Determinants of material mortality among women of reproductive age attending Kissi General Hospital, Kissi Central District, Kenya (January 2009 - June 2010)

Objective: To describe the causes and determinants of maternal mortality among women of reproductive age seeking healthcare services at Kisii General Hospital.Design: Descriptive retrospective study.Setting: Kisii General Hospital which is a Level-5 Referral Hospital.Subjects: Seventy-two women who had died as a result of pregnancy and childbirth related conditions who had sought obstetric services at Kisii General Hospital.Results: Majority 51 (70.8%) of deceased did not go to hospital promptly, due to; lack of transport 22 (30.6%), lack of money 17 (23.6%), and hospital distance 8 (11.1%). About 43 (60%) of those who died were between 15-25 years of age. Hospital experiences included; delay in service provision by staff 14 (19.4%), unavailability of blood for transfusion 6 (8.3%), and lack of money for drugs 12 (16.7%). Complications which led to maternal mortality were mainly; postpartum sepsis, bleeding, hypertension and cardiovascular conditions.Conclusion: Lack of lack of transport, inability to pay, delayed care seeking and lack of emergency obstetrics were the major challenges. Postpartum sepses, bleeding and pre-eclampsia were the leading complications that led to death

Residential Mortgage Default Risk and Market Returns of Public Mortgage Originator Firms in Kenya

The mortgage market plays a vital role in the development of the real estate sector. The mortgage industry in Kenya has experienced tremendous growth since the year 2000. Despite this growth, Kenya’s mortgage debt to GDP ratio is still relatively low when compared to other economies like South Africa. Default risk has been revealed as one of the risks that significantly impacts on the profitability of mortgagees. However, literature is inconclusive with reference to the relationship between default risk and the market returns of mortgage firms. Consequently, this study sought to determine the extent to which residential mortgage default risk influences the market returns of publicly listed mortgage firms in Kenya. Default risk in this case was measured using the non-performing loans ratio: the ratio of non-performing residential mortgage loans to total residential mortgage loans and advances. The study adopted descriptive and quantitative forms of research design. A census was conducted on the eleven NSE listed mortgage originating firms. A panel data regression model was utilized to draw inference from the secondary data collected. Descriptive statistical findings revealed a mean of 0.0796 with a standard deviation of 0.04219 for residential mortgage default risk. Inferential statistics revealed an R square value of 0.2794 between residential mortgage default risk and market returns of publicly listed mortgage originators. In addition, there was significant effect between default risk and the market returns of public mortgage originators. Consequently, mortgagees should develop strategies of reducing nonperforming loans. For instance, mortgage firms can improve their credit rating systems

A retrospective evaluation of proficiency testing, and rapid HIV test kits stock-outs among HTC facilities within Nairobi county

Background: Proficiency testing (PT) has been implemented as a form of External Quality Assurance (EQA) by the National HIV Reference Laboratory in Kenya since 2007 in order to monitor and improve on the quality of HIV testing and counselling HTC services.Objective: To compare concordance between National HIV Reference laboratory, and HIV testing and counseling (HTC) facilities.Design: A telephone survey was conducted to access consistencies in PT schemes. An independent EQA assessment questionnaire was developed and pretested on a randomly chosen sample of HTC facilities.Setting: HTC facilities selected from Client-initiated HTC and Provider initiated HTC facilities, within Nairobi County.Subjects: The HTC facilities were randomly selected (n = 45).Results: Inconsistencies and tremendous increase in non-participation in PT schemes. Gender χ² (5, N = 45) = 13.83; p= .017, experience using rapid test kits χ² (5, N =45) = 5.417; p = .020, and current facility ever participating in any PT scheme χ² (5, N = 45) = 15.38, p= .009, had significant effects in participation in PT schemes. Some facilities experienced test kits stock-outs most of the time (2.552 ≥ 3.777), while others sometimes (1.326 ≥ 2.551), t (43) =3.105; p= 0.003. However, there was no link between non participation in PT schemes and test kits stock-outs.Conclusion: The results generated by the study revealed inconsistencies in PT schemes and Test Kits stock-outs from 2012 up to May 2014. These findings will assist in the full adoption of HTC policy guidelines and ensure each and every HTC personnel participate in all PT quarters consistently. Challenges in forecasting, and quantification remains a major barrier to HTC supplies

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

The prevalence of TEM and SHV genes among Extended-Spectrum Beta-Lactamase-producing Klebsiella pneumoniae and Escherichia coli

