Factors associated with severity of neonatal sepsis on admission in Kenyatta hospital paediatric wards, Kenya: A descriptive cross-sectional study

Background: Neonatal sepsis is a major cause of neonatal mortality. In the year of 2012, it accounted for 44% of all deaths of under five years old children globally. Statistics indicate that 98% of the global, one million deaths as a result of neonatal sepsis occur in Africa. Neonatal sepsis contributes to 69% of neonatal mortality in Nigeria and 28% of neonatal mortality in Kenya. Objective: To establish factors associated with severity of neonatal sepsis among patients admitted in Kenyatta National Hospital Paediatric Wards. Design: The study adopted a descriptive cross-sectional design. Setting: The study was carried out in paediatric wards of Kenyatta National Hospital (KNH), Kenya. Subjects: Data was obtained from consenting mothers whose neonates had been admitted with neonatal sepsis and healthcare workers who worked within the paediatric wards. A total of 107 respondents were selected by systematic sampling method in which every alternate participant was selected. A semi-structured questionnaire was used to gather data on maternal and neonatal characteristics and environmental factors. In addition, three focused group discussions comprising nurses, doctors and clinical officers were conducted. Chi-square test was used to determine the factors associated with severity of neonatal sepsis (NNS) during admission. Results: Binary logistic regression analysis was performed to determine predictors of severe NNS. Of the 107 patients with neonatal sepsis, 37.4% had severe neonatal sepsis during admission. After multiple logistic regression analysis, the following factors were found to be independently associated with severe NNS: Neonates aged 8 to 28 days [AOR=2.89; 95%CI=1.07-7.99; P=0.047] compared to those neonates aged less than 8 days; Mothers with primary level of education [AOR=4.57; 95%CI=1.18-17.67; P=0.028] compared to those with tertiary education; primipara mothers [AOR=4.64; 95%CI=1.74-12.37; P=0.002] than multipara mothers and greenish amniotic fluid during labor [AOR=3.11; 95%CI=1.05-9.24; P=0.041] compared to clear amniotic fluid. Conclusion: The study found that severity of NNS was still high. The factors associated with severe NNS were; primiparity, maternal low economic status and poor antenatal clinic attendance. The study thus recommends that newborns at risk of developing severe neonatal sepsis should get prophylactic treatment and mothers be included in specialized programs geared towards reduction of the severity of NNS

Determinants of pneumococcal conjugate vaccine uptake among children attending immunisation services at Kenyatta National Hospital, Nairobi, Kenya

Objective: To establish the determinants of pneumococcal conjugate vaccine uptake among children  brought to Kenyatta National Hospital.Design: A cross-sectional hospital-based quantitative and qualitative study Setting: Kenyatta National hospital which is the largest teaching and referral hospital in East and Central Africa situated in Nairobi, Kenya.Subjects: The respondents were the parents/guardians of children less than two years of age attending immunisation services at KNH and those admitted in the peadiatric wards with pneumonia.Results: The study established that the determinants of uptake of Pneumococcal Conjugate Vaccine are age(OR 5.8, CI 1.4-23.4, p=0.014), level of education (OR 5.8, CI 1.5-22.4, p=0.01), parity (OR 0.2, CI 0.1-0.7, p=0.017), occupation (OR 6.5, CI 1.5-27.6, p=0.011), family income (OR 8.8, CI 1.4-55.6, p=0.001), knowledge (OR 6.5, CI 1.1-15.2, p=0.011) and attitude (OR 6.3, CI 1.9-26.8, p=0.001).Conclusion: The study concluded that factors of the caregivers/parents that are statistically significant to the uptake of Pneumococcal Conjugate Vaccine uptake are Income, parity, education leve, age and occupation. Also a friendly attitude from health personnel was shown to motivate parents/guardians’ adherence to vaccination schedules

Physical Chemical Parameters of Wastewater: A Case Study of Njoro Sewage Works, Nakuru, Kenya

Njoro sewage works is the main sewage work for Nakuru urban town that receives about 90% of industrial wastewater and 10 % domestic wastewater. In-sufficient pre-treatment of industrial wastewater, may affect the normal functioning of sewage works and the aquatic life (flora and fauna) of the receiving water body. The underground water aquifer may also be contaminated by both chemical elements and microbial through percolation. This study aimed at assessing the efficiency of the sewage works by analysing the physical and chemical parameters of wastewater from the inlet and outlet of Njoro sewage works. The study involved test analysis of the physical and chemical parameters in the laboratory and in-situ test. This study employed composite sampling method in the collection of samples. Data collection was done using experimental method while data analysis was done using descriptive statistics. This study found that BOD concentration was 400 mg/l for the influent and 150mg/l for effluent. COD concentration was 1399 mg/l for the influent and 222 mg/l for the effluent. DO concentrations were lower (0.05 mg/l) for influent and effluent. Traces of heavy metals were also found both for the influent and effluent. Njoro sewage works could not effectively reduce organic load in wastewater. Keywords: Discharge, Effluent, Influent, Sewage works, Wastewate

