Characteristics of newborns with surgical conditions, referred to and seen at a tertiary-level hospital in western Kenya

Background: World over, neonatal mortality contributes significantly to the under-five mortality rate, and 10% of neonatal deaths in low and middle-income countries (LMICs) are due to surgical conditions. The majority of surgical conditions are congenital malformations that are only amenable to surgical treatment in the neonatal period. In Kenya, specialized neonatal surgical care is only available in the two tertiary level hospitals in Eldoret and Nairobi. Since the majority of newborns with surgical conditions are born or seek initial care in the lower level health facilities, appropriate referral and transport to the tertiary-level hospitals determines the overall outcome of their treatment. Moreover, socio-demographic and clinical characteristics of newborns with surgical conditions are important determinants of the outcome of their care at the tertiary-level hospital.Study Objective: To describe the socio-demographic; clinical; and referral and transport characteristics of the newborns with surgical conditions, who were referred to and seen at Moi Teaching and Referral Hospital (MTRH).Study design: A hospital-based cross-sectional study was done on all newborns with surgical conditions referred, transported to and seen at the Newborn Unit.Study Setting: Moi Teaching and Referral Hospital, Eldoret, Kenya.Main Outcomes: Socio-demographic; clinical; and referral and transport characteristics of the newborns who met the inclusion criteria.Results: One-hundred and twenty-six newborns who met the inclusion criteria were recruited into the study between February 2018 and January 2019. The median age of the newborns at admission was 4.4 days (106.5 hours), and only 26 (20.6%) of their mothers had optimal antenatal care during pregnancy. The level of education and the occupation of their mothers had a significant association with the uptake of antenatal care during pregnancy (p-value = 0.000). The majority had congenital anomalies that were mainly gastroschisis (23.0%), hydrocephalus (18.3%), ano-rectal malformations (ARM) (14.3%) and Hirschsprung’s disease (14.3%). Most (96.0%) of the newborns were transported to MTRH using road ambulance, and 95.2% were escorted by trained medical personnel during transport.Conclusions: Congenital anomalies were the major surgical conditions seen in the newborns referred and transported to MTRH, and gastroschisis was the leading condition. The newborns had delay in accessing neonatal surgical care; and the majority of their mothers had poor antenatal care during pregnancy, despite the apparent high health-facility delivery

Modifiable factors associated with active pulmonary tuberculosis in a Kenyan prison

Objectives: To establish modifiable factors associated with active pulmonary tuberculosis (PTB) among prisoners.Design: Retrospective matched case-control study.Setting: Nakuru GK prison in Kenya.Subjects: A total of l44 subjects (48 cases and 96 controls) were recruited into the study. Cases were adult prisoners who had at least two initial sputum specimens being Acid Fast Bacilli-positive (AFB+) on direct smear microscopy and hence recruited to PTB WHO DOTS Programme. Controls were adults with no chronic cough and not on PTB treatment six months prior to the study.Results: Independent factors significantly associated with active PTB disease were: self reported HIV+ status (OR=11; 95%CI = 2.42-47.77), evidence of BCG vaccination (OR = 0.20; 95%CI = 0.05-0.60), contact with PTB case (OR = 7.0; 95%CI =1.17-38.23), unemployment (OR = 9.0; 95%CI = 1.84-43.97) and sharing linen (OR = 4.32; 95%CI = 1.08-17.29).Conclusions: Modifiable factors associated with active PTB in Nakuru G.K prison are: HIV status, BCG vaccination, PTB case contact, poverty and poor personal hygiene. We recommend HIV counselling and testing of all PTB patients, screening for TB upon prison entry and TB contact investigation and improving personal hygiene of prisoners

Prevalence, virulence genes and Antimicrobial Resistance of Shiga-toxigenic E.coli in diarrhoea patients from Kitale, Kenya

Introduction: Shiga toxin-producing Escherichia coli (STEC) are among the most important causes of food-borne diseases. They cause illnesses ranging from mild diarrhea to more severe conditions that may progress to hemorrhagic colitis (HC) and hemolytic uremic syndrome (HUS). The burden of STEC in patients with diarrheal illness in Kitale county referral hospital, Trans-Nzoia County had not been established.Objectives: To determine the prevalence of STEC, its associated virulence genes and antimicrobial resistance among patients seeking treatment for diarrhoeal illness at Kitale County Referral Hospital.Methods: Stool samples from patients seeking treatment for diarrheal illness and had consented to participate in the study were collected and cultured for enteric bacteria. Suspect E.coli isolates were further identified using conventional biochemical methods. Conventional multiplex PCR targeting Shiga toxins (stx1, stx2, hlyA and attaching and effacing mechanisms (eaeA) were used to detect STEC virulence markers responsible for the Pathogenicity of STEC infection among other E.coli pathotypes.Results: A total of 295 participants were enrolled; median age 120 months (IQR: 36-312). 39 %( 115) were children aged <5yearsof whom 54% (160) were females. The prevalence of pathogenic E.coli was 19%56/295 and STEC was the most prevalent among E.coli pathotypes at5.4%16/295. The Stx2 gene and the Stx1/Stx2/hlyAcombination were the most prevalent in the STEC strains. The virulence genes (Stx1, Stx2, eaeA* and HlyA*)were observed in 13, 19, 9 and 14 in STEC isolates respectively.The most common gene was Stx2 and combinations of (Stx1+Stx2+hlyA)genes. Antimicrobial resistance to commonly prescribed antibiotics: chloramphenicol, ampicillin 10μg, erythromycin15μg, gentamicin10μg, ciprofloxacin 5μg, tetracycline 30μg, Trimethoprim/Sulfamethoxazole 25 μg, Cefotaxime 30 μg, furazolidine (8μg) and nalidixic acid 30 μg. were observed for all E.coli isolates except one (1.8%; 95% CI=0.1-9.6%). No isolates among STEC showed resistance to Furazolidine drug. However, Trimethoprim / Sulphurmethoxazole) was the drug which exhibited the highest resistance at (94%, 95% CI 70 to 99%).Conclusion and recommendation: Prevalence of STEC was 5.4%, (Stx1/Stx2/hlyA) virulence genes combination was the most common. High resistance to commonly prescribed antibiotics were observed in E.coli isolates and may be an existing problem that needs to be further research investigation.Keywords: Shiga-Toxigenic Escherichia coli (STEC), antimicrobial resistance, Kitale County referral hospitalAfr J Health Sci. 2017; 30(2):105-11

MODIFIABLE FACTORS ASSOCIATED WITH ACTIVE PULMONARY TUBERCULOSIS IN A KENYAN PRISON

Objectives: To establish modifiable factors associated with active pulmonary tuberculosis(PTB) among prisoners.Design: Retrospective matched case-control study.Setting: Nakuru GK prison in Kenya.Subjects: A total of l44 subjects (48 cases and 96 controls) were recruited into the study.Cases were adult prisoners who had at least two initial sputum specimens being AcidFast Bacilli-positive (AFB+) on direct smear microscopy and hence recruited to PTBWHO DOTS Programme. Controls were adults with no chronic cough and not on PTBtreatment six months prior to the study.Results: Independent factors significantly associated with active PTB disease were:self reported HIV+ status (OR=11; 95%CI = 2.42-47.77), evidence of BCG vaccination(OR = 0.20; 95%CI = 0.05-0.60), contact with PTB case (OR = 7.0; 95%CI =1.17-38.23),unemployment (OR = 9.0; 95%CI = 1.84-43.97) and sharing linen (OR = 4.32; 95%CI= 1.08-17.29).Conclusions: Modifiable factors associated with active PTB in Nakuru G.K prison are:HIV status, BCG vaccination, PTB case contact, poverty and poor personal hygiene.We recommend HIV counselling and testing of all PTB patients, screening for TBupon prison entry and TB contact investigation and improving personal hygiene ofprisoners

ANTIMICROBIAL RESISTANCE IN SALMONELLA SEROTYPES ISOLATED FROM SLAUGHTER ANIMALS IN KENYA

Objectives: To isolate Salmonella from food animals and characterise the antimicrobial resistanceof the isolates.Design: A random sampling of slaughter animals was carried out.Setting: Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Kenyaand Institute for Animal Breeding, Neustadt-Mariensee, Germany.Subjects: Two hundred and eighty five samples, including faecal samples and carcass, cloacal andpharyngeal swab samples were analysed.Results: Sixteen (5.6%) of 285 samples were positive for Salmonella. The prevalence of Salmonellaon pig carcasses (19%) was higher than in faeces (8.6%). Three Salmonella enterica sub-speciesenterica serovars, namely Saintpaul (S. Saintpaul), Braenderup (S. Braenderup), and Heidelberg(S. Heidelberg), were identified, with S. Saintpaul being the predominant serovar. Antimicrobialresistance was found in 35.7% of all the isolates. The S. Heidelberg isolates were susceptible to allthe antimicrobial agents tested. Multidrug resistance was found in 7.1% of the resistant Salmonellaisolates. Plasmids were only detected in S. Heidelberg. Ampicillin resistance was based on expressionof a blaTEM gene, while chloramphenicol, streptomycin, and tetracycline resistances were encodedby the genes catAl, strA, and tet(A), respectively.Conclusion: Pigs may serve as reservoirs of antimicrobial resistant Salmonella and slaughterhousecross-contamination of pork may be a food safety risk. We recommended that slaughterhousehygiene be improved to minimise contamination of pig carcasses

Estimation of the Rift Valley Fever burden of disease in the 2006/2007 outbreak in Kenya

Rift Valley Fever (RVF) virus causes severe epidemics in livestock and humans resulting in considerable economic losses from disruption of livestock production and market chain and morbidity and mortality in humans. This study estimated the burden of RVF disease in humans using disability adjusted life years (DALYs), assessed human health RVF epidemiological parameters and private and public health costs during the last RVF epidemic in the 2006/2007 in Kenya. We interviewed family members that cared for an infected person in eligible household and key informants in the public health sector in Garissa and Kilifi districts that were heavily affected by the epidemic and at the public health leaders at the national level to assess the private and public health costs. An eligible household was household that had an RVF cases during the 2006/2007 outbreak as identified from the linelist. Secondary data from the Ministry of Health and published literature were reviewed for epidemiological parameters including age and sex categorized incidences, proportions of disease manifestation, and mortality rates in order to compute DALYs using methods developed by the World Health Organization. A total of 127 eligible households were enrolled in to the study with one member interviewed in each household. Those interviewed in these households included 54% males and ranged from 19 to 81 years old with 40 and 45 years as mode and median age, respectively. The RVF virus predominantly infected males during the outbreak with an annual incidence of 0.7 per 1,000 population compared to females at 0.5 per 1,000 population. The burden of RVF during the 2006 and 2007 outbreak was 3.4 DALYs per 1000 population, representing 1% of the total DALYs and estimated household costs of USD120 for every human case reported. In comparison, the total burden of HIV/AIDS and malaria in Kenya is the highest at 24.2% and 7.2% DALYs, respectively. Our results provide vital data on burden of RVF for use by the Government and other institutions to guide in health policy making and resource allocations for prevention and control