Background: Antimicrobial resistance to cephalosporin, penicillin and aztreonam is mediated by Extended-Spectrum Beta-Lactamases (ESBL) via hydrolysis of antibiotics. The most common bacteria associated with ESBL among the Enterobacteriaceae are Escherichia coli and Klebsiella pneumonia. Pathogenic Escherichia coli is associated with diarrhoea affecting mostly elderly, children under five years and the immunocompromised. There are a number of antibiotic regimens for treatment among them cephalosporins. There is reported increase in microbial resistance to cephalosporin use and the resistance is mediated by either TEM or SHV genes. Objective: To investigate the prevalence of ESBL-producing E. coli and Klebsiella pneumonia from patients presenting with diarrhea in Machakos District Hospital, Kenya. Methods: Bacterial isolates were identified to species level by biochemical methods and tested for sensitivity to twelve different antibiotics including cephalosporins, aminoglycosides and quinolones. Those resistant to cephalosporins with a zone diameter of ≤20 mm were tested phenotypically for Extended Spectrum Beta Lactamase (ESBL) phantom development and confirmed by MicroScan. Resistant strains to cephalosporin were further tested for presence and frequency of TEM and SHV genes. Results: Out of the 200 K. pneumonia and 100 E.coli tested, 18 (6%) were positive for ESBL production phenotypically. These 18 (100 %) isolates demonstrated phantom phenomena phenotypically. Eight (4%) and 2 (1%) of the 200 K. pneumonia isolates had TEM and SHV resistant genes, respectively. There were 5 (5%) TEM and 3 (3%) SHV detected from 100 E. coli isolates. The 18 phenotypically detected and E-test-positive strains (10 Klebsiella spp. and 8 E. coli) were retested with VITEK (GNS-532 card), and 17 of these strains (94.4%) were subsequently found to be ESBL positive. One strain (5.6%) tested ESBL negative by VITEK. The cefotaxime ESBL strip detected the presence of ESBL activity in these 18 phenotypically-positive strains. Discussion: The detection of ESBL-producing E. coli and Klebsiella isolates from Machakos District Hospital was 6%. The findings point out the need for continuous surveillance to determine prevalence of ESBL-producing Enterobacteria strains for better management of diarrheal illness. Key words: Extended spectrum Beta Lactamases; Cephalosporin resistance genes; Enterobacteriacea

Trypanocidal drugs: mechanisms, resistance and new targets.

The protozoan parasites Trypanosoma brucei and Trypanosoma cruzi are the causative agents of African trypanosomiasis and Chagas disease, respectively. These are debilitating infections that exert a considerable health burden on some of the poorest people on the planet. Treatment of trypanosome infections is dependent on a small number of drugs that have limited efficacy and can cause severe side effects. Here, we review the properties of these drugs and describe new findings on their modes of action and the mechanisms by which resistance can arise. We further outline how a greater understanding of parasite biology is being exploited in the search for novel chemotherapeutic agents. This effort is being facilitated by new research networks that involve academic and biotechnology/pharmaceutical organisations, supported by public-private partnerships, and are bringing a new dynamism and purpose to the search for trypanocidal agents

Predictors of maternal mortality among women of reproductive age seeking health care services at Kisii Level 5 Hospital

Background: The safe motherhood initiative was launched in 1987 as a flagship to set a base to reduce maternal mortality. Despite efforts by government and international agencies, Kenya has continued to experience a rise in maternal mortality.Objective: The purpose of this study was to identify the antecedents’ factors which have contributed to maternal deaths in Kisii County, Kenya.Methodology: A retrospective review of 72 maternal deaths which occurred between 1st January 2009 and 30th June 2010 was undertaken by an independent obstetrician. Interviews were conducted with relatives of the deceased women using a confidential questionnaire for female death based on distant as well as proximate factors that may have contributed to maternal death. Health care workers were also interviewed to assess the ability and readiness of the hospital to offer emergency obstetric care. Results: Among the 72 maternal deaths recorded during the study period 42 (58.3%) were as a result of direct obstetric complications which included haemorrhage, post-partum sepsis, pre-eclampsia and abortion. Thirty-three (45.8%) were as a result of indirect causes such as peritonitis, heart disease, HIV/AIDS, anaemia and convulsive disorders. Access to care was hampered by lack of money for transport and hospital user fees. Transport was also unavailable in some cases where money was not the problem. Besides, long distance to the hospital caused delay to seek care. But even for those who were prompt at the hospital also experienced delayed care as health service providers were unavailable as they were attending to other cases. Delay in service provision by healthcare workers, delayed quality obstetric emergency response and delayed care while at the hospital continue to be a challenge to maternal care. Conclusion: Maternal mortality continues as a result of failure of the health system, lack of access to quality care, poor health infrastructure, women empowerment and socio-economic  issues.Key words: Maternal mortality, Quality of care, Women empowerment, Health infrastructur

The Orma Boran - ten years of field observations

Presents the Orma Boran field observations carried out under tsetse fly challenge on Galana ranch in Kenya since 1980. Their response to trypanosomiasis has been compared to that of the ranch bred Kenya (Galana) Boran. The mean monthly prevalence of trypanosomiasis observed in Orma steers over five years was 17 percent compared with 31 percent in the Galana Borans. Mean annual mortality over five years was 35 percent in untreated Orma steers compared with 71 percent in untreated Galana steers. The primary difference appeared to be in their response to Trypanosoma vivax challenge. Their ability to acquire resistance has also been investigated under field conditions and both acquired and innate resistance appear to play a role. Steers monitored weekly over two years and treated with diminazene aceturate immediately on detection of infection showed some evidence of improved control of anaemia. In contrast, steers treated only when the PCV fell to 15 percent showed little evidence of improved anaemia control over two years. There was strong evidence for an innate component and the repeatabilities of PCV and infection rate were significant between the two years. Orma calves born on Galana ranch and herded together with their Galana counterparts were detected parasitaemic less often and the pre-weaning mortality was 7 percent compared with 17 percent for the Galana calves. The trypanosome prevalence in both groups of calves was lower than that observed over the same period in their dams and the vivax ratio was higher. Orma calves, however, had significantly lower birth & weaning weights than their Galana counterparts