Clinical and epidemiologic characteristics associated with dengue fever in Mombasa, Kenya.

OBJECTIVES: Information on dengue in Africa is limited. To estimate the proportion of dengue-positive cases among febrile patients and describe clinical indicators of dengue, we conducted passive health facility-based fever surveillance in Mombasa, Kenya. METHODS: Non-malarial febrile patients between one and 55 years were enrolled at three health facilities between March 2016 and May 2017. Acute and convalescent blood samples were collected with an interval of 10-21 days. Acute samples were tested with dengue RDT and a selected subset with RT-PCR, and acute/convalescent samples with IgM/IgG ELISA. RESULTS: Among 482 enrollees, 295 (61.2%) were dengue-positive based on laboratory results. The surveillance covered the beginning of a dengue outbreak in April-May 2017, during which 73.9% of enrollees were dengue-positive. By contrast, during the non-outbreak period, 54.6% were dengue-positive. Dengue case status was positively associated with rash, fatigue, headache, retro-orbital pain, nausea/vomiting, nose bleeding, gum bleeding, loss of appetite, myalgia, and arthralgia. Dengue-positive cases in our study had mostly mild disease, with only two requiring observation, and no DHF. CONCLUSIONS: The clinical response was generally mild relative to what was observed in SE Asia and the Americas. Given the high level of DENV transmission in Mombasa, more data would be needed to further understand the disease burden and improve case detection for surveillance/monitoring of outbreaks

Causes of Preterm and Low Birth Weight Neonatal Mortality in a Rural Community in Kenya: Evidence From Verbal and Social Autopsy

Abstract BackgroundUnder-five mortality in Kenya has declined over the past two decades. However, the reduction in the neonatal mortality rate has remained stagnant. In a country with weak civil registration and vital statistics systems, there is an evident gap in documentation of mortality and its causes among low birth weight (LBW) and preterm neonates. We aimed to establish causes of neonatal LBW and preterm mortality in Migori County, among participants of the PTBI-K (Preterm Birth Initiative-Kenya) study.MethodsThis was a cross sectional study whereby Verbal and social autopsy (VASA) interviews were conducted with caregivers of deceased LBW and preterm neonates delivered within selected 17 health facilities in Migori County, Kenya. The probable cause of death was assigned using the WHO International Classification of Diseases (ICD-10). ResultsBetween January 2017 to December 2018, 3175 babies were born preterm or LBW, and 162 (5.1%) died in the first 28 days of life in 17 participating health facilities in the PTBI-K project. VASA was conducted among 88 (53.7%) neonatal deaths. Almost half (38, 43.2%) of the deaths occurred within the first 24 hours of life. Birth asphyxia (45.5%), neonatal sepsis (26.1%), respiratory distress syndrome (12.5%) and hypothermia (11.0%) were the leading causes of death. In the early neonatal period, majority (54.3%) of the neonates succumbed to asphyxia while in the late neonatal period majority (66.7%) succumbed to sepsis. Delay in seeking medical care was reported for 4 (5.8%) of the neonatal deaths. ConclusionDeaths among LBW and preterm neonates occur early in life due to preventable causes. This calls for enhanced intrapartum and immediate postpartum care interventions targeting asphyxia, sepsis, respiratory distress syndrome and hypothermia.</jats:p

Causes of preterm and low birth weight neonatal mortality in a rural community in Kenya: evidence from verbal and social autopsy

Abstract Background Under-five mortality in Kenya has declined over the past two decades. However, the reduction in the neonatal mortality rate has remained stagnant. In a country with weak civil registration and vital statistics systems, there is an evident gap in documentation of mortality and its causes among low birth weight (LBW) and preterm neonates. We aimed to establish causes of neonatal LBW and preterm mortality in Migori County, among participants of the PTBI-K (Preterm Birth Initiative-Kenya) study. Methods Verbal and social autopsy (VASA) interviews were conducted with caregivers of deceased LBW and preterm neonates delivered within selected 17 health facilities in Migori County, Kenya. The probable cause of death was assigned using the WHO International Classification of Diseases (ICD-10). Results Between January 2017 to December 2018, 3175 babies were born preterm or LBW, and 164 (5.1%) died in the first 28 days of life. VASA was conducted among 88 (53.7%) of the neonatal deaths. Almost half (38, 43.2%) of the deaths occurred within the first 24 h of life. Birth asphyxia (45.5%), neonatal sepsis (26.1%), respiratory distress syndrome (12.5%) and hypothermia (11.0%) were the leading causes of death. In the early neonatal period, majority (54.3%) of the neonates succumbed to asphyxia while in the late neonatal period majority (66.7%) succumbed to sepsis. Delay in seeking medical care was reported for 4 (5.8%) of the neonatal deaths. Conclusion Deaths among LBW and preterm neonates occur early in life due to preventable causes. This calls for enhanced implementation of existing facility-based intrapartum and immediate postpartum care interventions, targeting asphyxia, sepsis, respiratory distress syndrome and hypothermia. </jats:sec

Environmental, Metabolic, and Inflammatory Factors Converge in the Pathogenesis of Moderate Acute Malnutrition in Children: An Observational Cohort Study

