Characterization and antimicrobial susceptibility pattern to commonly prescribed antimicrobials of diarrheagenic Escherichia coli in patients attending Thika district Hospital - Kenya, 2014.

Background: Diarrheagenic E. coli (DEC) are associated with outbreaks of severe diarrhea and multiple drug resistance. We characterize DEC among diarrhoeal patients attending Thika Hospital and determine their antimicrobial susceptibility patterns.Methods: A cross-sectional study was conducted among patients of all ages seeking diarrhea treatment. Stool samples were collected, inoculated on bacterial differential media for growth of enteric pathogens, characterized and antimicrobial susceptibility of DEC isolates determined.Results: A total of 402 stool samples were cultured. E. coli was isolated from 269, of which 72 (27%) were DEC; 60 (83.3%) enteroaggregative E. coli (EAEC), 6 (8.3%) enteropathogenic E. coli (EPEC) and 6 (8.3%) enterotoxigenic E. coli (ETEC). Of the 72, 58% were female, median age was 8 (IQR: 2-28) years, 75% did not boil water and 100% did not treat water. Twenty five (35%) patients with DEC were under-five years. Drinking un-boiled water (OR: 2.51, 95% CI: 1.36-4.61) was associated with having DEC. All DEC isolates were sensitive to cefoxitin, meropenem, amikacin, gentamicin and ciprofloxacin. They were resistance to ampicillin (92%), trimethoprim-sulfamethoxazole (92%) and amoxicillin-clavulanic acid (85%).Conclusion: The predominant DEC strain was EAEC. High resistant to ampicillin, trimethoprim-sulfamethoxazole and amoxicillin-clavulanic acid were observed. All isolates were sensitive to ciprofloxacin and gentamicin.Keywords: Diarrhea, E. coli, Diarrheagenic E. coli, Characterization, KenyaAfr J Health Sci. 2016; 29(1):25-3

Pastoralism: Animal health and food safety situation analysis, Kenya and Tanzania

Pastoralism is a farming system in societies that derive majority of their food and income from livestock production. This form of farming system is practised in the world’s arid and semi arid lands (ASALs). It is estimated that 70% of the landmass in the Horn of Africa is dry land; in Kenya 80% of the landmass is classified as ASAL while approximately half of Tanzania consists of dry land. These dry lands can only be effectively utilised when used for livestock rearing, supporting wildlife resource harvesting and tourism. In this paper we present a current situation analysis of animal health and its implication on food safety based on primary data collected from pastoralists in Kajiado County, Kenya and in Tanga and Morogoro regions in Tanzania. Less than 10% of pastoralists in these communities engage in crop farming to supplement household income, and with their high dependency on livestock rearing, animal health challenges are a significant problem. We report on the livestock diseases with high prevalence and postulate their effects on food safety and food security in pastoral communities. We also explore the extent of species rearing diversification, pastoralist trade orientation, and practices that may expose the community and their trading partners to animal and zoonotic infections. We also assess access to animal health service providers within these pastoral areas and veterinary drug usage that may have significant implications on animal health and food safety

Uptake of isoniazid preventive therapy and its associated factors among HIV positive patients in an urban health centre, Kenya

Background: Isoniazid Preventive Therapy (IPT) is an effective intervention for prevention of tuberculosis (TB) among HIV positive patients, and its use is recommended by the World Health Organization (WHO). Unfortunately the uptake of IPT in Kenya remains low (33%-40%) with limited knowledge on the factors that affect its uptake.Objective: To determine the uptake of IPT and its associated factors among HIV-positive patients enrolled in a urban health centre.Design: Hospital based cross-sectional studySetting: Riruta Health Centre, Nairobi, KenyaSubjects: HIV-positive patients ≥18 years who have been on care and treatment services in the health centre for at least six months preceding the study.Results: Four hundred and thirty six participants were enrolled with a mean age of 41 years (standard deviation± 9years). Females were 276 (63%), anti-retroviral therapy uptake of 427 (98%) and overall IPT uptake rate of 336 (77%). On multivariate analysis, fear of acquiring TB (adjusted odds ratio (AOR) 4.6, 95% confidence interval, CI 2.6-8.1), having received IPT-associated health education (AOR 5.0, 95% CI 3.0-8.4) and having a good relationship with the healthcare worker (HCW) (AOR 2.0, 95% CI 1.2-3.4) were independently associated with initiation of IPT.Conclusion: The uptake rate was above the current national coverage but fell below the national set target of 90%. Fear of acquiring TB, receipt of IPT-associated health education and favourable relationship with the HCWs promoted the initiation of IP

Operationalising sexual and reproductive health and rights in sub-Saharan Africa: constraints, dilemmas and strategies

BACKGROUND: The continued poor sexual and reproductive health (SRH) outcomes in sub-Saharan Africa highlight the difficulties in reforming policies and laws, and implementing effective programmes. This paper uses one international and two national case studies to reflect on the challenges, dilemmas and strategies used in operationalising sexual and reproductive health and rights (SRHR) in different African contexts. METHODS: The international case study focuses on the progress made by African countries in implementing the African Union’s Maputo Plan of Action (for the Operationalisation of the Continental Policy Framework for Sexual and Reproductive Health and Rights) and the experiences of state and non-state stakeholders in this process. The case was developed from an evaluation report of the progress made by nine African countries in implementing the Plan of Action, qualitative interviews exploring stakeholders’ experiences and perceptions of the operationalisation of the plan (carried out as part of the evaluation) in Botswana and Nigeria, and authors’ reflections. The first national case study explores the processes involved in influencing Ghana’s Domestic Violence Act passed in 2007; developed from a review of scientific papers and organisational publications on the processes involved in influencing the Act, qualitative interview data and authors’ reflections. The second national case study examines the experiences with introducing the 2006 Sexual Offences Act in Kenya, and it is developed from organisational publications on the processes of enacting the Act and a review of media reports on the debates and passing of the Act. RESULTS: Based on the three cases, we argue that prohibitive laws and governments’ reluctance to institute and implement comprehensive rights approaches to SRH, lack of political leadership and commitment to funding SRHR policies and programmes, and dominant negative cultural framing of women’s issues present the major obstacles to operationalising SRH rights. Analysis of successes points to the strategies for tackling these challenges, which include forming and working through strategic coalitions, employing strategic framing of SRHR issues to counter opposition and gain support, collaborating with government, and employing strategic opportunism. CONCLUSION: The strategies identified show future pathways through which challenges to the realisation of SRHR in Africa can be tackled