The Concept of Hierarchy and Doing Ministry in the Church: Evaluating the Roles of Leaders and the Use of Authority in Quakerism

The authority existing within the hierarchy of leadership in the church, if not well exercised, can create deficiency and imbalances in the running of church affairs. In Quakerism, the expectation is that everyone equally participates in doing ministry. As people gather in the presence of God for service in worship, all barriers of inequality have to be brought down. Conflicts and disagreements of who is supposed to be in authority among church leaders should be discouraged. Therefore, there is need to share about definitions of hierarchy, ministry, and authority, the historical background of church leadership, role of church leaders, evaluations of the existing relationship among church leaders, and the future of the church leadership

Symptomatic infantile helicobacter pylori gastritis infection in indigenous african infants: a case series

Helicobacter pylori gastritis infection rate increases with age. Higher rates have however been reported among young people in the developing countries of the world. The infection however has rarely been  reported in infants, especially in Africa. This case series describes three cases of Helicobacter pylori gastritis  infection as diagnosed in three infants. The goal is to raise the suspicion index of medical  practitioners about the possibility of this this infection among infants who  present with suggestive  symptoms. On three separate occasions in 2012 and 2013, three ill, indigenous, black African female  infants aged 4, 6 and 7 months,  were brought to hospital with symptoms ranging from fever, refusal to feed, diarrhoea, restlessness, vomiting and irritability. In each case, systemic examination  findings were unremarkable. After several laboratory investigations, each infant was found to have Helicobacter pylori infection following positive blood antibody  (using Tell Me Fast H. Pylori antibody serum and Plasma test manufactured by Biocan Diagnostics Canada) and fecal HpSA ImmunoCardSTAT antigen tests. Repeat  stool antigen test was negative in each case after  completion of the recommended triple therapy. Helicobacter pylori infection has been rarely reported among infants. This case series highlights the need for health care providers to have a high index of suspicion so that infants with suggestive symptoms, especially  in settings with high Helicobacter pylori colonization prevalence can be evaluated for Helicobacter pylori gastritis infection.Key words: Infantile, helicobacter pylori, gastritis, infectio

Quaker Pastoral Theology and its Embodiment in the Community

The reflection brought forth in this writing is part of the Quaker Theological Discussion Group in answering the question, what is Quaker pastoral theology, and how is it embodied in the community? It is majorly divided in two parts. There is exploration of the meaning of Quaker pastoral theology and embodiment of Quaker pastoral ministry

Magnitude and factors associated with delayed initiation of breastfeeding among mothers who deliver in Mulago hospital, Uganda.

Background: Breastfeeding as a determinant of infant health and nutrition saves up to 1.5 million infant lives annually. Though breastfeeding is mostly universal in sub-Saharan Africa, early initiation of breastfeeding is rarely practiced.Objective: To determine magnitude and factors associated with delayed initiation of breastfeeding among mother-infant pairs who deliver in Mulago hospital.Methods: We carried out a descriptive cross sectional study, where 665 mother-infant pairs were interviewed within 24 hours following delivery; with additional qualitative data collected using focus group discussions to understand reasons for delaying initiation. The data was analysed by identification and coding of themes.Results: In this study, 31.4% mothers delayed initiation of breastfeeding. This was associated with maternal HIV positive status (AOR 2.3; 95% CI 1.3-4.2), inadequate prenatal guidance, (AOR 3.6; 95% CI 1.9-6.8), inadequate professional assistance to initiate breastfeeding (AOR 1.8; 95% CI 1.2-2.8) and caesarean section delivery (AOR 8.6; 95% CI 4.7-16.0). Other reasons were perceived lack of breast milk, need of rest for both mother and baby after labor, and negative cultural beliefs.Conclusion: In Mulago Hospital 1:3 mothers delayed initiation of breastfeeding. The reasons for delayed initiation include; inadequate information during ANC, HIV positive serostatus, caesarian section delivery and negative cultural ideas.Keywords: Breastfeeding, initiation, delayed, HI

Invasive carbapenem-resistant Enterobacteriaceae infection at a paediatric hospital: A case series

Background. There are no paediatric reports of invasive infection caused by carbapenem-resistant Enterobacteriaceae (CRE) from Africa. Objectives. To document a series of cases of CRE infections at a tertiary children’s hospital in Cape Town, South Africa, describing the clinical and microbiological findings in these children.Methods. A retrospective, descriptive study was completed using data from a series of children with invasive CRE infection between 2010 and 2015, sourced from their clinical notes and microbiology results.Results. The first of 10 invasive CRE infections during the study period occurred in November 2012. Nine CRE infections were caused by Klebsiella pneumoniae, and one by both K. pneumoniae and Escherichia coli. The median age was 25 months (interquartile range (IQR) 5 - 60). All 10 CRE infections were hospital acquired. The median length of hospitalisation before CRE infection was 28.5 days (IQR 20 - 44). Eight of the children were exposed to carbapenems during the 12-month period prior to invasive CRE infection. Six were treated with colistin and carbapenem combination therapy, of whom 2 died, including 1 of a non-CRE event. The other 4 children received colistin monotherapy. All these children died, including 2 from non-CRE events.Conclusions. Children with invasive CRE infection and severe underlying disease must be treated with combination antibiotic therapy. Strict infection control practice and antibiotic stewardship are necessary to contain the spread of CRE and limit the number of new infections

Magnitude and factors associated with delayed initiation of breastfeeding among mothers who deliver in Mulago hospital, Uganda.

