Adherence to ministry of health guidelines in management of severe pre-eclampsia/eclampsia in Pumwani maternity hospital, Kenya

Background: Guidelines have shown to impact positively on the management of medical conditions. The impact of these guidelines has not been evaluated for severe preeclampsia and eclampsia in Kenya.Objective: To evaluate the level of adherence to Kenya Ministry of Health (MOH) guidelines in the management of severe pre-eclampsia and eclampsia at PumwaniMaternity Hospital, Kenya.Design: A cross sectionalSetting: Pumwani Maternity Hospital, Kenya.Subjects: Records of women managed for severe pre-eclampsia and eclampsia, deliveredbetween 2010 and 2013.Results: The overall adherence to guidelines was 31.4%. Adherence to specific parameters: history taking and examination, investigations, fetomaternal monitoring, use of recommended guidelines and post-partum guidelines was 67.8%, 13.9%, 26.1%, 29.5% and 20% respectively.Conclusions: Adherence to Kenya Ministry of Health (MOH) guidelines in management of severe pre-eclampsia and eclampsia in Pumwani Maternity Hospital is poor. Studies on the reasons for poor adherence and implementation need to be carried out

Establishment of a catchment monitoring network through a participatory approach in a small rural catchment in South Africa

International audienceThe establishment of a catchment monitoring network is a process, from the inception of the idea to its implementation, the latter being the construction of relevant gauging structures and installation of the various instruments. It is useful that the local communities and other stakeholders are involved and participate in such a process as was realised during the establishment of the hydrological monitoring network in the Potshini catchment in the Bergville district in the KwaZulu-Natal Province in South Africa. The paper illustrates the participatory application of various methods and techniques for establishing a hydrological monitoring network, in a small rural inhabited catchment, to monitor hydrological processes at both field and catchment scale for research purposes in water resources management. The authors conclude that the participation of the local community and other stakeholders in catchment monitoring and instilling the sense of ownership and management of natural resources to the local communities needs to be encouraged at all times. Success stories in water resources management by local communities can be realized if such a process is integrated with other development plans in the catchment at all forums with due recognition of the social dynamics of the communities living in the catchment

Symptom screen: diagnostic usefulness in detecting pulmonary tuberculosis in HIV-infected pregnant women in Kenya

OBJECTIVE: To determine the diagnostic usefulness of tuberculosis (TB) symptom screening to detect active pulmonary TB among human immunodeficiency virus (HIV) infected pregnant women in two PMTCT (prevention of mother-to-child transmission) clinics in western Kenya that are supported by the United States Agency for International Development–Academic Model Providing Access to Healthcare partnership. DESIGN: Cross-sectional study. Participants were interviewed for TB symptoms with a standardized questionnaire (cough >2 weeks, fever, night sweats, weight loss or failure to gain weight). Those with cough submitted sputum specimens for smear microscopy for acid-fast bacilli and mycobacterial culture. Women at >14 weeks gestation underwent shielded chest radiography (CXR). RESULTS: Of 187 HIV-infected women, 38 (20%) were symptom screen-positive. Of these, 21 had a cough for >2 weeks, but all had negative sputum smears and mycobacterial cultures. CXRs were performed in 26 symptomatic women: three were suggestive of TB (1 miliary, 1 infiltrates and 1 cavitary). Of 149 women with a negative symptom screen, 100 had a CXR and seven had a CXR suggestive of TB (1 cavitary, 2 miliary and 4 infiltrates). CONCLUSION: This study did not support the utility of isolated symptom screening in identification of TB disease in our PMTCT setting. CXR was useful in identification of TB suspects in both symptomatic and asymptomatic women

Uptake of isoniazid preventive therapy and its associated factors among HIV positive patients in an urban health centre, Kenya

Background: Isoniazid Preventive Therapy (IPT) is an effective intervention for prevention of tuberculosis (TB) among HIV positive patients, and its use is recommended by the World Health Organization (WHO). Unfortunately the uptake of IPT in Kenya remains low (33%-40%) with limited knowledge on the factors that affect its uptake.Objective: To determine the uptake of IPT and its associated factors among HIV-positive patients enrolled in a urban health centre.Design: Hospital based cross-sectional studySetting: Riruta Health Centre, Nairobi, KenyaSubjects: HIV-positive patients ≥18 years who have been on care and treatment services in the health centre for at least six months preceding the study.Results: Four hundred and thirty six participants were enrolled with a mean age of 41 years (standard deviation± 9years). Females were 276 (63%), anti-retroviral therapy uptake of 427 (98%) and overall IPT uptake rate of 336 (77%). On multivariate analysis, fear of acquiring TB (adjusted odds ratio (AOR) 4.6, 95% confidence interval, CI 2.6-8.1), having received IPT-associated health education (AOR 5.0, 95% CI 3.0-8.4) and having a good relationship with the healthcare worker (HCW) (AOR 2.0, 95% CI 1.2-3.4) were independently associated with initiation of IPT.Conclusion: The uptake rate was above the current national coverage but fell below the national set target of 90%. Fear of acquiring TB, receipt of IPT-associated health education and favourable relationship with the HCWs promoted the initiation of IP

Do clinicians adhere to practice guidelines? A descriptive study at a referral hospital in Kenya

