Trends in childhood mortality in Kenya: the urban advantage has seemingly been wiped out

Background: we describe trends in childhood mortality in Kenya, paying attention to the urban–rural and intra-urban differentials.Methods: we use data from the Kenya Demographic and Health Surveys (KDHS) collected between 1993 and 2008 and the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) collected in two Nairobi slums between 2003 and 2010, to estimate infant mortality rate (IMR), child mortality rate (CMR) and under-five mortality rate (U5MR).Results: between 1993 and 2008, there was a downward trend in IMR, CMR and U5MR in both rural and urban areas. The decline was more rapid and statistically significant in rural areas but not in urban areas, hence the gap in urban–rural differentials narrowed over time. There was also a downward trend in childhood mortality in the slums between 2003 and 2010 from 83 to 57 for IMR, 33 to 24 for CMR, and 113 to 79 for U5MR, although the rates remained higher compared to those for rural and non-slum urban areas in Kenya.Conclusions: the narrowing gap between urban and rural areas may be attributed to the deplorable living conditions in urban slums. To reduce childhood mortality, extra emphasis is needed on the urban slums

Injury Characteristics among Traumatic Brain Injury Patients on Admission at a National Teaching and Referral Hospital in Kenya

Introduction: Traumatic brain injury (TBI) is one of the leading causes of admissions in hospitals globally. It is associated with significant morbidity and mortality.TBI is a neurosurgical emergency and timely intervention is critical to favorable outcome. Study objective: To determine the injury characteristics among traumatic brain injury patients on admission at a national teaching and referral hospital in Kenya Methodology: A descriptive cross-sectional design was used for this study, with purposive sampling method being adopted. Data was collected from 91 patients with traumatic brain injuries by use of a check list. Results: The results showed that majority of the patients had severe head injury (n=79). There was a significant relationship between age above 40 years, low GCS and severity of brain injury (P= 0.042). There was no significant relationship between severity of brain injury and patients’ gender, marital status and level of education. However occupation yielded a significant association with severe brain injury with casual laborers having the lowest GCS (P=0.042). Conclusion: Majority of patients who had polytrauma had severe TBI at admission. Key words: Brain Injury, Injury characteristics, Traumatic Injury, Brain injury on admission

Determinants of the outcome on traumatic brain injury patients at Kenyatta National Hospital

Introduction: Traumatic brain injury (TBI) is among the leading causes of admissions in hospitals globally. TBI has been attributed with significant morbidity, mortality and disability. Most injuries have mainly been attributed to motor accidents and falls from heights.Traumatic brain injuries represent a significant and growing disease burden in the developing world, and one of the leading causes of death in economically active adults in many low- and middle-income countries.In Kenya, motor vehicle accidents, assaults and motorcycle are significant causes. Per vehicle mile travelled, motorcycle riders have a 34-fold higher risk of death in a crash than people driving vehicles and 8 times more likely to be injured. neurological injury progresses over hours and days, resulting in a secondary injury. Inflammatory and neurotoxic processes result in vasogenic fluid accumulation within the brain, contributing to raised intracranial pressure, hypoperfusion, and cerebral ischaemia a secondary injury may be amenable to intervention. Almost one-third of patients who die after a TBI will talk or obey commands before their death.Physiological insults, Hypoxia, hypotension, hyper - or hypocapnia, hyper - or hypoglycaemia have all been shown to increase the risk of secondary brain injuryObjectives: To determine the patients’ factor, clinical care and systems factor affecting outcome of Traumatic Brain Injury (TBI) patients at Kenyatta National Hospital. Which led to a poor outcome of above 40 years, casual laborers, Polytrauma and time lapse from trauma to hospitalization experienced. The clinical care factors indicating good outcome which included; diagnosis and medication, Nursing care and clinical setting A&E, CCU. Length of hospitalization >10 days. Protocols factors; Patients in surgical wards recording poor outcome.Design: The rationale for using purposive sampling was to be able to distinguish between traumatic brain injury patients, who did not have any neurological problems before the injury, and those who had suffered neurological problems prior to trauma. A descriptive cross-sectional design, Purposive sampling and Quantitative approach to data collection, analysis and presentation was adopted.Setting: The study was carried out at the Accident and Emergency department (A&E), Critical care unit (CCU) and surgical wards of Kenyatta National Hospital (KNH).Subjects: Patients with TBI within 72 hours of injury, aged between 18- 65 years and should have had no previous neurological problem.Results: Patient factors; that led to poor outcome; above 40 years (p=0.042), casual laborers (p=0.043), Polytrauma (p=0.042) and time lapse from trauma to hospitalization (p=0.051). The clinical care factors indicated good outcome which included; diagnosis and medication (p=0.001), Nursing care (p=0.055) and clinical setting A&E (p=0.051), CCU (p=0.032). Length of hospitalization >10 days (p=0.050). Protocols factors; Patients in surgical wards had poor outcome (p=0.051).Conclusion: Patient factor's influenced outcome of TBI, Intensive care and longer time of hospitalization is paramount for better outcome.Recommendation: Setup of a Trauma Neuro Ward and training of Neuro Teams to facilitate professional and quality care to improve outcome of Traumatic Brain Injury patient

