Exposure of Kenyan population to aflatoxins in foods with special reference to Nandi and Makueni counties

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Impact of COVID-19 on medical education: Introducinghomo digitalis

Purpose To determine how members of the Societe Internationale d'Urologie (SIU) are continuing their education in the time of COVID-19. Methods A survey was disseminated amongst SIU members worldwide by email. Results were analyzed to examine the influence of age, practice region and settings on continuing medical education (CME) of the respondents. Results In total, 2494 respondents completed the survey. Internet searching was the most common method of CME (76%; allps = 2 platforms, with approximately 10% of the respondents using up to 5 different platforms. Urologists < 40 years old were more likely to use online literature (69%), podcasts/AV media (38%), online CME courses/webinars (40%), and social media (39%). There were regional variations in the CME modality used but no significant difference in the number of methods by region. There was no significant difference in responses between urologists in academic/public hospitals or private practice. Conclusion During COVID-19, urologists have used web-based learning for their CME. Internet learning and literature were the top frequently cited learning methods. Younger urologists are more likely to use all forms of digital learning methods, while older urologists prefer fewer methods

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from −90% to +30%, were reported in many countries following early COVID-19 pandemic response measures (‘lockdowns’). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95–0.98, P value <0.0001), second (0.96, 0.92–0.99, 0.03) and third (0.97, 0.94–1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96–1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88–1.14, 0.98), third (0.99, 0.88–1.12, 0.89) and fourth (1.01, 0.87–1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02–1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03–1.15, 0.002), third (1.10, 1.03–1.17, 0.003) and fourth (1.12, 1.05–1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways

Adherence to Pneumonia Guidelines for Children 2 – 59 Months at Garrisa Provincial General Hospital

Background: Clinical Practice Guidelines for childhood illnesses including pneumonia in Kenya are contained in the Ministry of Health Basic Paediatric Protocols. In the presence of a cough and/ or difficulty in breathing and increased respiratory rate for age, pneumonia is diagnosed. In addition to these the presence of lower chest wall indrawing denotes severe pneumonia; The presence of cyanosis, inability to drink/ breastfeed, grunting, level of consciousness using the AVPU scale less than A in addition to the aforementioned is classified as very severe pneumonia. Recommended management is intravascular Crystalline penicillin, gentamycin and oxygen for severe pneumonia, intravascular crystalline penicillin for severe pneumonia and oral amoxyl or cotrimaxole for pneumonia. These guidelines have been disseminated through the Emergency Triage And Treatment Plus (ETAT +) courses held since 2007. Implementation of guidelines into care has been shown to reduce case fatality from pneumonia by 36%. Objectives: To evaluate the level of adherence and factors affecting adherence to the National guidelines on management of pneumonia in children aged two to fifty nine months at Garissa provincial General Hospital, Kenya. Design: Retrospective hospital based cross sectional study. Setting: Paediatric Department of Garissa Provincial General Hospital (PGH) in Kenya. Subjects: Hospital medical records of children aged two to fifty nine months diagnosed with pneumonia between January and June 2012 were reviewed. Data abstracted from the records included demographic information, recorded clinical signs and symptoms, disease classification and treatment. Results: Records of 91 children were reviewed. Their median age was 12 months (IQR 6 – 18 months). There were more boys than girls with a male to female ratio of 1.25:1. Forty-eight of the participants (52.8%) had severe pneumonia. Guideline adherence was assessed at three levels; assessment of clinical signs and symptoms reflected by their recording, correct disease severity classification and correct treatment prescribed. There were a minimum of two and a maximum of six clinical sign and symptoms recorded. The average level of adherence was 42.9% (SD ±17.3).Documented correct classification of disease severity was 56.6% and recommended treatment of pneumonia was 27.7%. The presence of a co-morbidity and severe disease was associated with better adherence to the assessment tasks (p = 0.033 and p = 0.021 respectively). Disease severity was associated with better adherence to the disease classification task (p = &lt;0.001) and treatment task (p = 0.02). Conclusion: Adherence to guidelines was low at all assessed levels. Overall, disease severity was associated with better guideline adherence. Presence of co-morbidities improved disease assessment

