Effects Of HIV and Intestinal Parasites Co-Infection On Hematological Parameters Among Pregnant Women Attending Selected Health Facilities In Nyeri County, Kenya

 Introduction: Prevalence of HIV among women in Nyeri County increased from 2.5% in 2007 to 5.5 % in 2009 and 6.3% in 2013. The study aimed to determine effect of co-infection of HIV and intestinal parasites on hemogram among pregnant women attending health facilities in the County. Methodology: A comparative cross-sectional study was conducted among 130 participants. Interview schedule was used to collect data. Stool and blood samples were processed using standard procedures. Data was analyzed using SPSS. Results among 130 respondents 34% had intestinal protozoans infection. Results: Among 65 HIV positive respondents, 25% had Entamoeba Coli infection and 2% Iodamoeba butschlii. Among 65 HIV negative respondents, 38% had Entamoeba Coli, and 6% Iodamoeba butschlii infection. One HIV negative respondent had Hymenolepis nana infection. Co-infection of HIV and intestinal parasites had significant effect on WBC (p < 0.05), RBC (p < 0.05), Haemoglobin (p < 0.05) and haematocrit (p < 0.05). Conclusion: (i) Prevalence of co-infection of intestinal protozoan parasites and HIV was high(ii) Co-infection of HIV and intestinal protozoan parasites decreased WBC, RBC, haemoglobin and haematocrit. Recommendation: Routine screening for intestinal parasites during antenatal healthcare and more research to verify pathogenicity of Entamoeba Coli. Key words: HIV, Intestinal parasites, co-infection, pregnant women, hemogram

Magnitude and factors associated with injection site infections among underfives in a district hospital, northern Tanzania

Injections are among the major procedures in health care facilities which need to be handled under sterile conditions. Unsafe injections have been found to cause deaths due to its associated complications.  The burden of injection site infections is unknown in Tanzania. This study was designed to determine the burden of injection site infections and factors associated to it among underfives in a district hospital, northern Tanzania. This cross-sectional hospital-based study was conducted at Huruma Hospital in Rombo District, northern Tanzania from November to December 2013. This study included children of less than five years attending reproductive child health clinic for the routine immunization. Demographic data and clinical information were collected using pre-tested self-administered questionnaires, with both closed and open ended questions. A total of 200 underfives attending clinics for vaccination were recruited. Majority (n=125, 62.5%) were males. Out of 200 underfives, 60 (30%) were infants. Injection site infections were observed in 18 (9%, 95% CI: 5-12.9) of children; of whom 13 (72.2%) were females. Factors associated with injection site infections were female sex (OR 5.03, 95% CI; 1.58-18.71, P=0.001), severe malnutrition (OR 90, 95% CI; 9.5-398, p<0.001) and HIV infection (OR 21.5, 95% CI; 4.27-114.19, p<0.001). In conclusion, injection site infection rate is relatively high in this hospital and was associated with female sex, malnutrition and positive HIV status.  Proper care and follow up should be instituted when injections are given to this high risk group of underfives. 

Subfossil statoblasts of Lophopodella capensis (Sollas, 1908) (Bryozoa: Phylactolaemata: Lophopodidae) in the Upper Pleistocene and Holocene sediments of a montane wetland, Eastern Mau Forest, Kenya

Lophopodella capensis (Sollas, 1908) is only known from a limited number of palustrine and lacustrine sites in southern Africa and single sites in both Kenya and Israel. Statoblasts of L. capensis were found preserved in the Upper Pleistocene and Holocene aged sediments of Enapuiyapui wetland, Eastern Mau Forest, western Kenya. The wetland is a headwater microcatchment of tributaries that feed into the Mara River and the Lake Victoria Basin. Bryozoan taxa were not surveyed in a 2007 macroinvertebrate biodiversity assessment. The presence of L. capensis at this site marks the second observation of this taxon in Kenya, 65 km from Lake Naivasha, where observed prior, and in a location some 1000 meters higher. The results suggest Bryozoa should be included in aquatic biodiversity surveys that target these wetlands and that bryozoan remains should be incorporated into palaeoecological studies as useful palaeoenvironmental indicators

The Effect of Early Versus Delayed Surgical Debridement on the Outcome of Open Long Bone Fractures at Bugando Medical Centre, Mwanza, Tanzania.