Water Safety Practices and Occurrence of Diarrhea Among Children Under Five in Different Households of Njemp Community, Baringo County, Kenya

Water safety and quality is a key component in public health. Despite substantial progress made during the last decades, 11% of the global population are still not accessing adequate clean water and only 64% are able to access improved sanitation. Household water treatment methods, such as boiling or chlorination, have long been recommended in developing countries. Diarrhea diseases cause major public health problem in children under-five years of age, in addition, Water safety practices has been shown to affect health status. More research has focused on information about water safety practices at household level with minimal information on the relationship between water safety practices and occurrence of diarrhea among children below 5 years. This study was carried out to outline the occurrence of childhood diarrhea in relation to water safety practices. The study adopted a cross-sectional study design. This was among Njemp community in Baringo County, Kenya. Assessed was the household socio-demographic characteristics, sources of water, methods of domestic water treatment and the prevalence of diarrhea. Four hundred and twenty-two (422) households were targeted. However, data is reported for 401 households. Data was collected using a semi-structured questionnaire also the laboratory water analysis from different sources and treatment methods was done to determine the level of E. coli.  Analysis was carried out using SPSS software. Chi-square was used for categorical variables while Pearson’s correlation coefficient was used for non-categorical variables to show the association between water safety practices and occurrence of diarrhea. Results show that majority of mothers (50.6%) were of age 26 – 35 years and married (78.3%). There was no significant difference in the mother’s various ages. The study also notes that most of the respondents (46.9%) had education up to primary level. Findings from household income indicates that majority of households earned less than Ksh. 10,000. River was the main source of water (50.6%). A few (31.2% and 18.2%) used borehole and rainwater respectively. The study found that river was the most contaminated source of water (50 MPN/100 mL) which was unsafe for human consumption according to WHO classification. On water treatment, majority (37.2%) used Moringa oleifera seeds for water treatment which acts as a natural absorbent and antimicrobial agent. 20.9% did not treat their water. The prevalence of diarrheal was 57.6%. There was a significant relationship between the water safety practices and occurrence of diarrhea. This study concludes that water safety practices of the Njemp community was low and as thus led to increased occurrence of diarrhea. This study recommends to the County Government of Baringo to come up with a centralized water treatment plant or dig boreholes and supply water to the people in Baringo County. Keywords: Water Safety, Diarrhea, children under 5 years DOI: 10.7176/FSQM/92-06 Publication date: December 31st 201

Food security and nutritional status of children under-five in households affected by HIV and AIDS in Kiandutu informal settlement, Kiambu County, Kenya

Background: HIV and AIDS affect most the productive people, leading to reduced capacity to either produce food or generate income. Children under-fives are the most vulnerable group in the affected households. There exists minimal information on food security status and its effect on nutritional status of children under-fives in households affected by HIV and AIDS. The aim of this study was to assess food security and nutritional status of children underfive in households affected by HIV and AIDS in Kiandutu informal settlement, Kiambu County. Methods: A cross-sectional analytical design was used. A formula by Fisher was used to calculate the desired sample size of 286. Systematic random sampling was used to select the children from a list of identified households affected by HIV. A questionnaire was used to collect data. Focus group discussion (FGD) guides were used to collect qualitative data. Nutri-survey software was used for analysis of nutrient intake while ENA for SMART software for nutritional status. Data were analyzed using SPSS computer software for frequency and means. Qualitative data was coded and summarized to capture the emerging themes Results and discussion: Results show that HIV affected the occupation of people with majority being casual laborers (37.3 %), thus affecting the engagement in high income generating activities. Pearson correlation coefficient showed a significant relationship between dietary diversity score and energy intake (r = 0.54 p = 0.044) and intake of vitamin A, iron, and zinc (p < 0.05). A significant relationship was also noted on energy intake and nutritional status (r = 0.78 p = 0.038). Results from FGD noted that HIV status affected the occupation due to stigma and frequent episodes of illness. The main source of food was purchasing (52.7 %). With majority (54.1 %) of the households earning a monthly income less than US$ 65, and most of the income (25.7 %) being used for medication, there was food insecurity as indicated by a mean household dietary diversity score of 3.4 \ub1 0.2. This together with less number of meals per day (3.26 \ub1 0.07 SD) led to consumption of inadequate nutrients by 11.4, 73.9, 67.7, and 49.2 % for energy, vitamin A, iron, and zinc, respectively. This resulted to poor nutritional status noted by a prevalence of 9.9 % in wasting. Stunting and underweight was 17.5 and 5.5 %, respectively. Qualitative data shows that the stigma due to HIV affected the occupation and ability to earn income. Conclusions: The research recommends a food-based intervention program among the already malnourished children

