How complete were maternal death reviews in Central Kenya 2015 - 2018?

In response to high maternal mortality ratio (MMR) Kenya implemented mandatory maternal death reviews (MDR) in 2004. This retrospective study used MDR data to assess the completeness of MDR process in seven hospitals of Thika sub-county, central Kenya from January 2015 to June 2018. Of all 43 maternal deaths that occurred, 98% were notified while 64% were audited. MDR forms were filled in 55% of the cases of which only 7% had complete documentation. The median age of patients was 30 years majority of whom died within 24 hours of admission. Caesarean sections were associated with 48% of deaths, with haemorrhage accounting for most of the direct causes. Data on hospital-related delays, missed opportunities and action points were most frequently omitted in MDR forms. Capacity building for audit teams is recommended to improve quality of MDR process particularly focusing on identifying causes of preventable maternal deaths. Keywords: Maternal, Mortality audits, SORT-IT En réponse à un taux de mortalité maternelle élevé (TMM), le Kenya a mis en œuvre des examens obligatoires des décès maternels (MDR) en 2004. Cette étude rétrospective a utilisé des données MDR pour évaluer l'exhaustivité du processus de MDR dans sept hôpitaux du sous-comté de Thika, dans le centre du Kenya, de janvier 2015 à Juin 2018. Sur les 43 décès maternels survenus, 98% ont été notifiés tandis que 64% ont été audités. Des formulaires MDR ont été remplis dans 55% des cas, dont seulement 7% avaient une documentation complète. L'âge médian des patients était de 30 ans dont la majorité est décédée dans les 24 heures suivant l'admission. Les césariennes étaient associées à 48% des décès, les hémorragies représentant la plupart des causes directes. Les données sur les retards hospitaliers, les occasions manquées et les points d'action étaient le plus souvent omises dans les formulaires MDR. Le renforcement des capacités des équipes d'audit est recommandé pour améliorer la qualité du  processus de MDR, en se concentrant en particulier sur l'identification des causes de décès maternels évitables.  Mots-clés: Audits maternels, de mortalité, SORT-I

Broad spectrum antibiotic use among in-patients at a hospital in Nairobi, Kenya

Background: Antimicrobial resistance is an increasingly serious threat to global public health. While the use of antibiotics is an important contributing factor, there are gaps regarding this in our region. This study aimed to describe the use of nine broad spectrum antibiotics among in-patients of The Nairobi Hospital (TNH) so as to identify opportunities for quality improvement.Methods: This was a retrospective review of the use of meropenem, ertapenem, imipenem, cefepime, piperacillin, gentamicin, amikacin, vancomycin and teicoplanin among in-patients of TNH from 1st January 2018 to 31st March 2018. Demographic and clinical data of all in-patients who were prescribed these antibiotics during the study period were retrieved from patient files.Results: There were 301 study participants with a median age (range) of 30years (1day-74years), of whom 161 (53.5%) were male. More than half of the participants were admitted for less than one week and had at least one co-morbidity. Meropenem was the most commonly prescribed study antibiotic 123 (40.9%) followed by amikacin 89 (29.6%). Respiratory tract infections 125 (41.5%) were the predominant indications. Meropenem had the longest mean duration of administration, 6.5days while the aminoglycosides were administered for a relatively shorter duration of about 4.8days. Cultures were done on 187 (62.1%) patients though it is only samples of 45 patients that grew an organism, E. coli and Klebsiella sp being the most frequently isolated organisms.Conclusions: There’s a need to strongly intensify implementation of restriction strategies for Meropenem use and introduction of education programs on antimicrobial stewardship targeting all prescribers

Responding to Major Burn Disasters in Resource-Limited Settings: Lessons Learned From an Oil Tanker Explosion in Nakuru, Kenya.

BACKGROUN

Analysis of Technical Efficiency of Sorghum Production in Lower Eastern Kenya: A Data Envelopment Analysis (DEA) approach.

There has been an increase in food insecurity problem in ASALs of Kenya and this has necessitated a renewed interest in promoting drought-tolerant crops such as sorghum, among smallholder farmers in these regions. Promotion of such crops as sorghum has been emphasized in these regions but the yields are low. Using a field survey data of randomly selected sample of 143 smallholder farmers in Machakos and Makindu districts in Kenya this paper used DEA approach to estimate their technical efficiency scores. Results showed that the average technical efficiency was low, 41%. Innovative arrangements should be enhanced to increase farmers’ capacity to efficiently use the available resources in sorghum production. Key words: Technical efficiency, sorghum, Data Envelopment Analysis, Machakos, Makindu, Keny

Watershed management practices and hydrological modelling under changing climatic conditions in the semi-arid regions of Mali and Ghana

United States Agency for International Developmen

Intermittent preventive treatment for malaria and anaemia control in Tanzanian infants; the development and implementation of a public health strategy.

Minimizing the time between efficacy studies and public health action is important to maximize health gains. We report the rationale, development and implementation of a district-based strategy for the implementation of intermittent preventive treatment in infants (IPTi) for malaria and anaemia control in Tanzania. From the outset, a research team worked with staff from all levels of the health system to develop a public-health strategy that could continue to function once the research team withdrew. The IPTi strategy was then implemented by routine health services to ensure that IPTi behaviour-change communication materials were available in health facilities, that health workers were trained to administer and to document doses of IPTi, that the necessary drugs were available in facilities and that systems were in place for stock management and supervision. The strategy was integrated into existing systems as far as possible and well accepted by health staff. Time-and-motion studies documented that IPTi implementation took a median of 12.4 min (range 1.6-28.9) per nurse per vaccination clinic. The collaborative approach between researchers and health staff effectively translated research findings into a strategy fit for public health implementation

Bringing care to the community: expanding access to health care in rural Malawi through mobile health clinics.

SETTING: Malawi has chronic shortages of health workers, high burdens of human immunodeficiency virus (HIV) infection and malaria and a predominately rural population. Mobile health clinics (MHCs) could provide primary health care for adults and children in hard-to-reach areas. OBJECTIVES: To determine the feasibility, volume, and types of services provided by three MHCs from 2011 to 2013 in Mulanje District, Malawi. DESIGN: Cross-sectional retrospective study. RESULTS: The MHCs conducted 309 492 visits for primary health care, and in 2013 services operated on 99% of planned days. Despite an improvement in service provision, overall patient visits declined over the study period. Malaria and respiratory and gastro-intestinal conditions constituted 60% of visits. Females (n = 11 543) significantly outnumbered males (n = 2481) tested for HIV, yet males tested HIV-positive (27%) more often than females (14%). Malaria accounted for 26 421 (35%) visits for children aged <5 years, with a significant increase in the rainy season. Implementation of rapid diagnostic testing was associated with a decline in numbers treated for malaria. Antibiotic stockouts at government clinics were associated with increased MHC visits. CONCLUSION: MHCs can routinely provide primary health care for adults and children living in rural Malawi and complement fixed clinics. Moving from a complementary role to integration within the government health system remains a challenge

Dry spells and evidence for scaling of agricultural water management and smallholder irrigation in northern Ghana

United States Agency for International Developmen