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

Molecular Identification of Soil Bacteria by 16srDNA Sequence

In this current study, 16S rDNA (genotypic) identification technique is focused on identification of conventionally unidentifiable isolates those are unevaluated in isolated by employing molecular techniques and Bioinformatics in uploading and retrieving isolate gene sequences which are rapid, reliable and accurate in differentiation of various soils isolates. This study is an automaton of 16Sr DNA gene sequence that allows a queue comparison analysis of published sequences deposited in the microbial genome database was used. Polymerase chain reaction (PCR) amplification of 16SrDNA gene using the consensus bacterial primer and separation of the resulting polymer chain reaction amplicon  by cloning, temperature gradient electrophoresis are major ecological techniques that are used in the description of soil bacteria. The isolated gene was cloned using PTZ57r or T cloning Vector amplified using 16SF and 16SR primer transformed in DH5? Cells resulting PCs 16s Plasmid hybrid. The primer 16S F2 obtained from M13 forward primer was used and aligned using BLAST and submitted to EMBL+GENEBANK+DDBJ+ PDB. 99% similarity was observed and later it was analyzed with the existing sequence in ribosomal database project II.  RDP classifier was used for confirmation with 100 % similarity. The bacteria were identified as Burkholderia cenocepacia  when the  sequence was submitted and retrieved via the World Wide Web and new sequence compared with those held in the database  using the basic local alignment tool (BLAST). A segment of 734 out of 736 nucleotide of 16S rDNA gene of Burholderia Cenocepacia is the region of choice for primer construction because of proximity that provides a successful discrimination in strains of Burholderia Cenocepacia in soil. 16S rDNA gene account to 99%  similarity score in molecular typing and identification of bacteria which concerns deposition of sequences into established microbial genomic database Key Words: Burkholderi; Bacterial transformation; Characterization; DNA based technique

Isolation, Identification and Characterization of Urinary Tract Infectious Bacteria and the Effect of Different Antibiotics

Introduction: Urinary Tract Infection (UTI) defines a condition in which the urinary tract is infected with a pathogen causing inflammation which is a common, distressing and occasionally life threatening condition. UTI affects people of all  ages and both gender. In all patients with UTI are reported with asymptomatic bacteriuria. Female are more susceptible to  UTIs compared to  male. To ensure appropriate therapy, current knowledge of  the  organisms  that  cause  UTI  and  their  antibiotic  is  susceptibility is mandatory. Methods: This study focused on the frequency of uropathogens and  their antibiotic susceptibility in different gender in Madurai District. Cultural and biochemical characterization  of  uropathogens revealed  the  prevalence  of  both  gram-positive and gram-negative organisms Results: E. coli was the predominant isolate isolated from the urine specimen followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, Proteus mirabilis and Enterococcus faecalis. Among the antibiotics tested, chloraphenicol and ciprofloxacin (100%) were found to be effective for empirical treatment of UTI and has covered the majority of urinary pathogens followed by tetracycline,  gentamycin and kanamycin (83%), Ampicillin (67). Streptomycin, Rifampicin and amoxicillin were less effective (50%). Conclusion: Some of the isolates were resistant to penicillin-G, Streptomycin, rifampicin and amoxicillin which are more frequently prescribed and indicates that increased consumption of a particular antibiotic leads to acquisition of resistance by the uropathogens.   Resistance rates among common uropathogens continue to evolve and appear to be increasing too many commonly used antimicrobial agents and a continued surveillance of resistance rates among uropathogens is needed to ensure appropriate recommendations for the treatment of the urinary tract infections. Keywords: Urinary tract infection, Drug resistence, Uropathogens, Biochemical tests

Commonly cited incentives in the community implementation of the emergency maternal and newborn care study in western Kenya

Background: Mortality of mothers and newborns is an important public health problem in low-income countries. In the rural setting, implementation of community based education and mobilization are strategies that have sought to reduce these mortalities. Frequently such approaches rely on volunteers within each community. Objective: To assess the perceptions of the community volunteers in rural Kenya as they implemented the EmONC program and to identify the incentives that could result in their sustained engagement in the project. Method: A community-based cross sectional survey was administered to all volunteers involved in the study. Data were collected using a self-administered supervision tool from all the 881 volunteers. Results: 881 surveys were completed. 769 respondents requested some form of incentive; 200 (26%) were for monetary allowance, 149 (19.4%) were for a bicycle to be used for transportation, 119 (15.5%) were for uniforms for identification, 88 (11.4%) were for provision of training materials, 81(10.5%) were for training in Home based Life Saving Skills (HBLSS), 57(7.4%) were for provision of first AID kits, and 39(5%) were for provision of training more facilitators, 36(4.7%) were for provision of free medication. Conclusion: Monetary allowances, improved transportation and some sort of identification are the main incentives cited by the respondents in this context

Socioeconomic differences in caesarean section - Are they explained by medical need? An analysis of patient record data of a large Kenyan hospital

Background: Caesarean section (C-section) rates are often low among the poor and very high among the better-off in low- and middle-income countries. We examined to what extent these differences are explained by medical need in an African context. Methods: We analyzed electronic records of 12,209 women who gave birth in a teaching hospital in Kenya in 2014. C-section rates were calculated by socioeconomic position (SEP), using maternal occupation (professional, small business, housewife, student) as indicator. We assessed if women had documented clinical indications according to hospital guidelines and if socioeconomic differences in C-section rates were explained by indication. Results: Indication for C-section according to hospital guidelines was more prevalent among professionals than housewives (16% vs. 9% of all births). The C-section rate was also higher among professionals than housewives (21.1% vs. 15.8% [OR 1.43; 95%CI 1.23-1.65]). This C-section rate difference was largely explained by indication (4.7 of the 5.3 percentage point difference between professionals and housewives concerned indicated C-sections, often with previous C-section as indication). Repeat C-sections were near-universal (99%). 43% of primary C-sections had no documented indication. Over-use was somewhat higher among professionals than housewives (C-section rate among women without indication: 6.6 and 5.5% respectively), which partly explained socioeconomic differences in primary C-section rate. Conclusions: Socioeconomic differences in C-section rates can be largely explained by unnecessary primary C-sections and higher supposed need due to previous C-section. Prevention of unnecessary primary C-sections and promoting safe trial of labor should be priorities in addressing C-section over-use and reducing inequalities. Tweetable abstract: Unnecessary primary C-sections and ubiquitous repeat C-sections drive overall C-section rates and C-section inequalities

Estimating the prevalence of obstetric fistula: a systematic review and meta-analysis.

BACKGROUND: Obstetric fistula is a severe condition which has devastating consequences for a woman's life. The estimation of the burden of fistula at the population level has been impaired by the rarity of diagnosis and the lack of rigorous studies. This study was conducted to determine the prevalence and incidence of fistula in low and middle income countries. METHODS: Six databases were searched, involving two separate searches: one on fistula specifically and one on broader maternal and reproductive morbidities. Studies including estimates of incidence and prevalence of fistula at the population level were included. We conducted meta-analyses of prevalence of fistula among women of reproductive age and the incidence of fistula among recently pregnant women. RESULTS: Nineteen studies were included in this review. The pooled prevalence in population-based studies was 0.29 (95% CI 0.00, 1.07) fistula per 1000 women of reproductive age in all regions. Separated by region we found 1.57 (95% CI 1.16, 2.06) in sub Saharan Africa and South Asia, 1.60 (95% CI 1.16, 2.10) per 1000 women of reproductive age in sub Saharan Africa and 1.20 (95% CI 0.10, 3.54) per 1000 in South Asia. The pooled incidence was 0.09 (95% CI 0.01, 0.25) per 1000 recently pregnant women. CONCLUSIONS: Our study is the most comprehensive study of the burden of fistula to date. Our findings suggest that the prevalence of fistula is lower than previously reported. The low burden of fistula should not detract from their public health importance, however, given the preventability of the condition, and the devastating consequences of fistula

Biopsychosocial risk factors and knowledge of cervical cancer among young women: A case study from Kenya to inform HPV prevention in Sub-Saharan Africa

Background: Cervical cancer is the second most common female reproductive cancer after breast cancer with 84% of the cases in developing countries. A high uptake of human papilloma virus (HPV) vaccination and screening, and early diagnosis leads to a reduction of incidence and mortality rates. Yet uptake of screening is low in Sub-Saharan Africa and there is an increasing number of women presenting for treatment with advanced disease. Nine women in their twenties die from cervical cancer in Kenya every day. This paper presents the biopsychosocial risk factors that impact on cervical cancer knowledge among Kenyan women aged 15 to 24 years. The findings will highlight opportunities for early interventions to prevent the worrying prediction of an exponential increase by 50% of cervical cancer incidences in the younger age group by 2034. Methods: Data from the 2014 Kenya Demographic and Health Survey (KDHS) was analysed using complex sample logistic regression to assess biopsychosocial risk factors of knowledge of cervical cancer among young women aged 15 to 24 years (n = 5398). Findings: Close to one third of the participants were unaware of cervical cancer with no difference between participants aged 15–19 years (n = 2716) and those aged 20–24 years (n = 2691) (OR = 1; CI = 0.69–1.45). Social predisposing factors, such as lack of education; poverty; living further from a health facility; or never having taken a human immunodeficiency virus (HIV) test, were significantly associated with lack of awareness of cervical cancer (p<0.001). Young women who did not know where to obtain condoms had an OR of 2.12 (CI 1.72–2.61) for being unaware of cervical cancer. Psychological risk factors, such as low self-efficacy about seeking medical help, and an inability to refuse unsafe sex with husband or partner, perpetuated the low level of awareness about cervical cancer (p<0.001). Conclusions: A considerable proportion of young women in Kenya are unaware of cervical cancer which is associated with a variety of social and psychological factors. We argue that the high prevalence of cervical cancer and poor screening rates will continue to prevail among older women if issues that affect young women’s awareness of cervical cancer are not addressed. Given that the Kenyan youth are exposed to HPV due to early sexual encounters and a high prevalence of HIV, targeted interventions are urgently needed to increase the uptake of HPV vaccination and screening