Orofacial Infections in Kenya: A Retrospective Study

Background: Orofacial infections are either odontogenic or non-odontogenic in nature. The clinical spectrum of these infections is diverse. This study aimed to describe the presentation and management of patients presenting with orofacial infections at Kenyatta National Hospital (KNH). Materials and Methods: This was a retrospective study based on clinical records of patients treated for orofacial bacterial infections at KNH fromJanuary 2016 to December 2018. Data on the following study variables were obtained and analyzed: demographic data, clinical presentation,  diagnosis, management, and treatment outcome. Results: 214 clinical records were studied. Male to female ratio was 1.4:1 with age range of 3 months to 78 years (mean=27.0 years). Swelling (96.30%, n=206) was the most common symptom, next was pain (58.90%, n=123). The most common source of infection was odontogenic (60.30%,n=129) in nature. Permanent teeth (57.00%, n=122) were more commonly involved than deciduous teeth (2.80%, n=6). In both dentitions, the mandibular posterior teeth were the most commonly involved, Ludwig’s angina (30.84%, n=66) and submandibular abscess (25.23%, n=54) were the most common clinical diagnoses of orofacial bacterial infection. The commonly used treatment modality was a triad of extraction of the associated tooth, incision and drainage, and antibiotic therapy. These management modalities resulted in favorable treatment outcomes (92.50%, n=198) in most cases. Conclusion: Orofacial infections can occur among all sociodemographic groups. These infections are potentially life-threatening if not diagnosed early and managed promptly. Multidisciplinary teams are required to manage the severe morbidity and mortality of advanced orofacial infections. Keywords: Orofacial infections, Odontogenic, Abscess, Ludwig’s angin

Interventions for Prevention of Non-Communicable Diseases among Adolescents Living with HIV: A Systematic Review

While the uptake of antiretroviral drugs has rapidly expanded among adolescents and adults living with HIV, research evidence suggests that people living with HIV have a higher risk of non-communicable diseases (NCDs). With more than 35% of the global burden of NCDs stemming from adolescence, there is a need to comprehend the existing evidence on early prevention, detection, and disease management, especially among the at-risk population. In line with the WHO Global Action Plan, 2013–2020 and “Best Buys”, recommendations on practical interventions for NCDs prevention, this systematic review seeks to synthesise evidence on the current interventions for preventing NCDs among adolescents living with HIV (ALHIV) and assessing the efectiveness of interventions targeted at preventing cardiovascular diseases, diabetes, and cancer among ALHIV. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The bibliographic database search yielded 2588 articles, though only four (4) studies met the inclusion criteria after screening for eligibility. While sub-Saharan Africa (SSA) sufers the brunt of HIV and NCDs, only one study was conducted in SSA, and three in high-income countries (Brazil and the USA). Physical activity and aerobic exercises (lifestyle interventions) indicated potential benefcial health efects in reducing cardiovascular conditions and improving quality of life among ALHIV. Hospital-based training and a home-based exercise program efectively improved ftness strengths and changes in body composition. Despite the disproportionate global burden of the HIV and NCDs comorbidities, limited adolescent-specifc evidence exists on the interventions for the prevention of NCDs among ALHIV. Thus, there is a need for health policy experts and researchers to steer research on interventions focused on the various NCDs among the ALHI

Knowledge, Attitudes, and Preparedness for Managing Pregnant and Postpartum Women with COVID-19 Among Nurse-Midwives in Kenya

