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

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

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

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

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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

Impact of visual features on capture of Aedes aegypti with host decoy traps (HDT)

The host decoy trap (HDT) is a surveillance trap that presents a combination of heat, visual and odour stimuli to attract bloodmeal‐seeking mosquitoes. Here we employed a semi‐field study to demonstrate the role of the visual attributes present on the HDT on the effectiveness of Aedes aegypti capture. Our results show that the HDT is an effective means of capturing Ae. aegypti mosquitoes in semi‐field conditions, with a per trial capture rate of up to 69% across four visually distinct HDTs. The solid black coloured HDT captured more mosquitoes than HDTs with black‐white stripes, black‐white checkerboard patches or solid white colour by a factor of 1.9, 1.7 and 1.5, respectively. In all cases, mosquito capture was not evenly distributed on the HDT surface, with captures on the HDT's outer downwind half, away from the odour delivery, exceeding captures on the inner upwind half. We conclude that the solid black surface of the original HDT design is more effective than the other surfaces (white or black/white patterns) for the capture of Ae. aegypti. Our results demonstrate that mosquito attraction to the thermal and odorant cues of the HDT is modulated by visual information

Introgression of drought tolerance traits into adapted Kenyan chickpea varieties using marker assisted backcrossing (MABC)

Drought is the major constraint causing considerable yield reduction in chickpea. Roots play a critical role in enhancing drought tolerance. The main objective of the study was to introgress drought tolerant root traits into Kenyan chickpea varieties through marker assisted breeding (MABC). Eight simple sequence repeat (SSR) markers, linked to quantitative trait loci (QTL) for root and yield traits, were used to screen the parents at ICRISAT, India. In addition, 1144 single nucleotide polymorphic markers (SNPs) were also used in genotyping these parents at Legume Genomics Center, United Kingdom. Crosses were made between two selected varieties, ICCV 92944 (Chania Desi II) and ICCV 00108 (LDT 068) and ‘QTL-hotspot’ donor parent ICC 4958 that has extensive rooting system. Polymor- In the face of increasing water scarcity, breeding for higher transpiration efficiency (TE), that is, the biomass produced per unit of water transpired, has become crucial. This could be achieved by reducing plant transpiration through a better closure of the stomatal pores at the leaf surface. However, this strategy generally also lowers growth, as stomatal opening is necessary for the capture of atmospheric CO2 that feeds daytime photosynthesis. Here, we considered the reduction in transpiration rate at night (En), when photosynthesis is inactive, as a possible strategy to limit water use without altering growth. We carried out a genetic analysis for En and TE in grapevine, a major crop in drought-prone areas. A 3 year experiment was conducted on the F1 progeny from a cross between Syrah and Grenache cultiphic SSR and SNP markers were used to select progenies with root QTL at F1, BC1F1 and BC2F1 that were later advanced to BC2F3. The BC2F3 populations were evaluated for root traits at Egerton University in randomized complete block design with two replications in pot experiment. The BC2F3 families were significantly different for root dry weight (RDW), shoot dry weight (SDW), total plant dry weight (PDW) and root to shoot dry weight (R/S) ratio (R/S) for Chania Desi II x ICC 4958 and R/S for LDT 068 x ICC 4958. These lineshad significantly improved root traits compared the recurrent parents. MABC is aneffective and efficient method of introgressing complex drought tolerant traits which leads to improvement in yield especially under drought conditions