Socio-cultural factors influencing utilization of prevention-of-mother-to child-transmission of HIV strategies among women attending antenatal care clinics in Rachuonyo North Sub-County-Homa-Bay County, Kenya

Objective: To assess the sociocultural characteristics influencing HIV positive women attending antenatal care clinics in North Rachuonyo Sub- CountyDesign: Health facility cross sectional studySetting: 20 antenatal care clinics in North Rachuonyo Sub-CountySubjects: Three hundred and eighty-five HIV infected pregnant women as participants.Results: The mean age of the women interviewed was 25.7 years (range =31) and 67% were married. Majority 60% (95% CI:55.0 -64.8) did not seek permission to know or undertake HIV testing, this contributed to nondisclosures of the HIV status where 13.6% (95% CI:9.0 -20.1) were in single parenthood and non- committal relationships and perceived fear of stigma and discrimination by partner 25% (95%CI:29.7 – 45.0). Barriers impeding women participation on MTCT awareness programs included cultural practices such as wife inheritance (26.8%), lack of support from partners in attending PMTCT services (25%), fear of losing property inheritance once HIV status is known by the family (22.3%) and cultural sexual ritual and beliefs by unknown partners 17.1%. Public discrimination and stigmatization 52%, protracted high cost of drugs 18% and 7% of health care attitude contributes to underutilization of PMTCT services. There are significant association between age, marital status and occupation with utilization of PMTCT services unlike to women with formal education.Conclusion: The study showed sociocultural impediments with little potential impact to influence, improve and promote PMTCT services. Therefore, there is need to further intervention and educating women by demystifying sociocultural factors associated with HIV/AIDS spread by engaging various players, stakeholders and other community resource persons to increase utilization with a goal towards free HIV generation

Factors associated with infant feeding practices and nutritional status among children aged 6-24 months attending child welfare clinics in Kajiado Sub-County

Objective: To determine knowledge and practices on infant feeding, socio-demographic factors that influence choice of infant feeding method and nutritional status of children aged 6 to 24 months attending Mother Child Health Clinics (MCH) in Kajiado North Sub-county.Design: A hospital based cross-sectional study.Setting: Three public health facilities: Ngong sub-district hospital, Ongata Rongai and Olo-sirkon health centres in Kajiado North Sub-county.Subjects: Three hundred and fifty mother-child pairs as participants.Results: All mothers were of reproductive age, mean age was 25 years (95%= 25+-5.03) and 92.6% were married. A high proportion of mothers 94.3% and of their spouses 88.9% had attended formal education at varying levels. Out of the 350 children in the study, 56.3% were males while 43.7% were females, 84.5% of all children being one year and below. Majority of mothers 68.6% had knowledge on infant feeding practices, mainly obtaining information from health workers. Only 38.8% of mothers had complete correct information on both breast and complementary feeding. All children were breastfed at one point in their life, 55.1%, immediately after birth, not all children were exclusively breastfed for the first six months or for a total of two years as recommended. Main reasons for early termination of breastfeeding were, voluntary refusal by the child to breastfeed or feeding on complementary food. Stunting level among the children was 26.5%, underweight level was 11.1% and no child was wasted. There was a significant association between marital status, children age group and stunting using ordinal regression.Conclusion: The study showed a knowledge gap on infant complementary feeding in area of quality and quantity of food. There is need for further interventions and more education regarding infant feding practices

Herbal Medicines in Kenya: A Review of the Toxicity and Quality Control Issues

In sub-Saharan Africa, it is estimated that 80% of the population depends on indigenous medicines for primary health-care. These herbs often contain highly active pharmacological compounds whose pharmacotherapeutic and toxicity profiles have not been well characterized. Toxicity may be related to several intrinsic and extrinsic factors. Most of the available reports related to the toxic effects of herbal medicines cite hepatoxicity as the most frequently experienced toxicity. However, noxious effects involving kidneys, the nervous system, skin, blood, the cardiovascular system, mutagenicity and carcinogenicity have also been published. This article presents a systematic review on safety and toxicity of herbal medicines used in Kenya. Keywords: Herbal medicine, herbal preparations, toxicity, Kenya, regulations, complementary and alternative medicin

Animal-level risk factors for Trypanosoma evansi infection in camels in eastern and central parts of Kenya

