Factors associated with Mother to child transmission of HIV in a Semi-arid County in Kenya, 2014-201

Introduction: To eliminate mother-to-child-transmission of HIV eMTCT) a rate of <5% was recommended by the WHO in 2015. The rate was 8.3% for Kenya and 8.8% for Kajiado County in 2016. To identify causes of these higher rates, we described  factors associated with HIV transmission among HIV exposed infants (HEI) in Kajiado. Methods: We reviewed HEI 2014-2017 records downloaded from the national early-infant-diagnosis (EID) database. A case was defined as any record of HEI undergoing EID in Kajiado in 2014–2017. Dependent variable was HIV test result and the independent variables were demographic and clinical characteristics. To describe the study population means were calculated for continuous variables and proportions for categorical variables. We performed Multivariate logistic regression to study the factors associated with MTCT while controlling for other factors and we reported the Prevalence OR and their 95% Confidence Intervals. Results: We reviewed 4,195 HEI records. Males were 1,999 (47.7%); median age was 2 months (range of 1.5 – 6months) and 199 (4.7%) tested positive for HIV. Antiretroviral (ARV) prophylaxis was not provided to 308 (7.34%) infants and 291 (6.94%) mothers of the infants. Exclusive-breastfeeding was offered to 2,976 (70.9%) infants and 320 (7.6%) had mixed-feeding. Odds of having a positive HIV result was higher in infants not on ARV prophylaxis compared to those who received ARV prophylaxis (POR: 8.3; 95% CI: 5.9 –11.5); in infants whose mothers received no ARV prophylaxis compared to those whose mothers received ARV prophylaxis (POR: 6.8; 95% CI: 4.9 – 9.6) and in those mixed-fed compared to those who received exclusive breastfeeding (POR: 2.4; 95% CI: 1.3 – 4.3). In infants not on ARV prophylaxis (aOR: 2.86; 95% CI: 1.02 – 6.93); infants whose mothers received no ARV prophylaxis (aOR: 2.45; 95% CI: 1.52 – 3.92) and those mixed-fed (aOR: 2.00; 95% CI: 1.05 – 3.79) were independently associated with a positive HIV result. Conclusion: Transmission was higher where infants missed ARV prophylaxis or had mixed-feeding. Infant prophylaxis and exclusive breastfeeding by HIV positive women should be encouraged

Factors Associated with Full Immunization Coverage among Children up to 12 Months, Kakuma Mission Hospital, Turkana County, Kenya

The 2014 Kenya Demographic Health Survey showed that only 56.7% of children in Turkana County had received all recommended vaccines by 12 months of age, which is 12% below national and 24% below World Health Organization global coverage rates. This study aimed to identify factors that influence full immunization coverage (FIC) by 12 months of age in Kakuma Mission Hospital (KMH), Turkana County, in 2015. Kakuma is the site of a UNHCR refugee camp, established in 1969. Administration of vitamin A by 6 months of age and administration of measles-containing vaccine by 9 months of age were predictive of FIC

Cholera outbreak at a city hotel in Kenya, 2017: a retrospective cohort study

Introduction: The Ministry of Health, Kenya (MOH) investigated a report on acute watery diarrhea (AWD) cases at a city hotel to confirm the cause, characterize, and identify associated factors. Methods: A suspected case of cholera was defined as AWD in any person aged >2 years at the hotel from August 31, 2017, to September 6, 2017. We took rectal swabs for laboratory confirmation and summarized the AWD data by person, place, and time. We defined a cohort of hotel staff with those who ate dinner on August 31, 2017, considered exposed and conducted a retrospective cohort study. We calculated attack rates (AR) and risk ratios (RR) with 95% confidence interval. Variables with p<0.1 at bivariate analysis were entered into a multivariate model and those with p<0.05 in the final model considered independently associated with the AWD. Results: Vibrio cholera was isolated from seven (10.1%) out of 69 samples. Line listed 139 cases with a median age of 32 years (Range: 20–58 years) included 127 (91.4%) male and 127 (91.4%) guests. Index case was reported on August 31, 2017, cases peaked at 95 cases on September 3, 2017, and declined to three on September 6, 2017. A total of 30 (81.1%) of 37 hotel staff were exposed with 17 (56.7%) cases. Food specific ARs were: steamed spinach 78.6% and pineapples 26.3%. Spinach (RR: 3.0 (95%CI: 1.76-72.97)) was a risk factor while pineapples (RR: 0.4 (95%CI: 0.01-0.58)) was protective. Conclusion: This was a point source cholera outbreak likely due to eating contaminated spinach

