Malaria parasitemia among asymptomatic infants seen in a malaria endemic region of western Kenya

Background: Sustainable Development Goal number three call for complete reversal in the incidence of malaria by 2030. Malaria however remains a health priority in sub-Saharan Africa, with children under five experiencing the highest morbidity and mortality. In clinical settings, management of malaria cases has primarily been  centred on case definition, giving minimal consideration to the asymptomatic  individuals who remain a major reservoir since they do not seek care. In malaria endemic areas, infants are likely to remain asymptomatic since they have partial immunity acquired from the mother.Objective: To determine the proportion of infants with positive parasitemia and  describe their clinical and demographic characteristics.Design: A cross-sectional study.Setting: Webuye District Hospital, Western Kenya.Subjects: Three hundred and eighty four infants.Results: Prevalence of malaria parasitemia among enrolled infants was 61%. Infants born to housewife mothers, born to mothers who attended ANC during pregnancy; those weaned late or with family history of sickle cell disease were more likely tohave malaria parasitemia with p-values of 0.031,0.015,0.007, and 0.025  respectively.Conclusion: Prevalence of malaria parasitemia among asymptomatic infants in  Webuye (Western Kenya) remains high

Anti-Malarial Prescription Practices for Children with Negative Microscopy Results for Malaria Parasites Admitted at the Moi Teaching and Referral Hospital, Kenya

Background: The burden of malaria is declining globally including Kenya, however a high number of  patients continue to be treated for malaria in our set up. Adopting correct diagnosis and appropriate  treatment is cost effective, prevents resistance to anti-malarial and has been shown to save lives.Objective: To determine the clinicians’ anti-malarial prescription practices in the management of children with negative microscopy results.Design:A prospective observational study.Setting: General Paediatric wards of Moi Teaching and Referral Hospital, Kenya.Subjects:A total of 250 children, aged one month to forteen years, admitted with a negative microscopy results for malaria parasites were enrolled from December 2012 to June 2013.Main Outcomes: Anti-malarial prescription and duration of stay in hospital.Results: The median age of the participants was 19.5 months (IQR10, 36) with 150 (60%) being male.  Forty one (16%) of the participants had travelled to malaria endemic regions in the preceding four weeks while 30 (12%) had used anti-malarial prior to admission. Those treated with anti-malarial with negative microscopy results were 34 (13.6%). Increased sleepiness, history of headache and prior anti-malarial  use were independent clinical characteristics associated with treatment. The mean duration of hospital stay was 3.53 days for those on anti-malarial versus 3.75 days for those not treated (P =0.61). One participant died in the group not on anti-malarial.Conclusion: There was a substantial proportion of children treated for malaria with negative microscopy results. No difference was noted in duration of hospital stay in comparison with the group not treated with anti-malarial

Assessment of cold chain management practices in immunisation centres in Kacheliba division, Pokot County, Kenya

Background: Immunisation contributes significantly to the achievement of MDGs. It is one of the eight elements and success stories of primary health care. Proper utilisation of Immunisation services is associated with improved child health outcomes. The WHO targets Immunisation coverage of 90% for urban areas and 80% for rural areas.Objectives: To assess the cold chain management practices that could affect  potency of vaccines and its utilisation by under five year old children in Kacheliba Division.Design: A cross-sectional descriptive study.Setting: All health facilities in Kacheliba Division, Kenya.Subjects: Parents/guardians of under-five year old children and all the health facility level within Kacheliba Division.Results: Seven (87.5%) health facilities reported that they collect vaccines at intervals of more than one month. Four (50%) health institution were located 20 kilometers from the local vaccine store - Kacheliba District Hospital. Kacheliba District Hospital gets their vaccine stocks from Eldoret KEMSA depot, an estimated 90 kilometers away. Completely melted ice packs during transportation of vaccine were encountered only in one (12.5%) centre- Kacheliba mobile dispensary. Major source of power for the refrigerators was the gas (75%), and electricity (28.6%). During electricity power block out, the right temperature intervals were then generated using gas. It was found that all the eight health facilities did not have a stand by biomedical technician who maintains and repair refrigerators. Furthermore there was no budgetary allocation for the refrigerators maintenance and repair among all the health facilities. Problems related to cold chain were observed in all the eight facilities in Kacheliba Division. Inadequate air circulation was seen in seven (87.5%) facilities, water bottles were kept inside the cold boxes and fridges in three (37.5%) facilities, Food and drinks were kept in cold boxes and fridges in 4(50%) facilities and vaccines were not kept in proper compartment in three (37.5%) facilities.Conclusion: The cold chain management practices among health facilities in Kacheliba Division of Pokot County were not upto the standards set by the Kenya Extended Programmeme on Immunisation (KEPI)) Guidelines. Cold chain  management should be improved through continuous medical educational  programmemes and sufficient budgetary allocation