Introduction: Globally, maternal morbidity and mortality have increased during the COVID-19 pandemic. Given the high burden of maternal and neonatal mortality in Kenya prior to COVID-19, front line health workers, including nurse-midwives, must be competent to ensure continued quality maternal services. Knowledge and awareness of COVID-19 transmission influence nurse-midwives risk perception and ability to implement prevention strategies. Objective: We examined nurse-midwives’ knowledge, attitudes, and preparedness in managing pregnant and postpartum women with COVID-19 in Kenya. Methods: A cross-sectional online survey was conducted among 118 nurse-midwives between July 2020 and November 2020. A 31-item survey comprising 15 knowledge, 11 attitude, and five preparedness questions was administered using SurveyMonkey. A link to the survey was distributed among nurse-midwives via email. Multiple logistic regression analysis was used to assess associations between the variables. A p-value \u3c.05 was considered statistically significant. Results: Eighty-five participants were included in the final analysis (response rate 72%). Most participants were female (n = 69, 81.2%), 52.9% (n = 45) worked in labor wards, and 57.6% (n = 49) worked in rural hospitals. Overall, 71% (n = 57) of par- ticipants had sufficient knowledge about managing COVID-19 in pregnant and postpartum women. However, only 63% were willing to receive COVID-19 vaccination. Nurse-midwives working in urban areas were 3.7 times more likely to have positive attitudes than those in rural areas (odds ratio 3.724, 95% confidence interval 1.042–13.31; p = .043). Conclusion: Nurse-midwives’ responses to the Kenyan government’s COVID-19 guidelines for managing and caring for pregnant women were inconsistent. Continued professional development for nurse-midwives is important to ensure they stay abreast of evolving COVID-19 guidelines for maternal health. Our findings also suggest vaccine hesitancy may be a hurdle for ongoing COVID-19 vaccination

Current State of Critical Care Nursing Worldwide

Strengthening of professional nurses’ competencies targeted at their defined role is important for global critical care capacity. In high-resource settings, critical care nursing is a defined clinical specialty reflecting specific knowledge and clinical competencies. The roles of critical care nurses are clearly understood and generally care is provided in intensive care units. However, in low-resourced settings (low- to middle-income countries) roles and responsibilities of critical care nurses are not well defined. Although in high-income countries critical care nurses frequently receive a formal orientation, including critical care consortium with intensive 1 to 3 months of lectures, didactic learning, and one-on-one preceptorship by a more experienced critical care nurse, ongoing professional development in low-resource settings are even fewer. Absence of clear national guidelines on critical care nursing practice and a critical care nursing body that sets standards and core competencies to ensure proficiency-based licensure contributes to the limited in-service training and uncertainty about roles and responsibilities. Lack of critical care guidelines, insufficient training, high workload, poor training, lack of knowledge, poor technology, limited resources, insufficient exposure to the critical care environment, and ongoing education are the largest barriers to proficient critical care, especially in low-resource settings. Although in-service training, emotional regulations, effective communication, and international partnerships emerge as some of the facilitators of critical care nursing practice, there is a need for a holistic strategy to overcome the existing barriers and improve nursing care of the critically ill in low-resource settings

Regulation of mucosal immunity in the genital tract: Balancing reproduction and protective immunity

More than 100 million new sexually transmitted infections (STIs) are acquired every day, with 357 million new infections each year caused by chlamydia, gonorrhea, syphilis, and trichomoniasis. At least 500 million people are estimated to have a genital herpes infection. Bacterial STIs are currently treatable with antibiotics, although antibiotic-resistant gonorrhea is becoming a major problem. Antivirals can be used to reduce symptoms and shedding of genital herpes but cannot cure latent infections. To date, vaccines have been developed only against human papillomavirus and hepatitis B, despite the recognition that vaccines represent the best means of halting this hidden STI epidemic. To facilitate successful reproduction, immunity in both the female and male reproductive tracts must be regulated. In females reproductive tract, immunity is regulated by sex hormones during pregnancy to allow successful implantation and growth to term of a semiallogeneic fetus. In males, sperm development begins at puberty, well after tolerance to self has developed. Therefore immune responses in the testes and epididymides must be suppressed to prevent autoimmunity against developing sperm and male infertility. These restraints on reproductive tract immune responses not only may provide opportunities for many sexually transmitted pathogens to establish chronic infections but also represent major challenges to the development of successful vaccines to target the major STIs. In this chapter, we describe how immunity in the female and male reproductive tracts is regulated to facilitate reproduction and discuss current research progress toward the development of vaccines for chlamydia and genital herpes.</p