Prevalence and Antimicrobial Susceptibility of Bacteria Implicated in Neonatal Sepsis at Pumwani Maternity Hospital

Neonatal sepsis is one of the most common causes of morbidity and mortality among infants in developing countries. The etiology and antimicrobial sensitivity patterns of bacteria responsible vary in different hospitals. This study identified bacteria in blood cultures of neonates with clinically suspected septicemia and demonstrated their susceptibility patterns. A longitudinal design targeting all neonates at Pumwani maternity hospital with suspected sepsis was used. One hundred and fifty neonates were selected using consecutive sampling. Data was collected using a questionnaire. Out of 150 blood specimens cultured, the cases of confirmed bacterial sepsis were 48(32%). Gram-positive pathogens predominated with Staphylococcus aureus and Streptococcus viridans accounting for 70%. The only Gram-negative isolates were E. coli and Klebsiella spp. Gram-positive isolates showed high sensitivity (above 80%) to meropenem, gentamicin, ceftriaxone, ofloxacin, and amikacin. Gram- negative organisms were generally resistant to penicillins and absolutely sensitive to meropenem, ceftazidime and ciprofloxacin. Keywords: Prevalence, Antimicrobial susceptibility, Neonatal sepsi

Drug resistant tuberculosis in Kenya: trends, characteristics and treatment outcomes, 2008 – 2016

Background: Drug resistant (DR) tuberculosis (TB) remains a major public health concern. Failure to treat patients with TB adequately increases the risk of transmission of infection to the general population. Treatment of DR TB is characterized by lengthy treatment duration, use of toxic and less effective drugs and high likelihood of adverse treatment outcomes that include adverse drug reactions, high mortality and loss to follow up.Objective: To determine the trends, characteristics and treatment outcomes of patients >15 years notified with DR‐TB in Kenya from 2008 to 2016Design: Retrospective descriptive cross‐sectional studySetting: Tuberculosis treatment centers in KenyaSubjects: Persons above 15 years notified with DR TBResults: We reviewed records of 1903 DR‐TB patients who were notified between 2008 and 2016. The public sector made the highest contribution of the notified cases (80%). Most of the cases were male (62.3%). The HIV testing rate was 99.5%, with the TB/HIV co‐infection being 36%. Initiation of antiretroviral therapy among those who tested positive for HIV was 94.6%. Co‐trimoxazole preventive therapy uptake was 99.3%. Most patients had secondary DRTB (77.3%). Multi‐drug resistant TB accounted for 78.4% of the DR TB cases while mono drug resistance was observed in 26% of the cases. Treatment success was achieved in 79% of the cases. Mortality and treatment failure during the study period was 11% and 0.2% respectively.Conclusion: An upward trend in notified DR‐TB cases was observed during the period under review. The public sector gave the most contribution. Active surveillance on patients lost to follow up while on treatment and poor drug adherence will be of importance to reduce the potential of development of drug resistance

Outcomes of Kenyan children under five years of age, initiated on isoniazid preventive therapy following exposure to bacteriologically confirmed pulmonary tuberculosis, 2013-2016

Background: Isoniazid preventive therapy (IPT) is one of the key interventions in achieving the End TB Strategy of 90% reduction in Tuberculosis (TB) incidence by 2030 compared with 2015. One of the key pillars in achieving this is preventive treatment of persons at high risk of contracting TB. This group includes children less than five years exposed to bacteriologically confirmed TB. Despite Kenya national IPT roll out in 2015, there still exists limited information on its programmatic coverage, outcomes and missed opportunities for initiation of IPT.Objective: To determine the coverage, outcomes and missed opportunities for initiation of IPT among children under-five years in contact with bacteriologically confirmed pulmonary tuberculosis (PTB) in Kenya.Design: Cross sectional descriptive study.Setting: All the 47 counties in Kenya.Subjects: Children under-five years exposed to bacteriologically confirmed PTB initiated on IPT and notified between 2013 and 2016.Results: During the study period (2013-2016), a total of 6,507 children aged less than five years who were exposed to bacteriologically confirmed PTB were initiated on IPT. The number of children initiated on IPT increased from 721 in 2013 to 3306 in 2016.The number of counties notifying cases increased from 26 in 2013 to 47 in 2016. Treatment completion was 78%, 87% and 82% for 2013, 2014 and 2015 respectively. Of the 1390 children who had completed the 6 month-course of IPT during the study period, 9%had no TB, 7% were not accessed while84% had no documentation of outcomes by the end of the follow up period of 24 months. Missed opportunities for initiation of IPT reduced from 90% (7109) in 2013 to 60% (4872) in 2016.Conclusion: IPT coverage and completion rates have improved from 721 in 2013 to 3306 in 2016 and 78% in 2013 to 82% in 2015 respectively. Despite this, Kenya is yet to meet the targets set by the World Health Organization (WHO). Sustainable measures need to be put in place to achieve the WHO targets

Spatial and temporal distribution of notified tuberculosis cases in Nairobi County, Kenya, between 2012 and 2016

Background: Tuberculosis (TB) is an infectious disease of major public health concern globally. The disease has showed space‐time variations across settings. Spatial temporal assessment can be used to understand the distribution and variations of TB disease.Objective: To determine the spatial and temporal distribution of notified TB cases in Nairobi County, Kenya, between 2012 and 2016Design: A cross sectional studySetting: Nairobi County, KenyaSubjects: Tuberculosis cases notified in Tuberculosis Information for Basic Units from 2012 to 2016Results: A total of 70,505 cases of TB were notified in Nairobi County between 2012 and 2016, with male to female ratio of 3:2 and HIV coinfection rate of 38%.The temporal analysis showed a declining trend of the notified cases. The spatial clusters showed stability in most areas while others varied annually during the study period. The space‐time analysis also detected the four most likely clusters or hotspots. Cluster 1 which covered the informal settlements of Kibera, Kawangware and Kangemi with 4,011observed cases against 2,977expected notified TB cases(relative risk (RR) 1.37, p<0.001). Further, Cluster 2 covered Starehe and parts of Kamukunji, Mathare, Makadara, Kibra and Dagoretti North Constituencies (RR 1.93, p<0.001; observed and expected cases were 4,206 and 2,242, respectively.Conclusion: This study identified high TB case notifications, declining temporal trends and clustering of TB cases in Nairobi. Evidence of clustering of TB cases indicates the need for focused interventions in the hotspot areas. Strategies should be devised for continuous TB surveillance and evidence based decision making