Urgent surgical debridement of open long bone fractures is of paramount importance for prevention of subsequent infection. Due to limited information on the timing of this surgical procedure in Mwanza, Tanzania; the present study was conducted to evaluate the effect of early versus delayed surgical debridement on the outcome of open long bone fractures. A prospective cohort study involving 143 patients with open long bone fractures admitted at Bugando Medical Centre (BMC) between December 2014 and April 2015 was conducted. Patients were stratified into two main groups basing on whether they presented at BMC and operated early (within 6 h) or late (more than 6 h). Socio-demographic and clinical information were collected using structured questionnaire. Analysis was done using STATA software version 11. The male to female ratio was 1.6: 1, with most of the patients being in their third decade of life (30.8 %). Road traffic accident (RTA) was the most common cause of fractures (67.8 %). Majority of patients, 91 (63.6 %) had Gustillo-Anderson grade II and the timing of debridement was significantly associated with this grading (p-value = 0.05). Nine (6.3 %) patients developed surgical site infection (SSI) and the median length of hospital stay (LOS) (interquartile range) was 7 (5-10) days, ranging from 3 to 35 days. SSI was found more in the late group compared to the early group [7.5 % (6/80) versus 4.8 % (3/63) respectively, p-value = 0.503)] and LOS was also longer in the late group compared to the early group [7 (6-11.5) days and 6 (5-10) days respectively, p-value = 0.06]. Pseudomonas aeruginosa was the predominant bacteria causing SSI. Open long bone fracture injuries due to RTA are common at BMC. The risk of developing SSI in this setting is low and comparable to many other countries. Despite the fact that there was no statistical significant difference between early versus delayed debrided groups on SSI and LOS stays; the need for prompt surgical intervention in both groups should be an enduring focus to maintain these favorable outcomes

Evaluating strategies to improve HIV care outcomes in Kenya: a modelling study

Background With expanded access to antiretroviral therapy (ART) in sub-Saharan Africa, HIV mortality has decreased, yet life-years are still lost to AIDS. Strengthening of treatment programmes is a priority. We examined the state of an HIV care programme in Kenya and assessed interventions to improve the impact of ART programmes on population health. Methods We created an individual-based mathematical model to describe the HIV epidemic and the experiences of care among adults infected with HIV in Kenya. We calibrated the model to a longitudinal dataset from the Academic Model Providing Access To Healthcare (known as AMPATH) programme describing the routes into care, losses from care, and clinical outcomes. We simulated the cost and effect of interventions at different stages of HIV care, including improvements to diagnosis, linkage to care, retention and adherence of ART, immediate ART eligibility, and a universal test-and-treat strategy. Findings We estimate that, of people dying from AIDS between 2010 and 2030, most will have initiated treatment (61%), but many will never have been diagnosed (25%) or will have been diagnosed but never started ART (14%). Many interventions targeting a single stage of the health-care cascade were likely to be cost-effective, but any individual intervention averted only a small percentage of deaths because the effect is attenuated by other weaknesses in care. However, a combination of five interventions (including improved linkage, point-of-care CD4 testing, voluntary counselling and testing with point-of-care CD4, and outreach to improve retention in pre-ART care and on-ART) would have a much larger impact, averting 1·10 million disability-adjusted life-years (DALYs) and 25% of expected new infections and would probably be cost-effective (US$571 per DALY averted). This strategy would improve health more efficiently than a universal test-and-treat intervention if there were no accompanying improvements to care ($1760 per DALY averted). Interpretation When resources are limited, combinations of interventions to improve care should be prioritised over high-cost strategies such as universal test-and-treat strategy, especially if this is not accompanied by improvements to the care cascade. International guidance on ART should reflect alternative routes to programme strengthening and encourage country programmes to evaluate the costs and population-health impact in addition to the clinical benefits of immediate initiation

Prevalence of Hepatitis B surface antigen among pregnant women attending antenatal clinic at Nyamagana District Hospital Mwanza, Tanzania

In developing countries there is no routine screening of hepatitis B virus (HBV) infection among pregnant women resulting into limited data on its magnitude. The objective of this study was to determine the prevalence and risk factors associated with active HBV infection among pregnant women attending antenatal clinic (ANC) in Mwanza City, Tanzania. A total of 211 pregnant women were serially enrolled between May and July 2014. Hepatitis B surface antigen (HBsAg) was determined using a rapid Immuno-chromatographic assay. The median age of the study population was 23 years (IQR 20-29 years).  Of 211 pregnant women, 61.6% (130/211) were multigravidae. Eight (3.8%) of the pregnant women were positive with HBsAg. There was a significant difference in prevalence between primigravidae and multigravidae (0.8% vs. 8.6%, p=0.017). Active hepatitis B infection among pregnant women in Mwanza city is low and associated with multigravidity. Despite low prevalence of acute hepatitis B infection routine screening of HBsAg and anti HBsAg antibodies, coupled with the vaccination of those at risk should be introduced to prevent hepatitis B infection complications.

