Outcomes of neonates requiring surgical interventions in Eldoret

Background: Neonatal surgical conditions account for 11% of the Global Burden of Diseases (GBD); neglect of their management has been reported though most are amenable to surgery. Timely surgical interventions play a major role in determining better outcomes, thus improving quality of life and reducing disability. Several factors—sepsis control, care in newborn intensive care unit and availability of total parenteral nutrition—have been shown to improve the outcomes of neonates with surgical conditions.Objective: To evaluate the outcomes of neonates with conditions requiring surgical interventions.Methods: A prospective descriptive study in the Newborn Unit, Moi Teaching and Referral Hospital (MTRH). Data on the following study variables were obtained and analyzed: maternal age, place and mode of delivery, newborn’s age at admission, birth weight, surgical condition, co-morbid conditions, treatment outcomes (discharge, death or referral to Kenyatta National Hospital for specialized care), surgical complications, time-to-initiation of oral feeds post-operatively, antenatal history and laboratory parameters; and length of hospital stay.Results: A total of 124 neonates were recruited; male to female ratio was 1.1:1 and median age at admission was 2 days (IQR 1, 5). Most (59.7%) were in the birth weight range of 2.5–3.9 kg. The leading neonatal surgical conditions were gastroschisis 33(26.6%), neural tube defects 25(20.2%) and ARM 25(20.2%). Overall mortality rate was 31.5%. Antenatal clinic attendance was associated with decreased odds of mortality (OR 0.126; 95% CI 0.025–0.6429; p=0.013), while neonatal sepsis, respiratory distress and electrolyte imbalance were associated with increased odds of mortality ([OR 3.4; 95% CI 1.09–22.06; p=0.049], [OR 4.9; CI 0.91–11.61; p=0.001] and [OR 3.1; CI 1.21–31.60; p=0.029], respectively).Conclusions: The overall mortality rate of neonates requiring surgical interventions at MTRH was 31.5% and the median length of hospital stay was 14.5 days. Co-morbid conditions that increased the odds of mortality among these neonates were neonatal sepsis, respiratory distress and electrolyte imbalance.Keywords: Neonates, Surgical, Interventions, Outcome

Label-free assaying of testosterone and growth hormones in blood using surface-enhanced raman spectroscopy

This work reports the potential use of surface enhanced Raman spectroscopy (SERS) in rapid, label-free assaying of testosterone (TE) and growth hormone (GH) in whole blood. Biomarker SERS spectral bands from the two hormones (TE and GH) in intentionally spiked water for injection and in male Sprague-Dawley (SD) rat blood are reported. Abuse of the two hormones (TE and GH) singly or simultaneously is widespread and not only has prolonged side effects such as hypertension and liver failure, but their illegal use by athletes is against clean competition. Currently used highly label-dependent doping detection methods involve complex and time-consuming procedures, rendering them unsuitable for rapid analysis. In blood, the most concentration-sensitive bands (in both TE and GH), as deduced through Principal Component Analysis (PCA) and Analysis of Variance (ANOVA), were around 684 cm-1 (assigned to C-C stretching) and 1614 cm-1 (assigned to C-C stretching) in GH; and 786 cm-1 (assigned to N-H wagging), 856 cm-1 (assigned to C-C stretching), and 1490 cm-1 (assigned to CH2 bending) in TE. In addition, a characteristic variance was noted in the bands around 1510 cm-1 (attributable to CH2 stretching) in GH and 1636 cm-1 (C-C stretching) in TE, which could be used as biomarker bands for the respective hormones in the blood. This work has shown the capability of SERS for potential hormone concentration level determination when concentration-sensitive or biomarker bands are employed. This discovery opens new possibilities for the use of SERS in fields such as sports science, clinical diagnostics, and biomedical research

