Factors associated with rota virus diarrhea in the post vaccine period as seen at Moi Teaching and Referral Hospital, Kenya

Objectives: To describe the prevalence and factors associated with rotavirus diarrhea in the post vaccine era.Design: Cross-sectional study.Setting: Moi Teaching and referral Hospital, Pediatric Emergency Department.Participants: Children ≤2 years with acute diarrhea illness. Data was collected onto an interviewer administered questionnaire and a Certest® rapid rotavirus stool antigen test done.Main outcome measures: Socio-demographic and clinical characteristics including: Age, Gender, Rotavirus antigen test results, level of dehydration and anthropometric measurements.Results: 311 participants with acute diarrhea were recruited, with 55.6% (173/311) being rotavirus positive. On bivariate analysis, age appropriate completion of routine vaccination (p=0.030), two doses of rotavirus vaccination (p=0.005) and nutrition status (p=0.009) were associated with a positive rotavirus test. On logistic regression, mild wasting (OR 2.581; CI 95% 1.068-6.236;p=0.035) and moderate wasting (OR 3.424; CI 95% 1.221-9.604;p=0.019) were associated with rotavirus positive diarrhea. Receiving two rotavirus vaccines (OR 0.151; CI 95% 0.032-0.709;p=0.017) and age appropriate completion of routine vaccination (OR 0.478; CI 95% 0.256-0.892;p=0.003) was protective. The peak rotavirus prevalence was during the dry season. Receiving one rotavirus vaccine, severe malnutrition and socio-demographic characteristics e.g. age, the child’s primary caregiver, overcrowding were not statistically significant. Although majority of the children with rotavirus positive diarrhea had non-severe dehydration (63%, 109/173) this was also not significant (OR 1.066; CI 95% 0.6695- 1.699;p=0.786).Conclusion: Prevalence of Rotavirus diarrhea is still high among the under twos in our set up. Two rotavirus vaccines are needed for full protection. Advocacy and public health interventions should intensify to improve the vaccine coverag

Quantitative Analysis of Total Phenolic Content in Avocado (Persia Americana) Seeds in Eastern Province of Kenya

Phytochemical rich plants have played a significant role in diet based therapies to prevent and cure various ailments. The avocado (Persia Americana Mill,) fruits are much sought after for their high nutritional and sensory value. Avocado (Persia Americana) seeds were analysed for total phenolic content. This phenolic component is responsible for antioxidant activity. The amount of phenols was analysed using Folin-Ciocalteu method. The maximum phenolic content was found in the Fuerte seed extract (18.55 ± 2.8 mg/g) prepared at 50ºC. The phenolic content decreased by 10.3% at an extraction temperature of 50 °C to 70 °C and 32.1% at an extraction temperature of 50 °C to 100 °C for a duration of 30 minutes. Keywords: Avocado seeds, Persia Americana, Total phenolic

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

Morbidity and mortality in HIV - infected children admitted at Moi Teaching and Referral Hospital in Western Kenya

Background: HIV-infected children are at higher risk of opportunistic infections that could result in hospitalisation. The outcomes of hospitalisation are variable and depend on the admission diagnosis, the patients’ immune status and whether or not the patient is on anti-retroviral drugs.Objective: To describe the characteristics and causes of hospitalisation and mortality for HIV infected children admitted to Moi Teaching and Referral hospital in western Kenya.Design: a retrospective study of prospectively collected data.Setting: The paediatric wards of Moi Teaching and Referral Hospital (MTRH). A Kenyan National Referral Hospital.Subjects: HIV-infected children admitted the paediatric wards.Interventions: Treatment with combination anti-retroviral therapy (cART), treatment of common opportunistic infections.Main outcome measures: Demographic and clinical data, including diagnosis, immune status, and treatment with combination anti-retroviral therapy (cART), were extracted from hospital admission records of HIV-infected children registered with the USAIDAcademic Model Providing Access to Healthcare (AMPATH) partnership. We conducted descriptive statistical analyses and used chi-square and fisher’s exact tests to assess for associations between categorical variables and each of the independent variables.Results: Between December 2006 and May 2009, 396 HIV-infected children were admitted to MTRH. Median age at admission was 2.0 years (range 0-15); 236 (59%) were male; 36 (15%) of available 236 orphan status entries were orphaned; 198 (73%) were in CDC categories B and C and 61 (16%) of available 386 had been on ART. Among 108 patients with documented immunologic status, the mean CD4 cell percentage was 16% (SD 10.8). Among the 396 children, 104 (15%) were diagnosed with pneumonia, 92 (14%) with gastroenteritis, 36 (9%) with tuberculosis and 37 (9%) with malaria. Deaths occurred in 28(7%) of the patients. The median duration of hospitalisation was seven days (range 1- 516) for discharged patients and six days (range 0-72) for those who died. A significantly higher percentage of the children who were not previously enrolled in AMPATH died, signifying 14 (15%) mortality among this population of admitted patients, p = 0.0017. Of those who died, (17%) were diagnosed with pneumonia and 22 (79%) of them were not on cART.Conclusion: The common diagnoses at hospitalisation included pneumonia, gastroenteritis, malaria and tuberculosis. Higher mortality occurred among those diagnosed with pneumonia and those not previously enrolled in the HIV care programme. Aggressive treatment and prevention of the most prevalent diseases and early enrollment into HIV care are recommended for HIV-infected children. A follow-up study to investigate the pathological causes of death in this population is recommended

