Prevalence of sepsis among neonates admitted to Kisii Level 5 Hospital

Introduction: Infections are the third commonest cause of death in the neonate, with the vast majority of deaths occurring in resource limited countries such as Kenya which has a neonatal mortality rate of 22 per 1000 live births according to the Kenya Demographic and Health Survey, 2014.Objectives: To determine the prevalence, pattern of bacterial causes and the economic and socio-demographic factors associated with sepsis in neonates admitted to Kisii Level 5 Hospital.Design: A descriptive cross- sectional study.Setting: Newborn Unit and Paediatric Wards of the Kisii Level 5 Hospital.Subjects: Eighty neonates admitted at Kisii Level 5 Newborn Unit and Paediatric wards.Methods: Out of a study population of 406, consecutive sampling was done until the sample size of 80 neonates with clinical definition of sepsis was achieved. Sepsis was defined as refusal to breastfeed, convulsions, lethargy, fast breathing, grunting, nasal flaring, severe lower chest wall in- drawing, fever ≥ 37.5°C or hypothermia <35.5°C, deep jaundice involving palms and soles of the feet, ten or more pustules, umbilical redness extending to the periumbilical skin, pus draining from the ear and central cyanosis. These neonates had blood taken for full blood count and culture with sensitivity.Results: The prevalence of clinical sepsis was 19.7% (95% CI 15.9- 23.9). Neonatal sepsis was significantly associated with maternal dysuria (p= 0.018). There were no significant associations between socio -demographic factors and neonatal sepsis.Conclusion: Neonatal sepsis contributes to a significant proportion of neonatal admissions to Kisii Level 5 Hospital

Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya

Poor breastfeeding practices are widely documented in Kenya, where only a third of children are exclusively breastfed for 6 months and only 2% in urban poor settings. This study aimed to better understand the factors that contribute to poor breastfeeding practices in two urban slums in Nairobi, Kenya. In-depth interviews (IDIs), focus group discussions (FGDs) and key informant interviews (KIIs) were conducted with women of childbearing age, community health workers, village elders and community leaders and other knowledgeable people in the community. A total of 19 IDIs, 10 FGDs and 11 KIIs were conducted, and were recorded and transcribed verbatim. Data were coded in NVIVO and analysed thematically. We found that there was general awareness regarding optimal breastfeeding practices, but the knowledge was not translated into practice, leading to suboptimal breastfeeding practices. A number of social and structural barriers to optimal breastfeeding were identified: (1) poverty, livelihood and living arrangements; (2) early and single motherhood; (3) poor social and professional support; (4) poor knowledge, myths and misconceptions; (5) HIV; and (6) unintended pregnancies. The most salient of the factors emerged as livelihoods, whereby women have to resume work shortly after delivery and work for long hours, leaving them unable to breastfeed optimally. Women in urban poor settings face an extremely complex situation with regard to breastfeeding due to multiple challenges and risk behaviours often dictated to them by their circumstances. Macro-level policies and interventions that consider the ecological setting are needed

NEONATAL SURVIVAL OF INFANTS LESS THAN 2000 GRAMS BORN AT KENYATTA NATIONAL HOSPITAL

Background: Survival of patients is regularly used as a measure of the level and appropriatenessof medical care provided by institutions. Newborn services have been evaluated in thismanner since the 1960s. Though Kenyatta National Hospital has provided neonatal servicesfor over 25 years, no survival data for the low birth weight infants has been published since1978.Objective: To determine the birthweight specific neonatal survival of infants born weighingless than 2000 grams at Kenyatta National Hospital.Design: A cross sectional survey.Setting: Newborn Unit, Kenyatta National Hospital, Nairobi.Main outcome measures: The proportion of infants surviving the first 28 days of life groupedin the following birthweight categories; below 1000 grams (extremely low birthweight), 1000- 1499 grams (very low birthweight) and 1500 - 1999 grams (low birthweight).Results: The overall neonatal survival of 163 infants born below 2000 grams was 62.6%. Noneof the 23 infants born less than 1000 grams survived the neonatal period. Bigger infants faredmuch better with 68% (n=73) of the 1000 - 1499 and 78% (n=67) of the 1500-1999 gram groupssurviving. Survival based on gestational age was also determined. Sixty nine per cent of infantsborn between 32 and 35 weeks survived while only 27% and 9% of the 28 - 31 weeks and thoseless than 28 weeks survived respectively. When the patients were analysed for age at death, itwas found that over 28% of the deaths occurred within the first day and by the seventh day,more than 70% had died. Less than 30% of the deaths occurred after the first week. Thecommonest clinical syndromes seen were infection (41%) and respiratory distress (43%).Conclusion: Neonatal survival rates of low birthweight infants are still much lower thanthose observed in developed countries as far back as the early 1970’s. The big proportion ofdeaths occurring during the first week, and in particular the first day, is due to lack ofneonatal intensive care facilities and inadequate obstetric services

Potential effectiveness of Community Health Strategy to promote exclusive breastfeeding in urban poor settings in Nairobi, Kenya: a quasi-experimental study

Early nutrition is critical for later health and sustainable development. We determined potential effectiveness of the Kenyan Community Health Strategy in promoting exclusive breastfeeding (EBF) in urban poor settings in Nairobi, Kenya. We used a quasi-experimental study design, based on three studies [Pre-intervention (2007–2011; n=5824), Intervention (2012–2015; n=1110) and Comparison (2012–2014; n=487)], which followed mother–child pairs longitudinally to establish EBF rates from 0 to 6 months. The Maternal, Infant and Young Child Nutrition (MIYCN) study was a cluster randomized trial; the control arm (MIYCN-Control) received standard care involving community health workers (CHWs) visits for counselling on antenatal and postnatal care. The intervention arm (MIYCN-Intervention) received standard care and regular MIYCN counselling by trained CHWs. Both groups received MIYCN information materials. We tested differences in EBF rates from 0 to 6 months among four study groups (Pre-intervention, MIYCN-Intervention, MIYCN-Control and Comparison) using a ?2 test and logistic regression. At 6 months, the prevalence of EBF was 2% in the Pre-intervention group compared with 55% in the MIYCN-Intervention group, 55% in the MIYCN-Control group and 3% in the Comparison group (P<0.05). After adjusting for baseline characteristics, the odds ratio for EBF from birth to 6 months was 66.9 (95% CI 45.4–96.4), 84.3 (95% CI 40.7–174.6) and 3.9 (95% CI 1.8–8.4) for the MIYCN-Intervention, MIYCN-Control and Comparison group, respectively, compared with the Pre-intervention group. There is potential effectiveness of the Kenya national Community Health Strategy in promoting EBF in urban poor settings where health care access is limited