Characteristics of HIV-infected children seen in Western Kenya

Objectives: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya. Design: A retrospective descriptive study. Setting: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya. Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya. Interventions: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART). Main outcome measures: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive statistical analyses and chi square tests were performed. Results: Four thousand and seventeen HIV-infected children seen between June 2002 and April 2008. Median age at enrollment was four years (0-14.2 years), 51% girls, 25% paternal orphans, 10% total orphans and 13% maternal orphans. At enrollment, 25% had weight-for-Age Z scores (WAZ)\u3e -1 and 21% had WAZ scores \u3c 3. Orphaned children had worse WAZ scores (p=0.0001). Twenty five per cent of children were classified as WHO clinical stage 3 and 4, 56% were WHO clinical stages 1 and 2 with 19% missing clinical staging at enrollment. Cough (25%), gastroenteritis (21%), fever (15%), pneumonia (10%) were the commonest presenting features. Twenty six per cent had been diagnosed with tuberculosis and only 25% started on cotrimoxazole preventive therapy (CPT). Median CD4% at enrollment was 16% (0-64%); latest recorded values were 22% (0-64). Sixty four per cent were on cART (cART+), median age at start was 5.4 (014.4 years).The median initial CD4% among cART+ was 13 (0-62) compared to 24 (0-64) for those not on ART (cART-). Median CD4% for cART+ improved to 22% (0-59); whereas cART- was 23% (0- 64) at last appointment. During the period of follow-up, one fifth (19%) of children on cART were lost to follow-up compared to slightly over one third (37%) for those not on cART. Thirty four percent were hospitalised; 41% diagnosed with pneumonia. Six per cent of 4017 were confirmed dead. Conclusions: HIV -infected children were enrolled in care early in childhood. Orphanhood was prevalent in these children as were gastroenteritis, fever, pneumonia and advanced immuno-suppression. Orphans were more likely to be severely malnourished. Only a quarter of children were put on cotrimoxazole preventive therapy. Children commenced on cART late but responded well to treatment. Loss to follow-up was less prevalent among those on cART

Removing subordinate species in a biodiversity experiment to mimic observational field studies

Background: Positive effects of plant species richness on community biomass in biodiversity experiments are often stronger than those from observational field studies. This may be because experiments are initiated with randomly assembled species compositions whereas field communities have experienced filtering. Methods: We compared aboveground biomass production of randomly assembled communities of 2–16 species (controls) with experimentally filtered communities from which subordinate species were removed, resulting in removal communities of 1–8 species. Results: Removal communities had (1) 12.6% higher biomass than control communities from which they were derived, that is, with double species richness and (2) 32.0% higher biomass than control communities of equal richness. These differences were maintained along the richness gradient. The increased productivity of removal communities was paralleled by increased species evenness and complementarity. Conclusions: Result (1) indicates that subordinate species can reduce community biomass production, suggesting a possible explanation for why the most diverse field communities sometimes do not have the highest productivity. Result (2) suggests that if a community of S species has been derived by filtering from a pool of 2S randomly chosen species it is more productive than a community derived from a pool of S randomly chosen species without filtering

Where Are the Newly Diagnosed HIV Positives in Kenya? Time to Consider Geo-Spatially Guided Targeting at a Finer Scale to Reach the “First 90”

Background: The UNAIDS 90-90-90 Fast-Track targets provide a framework for assessing coverage of HIV testing services (HTS) and awareness of HIV status – the “first 90.” In Kenya, the bulk of HIV testing targets are aligned to the five highest HIV-burden counties. However, we do not know if most of the new HIV diagnoses are in these five highest-burden counties or elsewhere. Methods: We analyzed facility-level HTS data in Kenya from 1 October 2015 to 30 September 2016 to assess the spatial distribution of newly diagnosed HIV-positives. We used the Moran's Index (Moran's I) to assess global and local spatial auto-correlation of newly diagnosed HIV-positive tests and Kulldorff spatial scan statistics to detect hotspots of newly diagnosed HIV-positive tests. For aggregated data, we used Kruskal-Wallis equality-of-populations non-parametric rank test to compare absolute numbers across classes. Results: Out of 4,021 HTS sites, 3,969 (98.7%) had geocodes available. Most facilities (3,034, 76.4%), were not spatially autocorrelated for the number of newly diagnosed HIV-positives. For the rest, clustering occurred as follows; 438 (11.0%) were HH, 66 (1.7%) HL, 275 (6.9%) LH, and 156 (3.9%) LL. Of the HH sites, 301 (68.7%) were in high HIV-burden counties. Over half of 123 clusters with a significantly high number of newly diagnosed HIV-infected persons, 73(59.3%) were not in the five highest HIV-burden counties. Clusters with a high number of newly diagnosed persons had twice the number of positives per 1,000,000 tests than clusters with lower numbers (29,856 vs. 14,172). Conclusions: Although high HIV-burden counties contain clusters of sites with a high number of newly diagnosed HIV-infected persons, we detected many such clusters in low-burden counties as well. To expand HTS where most needed and reach the “first 90” targets, geospatial analyses and mapping make it easier to identify and describe localized epidemic patterns in a spatially dispersed epidemic like Kenya's, and consequently, reorient and prioritize HTS strategies.publishedVersio