Malaria Parasitaemia among Febrile Children Infected with Human Immunodeficiency Virus in the Context of Prophylactic Cotrimoxazole as Standard of Care: A Cross- Sectional Survey in Western Kenya

Objective: To document the prevalence of malaria parasitaemia among the HIV infected febrile children in a malaria endemic area. Design: A cross-sectional study. Setting: An ambulatory paediatric HIV clinic in Western Kenya, between November 2011 and December 2012. Subjects: A total of 245 febrile HIV infected children aged less than 14 years attending the HIV clinic in the Webuye level IV hospital were included in the study. A systematic sampling method was used. Main outcomes: A blood sample was taken for malaria parasite testing. Presence or absence of malaria parasites was documented. Clinical and socio-demographic characteristics of the participants were also recorded. Results: A total of 245 participants were recruited mean age being 5.53 years. Malaria prevalence was 81.9%. Most participants (97%) were on cotrimoxazole prophylaxis. Some of the factors found to be positively associated with malaria parasitaemia were; male sex, care taker category (parent), WHO stage 3 and 4 of HIV disease, and a high absolute CD4 count. However, only the caretaker association was statistically significant. Conclusion: The frequency of malaria parasitaemia among febrile HIV infected children is still high regardless of the high cotrimoxazole prophylaxis uptake. It is also noted that there is a shift in the age group of fever among children toward the older age group. This implies that policies may need to be relooked at to include the older age group in the aggressive malaria prevention measures to avoid losing on the already made gains

Nutritional status of children admitted for diarrhoeal diseases in a referral hospital in western Kenya

Objectives: To determine the prevalence of malnutrition among children admitted with acute diarrhoea disease at Moi Teaching and Referral Hospital and to establish the effect of malnutrition on duration of hospital stay. Design: Prospective observational study. Setting: Paediatric wards of Moi Teaching and Referral Hospital, Eldoret, Kenya Subjects: A total of 191 children aged 6 and 59 months admitted with acute diarrhoea disease, without chronic co-morbidities or visible severe malnutrition, were systematically enrolled into the study between November 2011 and March 2012. Outcome Measures: Nutritional status based on WHO WHZ scores taken at admission and duration of hospital stay. Results:The mean age was 13.2 months with a male to female sex ratio of 1.16:1. Of all the children seen with acute diarrhoeal diseases, 43.9% had acute malnutrition ( Conclusion: Routine anthrometry including weight for height identifies more children with malnutrition in acute diarrhoeal diseases. Presence of malnutrition did not affect duration of hospital stay

Asthma control and factors associated with control among children attending clinics at a national referral hospital in western Kenya