Estudo in vitro e in vivo da eficácia anti leishmaniótica de terapêutica combinada de Diminazene e Artesunate contra Leishmania donovani em camundongos Balb/c

The in vitro and in vivo activity of diminazene (Dim), artesunate (Art) and combination of Dim and Art (Dim-Art) against Leishmania donovani was compared to reference drug; amphotericin B. IC50 of Dim-Art was found to be 2.28 ± 0.24 µg/mL while those of Dim and Art were 9.16 ± 0.3 µg/mL and 4.64 ± 0.48 µg/mL respectively. The IC50 for Amphot B was 0.16 ± 0.32 µg/mL against stationary-phase promastigotes. In vivo evaluation in the L. donovani BALB/c mice model indicated that treatments with the combined drug therapy at doses of 12.5 mg/kg for 28 consecutive days significantly (p < 0.001) reduced parasite burden in the spleen as compared to the single drug treatments given at the same dosages. Although parasite burden was slightly lower (p < 0.05) in the Amphot B group than in the Dim-Art treatment group, the present study demonstrates the positive advantage and the potential use of the combined therapy of Dim-Art over the constituent drugs, Dim or Art when used alone. Further evaluation is recommended to determine the most efficacious combination ratio of the two compounds.A atividade in vitro e in vivo de Diminazene (Dim), Artezunate (Art) e a combinação Dim e Art (Dim-Art) contra Leishmania donovani foi comparada com a droga de referência Anfotericina B. IC50 da Dim-Art foi 2,28 ± 0,24 µg/mL enquanto aquelas de Dim e Art foram 9,16 ± 0,3 µg/mL e 4,64 ± 0,48 µg/mL respectivamente. O IC50 da Anfotericina B foi 0,16 ± 0,32 µg/mL contra a fase estacionária de promastigotas. A avaliação in vivo do modelo de L. donovani em camundongos Balb/c indicou que os tratamentos com a terapêutica de drogas combinadas em doses de 12,5 mg/kg por 28 dias consecutivos significantemente (p < 0,001) reduziu a carga parasitária no baço quando comparada a tratamentos com uma única droga dada nas mesmas dosagens. Embora a carga parasitária tenha sido levemente mais baixa (p < 0.05) no grupo Anfotericina B quando comparada com o grupo tratado Dim-Art, o estudo presente demonstra a vantagem positiva do uso potencial da terapêutica combinada Dim-Art sobre drogas como Dim ou Art quando usadas isoladamente. Posterior avaliação é recomendada para determinar a média de combinação mais eficaz dos dois compostos

Predictors of post-partum family planning uptake in Webuye Hospital, western Kenya

Background: A short inter-pregnancy interval increases the risk for maternal and neonatal deaths in addition to other pregnancy complications including: preterm delivery, low birth weight, anaemia and premature rupture of membranes. However, only one half of Kenyan women, who have no desire to conceive immediately after birth, are using contraception one year after delivery.   Aim: The aim of this study was to determine the predictors of uptake of post-partum family planning (PPFP).   Setting: The study was conducted among post-partum women accompanying their children for their first measles vaccination at Webuye County Hospital (WCH), in western Kenya.   Methods: This was a cross-sectional study involving 259 randomly sampled post-partum women, accompanying their children for their first measles vaccination. A structured, interviewer-administered questionnaire was used to collect data. Logistic regression was used to identify correlates of PPFP uptake.   Results: The uptake of PPFP among women at 9 months post-partum at WCH was found to be 78.4% ± 5.0%. The odds of PPFP uptake among women living with their sexual partners was 88.2% less than among those not living with their partners with the true population effect between 97% and 51% (OR = 0.118; 95% CI: 0.028–0.494; p = 0.003).   Conclusions: Not living with her sexual partner in the same house is the key predictor of a woman’s PPFP uptake in WCH. This study recommends that any programme aimed at improving post-partum contraceptive use in WCH should target women who live with their partners in the same house

Retention of ?- Carotene, Iron and Zinc in Solar Dried Amaranth Leaves in Kajiado County, Kenya

Amaranth is one of the underutilized vegetable with high nutritive value. Availability of amaranth leaves is seasonal and therefore preservation for use in other seasons is necessary. Solar drying is one of the recommended methods for vegetable preservation. Minimal information exists on nutrient content of amaranth leaves grown in dry areas. There is also scarce information on the effect of solar drying on the