High rate of drinking water contamination due to poor storage in squatter settlements in Mwanza, Tanzania

Background: Drinking water of acceptable quality is supposed to be free from faecal coliform and chemical substances that may be hazardous to human health. Water treatment and safe storage at the household level has been advocated as effective means of ensuring safe drinking water. This study was undertaken to determine the microbiological quality of the drinking water at household level in the squatter settlements in the city of Mwanza, Tanzania.Methods: A cross-sectional study was conducted between June 2014 and September 2014.  A total of 15 randomly selected water sources (tap) and 207 households’ drinking water samples from these sources were studied to ascertain level of water contamination using Membrane Filtration Method. Pre-tested questionnaire was used to collect demographic and other data regarding water treatment and storage.  Data were entered, cleaned and analysed using STATA Version 11.Results:  All 15 samples from tap used as water sources were found to be free of indicator organism (Escherichia coli) while 109 (52.66%) of drinking water samples from 207 households were found to be contaminated with E. coli.  All contaminated drinking water samples were from containers with no cover and spigot. Conclusions: There is a significant level of deterioration of water quality from the source to the drinking cup. Efforts to ensure quality storage methods for drinking water should be addressed at household level

The Effect of Early Versus Delayed Surgical Debridement on the Outcome of Open Long Bone Fractures at Bugando Medical Centre, Mwanza, Tanzania.

Urgent surgical debridement of open long bone fractures is of paramount importance for prevention of subsequent infection. Due to limited information on the timing of this surgical procedure in Mwanza, Tanzania; the present study was conducted to evaluate the effect of early versus delayed surgical debridement on the outcome of open long bone fractures. A prospective cohort study involving 143 patients with open long bone fractures admitted at Bugando Medical Centre (BMC) between December 2014 and April 2015 was conducted. Patients were stratified into two main groups basing on whether they presented at BMC and operated early (within 6 h) or late (more than 6 h). Socio-demographic and clinical information were collected using structured questionnaire. Analysis was done using STATA software version 11. The male to female ratio was 1.6: 1, with most of the patients being in their third decade of life (30.8 %). Road traffic accident (RTA) was the most common cause of fractures (67.8 %). Majority of patients, 91 (63.6 %) had Gustillo-Anderson grade II and the timing of debridement was significantly associated with this grading (p-value = 0.05). Nine (6.3 %) patients developed surgical site infection (SSI) and the median length of hospital stay (LOS) (interquartile range) was 7 (5-10) days, ranging from 3 to 35 days. SSI was found more in the late group compared to the early group [7.5 % (6/80) versus 4.8 % (3/63) respectively, p-value = 0.503)] and LOS was also longer in the late group compared to the early group [7 (6-11.5) days and 6 (5-10) days respectively, p-value = 0.06]. Pseudomonas aeruginosa was the predominant bacteria causing SSI. Open long bone fracture injuries due to RTA are common at BMC. The risk of developing SSI in this setting is low and comparable to many other countries. Despite the fact that there was no statistical significant difference between early versus delayed debrided groups on SSI and LOS stays; the need for prompt surgical intervention in both groups should be an enduring focus to maintain these favorable outcomes

Predictors of blaCTX-M-15 in varieties of Escherichia coli genotypes from humans in community settings in Mwanza, Tanzania

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae commonly cause infections worldwide. Bla CTX-M-15 has been commonly detected in hospital isolates in Mwanza, Tanzania. Little is known regarding the faecal carriage of ESBL isolates and bla CTX-M-15 allele among humans in the community in developing countries. A cross-sectional study involving 334 humans from the community settings in Mwanza City was conducted between June and September 2014. Stool specimens were collected and processed to detect ESBL producing enterobacteriaceae. ESBL isolates were confirmed using disc approximation method, commercial ESBL plates and VITEK-2 system. A polymerase chain reaction and sequencing based allele typing for CTX-M ESBL genes was performed to 42 confirmed ESBL isolates followed by whole genome sequence of 25 randomly selected isolates to detect phylogenetic groups, sequence types plasmid replicon types. Of 334 humans investigated, 55 (16.5 %) were found to carry ESBL-producing bacteria. Age, history of antibiotic use and history of admission were independent factors found to predict ESBL-carriage. The carriage rate of ESBL-producing Escherichia coli was significantly higher than that of Klebsiella pneumoniae (15.1 % vs. 3.8 %, p = 0.026). Of 42 ESBL isolates, 37 (88.1 %) were found to carry the bla CTX-M-15 allele. Other transferrable resistance genes were aac(6')Ib-cr, aac(3)-IIa, aac(3)-IId, aadA1, aadA5, strA, strB and qnrS1. Eight multi-locus sequence types (ST) were detected in 25 E. coli isolates subjected to genome sequencing. ST-131 was detected in 6 (24 %), ST-38 in 5 (20 %) and 5 (20 %) clonal complex - 10(ST-617, ST-44) of isolates. The pathogenic phylogenetic groups D and B2 were detected in 8/25 (32 %) and 6/25 (24 %) of isolates respectively. BlaCTX-M-15 was found to be located in multiple IncY and IncF plasmids while in 13/25(52 %) of cases it was chromosomally located. The overlap of multi-drug resistant bacteria and diversity of the genotypes carrying CTX-M-15 in the community and hospitals requires an overall approach that addresses social behaviour and activity, rationalization of the antibiotic stewardship policy and a deeper understanding of the ecological factors that lead to persistence and spread of such alleles