Socio-demographic factors associated with normal linear growth among pre-school children living in better-off households: A multi-country analysis of nationally representative data.

This study examined the socio-demographic factors associated with normal linear growth among pre-school children living in better-off households, using survey data from Ghana, Kenya, Nigeria, Mozambique and Democratic Republic of Congo (DRC). The primary outcome variable was child height-for-age z-scores (HAZ), categorised into HAZ≥-2SD (normal growth/not stunted) and HAZ<-2 (stunted). Using logistic regression, we estimated adjusted odds ratios (aORs) of the factors associated with normal growth. Higher maternal weight (measured by body mass index) was associated with increased odds of normal growth in Mozambique, DRC, Kenya and Nigeria. A unit increase in maternal years of education was associated with increased odds in normal growth in DRC (aOR = 1.06, 95% CI = 1.03, 1.09), Ghana (aOR = 1.08, 95% CI = 1.04, 1.12), Mozambique (aOR = 1.08, 95% CI = 1.05, 1.11) and Nigeria (aOR = 1.07, 95% CI = 1.06, 1.08). A year increase in maternal age was positively associated with normal growth in all the five countries. Breastfeeding was associated with increased odds of normal growth in Nigeria (aOR = 1.30, 95% CI = 1.16, 1.46) and Kenya (aOR = 1.37, 95% CI = 1.05, 1.79). Children of working mothers had 25% (aOR = 0.75, 95% CI = 0.60, 0.93) reduced odds of normal growth in DRC. A unit change in maternal parity was associated with 10% (aOR = 0.90, 95% CI = 0.84, 0.97), 23% (aOR = 0.77, 95% CI = 0.63, 0.93), 25% (aOR = 0.75, 95% CI = 0.69, 0.82), 6% (aOR = 0.94, 95% CI = 0.89, 0.99) and 5% (aOR = 0.95, 95% CI = 0.92, 0.99) reduced odds of normal growth in DRC, Ghana, Kenya, Mozambique and Nigeria, respectively. A child being a male was associated with 18% (aOR = 0.82, 95% CI = 0.68, 0.98), 40% (aOR = 0.60, 95% CI = 0.40, 0.89), 37% (aOR = 0.63, 95% CI = 0.51, 0.77) and 21% (aOR = 0.79, 95% CI = 0.71, 0.87) reduced odds of normal child growth in DRC, Ghana, Kenya and Nigeria, respectively. In conclusion, maternal education, weight, age, breastfeeding and antenatal care are positively associated with normal child growth. In contrast, maternal parity, employment, and child sex and age are associated negatively with normal growth. Interventions to improve child growth should take into account these differential effects

Evaluation of POSSUM and P-POSSUM as predictors of mortality and morbidity in patients undergoing laparotomy at a referral hospital in Nairobi, Kenya