Background: Clinical guidelines when implemented correctly have shown to improve disease outcomes. This study describes utilization of Kenya National guidelines in managing ante partum haemorrhage (APH) in 3rd trimester.Objective: To describe adherence to clinical guideline in management of antepartum haemorrhage at Garissa Provincial General Hospital Design: Crossectional mixed methods studySetting: Garissa Provincial General HospitalSubjects: Medical records of patients managed for APH between 2002 and 2012 and Key Informant Interviews (KIIs) of Health workers.Results: 36.1% of the cases assessed were managed with strict adherence to guidelines. 90% of health care workers had high levels of awareness of the existence of guidelines and sited utilization challenges attributed to resource inadequacies.Conclusion: Clinicians are skilled on APH guidelines, but adherence levels are still low. Therefore, continuous appraisal of clinical practices, availing equipment, facilities and supplies to reinforce adherence is recommended

Diagnostic methods and treatment outcomes for TB in children under 15 years in Kisii County, 2012-2016

Background: Diagnosis of TB in children poses a challenge due to the paucibacillairy nature of TB and difficulties in making a bacteriological confirmation. Globally, the TB burden in children is unknown with WHO estimating that they account for 10‐15% of all cases. In Kenya, children contributed to 8.5% of all notified TB cases in 2016.Objective: To describe the diagnostic methods and treatment outcomes among children aged<15 years in Kisii County, 2012‐2016.Design: A descriptive analysis of children aged <15 years in Kisii County diagnosed and notified of TB to the National TB program.Results: We abstracted 825 records of children:217 in 2012,156 in 2013,164 in 2014,136 in 2015 and 152 in 2016.The median age was 8(IQR 2‐13) years with a male: female of ratio 1:1. The 10‐15 years age‐group accounted for 43% (351) while those aged<1year accounted for 10% (81). HIV testing was done among 806 (98%) with a TB/HIV co‐infection of 31% and 96% ART initiation rate. Bacteriological and clinical diagnosis was done for 129/825 (16%) and 696/825(84 %). Gene Xpert was done for 28/825 (3%) in 2016 and 1/825 in 2012. Overall, for the period 2012‐2015, the treatment success rate (TSR) was 96%Conclusion: There has been a decline in notification rates over time, however, it was not clear whether this was due to absence of disease or improved use of diagnostics which requires further research. Older children accounted for majority of the cases diagnosed for TB. Most of the children in the younger age groups <5 years were initiated on treatment based on clinical diagnosis or a chest X‐ray and hence a need to support health workers and health system in general on acquisition of sputum specimen in this younger age group

Task Shifting in HIV Clinics, Western Kenya

Background: United states Agency for International development-Academic Model for Providing Accesses to Healthcare (USAID-AMPATH) cares for over 80,000 HIVinfected patients. Express care (EC) model addresses challenges of: clinically stable patient’s adherent to combined-antiretroviral-therapy with minimal need for clinician intervention and high risk patients newly initiated on cART with CD4 counts ≤100 cells/mm3 with frequent need for clinician intervention. Objective: To improve patient outcomes without increasing clinic resources. Design: A descriptive study of a clinician supervised shared nurse model. Setting: USAID-AMPATH clinics, Western Kenya. Results: Four thousand eight hundred and twenty four patients were seen during the pilot period, 90.4% were eligible for EC of whom 34.6% were enrolled. Nurses performed all traditional roles and attended to two thirds and three quarters of stable and high risk patient visits respectively. Clinicians attended to one third and one quarter of stable and high risk patient visits respectively and all visits ineligible for express care. Conclusion: The EC model is feasible. Task shifting allowed stable patients to receive visits with nurses, while clinicians had more time to concentrate on patients that were new as well as more acutely ill patients.East African Medical Journal Vol. 87 No. 7 July 201

Establishment of a catchment monitoring network through a participatory approach in a rural community in South Africa

The establishment of a catchment monitoring network is a process, from the inception of the idea to its implementation, the latter being the construction of relevant gauging structures and installation of the various instruments. It is useful that the local communities and other stakeholders are involved and participate in such a process, as was highlighted during the establishment of the hydrological monitoring network in the Potshini catchment in Bergville District in the KwaZulu-Natal Province, South Africa. The paper highlights the participatory establishment of a hydrological monitoring network in a small rural inhabited catchment, in line with the overall objective of the Smallholder System Innovations (SSI) research programme, to monitor hydrological processes at both field and catchment scale for water resources management research purposes. The engagement and participation of the Potshini community precipitated a learning opportunity for both the researchers and the local community on (i) the understanding of hydrological processes inherent in the catchment (ii) appreciating the inherent dynamics in establishing a catchment monitoring network in the midst of a community (iii) paradigm shift on how to engage different stakeholders at different levels of participation. The participatory engagement in the monitoring process led to appreciation and uptake of some of the research results by the Potshini community and ensured continued support from all stakeholders. This paper is of the view that the participation of the local community and other stakeholders in catchment monitoring and instilling a sense of ownership and management of natural resources to the local communities needs to be encouraged at all times. Success stories in water resources management by local communities can be realized if such a process is integrated with other development plans in the catchment at all forums, with due recognition of the social dynamics of the communities living in the catchment

Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007-2013.

SETTING: A rural private health facility, Ruby Medical Centre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya. OBJECTIVES: Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete antenatal care (ANC) package and associated factors. DESIGN: Retrospective cross-sectional study using routine programme data. RESULTS: During the study period, 2635 women delivered at the RMC: 50% were aged 16-24 years, 60% transferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the tetanus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC elsewhere were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births. CONCLUSION: This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, increased efforts should be made to ensure earlier presentation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions

The Structured Operational Research and Training Initiative (SORT IT), second workshop using the national tuberculosis routinely collected program data

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