A case of refractory thrombotic thrombocytopenic purpura treated with plasmapheresis and rituximab

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disorder with no prevalence or incidence studies in sub-Saharan Africa. Acquired TTP has several causes, all of which lead to decreased activity of von Willebrand factor cleaving protease (ADAMTS13) due to autoantibodies that are directed towards ADAMTS13. We report a case of a 46-year-old man who presented with most of the classic clinical manifestations of TTP

A case of refractory thrombotic thrombocytopenic purpura treated with plasmapheresis and rituximab

 Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening disorder with no prevalence or incidence studies in sub-Saharan Africa. Acquired TTP has several causes, all of which lead to decreased activity of von Willebrand factor cleaving protease (ADAMTS13) due to autoantibodies that are directed towards ADAMTS13. We report a case of a 46-year-old man who presented with most of the classic clinical manifestations of TTP

Fabrication of Smart Meter for Accurate Use in Home and Industry

This study addresses the challenges posed by conventional energy meters, which rely on manual readings, leading to human errors and inefficiencies. In response to this, a battery-powered smart meter was developed utilizing an STM32 microcontroller, ADE7758 and STPM32 metering integrated circuits (ICs), SIM and ESP32 communication modules, along with a MYSQL database. Real-time energy data from both single and three-phase appliances were collected, and their energy consumption, errors, Mean Absolute Error (MAE), and Root Mean Squared Error (RMSE) were quantified. The model demonstrated an acceptable accuracy level, with an estimated MAE of approximately 2.912 units and an estimated RMSE of around 4.048 units, particularly in predicting motor power consumption. Additionally, ARIMA forecasting was applied to a three-phase asynchronous motor, revealing an average active motor power of 250.95 watts, indicating precise results over time

Treatment outcomes for drug resistant tuberculosis among children below 15 years in Kenya, 2010‐2016

Background: Tuberculosis is a common cause of morbidity and mortality in children. Children are less likely to acquire resistance during the treatment of tuberculosis (TB). Most of the drug resistant TB infection in children is transmitted from adults.Objective: To determine the characteristics and treatment outcomes among children below 15 years managed for drug resistant TB in Kenya, 2010 – 2016.Design: Retrospective descriptive study.Setting: All health facilities managing drug resistant TB in KenyaSubjects: Children below 15 years treated for drug resistant TB between 2010 and 2016.Results: Sixty three children were notified with DR TB between 2010 and 2016. The median (IQR) age was11 (10‐13) years with a female to male ratio of 1:1. With 32 (52%) and 31 (51%) with smear and culture positive laboratory results respectively. Primary drug resistance was present in 25 (40%) of the children All the sputum and culture converted negative at month three of treatment. HIV testing uptake was 100% with a positivity rate of 26 (41%) and 100% anti‐retroviral therapy uptake. The treatment success rate for the cases was 31(91%) with a mortality rate of 2(5%) and lost‐to‐follow up 1 (3%).Conclusion: Drug‐resistant tuberculosis can be successfully treated and therapy well tolerated among children. There  is need for contact tracing and screening for all at risk including paediatric population

Drug resistant tuberculosis in Kenya: trends, characteristics and treatment outcomes, 2008 – 2016

Background: Drug resistant (DR) tuberculosis (TB) remains a major public health concern. Failure to treat patients with TB adequately increases the risk of transmission of infection to the general population. Treatment of DR TB is characterized by lengthy treatment duration, use of toxic and less effective drugs and high likelihood of adverse treatment outcomes that include adverse drug reactions, high mortality and loss to follow up.Objective: To determine the trends, characteristics and treatment outcomes of patients >15 years notified with DR‐TB in Kenya from 2008 to 2016Design: Retrospective descriptive cross‐sectional studySetting: Tuberculosis treatment centers in KenyaSubjects: Persons above 15 years notified with DR TBResults: We reviewed records of 1903 DR‐TB patients who were notified between 2008 and 2016. The public sector made the highest contribution of the notified cases (80%). Most of the cases were male (62.3%). The HIV testing rate was 99.5%, with the TB/HIV co‐infection being 36%. Initiation of antiretroviral therapy among those who tested positive for HIV was 94.6%. Co‐trimoxazole preventive therapy uptake was 99.3%. Most patients had secondary DRTB (77.3%). Multi‐drug resistant TB accounted for 78.4% of the DR TB cases while mono drug resistance was observed in 26% of the cases. Treatment success was achieved in 79% of the cases. Mortality and treatment failure during the study period was 11% and 0.2% respectively.Conclusion: An upward trend in notified DR‐TB cases was observed during the period under review. The public sector gave the most contribution. Active surveillance on patients lost to follow up while on treatment and poor drug adherence will be of importance to reduce the potential of development of drug resistance