Prevalence and factors associated with metabolic syndrome in an urban population of adults living with HIV in Nairobi, Kenya

Introduction: Metabolic syndrome affects 20-25% of the adult population globally. It predisposes to cardiovascular disease and Type 2 diabetes. Studies in other countries suggest a high prevalence of metabolic syndrome among HIV-infected patients but no studies have been reported in Kenya. The objective of this study was to assess the prevalence and factors associated with metabolic syndrome in adult HIV-infected patients in an urban population in Nairobi, Kenya. Methods: in a cross-sectional study design, conducted at Riruta Health Centre in 2016, 360 adults infected with HIV were recruited. A structured questionnaire was used to collect data on socio-demography. Blood was collected by finger prick for fasting glucose and venous sampling for lipid profile. Results: Using the harmonized Joint Scientific Statement criteria, metabolic syndrome was present in 19.2%. The prevalence was higher among females than males (20.7% vs. 16.0%). Obesity (AOR = 5.37, P < 0.001), lack of formal education (AOR = 5.20, P = 0.002) and family history of hypertension (AOR = 2.06, P = 0.029) were associated with increased odds of metabolic syndrome while physical activity (AOR = 0.28, P = 0.001) was associated with decreased odds. Conclusion: Metabolic syndrome is prevalent in this study population. Obesity, lack of formal education, family history of hypertension, and physical inactivity are associated with metabolic syndrome. Screening for risk factors, promotion of healthy lifestyle, and nutrition counselling should be offered routinely in HIV care and treatment clinics

Use of short text message reminders to improve attendance of postnatal care at a referral maternity hospital, Kenya, 2016—A randomised controlled trial

Introduction: Globally about 830 women die daily due to complications of pregnancy and child birth out of which 550 occur in Sub-Saharan Africa, with about 8,000 maternal deaths occurring annually in Kenya. 66% of maternal deaths occur within the first week and 85% of maternal deaths occur within two weeks post-delivery. Attendance of postnatal services during this time could significantly reduce morbidity and mortality. We determined effectiveness of short text message (SMS) in reducing failure-to-attend rates (FTA) of postnatal clinic at the largest maternity hospital in Nairobi, Kenya. Methods: We conducted a hospital-based randomised controlled trial. Women who delivered between March and May 2016 at Pumwani Maternity Hospital were recruited, enrolled and randomised into SMS (intervention) or no SMS (control) arms. Women were masked to which arm they belonged during randomisation but were unmasked during the appointments as the intervention had been sent. The investigators were not masked. Reminders were sent three days prior to and on the morning of the appointment. Relative Risk (RR) at 95% Confidence Interval were calculated to estimate the effectiveness of intervention at two and six-weeks. Results: We enrolled 754 women, with 377 randomly assigned into each arm. There were no differences in socio-demographic characteristics between the study arms at baseline. After two-weeks, women in the intervention arm had an 80% reduction in FTA risk (RR=0.2, 95% CI 0.1–0.3). After six weeks, women in the intervention arm had a 60% reduction in FTA risk (RR=0.4, 95% CI 0.2–0.6). Among participants, 80 (42.1%) women at two-weeks and 30 (41.7%) women at six-weeks cited forgetting appointment as the most common reason for failing to attend postnatal clinic. Conclusion: SMS reminders were effective in reducing failure-to-attend clinic appointments. We recommend the use of SMS reminder strategy for postnatal care

Prevalence and risk factors associated with asymptomatic Plasmodium falciparum infection and anemia among pregnant women at the first antenatal care visit: A hospital based cross-sectional study in Kwale County, Kenya.