Time to First-Line ART Failure and Time to Second-Line ART Switch in the IeDEA Pediatric Cohort

BACKGROUND: Globally, 49% of the estimated 1.8 million children living with HIV are accessing antiretroviral therapy (ART). There are limited data concerning long-term durability of first-line ART regimens and time to transition to second-line. METHODS: Children initiating their first ART regimen between 2 and 14 years of age and enrolled in one of 208 sites in 30 Asia-Pacific and African countries participating in the Pediatric International Epidemiology Databases to Evaluate AIDS consortium were included in this analysis. Outcomes of interest were: first-line ART failure (clinical, immunologic, or virologic), change to second-line, and attrition (death or loss to program ). Cumulative incidence was computed for first-line failure and second-line initiation, with attrition as a competing event. RESULTS: In 27,031 children, median age at ART initiation was 6.7 years. Median baseline CD4% for children ≤5 years of age was 13.2% and CD4 count for those >5 years was 258 cells per microliter. Almost all (94.4%) initiated a nonnucleoside reverse transcriptase inhibitor; 5.3% a protease inhibitor, and 0.3% a triple nucleoside reverse transcriptase inhibitor-based regimen. At 1 year, 7.7% had failed and 14.4% had experienced attrition; by 5 years, the cumulative incidence was 25.9% and 29.4%, respectively. At 1 year after ART failure, 13.7% had transitioned to second-line and 11.2% had experienced attrition; by 5 years, the cumulative incidence was 31.6% and 25.9%, respectively. CONCLUSIONS: High rates of first-line failure and attrition were identified in children within 5 years after ART initiation. Of children meeting failure criteria, only one-third were transitioned to second-line ART within 5 years

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

Immunization in pregnancy clinical research in low- and middle-income countries - Study design, regulatory and safety considerations.

Immunization of pregnant women is a promising public health strategy to reduce morbidity and mortality among both the mothers and their infants. Establishing safety and efficacy of vaccines generally uses a hybrid design between a conventional interventional study and an observational study that requires enrolling thousands of study participants to detect an unknown number of uncommon events. Historically, enrollment of pregnant women in clinical research studies encountered many barriers based on risk aversion, lack of knowledge, and regulatory ambiguity. Conducting research enrolling pregnant women in low- and middle-income countries can have additional factors to address such as limited availability of baseline epidemiologic data on disease burden and maternal and neonatal outcomes during and after pregnancy; challenges in recruiting and retaining pregnant women in research studies, variability in applying and interpreting assessment methods, and variability in locally acceptable and available infrastructure. Some measures to address these challenges include adjustment of study design, tailoring recruitment, consent process, retention strategies, operational and logistical processes, and the use of definitions and data collection methods that will align with efforts globally

Community based weighing of newborns and use of mobile phones by village elders in rural settings in Kenya: a decentralised approach to health care provision

<p>Abstract</p> <p>Background</p> <p>Identifying every pregnancy, regardless of home or health facility delivery, is crucial to accurately estimating maternal and neonatal mortality. Furthermore, obtaining birth weights and other anthropometric measurements in rural settings in resource limited countries is a difficult challenge. Unfortunately for the majority of infants born outside of a health care facility, pregnancies are often not recorded and birth weights are not accurately known. Data from the initial 6 months of the Maternal and Neonatal Health (MNH) Registry Study of the Global Network for Women and Children's Health study area in Kenya revealed that up to 70% of newborns did not have exact weights measured and recorded by the end of the first week of life; nearly all of these infants were born outside health facilities.</p> <p>Methods</p> <p>To more completely obtain accurate birth weights for all infants, regardless of delivery site, village elders were engaged to assist in case finding for pregnancies and births. All elders were provided with weighing scales and mobile phones as tools to assist in subject enrollment and data recording. Subjects were instructed to bring the newborn infant to the home of the elder as soon as possible after birth for weight measurement.</p> <p>The proportion of pregnancies identified before delivery and the proportion of births with weights measured were compared before and after provision of weighing scales and mobile phones to village elders. Primary outcomes were the percent of infants with a measured birth weight (recorded within 7 days of birth) and the percent of women enrolled before delivery.</p> <p>Results</p> <p>The recorded birth weight increased from 43 ± 5.7% to 97 ± 1.1. The birth weight distributions between infants born and weighed in a health facility and those born at home and weighed by village elders were similar. In addition, a significant increase in the percent of subjects enrolled before delivery was found.</p> <p>Conclusions</p> <p>Pregnancy case finding and acquisition of birth weight information can be successfully shifted to the community level.</p