Background: Asthma control is the extent to which the various manifestations of asthma have been reduced or removed by treatment. In developing countries including Kenya, many children continue to visit hospitals with acute symptoms of asthma, which is a pointer to poor control.Objectives: To determine the level of asthma control and factors associated with the observed control among children at a national referral hospital.Design: Cross-sectional studySetting: Moi Teaching and Referral Hospital, Eldoret, Kenya paediatric clinics.Subjects: A total of 166 asthmatic children aged 6-11 years and their parents/caretakers were enrolled between August 2016 and October 2017.Main Outcome: Level of control using childhood asthma control test (c-ACT)Results: The median age of enrolled children was 8.17 years with males being the majority, 94 (56.6%). Using c-ACT, 92 (55.4%, 95%CI: 47.52, 63.10) had well controlled asthma at baseline. At univariate analysis, having a medical insurance cover (p=0.034), dry season (p=0.036), and parental perception of asthma control (p=0.002) were significantly associated with good control of asthma. Acceptance that a child had asthma was associated with poor control of asthma, p=0.046. On multivariate logistic regression, a perception of a well-controlled child by the parent/caretaker correlated well with good control of asthma.Conclusion: About half of the children in this set up have good control of asthma with the observed status of control being affected by parental/caretaker perception on asthma

A novel use of high density SNP assays to optimize choice of different crossbred dairy cattle genotypes in smallholder systems in East Africa

We present use of SNP technologies to obtain for the first time, rapid, large-scale, in situ estimates of performance of crossbred cows in smallholder herds. Compared to historical approaches, our approach allowed optimum crossbreed choices to be determined more rapidly and without question about the relevance of the environment. High-density SNP assays were used to estimate breed composition for a monitored population comprising 1292 cows from 610 smallholder farms in Kenya. The achieved milk yields are much lower than generally assumed and lactation curves are very flat out to 400 days. In poor production environments, lower grade crosses (containing <60% exotic dairy alleles) had the same yield as high grade crosses. Allowing for the larger size and maintenance requirements of high grade exotics, lower grade exotics will be the most economically productive animals in these environments

Use of high density SNP genotypes to determine the breed composition of cross bred dairy cattle in smallholder farms: Assessment of reproductive and health performance

Reproductive performance and disease data were recorded for 2 years on 1,824 dairy cows in smallholder farms using participatory approaches and onfarm recording. Most animals experienced one service to conception. Calving intervals were long, ranging between 261 and 761 days, with an average of 451±101days. Herd level of production (HeL) had significant effect on calving interval. However, there was no difference between crossbreds with different levels of exotic breed percentage or in different HeL classes in disease incidence. Most animals had less than 2 treatment events, despite the high disease burden in the study areas. Mortality rates were low, ranging from 2.13% to 2.65%. Even though the crossbred animals had higher performance compared to indigenous animals, the gains obtained were below what would be possible with better management. These results suggest that crosses with low exotic proportions would be the most optimal for the production systems studied

Trends and determinants of stillbirth in developing countries: results from the Global Network\u27s Population-Based Birth Registry.

BACKGROUND: Stillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations\u27 Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries. METHODS: From a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births of which 12,181 were stillbirths. RESULTS: The mean stillbirth rates for the sites were 21.3 per 1000 births for Africa, 25.3 per 1000 births for India, 56.9 per 1000 births for Pakistan and 19.9 per 1000 births for Guatemala. From 2010 to 2016, across all sites, the mean stillbirth rate declined from 31.7 per 1000 births to 26.4 per 1000 births for an average annual decline of 3.0%. Risk factors for stillbirth were similar across the sites and included maternal age \u3c 20 years and age \u3e 35 years. Compared to parity 1-2, zero parity and parity \u3e 3 were both associated with increased stillbirth risk and compared to women with any prenatal care, women with no prenatal care had significantly increased risk of stillbirth in all sites. CONCLUSIONS: At the current rates of decline, stillbirth rates in these sites will not reach the Every Newborn Action Plan goal of 12 per 1000 births by 2030. More attention to the risk factors and treating the causes of stillbirths will be required to reach the Every Newborn Action Plan goal of stillbirth reduction. TRIAL REGISTRATION: NCT01073475