Background: Breastfeeding as a determinant of infant health and nutrition saves up to 1.5 million infant lives annually. Though breastfeeding is mostly universal in sub-Saharan Africa, early initiation of breastfeeding is rarely practiced. Objective: To determine magnitude and factors associated with delayed initiation of breastfeeding among mother-infant pairs who deliver in Mulago hospital. Methods: We carried out a descriptive cross sectional study, where 665 mother-infant pairs were interviewed within 24 hours following delivery; with additional qualitative data collected using focus group discussions to understand reasons for delaying initiation. The data was analysed by identification and coding of themes. Results: In this study, 31.4% mothers delayed initiation of breastfeeding. This was associated with maternal HIV positive status (AOR 2.3; 95% CI 1.3-4.2), inadequate prenatal guidance, (AOR 3.6; 95% CI 1.9-6.8), inadequate professional assistance to initiate breastfeeding (AOR 1.8; 95% CI 1.2-2.8) and caesarean section delivery (AOR 8.6; 95% CI 4.7-16.0). Other reasons were perceived lack of breast milk, need of rest for both mother and baby after labor, and negative cultural beliefs. Conclusion: In Mulago Hospital 1:3 mothers delayed initiation of breastfeeding. The reasons for delayed initiation include; inadequate information during ANC, HIV positive serostatus, caesarian section delivery and negative cultural ideas

Management of Multisystem Inflammatory Syndrome in Children (MIS-C) in resource limited settings: The Kenyan Experience

Background: Since the onset of the recent COVID-19 pandemic, there have been growing concerns regarding multisystem inflammatory syndrome in children (MIS-C). This study aims to describe the clinico-epidemiological profile and challenges in management of MIS-C in low-middle income countries by highlighting the Kenyan experience. Methods: A retrospective study at the Aga Khan University Hospital Nairobi, Avenue Hospital Kisumu and Kapsabet County Referral Hospital was undertaken to identify cases of MIS-C. A detailed chart review using the World Health Organization (WHO) data collection tool was adapted to incorporate information on socio-demographic details and treatment regimens. Findings: Twenty children with MIS-C were identified across the three facilities between August 1st 2020 and August 31st 2021. Seventy percent of the children were male (14 of 20). COVID-19 PCR testing was done for five children and only one was positive. The commonest clinical symptoms were fever (90%), tachycardia (80%), prolonged capillary refill (80%), oral mucosal changes (65%) and peripheral cutaneous inflammation (50%). Four children required admission into the critical care unit for ventilation support and inotropic support. Cardiac evaluation was available for six patients four of whom had myocardial dysfunction, three had valvulitis and one had pericarditis. Immunoglobulin therapy was availed to two children and systemic steroids provided for three children. There were no documented mortalities. Interpretation: We describe the first case series of MIS-C in East and Central Africa. Majority of suspected cases of MIS-C did not have access to timely COVID-19 testing and other appropriate evaluations which highlights the iniquity in access to diagnostics and treatment

Invasive carbapenem-resistant Enterobacteriaceae infection at a paediatric hospital: A case series

Background. There are no paediatric reports of invasive infection caused by carbapenem-resistant Enterobacteriaceae (CRE) from Africa.Objectives. To document a series of cases of CRE infections at a tertiary children’s hospital in Cape Town, South Africa, describing the clinical and microbiological findings in these children.Methods. A retrospective, descriptive study was completed using data from a series of children with invasive CRE infection between 2010 and 2015, sourced from their clinical notes and microbiology results.Results. The first of 10 invasive CRE infections during the study period occurred in November 2012. Nine CRE infections were caused by Klebsiella pneumoniae, and one by both K. pneumoniae and Escherichia coli. The median age was 25 months (interquartile range (IQR) 5 - 60). All 10 CRE infections were hospital acquired. The median length of hospitalisation before CRE infection was 28.5 days (IQR 20 - 44). Eight of the children were exposed to carbapenems during the 12-month period prior to invasive CRE infection. Six were treated with colistin and carbapenem combination therapy, of whom 2 died, including 1 of a non-CRE event. The other 4 children received colistin monotherapy. All these children died, including 2 from non-CRE events.Conclusions. Children with invasive CRE infection and severe underlying disease must be treated with combination antibiotic therapy. Strict infection control practice and antibiotic stewardship are necessary to contain the spread of CRE and limit the number of new infections

Adverse events following immunization reporting and impact on immunization services in informal settlements in Nairobi, Kenya: a prospective mixed-methods study

Introduction: adverse events following immunization (AEFIs) are thought to contribute to cases of vaccine hesitancy, yet little data exists describing the state of reporting and management of AEFIs. This study investigated the occurrence and influence of AEFIs on vaccine hesitancy in an informal settlement of Nairobi. Methods: this was a prospective mixed-methods study involving 7 focus group discussions, 8 key informant interviews and 457 face-to-face interviews with caregivers. Caregivers were recruited at/or before the 6-week clinic visit and assessed for occurrence of AEFIs in their children at the subsequent 10- and 14-week visits and a follow-up two weeks following the 14 weeks visit via phone calls. Results: in this study, 12.3% (56/457) of the infants experienced an AEFI. Of these, 19 did not report for the next scheduled vaccine. Fever was the most common AEFI, for which most caregivers (66.7%) used paracetamol as antipyretic, while 20.8% sought help from a nearby health facility. Three of the 56 AEFIs (convulsions) that occurred in study participants could be classified as severe reactions. Diphtheria, pertussis and tetanus (DPT) 3 completion rate was 75.3%. Most (96.4%) caregivers considered immunization an important strategy for child survival. Vaccine hesitancy occurred among 3.6% of participants, 30% of whom attributed their hesitancy to occurrence of AEFIs. The review of health records revealed that no AEFI had been reported from any of the study facilities. Conclusion: cases of adverse events following immunization are not reported in Mathare Valley and they do have implications for vaccine hesitancy by some caregivers