Point prevalences and animal-level risk factors for Trypanosoma evansi infection were investigated in a cross-sectional study that involved 2227 camels from eastern and central parts of Kenya. The screening tests used were haematocrit centrifugation technique (HCT), mouse inoculation and latex agglutination (Suratex®). All camels were screened with HCT, while 396 and 961 of them were, in addition, screened with mouse inoculation and Suratex® tests, respectively. Parasitological and Suratex® test results were used in parallel to determine the number of camels exposed to T. evansi infections. Statistical analyses were conducted using Statistical Analysis Systems. Parasitological and Suratex® test results in parallel were dependent variables in multivariable logistic regression models that determined risk factors for T. evansi infection. Herd-level clustering was corrected with general estimation equations. The prevalences were 2.3% and 19.6%, using parasitological and Suratex® tests, respectively, and 21.7% when both tests were used in parallel. There was a positive association between the screening tests (McNemar's test=104.8, P=0.001) although the strength of association was low (Kappa=0.2; 95% CI: 0.1-0.3). Before accounting for herd-level clustering, dry season (OR=1.5; 95% CI: 1.0, 2.1) and nomadic pastoralism (OR=1.8; 95% CI: 1.1, 3.2) were associated with increased odds of a camel being exposed to T. evansi infection compared to wet season and ranching, respectively. Following this correction, only nomadic pastoralism was significantly associated (OR=3.1; 95% CI=1.0, 14.4) with T. evansi infection compared to ranching. It is concluded that camels managed under nomadic pastoralism had higher risk of being exposed to T. evansi infections than camels from ranching systems of management.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat v.9 was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.DFID's Animal health Programme.mn201

Safety of Prunus africana and Warburgia ugandensis in asthma treatment

AbstractThe aim of the study was to determine the possible cytotoxicity of the aqueous stem bark extracts of Prunus africana and Warburgia ugandensis to Vero E6 cells and acute toxicity in BALB/c mice. Despite being some of the most popular medicinal plants used in Africa, little is known about the safety. In-vitro cytotoxicity tests on Vero E6 cells were investigated using MTT assay to assess the safety of the two plant extracts. Vero E6 cells on growing to confluence were incubated with different drug concentrations for 48h for the drug to take effect. Viability of the cells was measured by a scanning multiwell spectrophotometer, color intensity being equivalent to viable cells which reduce MTT to soluble formazan crystals. This was done by determining the CC50 of the extracts, CC50 being the concentration of the dose of the compound/extract that kills 50% of the cells. In acute toxicity a total of 55 mice were used. Mice were divided into eleven groups of 5 mice, one group served as negative control and ten groups received oral gavage doses at 500, 889.56, 1581.6, 2812.15 or 5000mg/kg body weight once. Mortality and other signs of toxicity were recorded within 24h and the weights of the surviving mice taken for 14days thereafter. P. africana had CC50 of 104.08μg/ml while W. ugandensis had CC50>250μg/ml and both were classified as not cytotoxic. There was no mortality observed in groups of mice that received P. africana extracts at 500 and 889.56mg/kg body weight. There was 20%, 60% and 100% mortality observed within 24h for mice that received P. africana extracts at 1581.64, 2812.15 and 5000mg/kg body weight respectively. Lethal dose (LD50) for P. africana was 2201.207mg/kg body weight. W. ugandensis extracts had no mortality recorded in all dose levels and the LD50 was >5000mg/kg body weight. The weights of mice that survived the entire 14days in all groups increased and were not significantly different from that of controls p>0.05. From the in vitro and in vivo studies, the two extracts were safe to use. Though with their customary value among many Kenyan communities in management of asthma among other ailments there is a need for further validation of any anti-asthmatic properties and responsible chemical compounds to augment the findings

Incidence and predictors of intensive care unit-acquired urinary tract infections among catheterized patients admitted at Kenyatta national hospital critical care unit

Objective: To determine the incidence and predictors of hospital acquired catheter associated urinary tract infections among catheterized patients admitted at Kenyatta National Hospital Critical Care UnitStudy Design: Prospective Cohort StudySetting: Kenyatta National Hospital Critical Care UnitSubjects: the study population was two hundred and thirty-eight patients admitted in the critical care unit between January 2019 and January 2020 and were put on urinary catheterMain Outcome Measures: Incidence of hospital acquired urinary tract infection, patient level and hospital level risk factors associated with catheter associated urinary tract infections.Results: the incidence density of hospital acquired catheter associated urinary tract infection was 32 per 1000 Catheter-days in the critical care unit. The cumulative incidence was 28.7%. Patients having other comorbidities had a higher risk to acquire catheter associated urinary tract infection; risk ratio of 1.669. Failure to observe aseptic techniques during emptying of the urine bag had a higher risk to acquire catheter associated urinary tract infection; risk ratio of 3.392. Failure to secure the urinary catheter on the patient’s thigh had a higher risk to acquire catheter associated urinary tract infection; risk ratio of 1.836.Conclusion: the incidence of intensive care acquired catheter associated urinary tract infection at the critical care unit is relatively high compared to other jurisdictions. The risk factors associated with the high incidence of the urinary tract infection are comorbidities, failure to observe aseptic techniques during emptying of the urine bag and failure to secure the urinary catheter on the patient’s thigh