BackgroundPrevalence of Prevalence of malaria in pregnancy (MiP) in Kenya ranges from 9% to 18%. We estimated the prevalence and factors associated with MiP and anemia in pregnancy (AiP) among asymptomatic women attending antenatal care (ANC) visits.MethodsWe performed a cross-sectional study among pregnant women attending ANC at Msambweni Hospital, between September 2018 and February 2019. Data was collected and analyzed in Epi Info 7. Descriptive statistics were calculated and we compared MiP and AiP in asymptomatic cases to those without either condition. Adjusted prevalence Odds odds ratios (aPOR) and 95% confidence intervals (CI) were calculated to identify factors associated with asymptomatic MiP and AiP.ResultsWe interviewed 308 study participants; their mean age was 26.6 years (± 5.8 years), mean gestational age was 21.8 weeks (± 6.0 weeks), 173 (56.2%) were in the second trimester of pregnancy, 12.9% (40/308) had MiP and 62.7% had AiP. Women who were aged ≤ 20 years had three times likelihood of developing MiP (aPOR = 3.1 Cl: 1.3-7.35) compared to those aged >20 years old. The likelihood of AiP was higher among women with gestational age ≥ 16 weeks (aPOR = 3.9, CI: 1.96-7.75), those with parasitemia (aPOR = 3.3, 95% CI: 1.31-8.18), those in third trimester of pregnancy (aPOR = 2.6, 95% CI:1.40-4.96) and those who reported eating soil as a craving during pregnancy (aPOR = 1.9, 95%CI:1.15-3.29).ConclusionsMajority of the women had asymptomatic MiP and AiP. MiP was observed in one tenth of all study participants. Asymptomatic MiP was associated with younger age while AiP was associated with gestational age parasitemia, and soil consumption as a craving during pregnancy

Plasmodium falciparum parasite prevalence in East Africa:Updating data for malaria stratification

The High Burden High Impact (HBHI) strategy for malaria encourages countries to use multiple sources of available data to define the sub-national vulnerabilities to malaria risk, including parasite prevalence. Here, a modelled estimate of Plasmodium falciparum from an updated assembly of community parasite survey data in Kenya, mainland Tanzania, and Uganda is presented and used to provide a more contemporary understanding of the sub-national malaria prevalence stratification across the sub-region for 2019. Malaria prevalence data from surveys undertaken between January 2010 and June 2020 were assembled form each of the three countries. Bayesian spatiotemporal model-based approaches were used to interpolate space-time data at fine spatial resolution adjusting for population, environmental and ecological covariates across the three countries. A total of 18,940 time-space age-standardised and microscopy-converted surveys were assembled of which 14,170 (74.8%) were identified after 2017. The estimated national population-adjusted posterior mean parasite prevalence was 4.7% (95% Bayesian Credible Interval 2.6–36.9) in Kenya, 10.6% (3.4–39.2) in mainland Tanzania, and 9.5% (4.0–48.3) in Uganda. In 2019, more than 12.7 million people resided in communities where parasite prevalence was predicted ≥ 30%, including 6.4%, 12.1% and 6.3% of Kenya, mainland Tanzania and Uganda populations, respectively. Conversely, areas that supported very low parasite prevalence (<1%) were inhabited by approximately 46.2 million people across the sub-region, or 52.2%, 26.7% and 10.4% of Kenya, mainland Tanzania and Uganda populations, respectively. In conclusion, parasite prevalence represents one of several data metrics for disease stratification at national and sub-national levels. To increase the use of this metric for decision making, there is a need to integrate other data layers on mortality related to malaria, malaria vector composition, insecticide resistance and bionomic, malaria care-seeking behaviour and current levels of unmet need of malaria interventions

Afri-Can Forum 2

CITATION: Mukudu, H., et al. 2016. Afri-Can Forum 2. BMC Infectious Diseases, 16:315, doi:10.1186/s12879-016-1466-6.The original publication is available at https://bmcinfectdis.biomedcentral.comENGLISH ABSTRACT: We are pleased to present peer reviewed forum proceedings of the 2nd synchronicity forum of GHRI/CHVIfunded Canadian and African HIV prevention and vaccine teams Forum objectives ∙GHRI-funded capacity building and HIV prevention research teams presented highlights of achievements ∙Teams discussed how to jointly build on achievements for sustainability ∙Provided an opportunity for inter-team collaboration, synchronize best approach to capacity building, mentoring of new researchers and building leadership ∙Provided opportunities for informal discussions and networking among the teams. ∙Teams learnt about recent advances in the area of African regulatory and ethics review process ∙The forum proceedings was a special supplement in an openaccess journal was producedhttps://bmcinfectdis.biomedcentral.com/articles/supplements/volume-16-supplement-2Publisher's versio