Feasibility, acceptability, effect, and cost of integrating counseling and testing for HIV within family planning services in Kenya

FRONTIERS supported the Division of Reproductive Health and the National AIDS and STI Control Program of the Kenya Ministry of Health to design, implement, and compare two models of integrating counseling and testing (CT) for HIV within family planning (FP) services in terms of their feasibility, acceptability, cost, and effect on the voluntary use of CT, as well as the quality of FP services. The study demonstrated that both models were feasible and acceptable to providers and to clients as means of integrating and linking HIV prevention counseling, condom promotion, and counseling and testing with FP services, and are effective in increasing quality of care and service utilization. Drawing from the lessons learned, the report outlines a number of key programmatic recommendations for institutionalizing and scaling up this approach. Lessons from this study were presented at several national and international workshops and conferences

Effectiveness of the baby‐friendly community initiative on exclusive breastfeeding in Kenya

The baby‐friendly hospital initiative (BFHI) promotes exclusive breastfeeding (EBF) in hospitals, but this is not accessible in rural settings where mothers give birth at home, hence the need for a community intervention. We tested the effectiveness of the baby‐friendly community initiative (BFCI) on EBF in rural Kenya. This cluster randomized study was conducted in 13 community units in Koibatek sub‐county. Pregnant women aged 15–49 years were recruited and followed up until their children were 6 months old. Mothers in the intervention group received standard maternal, infant and young child nutrition counselling, support from trained community health volunteers, health professionals and community and mother support groups, whereas those in the control group received standard counselling only. Data on breastfeeding practices were collected longitudinally. The probability of EBF up to 6 months of age and the restricted mean survival time difference were estimated. A total of 823 (intervention group n = 351) pregnant women were recruited. Compared with children in the control group, children in the intervention group were more likely to exclusively breastfeed for 6 months (79.2% vs. 54.5%; P < .05). Children in the intervention group were also exclusively breastfed for a longer time, mean difference (95% confidence interval [CI]) 0.62 months (0.38, 0.85; P < .001). The BFCI implemented within the existing health system and including community and mother support groups led to a significant increase in EBF in a rural Kenyan setting. This intervention has the potential to improve EBF rates in similar settings

Chromosomal-level assembly of the Asian Seabass genome using long sequence reads and multi-layered scaffolding

We report here the ~670 Mb genome assembly of the Asian seabass (Lates calcarifer), a tropical marine teleost. We used long-read sequencing augmented by transcriptomics, optical and genetic mapping along with shared synteny from closely related fish species to derive a chromosome-level assembly with a contig N50 size over 1 Mb and scaffold N50 size over 25 Mb that span ~90% of the genome. The population structure of L. calcarifer species complex was analyzed by re-sequencing 61 individuals representing various regions across the species' native range. SNP analyses identified high levels of genetic diversity and confirmed earlier indications of a population stratification comprising three clades with signs of admixture apparent in the South-East Asian population. The quality of the Asian seabass genome assembly far exceeds that of any other fish species, and will serve as a new standard for fish genomics