Antimicrobial Susceptibility Patterns of Isolates from Catheterized Patients at Kenyatta National Hospital Critical Care Unit

Background: Intensive care unit acquired urinary tract infection is a complication which is common in critical illness and has been associated with increased patient morbidity and mortality. Urinary tract infections are said to complicate the critically ill patients’ clinical course and at the same time create substantial economic and human cost. Identification of the type of microorganisms causing the infections and their drug sensitivity profiles is essential in the management of these infections. The aim of this study was to identify microorganisms causing catheter associated urinary tract infection in the Kenyatta National Hospital critical care unit and their drugsensitivity. Methodology: The study was conducted at Kenyatta National Hospital main critical care unit. The study population was two hundred and thirty eight patients admitted in the critical care unit between January 2019 and January 2020 and on urinary catheters. A prospective cohort design was adopted. Urine culture and sensitivity was done to identify infective microorganisms and their drug sensitivity profiles. Patients were recruited consecutively for the period of the study. Results: The microorganisms identified were Enterococcus species (32%), Escherichia coli (20%), Klebsiella species (10.4%), Acinobacter baumaunnii (8%), Pseudomonas aeruginosa (6%), Candida albicans (6%), Serratia species (11.7%), Pantoea agglomerans (3.5%), and Raoultella planticola (2.4%). Enterococcus species were 100% sensitive to Vancomycin, Linezolid and Teicoplanin and 73% to Nitrofurantoin and Ampicillin. Staphylococcus haemolyticus was also 100% sensitive to Vancomycin, Linezolid and Teicoplanin. Serratia species was sensitive to Cefazolin, Nitrofurantoin, Amoxicillin/ Clavulanic Acid, Piperacillin/ Tazobactam, and Ampicillin/ Sulbactam. Pantoea agglomerans was 66.7% sensitive to Amikacin. Klebsiella species were sensitive to Amikacin and Meropenem. Escherichia coli was sensitive to Amikacin, Meropenem and Nitrofurantoin. Acinetobacter baumaunnii and Raoultella planticola were resistant. Candida albicans were highly sensitive to Fluconazole and Voriconazole. Conclusion: The most common microorganisms (60.9%) causing catheter associated urinary tract infections in ICU are gram-negative: (Escherichia coli 20%, Klebsiella species 10.4%, Acinobacter baumaunnii 8%, Pseudomonas aeruginosa 6%, Serratia species 8% and others 6.5%). Gram positive organisms were isolated at a proportion of 33.2%: (Enterococcus species, 32% & Staphylococcus haemolyticus 1.2%). Candida albicans 6%. Majority of the gram-negative microorganisms were sensitive to Amikacin, and Meropenem. Gram positive micro-organisms were sensitive to Vancomycin, Linezolid, and Teicoplanin. Fluconazole and Voriconazole therapy were the most appropriate choice for the treatment of Catheter-Associated Urinary Tract Infections (CAUTIs) caused by C. albicans. Keywords: Catheter-Associated Urinary Tract Infections, Critical Care Unit, Urinary Tract Infection, Microorganisms, Urinary Catheter,  Anti –Microbial Drug

Biochemical changes in cerebrospinal fluid of Chlorocebus aethiops naturally infected with zoonotic Meningonema peruzzii

Journal ArticleThirty-four wild Chlorocebus aethiops monkeys were trapped for research purposes. During routine quarantine check-up, cerebrospinal fluid (CSF) and blood were microscopically examined for parasites. Estimations of CSF protein levels were made by the biuret method and the white cell counts by the hemocytometer. Seven monkeys demonstrated microfilariae in blood and CSF. This was accompanied by a two- and ninefold increase in CSF total protein and white cell counts, respectively. Necropsy of one of the blood and CSF microfilariae-positive animals revealed the presence of adult worms in the brain meninges. The parasites were identified as the zoonotic filaroid nematode Meningonema peruzii. Wild C. aethiops monkeys developed CSF changes resulting, most probably, from infection with M. peruzii. Moreover, the monkeys could be acting as an important reservoir. The study highlights the need for epidemiological and pathogenological studies of this parasite, which is of public health significance. Moreover, C. aethiops proved to be a useful primate model for the study of this zoonotic infection