Adherence to the basic paediatric protocol on administration of fluids, feeds and antibiotics to neonates at a County Hospital in Kenya

Objective: The objective of the study was to determine the level of adherence to the Basic Paediatric Protocol on administration of fluids, feeds and antibiotics to neonates admitted in a county hospital’s newborn unit (NBU). Design: Descriptive cross-sectional study using secondary data Setting: A County Hospital Newborn Unit (NBU), Kenya Subjects: In-patient records of two hundred and thirty-eight neonates admitted in the newborn unit between January and June 2019. Outcome Measures: Level of adherence to the basic paediatric protocol guidelines on administration of fluids, feeds and antibiotics. Results: The overall level of adherence to the protocol on fluid administration over the first seven days was 20.6%. A marked difference in management between the first and subsequent days of fluid administration was noted. Up to 71% of neonates received Sodium and Potassium supplementation from the second day of life as per the protocol. Level of adherence to the protocol on feeds administration was 6.9%. On antibiotic administration, penicillin was appropriately given according to the protocol in 56% of the neonates and gentamicin in 57% of neonates. Conclusion: Level of adherence to the protocol on the use of fluids, feeds and antibiotics was low and hence there was a significant gap in management of the neonates with regards to nutrition, fluids and antibiotic administration

Prevalence of aflatoxin contamination in cereals from Nandi County, Kenya

Aflatoxins are secondary fungal metabolites that contaminate cereals, other crops and animal source foods and are a recognized health risk. Kenya has had several outbreaks of aflatoxicosis affecting humans and pets. The aim of this study was to compare aflatoxin levels in cereals, the staple diet of Kenyans, in Nandi where aflatoxicosis has not been reported despite being a maize growing area. Maize, sorghum and millet were sampled from households and also from markets serving various villages in the selected sub-locations (408 samples). The samples were tested for total aflatoxin contamination using cELISA. Households in the study sub-locations depended on homegrown grains than market sourced. Sixty seven point nine percent (72/106), 73.3% (44/60) and 65.7% (67/102) of maize samples collected from Laboret, Kilibwoni and Chepkongony were contaminated with aflatoxins ranging between 0.17-5.3 parts per billion (ppb). Ninety two point nine percent (13/14), 100% (9/9) and 87.5% (14/16) of millet samples from Laboret, Kilibwoni and Chepkongony were positive for aflatoxin at a range of 0.14-6.4 ppb. Fifty percent (9/18), 36.4% (8/22) and 27.3% (6/22) of sorghum samples from Laboret, Kilibwoni and Chepkongony, respectively were contaminated with aflatoxins beyond Kenya Bureau of Standards (KEBS) maximum tolerable limits of 10 ppb. To manage aflatoxin contamination of the cereals in Nandi, the county government needs to step up awareness creation of the dangers posed by chronic aflatoxin exposure to households through cereals and promote good Agricultural practices

Re-admission rate and its associated factors in a county hospital in Kenya

Objective: To assess the re-admission rate and its associated factors in the paediatric ward at Thika level five hospital. Design: A descriptive cross-sectional study. Setting: Secondary level hospital in sub-Saharan Africa. Subjects: A total of 803 children aged 13 years and below admitted between March and June 2019. Outcome measures: Re-admission of a patient within 30 days of the index admission. Results: The study found a re-admission of rate 10.2%. Among the readmitted patients 26.83% had a comorbidity and 29.26% had been given incorrect drug dosages during their first admission. A greater proportion (63.4%) of the readmitted patients had the same diagnosis with the index admission with pneumonia, gastroenteritis and meningitis ranking top in the list. A larger percentage of the readmitted children were discharged (83.5%), 8.9% were referred and 7.6% died. Multivariate analysis identified strong associations of hospital re-admission with the length of hospital stay during the index admission, the qualification of the health practitioner who initially discharged the patient and whether the correct drug dosages were administered during the index hospital stay. Conclusion: About a tenth of discharged children were readmitted within 30 days of discharge. Pneumonia was the commonest condition at admission and re-admission. The hospital factors associated with re-admission included length of hospital stay, level of training of the health care worker who discharged the patient as well as having received incorrect drug dosage during the first admission. There were no significant patient factors