Acceptability of HIV Testing and Counseling Services among Persons Visiting a Funeral Home in a Regional Referral Hospital in Western Kenya, 2014-2015

Funeral homes in health facilities are accessed by persons who may not visit other parts of the hospital to access HTC services. Between November 2014 and February 2015, all persons visiting the Jaramogi Oginga Odinga Teaching and Referral Hospital funeral home were offered HTC and grief counseling services and interviewed to determine the acceptability of HTC services at this location. This was done as they waited for various services. ‘Acceptability’ was defined as the proportion of those who felt people should receive HTC services at the funeral home. Qualitative data was manually coded and thematically analyzed. Of 609 persons interviewed, majority were aged 25-34 years (33%), female (54%), married (68%), of primary level education (39%), self-employed (49%) and were not related to the deceased (53%). Majority had come to collect/bring the body of the deceased (63%) and had undergone prior testing (91%). A minority (2%) who found HTC services unacceptable were aged 18-24 years (42%), single (50%), of tertiary level education (58%), came to collect/bring the bodies of their deceased (83%), had ever been tested (92%) and were self-employed (33%) or unemployed (33%). Respondents stated that this was because, “….the bereaved not in the right frame of mind” (76%) and “…the HTC service-providers were very conspicuous” (26%). Acceptability did not differ by age-group, gender or relationship to the deceased. Of the 569 (93%) who were tested, 42 (7%) were first-time testers; HIV prevalence was 3% and 5% respectively. Funeral homes provide acceptable avenues for increasing access to knowledge of HIV status which could have a substantial impact on the HIV epidemic

High prevalence of multi-drug resistant Klebsiella pneumoniae in a tertiary teaching hospital in western Kenya

Introduction: Klebsiella pneumoniae is a gram negative enterobacteriaciae commonly associated with nosocomial infections. Multidrug resistant strains are increasingly being reported with corresponding increase in morbidity and mortality. The study outlines the epidemiology and antibiotic resistance pattern of K. pneumonia over a 10 year period in Moi Teaching and Referral Hospital, Eldoret, Kenya.Methodology and Study Design: This is a retrospective analysis of all the blood culture results for K. pneumoniae isolates in the hospital for the period 2002-2013.Results: K. pneumoniae accounted for 23% of the hospital isolates (231/1356) during the study period; of these, 82.6% were from the New Born Unit. Most of the isolates were multi drug resistant with highest resistance of over 80% to Penicillins, Cephalosporins, Macrolides, Tetracyclines, Sulphonamides, Lincosamides and Chloramphenicol. Aminoglycoside and Quinolone resistance was also high at 49.2% and 41.3% respectively. The lowest resistance rates were documented for Carbapenems (23.2%). For specific antibiotics, there was high resistance to commonly used antibiotics (over 80% for Ceftriaxone, Cefipime, Gentamycin and Ceftazidime). The antibiotics with least resistance were Amikacin and Meropenem (21% and 7 % respectively).Conclusion: There was a high prevalence of multidrug resistant K. pneumoniae isolates in the hospital, the majority originated from the New Born Unit. Resistance to third generation Cephalosporins and Gentamycin was high while Meropenem and Amikacin had the least resistance.Keywords: Klebsiella pneumoniae; Antibiotic resistance; Multi drug resistance; Nosocomial infection

HIGH PREVALENCE OF MULTI-DRUG RESISTANT KLEBSIELLA PNEUMONIAE IN A TERTIARY TEACHING HOSPITAL IN WESTERN KENYA

Introduction: Klebsiella pneumoniae is a gram negative enterobacteriaciae commonly associated with nosocomial infections. Multidrug resistant strains are increasingly being reported with corresponding increase in morbidity and mortality. The study outlines the epidemiology and antibiotic resistance pattern of K. pneumonia over a 10 year period in Moi Teaching and Referral Hospital, Eldoret, Kenya. Methodology and Study Design: This is a retrospective analysis of all the blood culture results for K. pneumoniae isolates in the hospital for the period 2002-2013. Results: K. pneumoniae accounted for 23% of the hospital isolates (231/1356) during the study period; of these, 82.6% were from the New Born Unit. Most of the isolates were multi drug resistant with highest resistance of over 80% to Penicillins, Cephalosporins, Macrolides, Tetracyclines, Sulphonamides, Lincosamides and Chloramphenicol. Aminoglycoside and Quinolone resistance was also high at 49.2% and 41.3% respectively. The lowest resistance rates were documented for Carbapenems (23.2%). For specific antibiotics, there was high resistance to commonly used antibiotics (over 80% for Ceftriaxone, Cefipime, Gentamycin and Ceftazidime). The antibiotics with least resistance were Amikacin and Meropenem (21% and 7 % respectively). Conclusion: There was a high prevalence of multidrug resistant K. pneumoniae isolates in the hospital, the majority originated from the New Born Unit. Resistance to third generation Cephalosporins and Gentamycin was high while Meropenem and Amikacin had the least resistance

Trends and factors associated with illicit drug use in South Africa:Findings from multiple national population-based household surveys, 2002-2017

Background:Illicit drug use results in considerable global morbidity, but there is little data on its trends and factors associated with it in sub-Saharan Africa. We consider these questions using national data from South Africa for 2002-2017.Methods:We analysed data among individuals aged 15 years or older from five national population-based household surveys in South Africa (2002-2017;n=89,113). Recent drug use was defined as the last three-months use of illicit drugs, i.e., any use of cannabis, cocaine, amphetamine, inhalants, sedatives, hallucinogens, opioids, and/or other illicit drugs. Time trends in recent drug use were assessed using logistic regression. Multivariable logistic regression assessed the association between recent drug use and socio-demographic factors and between drug use and sexual risk behaviours, HIV-related and other well-being variables. Results: The prevalence of recent drug use increased from 1·5% to 10·0% from 2002-2017, driven by increases in cannabis use (1·5% to 7·8%) and use of opioids (0·01% to 1·6%), cocaine (0·02% to 1·8%), or amphetamines (0·1% to 1·5%). In adjusted analyses, male gender, younger age, living in urban areas, mixed-ancestry or white ethnicity (compared to black-African), and unemployment were positively associated with recent drug use. Recent drug use was associated with: multiple sexual partners (adjusted odds ratio [aOR] 2·13, 95% confidence interval [CI]: 1·80-2·51); sexual debut before 15 years old (aOR 1·70, 95%CI: 1·29-2·23); hazardous/harmful alcohol use (aOR 2·50, 95%CI: 2·14-2·93) or alcohol dependence (aOR 3·33, 95%CI 2·92-3·80); ever experiencing intimate partner violence (aOR 1·56, 95%CI 1·12-2·17); psychological distress (aOR 1·53, 95%CI: 1·28-1·82); and lower chance of ever testing for HIV (aOR 0·89, 95%CI 0·80-1·00). Recent drug use was not associated with HIV positivity, condom use or being on antiretroviral therapy. Conclusion:Illicit drug use has increased substantially in South Africa and is associated with numerous socio-demographic characteristics, higher sexual risk behaviours and other well-being variables