Background The Physiological and Operative Severity Score for enUmeration of Morbidity and Mortality (POSSUM) and its Portsmouth modification (P-POSSUM) were developed for comparative audit in surgical patients. This study evaluated applicability of these systems in estimating mortality and morbidity risks in a cohort of patients undergoing laparotomy at the national referral hospital in Nairobi, Kenya. Methods Data of 166 patients undergoing laparotomy was subjected to POSSUM and P-POSSUM scoring systems and analyzed using linear and exponential methods. The discrimination power of POSSUM and P-POSSUM as predictors of surgical outcome was measured using the receiver–operating characteristic (ROC) curve. Results The overall observed to expected (O:E) ratio using linear analysis was 0.29:1 (POSSUM) and 0.67:1 (P-POSSUM) while exponential analysis gave an O:E of 0.2:1 (POSSUM) and 0.4:1 (P-POSSUM). The predicted morbidity using POSSUM was 1.09:1 (linear analysis) and 1:1 (exponential analysis). Hosmer–Lemeshow analysis did not show a significant lack of fit with the observed mortality when applied to POSSUM and P-POSSUM. The area under ROC curve was 0.74 (POSSUM) and 0.78 (P-POSSUM). Conclusion Our results support the suitability of P-POSSUM and POSSUM scoring systems to stratify morbidity and mortality risk in our study population

Effect of Legal and Technological Arrangements on Performance of Micro and Small Enterprises in Kenya

The purpose of technology is to improve productivity of enterprises and enhance the quality of goods produced by the firms to help them withstand local and international competition. When applied to micro and small enterprises, technology has proved to be the engine of economic growth amongst “Asian Tigers”. This paper aimed at investigating how legal and technological arrangements that micro and small enterprises (MSEs) have entered into enforce quality practices in their industry to improve performance of their businesses. It used training, purchase of equipment, franchising and sub-contracting as its independent variables while enterprise performance was its dependent variable. Both qualitative and quantitative research designs were used which was descriptive in nature. The target population for the study was MSEs in Embu district who received any form of technology between the years 2008 and 2010. The findings of the study revealed that dependent variables were a function of investment in technology. Consequently, these variables affect performance of MSEs which in turn influences the type of legal and technological arrangements that the MSEs adopt. At start-ups and early stages of business growth, there is very minimal investment in technology which results to adoption of lower levels of legal and technological arrangements and consequently to ineffective MSE performance. This is the situation in Kenya today and unless interventions are made to break this status quo, the study concluded that the MSEs are off the road to achievement of Kenya’s vision 2030. Key words; Micro and Small Enterprise Performance, Quality, Technology

Similarities in functional attributes and nutritional effects of magadi soda and bean debris-ash used in cooking African traditional dishes

Magadi soda and bean debris-ash have been used as condiments for a long time by various ethnic groups in East and Central Africa in cooking traditional dishes. The aim of the study was to investigate whether magadi soda and bean debris-ash had similar effects and functional attributes when added to traditional dishes during cooking. Reason for the addition of the two condiments has not been revealed by researchers. Mineral content, in-vitro bioavailability studies and pH of non-ashed and ashed magadi soda and bean debris were evaluated. The results indicated that high concentrations of sodium ions (30.2%) and potassium ions (64.2%) were observed in magadi soda and bean debris-ash, respectively. In-vitro iron and zinc bioavailability decreased significantly with the addition of magadi soda and bean debris-ash in maize, beans and sorghum. Equally, the cooking time was significantly reduced. The mean pH for both magadi soda (9.66) and bean debris-ash (9.75) were not significantly different indicating that both aqueous solutions had alkaline properties. The similarity in properties especially in mineral profile, alkalinity, decreased cooking time and lowered mineral uptake by magadi soda and bean  debris-ash explain similar functionality in foods they are added to during cooking. Despite the similarities  observed, communities should be informed of the negative nutritional effects of these condiments so as to diversify their meal patterns accordingly.Key words: Magadi soda, bean ash, traditional dishes, minerals, in-vitro bioavailabilit

Evaluation of a Quantitative Real-Time PCR Assay to Measure HIV-Specific Mucosal CD8+ T Cell Responses in the Cervix