Outcomes of Kenyan children under five years of age, initiated on isoniazid preventive therapy following exposure to bacteriologically confirmed pulmonary tuberculosis, 2013-2016

Background: Isoniazid preventive therapy (IPT) is one of the key interventions in achieving the End TB Strategy of 90% reduction in Tuberculosis (TB) incidence by 2030 compared with 2015. One of the key pillars in achieving this is preventive treatment of persons at high risk of contracting TB. This group includes children less than five years exposed to bacteriologically confirmed TB. Despite Kenya national IPT roll out in 2015, there still exists limited information on its programmatic coverage, outcomes and missed opportunities for initiation of IPT.Objective: To determine the coverage, outcomes and missed opportunities for initiation of IPT among children under-five years in contact with bacteriologically confirmed pulmonary tuberculosis (PTB) in Kenya.Design: Cross sectional descriptive study.Setting: All the 47 counties in Kenya.Subjects: Children under-five years exposed to bacteriologically confirmed PTB initiated on IPT and notified between 2013 and 2016.Results: During the study period (2013-2016), a total of 6,507 children aged less than five years who were exposed to bacteriologically confirmed PTB were initiated on IPT. The number of children initiated on IPT increased from 721 in 2013 to 3306 in 2016.The number of counties notifying cases increased from 26 in 2013 to 47 in 2016. Treatment completion was 78%, 87% and 82% for 2013, 2014 and 2015 respectively. Of the 1390 children who had completed the 6 month-course of IPT during the study period, 9%had no TB, 7% were not accessed while84% had no documentation of outcomes by the end of the follow up period of 24 months. Missed opportunities for initiation of IPT reduced from 90% (7109) in 2013 to 60% (4872) in 2016.Conclusion: IPT coverage and completion rates have improved from 721 in 2013 to 3306 in 2016 and 78% in 2013 to 82% in 2015 respectively. Despite this, Kenya is yet to meet the targets set by the World Health Organization (WHO). Sustainable measures need to be put in place to achieve the WHO targets

Spatial and temporal distribution of notified tuberculosis cases in Nairobi County, Kenya, between 2012 and 2016

Background: Tuberculosis (TB) is an infectious disease of major public health concern globally. The disease has showed space‐time variations across settings. Spatial temporal assessment can be used to understand the distribution and variations of TB disease.Objective: To determine the spatial and temporal distribution of notified TB cases in Nairobi County, Kenya, between 2012 and 2016Design: A cross sectional studySetting: Nairobi County, KenyaSubjects: Tuberculosis cases notified in Tuberculosis Information for Basic Units from 2012 to 2016Results: A total of 70,505 cases of TB were notified in Nairobi County between 2012 and 2016, with male to female ratio of 3:2 and HIV coinfection rate of 38%.The temporal analysis showed a declining trend of the notified cases. The spatial clusters showed stability in most areas while others varied annually during the study period. The space‐time analysis also detected the four most likely clusters or hotspots. Cluster 1 which covered the informal settlements of Kibera, Kawangware and Kangemi with 4,011observed cases against 2,977expected notified TB cases(relative risk (RR) 1.37, p<0.001). Further, Cluster 2 covered Starehe and parts of Kamukunji, Mathare, Makadara, Kibra and Dagoretti North Constituencies (RR 1.93, p<0.001; observed and expected cases were 4,206 and 2,242, respectively.Conclusion: This study identified high TB case notifications, declining temporal trends and clustering of TB cases in Nairobi. Evidence of clustering of TB cases indicates the need for focused interventions in the hotspot areas. Strategies should be devised for continuous TB surveillance and evidence based decision making

Voluntary Medical Male Circumcision: Translating Research into the Rapid Expansion of Services in Kenya, 2008–2011

Zebedee Mwandi and colleagues discuss Kenya's scale-up of voluntary medical male circumcision services, highlighting government leadership, a clear implementation strategy, and program flexibility and innovation as keys to Kenya's success

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd