Oxygen saturation ranges for healthy newborns within 24 hours at 1800 m.

There are minimal data to define normal oxygen saturation (SpO2) levels for infants within the first 24 hours of life and even fewer data generalisable to the 7% of the global population that resides at an altitude of >1500 m. The aim of this study was to establish the reference range for SpO2 in healthy term and preterm neonates within 24 hours in Nairobi, Kenya, located at 1800 m. A random sample of clinically well infants had SpO2 measured once in the first 24 hours. A total of 555 infants were enrolled. The 5th-95th percentile range for preductal and postductal SpO2 was 89%-97% for the term and normal birthweight groups, and 90%-98% for the preterm and low birthweight (LBW) groups. This may suggest that 89% and 97% are reasonable SpO2 bounds for well term, preterm and LBW infants within 24 hours at an altitude of 1800 m

ANTIINFLAMMATORY PROPERTIES OF DICHLOROMETHANE: METHANOLIC LEAF EXTRACTS OF CAESALPINIA VOLKENSII AND MAYTENUS OBSCURA IN ANIMAL MODELS

Objective: Inflammation is the reaction to injury of the living tissues. Conventional medication of inflammation is expensive and arguably associated with various severe adverse effects hence the need to develop herbal agents that are effective as alternative. Caesalpinia volkensii and Maytenus obscura are plants that grow in Mbeere County of Eastern region of Kenya. This study was designed to evaluate the anti-inflammatory activity of C. volkensii and M. obscura plants. Methods: Experimental animals were divided in to four groups; normal group, diseased negative control group, diseased reference group and diseased experimental groups. Inflammation was inducted into the mice using carrageenan. The experimental groups were treated with leaf extracts of the plants at concentration of 50 mg/kg, 100 mg/kg and 150 mg/kg. Anti-inflammatory activities in rats were compared with diclofenac (15 mg/kg) as the standard conventional drug. Results: The leaf extracts of C. volkensii reduced the paw edema by between 6.50%-13.42% while the extracts of M. obscura reduced it by between 4.94%-22.36%. Diclofenac reduced the paw edema by between 4.11%-10.47%. Conclusion: The phytochemical screening results showed that the extracts of C. volkensii had flavonoids, steroids and phenolics while the leaf extracts M. obscura had phenolics, terpenoids and saponins. Flavonoids, saponins and phenolics have been associated with anti-inflammatory activities. Therefore, the study has established that the DCM: methanolic leaf extracts of Caesalpinia volkensii and Maytenus obscura are effective in management of inflammation

Challenges in Diagnosing Paediatric Malaria in Dar es Salaam, Tanzania.

Malaria is a major cause of paediatric morbidity and mortality. As no clinical features clearly differentiate malaria from other febrile illnesses, and malaria diagnosis is challenged by often lacking laboratory equipment and expertise, overdiagnosis and overtreatment is common. Children admitted with fever at the general paediatric wards at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania from January to June 2009 were recruited consecutively and prospectively. Demographic and clinical features were registered. Routine thick blood smear microscopy at MNH was compared to results of subsequent thin blood smear microscopy, and rapid diagnostics tests (RDTs). Genus-specific PCR of Plasmodium mitochondrial DNA was performed on DNA extracted from whole blood and species-specific PCR was done on positive samples. Among 304 included children, 62.6% had received anti-malarials during the last four weeks prior to admission and 65.1% during the hospital stay. Routine thick blood smears, research blood smears, PCR and RDT detected malaria in 13.2%, 6.6%, 25.0% and 13.5%, respectively. Positive routine microscopy was confirmed in only 43% (17/40), 45% (18/40) and 53% (21/40), by research microscopy, RDTs and PCR, respectively. Eighteen percent (56/304) had positive PCR but negative research microscopy. Reported low parasitaemia on routine microscopy was associated with negative research blood slide and PCR. RDT-positive cases were associated with signs of severe malaria. Palmar pallor, low haemoglobin and low platelet count were significantly associated with positive PCR, research microscopy and RDT. The true morbidity attributable to malaria in the study population remains uncertain due to the discrepancies in results among the diagnostic methods. The current routine microscopy appears to result in overdiagnosis of malaria and, consequently, overuse of anti-malarials. Conversely, children with a false positive malaria diagnosis may die because they do not receive treatment for the true cause of their illness. RDTs appear to have the potential to improve routine diagnostics, but the clinical implication of the many RDT-negative, PCR-positive samples needs to be elucidated.\u

Interactions between Natural Populations of Human and Rodent Schistosomes in the Lake Victoria Region of Kenya: A Molecular Epidemiological Approach