Several candidate HIV vaccines aim to induce virus-specific cellular immunity particularly in the genital tract, typically the initial site of HIV acquisition. However, standardized and sensitive methods for evaluating HIV-specific immune responses at the genital level are lacking. Therefore we evaluated real-time quantitative PCR (qPCR) as a potential platform to measure these responses. β-Actin and GAPDH were identified as the most stable housekeeping reference genes in peripheral blood mononuclear cells (PBMCs) and cervical mononuclear cells (CMCs) respectively and were used for normalizing transcript mRNA expression. HIV-specific cellular T cell immune responses to a pool of optimized CD8+ HIV epitopes (HIV epitope pool) and Staphylococcal enterotoxin B (SEB) superantigen control were assayed in HIV infected PBMC by qPCR, with parallel assessment of cytokine protein production. Peak HIV-specific mRNA expression of IFNγ, IL-2 and TNFα occurred after 3, 5 and 12 hours respectively. PBMCs were titrated to cervical appropriate cell numbers to determine minimum required assay input cell numbers; qPCR retained sensitivity with input of at least 2.5×104 PBMCs. This optimized qPCR assay was then used to assess HIV-specific cellular T cell responses in cytobrush-derived cervical T cells from HIV positive individuals. SEB induced IFNγ mRNA transcription was detected in CMCs and correlated positively with IFNγ protein production. However, qPCR was unable to detect HIV-induced cytokine mRNA production in the cervix of HIV-infected women despite robust detection of gene induction in PBMCs. In conclusion, although qPCR can be used to measure ex vivo cellular immune responses to HIV in blood, HIV-specific responses in the cervix may fall below the threshold of qPCR detection. Nonetheless, this platform may have a potential role in measuring mitogen-induced immune responses in the genital tract

The quaternary structure of the amidase from Geobacillus pallidus RAPc8 is revealed by its crystal packing

The amidase from Geobacillus pallidus RAPc8, a moderate thermophile, is a member of the nitrilase enzyme superfamily. It converts amides to the corresponding acids and ammonia and has application as an industrial catalyst. RAPc8 amidase has been cloned and functionally expressed in Escherichia coli and has been purified by heat treatment and a number of chromatographic steps. The enzyme was crystallized using the hanging-drop vapour-diffusion method. Crystals produced in the presence of 1.2 M sodium citrate, 400 mM NaCl, 100 mM sodium acetate pH 5.6 were selected for X-ray diffraction studies. A data set having acceptable statistics to 1.96 Å resolution was collected under cryoconditions using an in-house X-ray source. The space group was determined to be primitive cubic P4232, with unit-cell parameter a = 130.49 (±0.05) Å. The structure was solved by molecular replacement using the backbone of the hypothetical protein PH0642 from Pyrococcus horikoshii (PDB code 1j31 ) with all non-identical side chains substituted with alanine as a probe. There is one subunit per asymmetric unit. The subunits are packed as trimers of dimers with D3 point-group symmetry around the threefold axis in such a way that the dimer interface seen in the homologues is preserved

Does a voucher program improve reproductive health service delivery and access in Kenya?

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Background - Current assessments on Output-Based Aid (OBA) programs have paid limited attention to the experiences and perceptions of the healthcare providers and facility managers. This study examines the knowledge, attitudes, and experiences of healthcare providers and facility managers in the Kenya reproductive health output-based approach voucher program. Methods - A total of 69 in-depth interviews with healthcare providers and facility managers in 30 voucher accredited facilities were conducted. The study hypothesized that a voucher program would be associated with improvements in reproductive health service provision. Data were transcribed and analysed by adopting a thematic framework analysis approach. A combination of inductive and deductive analysis was conducted based on previous research and project documents. Results - Facility managers and providers viewed the RH-OBA program as a feasible system for increasing service utilization and improving quality of care. Perceived benefits of the program included stimulation of competition between facilities and capital investment in most facilities. Awareness of family planning (FP) and gender-based violence (GBV) recovery services voucher, however, remained lower than the maternal health voucher service. Relations between the voucher management agency and accredited facilities as well as existing health systems challenges affect program functions. Conclusions - Public and private sector healthcare providers and facility managers perceive value in the voucher program as a healthcare financing model. They recognize that it has the potential to significantly increase demand for reproductive health services, improve quality of care and reduce inequities in the use of reproductive health services. To improve program functioning going forward, there is need to ensure the benefit package and criteria for beneficiary identification are well understood and that the public facilities are permitted greater autonomy to utilize revenue generated from the voucher program.This work was supported by the Bill and Melinda Gates Foundation to the Population Council as part of a multi country study evaluation of voucher-andaccreditation interventions. Grant number 51761