS-CoV-2 immunity and emergence of immune-evading virus variants