One of the world's most prevalent neglected diseases is schistosomiasis, which infects approximately 200 million people worldwide. Schistosoma mansoni is transmitted to humans by skin penetration by free-living larvae that develop in freshwater snails. The origin of this species is East Africa, where it coexists with its sister species, S. rodhaini. Interactions between these species potentially influence their epidemiology, ecology, and evolutionary biology, because they infect the same species of hosts and can hybridize. Over two years, we examined their distribution in Kenya to determine their degree of overlap geographically, within snail hosts, and in the water column as infective stages. Both species were spatially and temporally patchy, although S. mansoni was eight times more common than S. rodhaini. Both species overlap in the time of day they were present in the water column, which increases the potential for the species to coinfect the same host and interbreed. Peak infective time for S. mansoni was midday and dawn and dusk for S. rodhaini. Three snails were coinfected, which was more common than expected by chance. These findings indicate a lack of obvious isolating mechanisms to prevent hybridization, raising the intriguing question of how the two species retain separate identities

Oxygen saturation ranges for healthy newborns within 24 hours at 1800 m

There are minimal data to define normal oxygen saturation (SpO2) levels for infants within the first 24 hours of life and even fewer data generalisable to the 7% of the global population that resides at an altitude of >1500 m. The aim of this study was to establish the reference range for SpO2 in healthy term and preterm neonates within 24 hours in Nairobi, Kenya, located at 1800 m. A random sample of clinically well infants had SpO2 measured once in the first 24 hours. A total of 555 infants were enrolled. The 5th–95th percentile range for preductal and postductal SpO2 was 89%–97% for the term and normal birthweight groups, and 90%–98% for the preterm and low birthweight (LBW) groups. This may suggest that 89% and 97% are reasonable SpO2 bounds for well term, preterm and LBW infants within 24 hours at an altitude of 1800 m

An Investigation into a Human Anthrax Outbreak in Maragua District, Central Kenya

An outbreak of human anthrax occurred in Maragua district between December 2005 and January 2006 and an investigation was undertaken through visits and interviews with the District Veterinary (DVO) and Public Health Officers, owners of cattle that had died, people who had butchered or eaten the meat from dead animals and patients who had been affected by the disease. It was found that 514 out of 700 people had eaten the affected meat but only 30 got clinical disease, one (1) of which was enteric and the rest twenty nine (29) were cutaneous. The attack rate appeared to have been greatly reduced by the practice of repeatedly boiling the meat and discarding the soup before eating the meat. The disease outbreak in cattle was associated with low vaccination rates of cattle against anthrax in the area, human movement, poor handling of the infected meat, and activities of scavenging dogs and chickens and possibly insects. Ignorance, retrogressive socio-cultural practices and poor socio-economic conditions were risk factors that contributed to the outbreak of the disease in humans. Kenya Veterinarian Vol. 30 (2) 2006: pp. 62-6

Hospital outcomes for paediatric pneumonia and diarrhoea patients admitted in a tertiary hospital on weekdays versus weekends: a retrospective study.

BACKGROUND: Quality of patient care in hospitals has been shown to be inconsistent during weekends and night-time hours, and is often associated with reduced patient monitoring, poor antibiotic prescription practices and poor patient outcomes. Poorer care and outcomes are commonly attributed to decreased levels of staffing, supervision and expertise and poorer access to diagnostics. However, there are few studies examining this issue in low resource settings where mortality from common childhood illnesses is high and health care systems are weak. METHODS: This study uses data from a retrospective cross-sectional study aimed at "evaluating the uptake of best practice clinical guidelines in a tertiary hospital" with a pre and post intervention approach that spanned the period 2005 to 2009. We evaluated a primary hypothesis that mortality for children with pneumonia and/or dehydration aged 2-59 months admitted on weekends differed from those admitted on weekdays. A secondary hypothesis that poor quality of care could be a mechanism for higher mortality was also explored. Logistic regression was used to examine the association between mortality and the independent predictors of mortality. RESULTS: Our analysis indicates that there is no difference in mortality on weekends compared to weekdays even after adjusting for the significant predictors of mortality (OR = 1.15; 95% CI 0.90 -1.45; p = 0.27). There were similarly no significant differences between weekends and weekdays for the quality of care indicators, however, there was an overall improvement in mortality and quality of care through the period of study. CONCLUSION: Mortality and the quality of care does not differ by the day of admission in a Kenyan tertiary hospital, however mortality remains high suggesting that continued efforts to improve care are warranted