Acute malnutrition affects more than 50 million children worldwide. These children are at an increased risk of morbidity and mortality from infectious disease. However, the pathogenesis of acute malnutrition and mechanisms underlying the increased risk and poor outcomes from infection are not well understood. Our objective was to identify differences in inflammation and inflammatory responses between children with moderate acute malnutrition (MAM) and healthy controls (HCs), and search for environmental, pathophysiological, and metabolic factors that may influence this response. Sixteen children with MAM and 16 HCs aged 18-36 months were studied in Nairobi, Kenya. None of the children had symptoms of an infectious disease (fever, diarrhea, or cough) in the 2 weeks before enrollment and sample collection. Demographic and health data were provided by their primary caregivers. Blood samples were collected to measure various biomarkers and the response to an inflammatory stimulus. Children with MAM were more frequently from households with contaminated water, crowding, and unstable income sources. They also had increases in basal inflammation, circulating bacterial lipopolysaccharide (LPS), markers of intestinal damage, and an exaggerated whole blood inflammatory response to LPS. Metabolic changes in children with MAM led to increased plasma levels of long-chain fatty acids, which were found to contribute to the pro-inflammatory state. These exploratory findings suggest convergence of multiple factors to promote dysregulated inflammatory responses and prompt several mechanistic hypotheses that can be pursued to better understand the pathogenesis of MAM

Environmental, Metabolic, and Inflammatory Factors Converge in the Pathogenesis of Moderate Acute Malnutrition in Children: An Observational Cohort Study

ABSTRACTAcute malnutrition affects more than 50 million children worldwide. These children are at an increased risk of morbidity and mortality from infectious disease. However, the pathogenesis of acute malnutrition and mechanisms underlying the increased risk and poor outcomes from infection are not well understood. Our objective was to identify differences in inflammation and inflammatory responses between children with moderate acute malnutrition (MAM) and healthy controls (HCs), and search for environmental, pathophysiological, and metabolic factors that may influence this response. Sixteen children with MAM and 16 HCs aged 18–36 months were studied in Nairobi, Kenya. None of the children had symptoms of an infectious disease (fever, diarrhea, or cough) in the 2 weeks before enrollment and sample collection. Demographic and health data were provided by their primary caregivers. Blood samples were collected to measure various biomarkers and the response to an inflammatory stimulus. Children with MAM were more frequently from households with contaminated water, crowding, and unstable income sources. They also had increases in basal inflammation, circulating bacterial lipopolysaccharide (LPS), markers of intestinal damage, and an exaggerated whole blood inflammatory response to LPS. Metabolic changes in children with MAM led to increased plasma levels of long-chain fatty acids, which were found to contribute to the pro-inflammatory state. These exploratory findings suggest convergence of multiple factors to promote dysregulated inflammatory responses and prompt several mechanistic hypotheses that can be pursued to better understand the pathogenesis of MAM.</jats:p

Social innovation in the face of the COVID-19 pandemic

The INSIST Cahier 4 will review COVID-19 related dynamics from the lens of social innovation, as addressed above, and assess various aspects of life and experiences faced by different countries around the globe. These dynamics will be summarised along several sub-questions to answer our general question: To what extent has the COVID-19 pandemic affected aspects of human life on at various scales? What happened to existing inequalities? And to what extent and how have socially innovative responses been triggered by multiple parties (governments, private parties, communities)? Specifically, the purpose of INSIST Cahier 4 is to produce an initial compilation of knowledge and analysis of COVID-19 related social innovations around the globe. This collective knowledge will enrich public discourse about dealing with the ongoing pandemic, which involves multiple agents--governments, communities, business, local, regional, national and international actors. In each of these themes, the existence of the Coronavirus in our future lives forced socially innovative initiatives, expanding our resources, thinking out of the box to find new ways and instruments to adjust this situation into a better future. Based on this compilation of knowledge, a number of recommendations are formulated in terms of a manifesto. This study is written from various perspectives and covers quite diverse sectors, with varied writing styles: academic pieces, artistic interpretations, and graphical representations linking to existing material. Contributors are 32 young academics, researchers and students, participating from the beginning of March until the end of May 2020 in the intensive programme “International Module in Spatial Development Planning (IMSDP)” in Leuven (Belgium), supported by VLIR-UOS. They all have respective fields of study, and come from almost all continents: Africa, Asia, Europe and Latin-America. Therefore, the analysis presented varies and provides a kaleidoscopic understanding of the COVID-19's impacts and socially innovative responses from different perspectives. The writing and discussing process ran intensively for six weeks, exclusively through online meetings and collaboration, and was followed by 3 weeks of post-processing. All contributors were actively involved from the beginning in a bottom-linked writing process. They generally used data sourced from digital media, both in the form of news and various reports available, as well as primary data through observations/interviews/questionnaires. The framework that unites the diversity of writing is the pandemic implications through the lens of social innovation. Hopefully, these writings will give colour to the analysis presented

Social Innovation in the Face of COVID-19 Pandemic

The INSIST Cahier 4 will review COVID-19 related dynamics from the lens of social innovation, as addressed above, and assess various aspects of life and experiences faced by different countries around the globe. These dynamics will be summarised along several sub-questions to answer our general question: To what extent has the COVID-19 pandemic affected aspects of human life on at various scales? What happened to existing inequalities? And to what extent and how have socially innovative responses been triggered by multiple parties (governments, private parties, communities)? Specifically, the purpose of INSIST Cahier 4 is to produce an initial compilation of knowledge and analysis of COVID-19 related social innovations around the globe. This collective knowledge will enrich public discourse about dealing with the ongoing pandemic, which involves multiple agents--governments, communities, business, local, regional, national and international actors. From collective brainstorming the following themes for this INSIST Cahier 4 emerged: the environmental effects; food & supply systems; urban politics; housing; social solidarity; public space & transportation; body & soul; urban-rural exodus; and populist lens against post truth reality.status: Published onlin