Efficacy of the Nutritional Supplement, EvenFlo, in the Management of Sickle Cell Disease: A Randomized Controlled Trial

Background: In this study, we investigated if a combination of the nutraceutical supplement, EvenFlo and folic acid will be superior to the standard stand-alone use of folic acid. Methods: We conducted a randomized double-blind, active-controlled, clinical trial. A total of 70 subjects with SCD ages 5-12 years were enrolled into the study with 35 in the intervention group and 35 in the control group; 61 completed the trial (32 from the intervention group and 29 from the control group). Results: Participants in the intervention group were significantly less likely to experience crises compared to subjects in the control group. None of the subjects in the intervention group experienced any form of vasoocclusive crisis (VOC) compared to 93.1% of the subjects in the controlled group. Additionally, the intervention group experienced a significantly higher increase in their hemoglobin concentration from baseline (2.92 g/dL, 95% CI [2.33, 3.51]) compared the control group (1.77 g/dL, 95% CI [1.00, 2.54]). The intervention group experienced a significantly higher increase in their mean weight from baseline (4.47 Kg, 95% CI [4.02, 4.92]) while the control group experienced a decrease (-1.05 Kg, 95% CI [-1.60, -0.51]). Conclusions: EvenFlo is a nutritional supplement effective in the management of SCD when combined with folic acid; its beneficial effect would be useful in boosting the hemoglobin concentration and weight indices individuals with SCD as well as and in limiting the crises they suffered

Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study

Background Most of the deaths among neonates in low-income and middle-income countries (LMICs) can be prevented through universal access to basic high-quality health services including essential facility-based inpatient care. However, poor routine data undermines data-informed efforts to monitor and promote improvements in the quality of newborn care across hospitals.Methods Continuously collected routine patients’ data from structured paper record forms for all admissions to newborn units (NBUs) from 16 purposively selected Kenyan public hospitals that are part of a clinical information network were analysed together with data from all paediatric admissions ages 0–13 years from 14 of these hospitals. Data are used to show the proportion of all admissions and deaths in the neonatal age group and examine morbidity and mortality patterns, stratified by birth weight, and their variation across hospitals.Findings During the 354 hospital months study period, 90 222 patients were admitted to the 14 hospitals contributing NBU and general paediatric ward data. 46% of all the admissions were neonates (aged 0–28 days), but they accounted for 66% of the deaths in the age group 0–13 years. 41 657 inborn neonates were admitted in the NBUs across the 16 hospitals during the study period. 4266/41 657 died giving a crude mortality rate of 10.2% (95% CI 9.97% to 10.55%), with 60% of these deaths occurring on the first-day of admission. Intrapartum-related complications was the single most common diagnosis among the neonates with birth weight of 2000 g or more who died. A threefold variation in mortality across hospitals was observed for birth weight categories 1000–1499 g and 1500–1999 g.Interpretation The high proportion of neonatal deaths in hospitals may reflect changing patterns of childhood mortality. Majority of newborns died of preventable causes (>95%). Despite availability of high-impact low-cost interventions, hospitals have high and very variable mortality proportions after stratification by birth weight