Profiling antibiotic resistant bacteria and antibiotic residues in raw chicken products sold around Kenyatta University, Kenya

AbstractAntibiotic resistant bacteria and antibiotic residues are a serious safety problem for animal food products. Poultry products have been long recognized as a reservoir for antibiotic resistant commensals and pathogens. Antibiotic residues ingested via food animal products expose gut micro-flora to low concentrations of antibiotics, which promote antibiotic resistance. However, there is limited knowledge regarding the potential of chicken products to act as a transmission corridor for the spread of the antibiotic resistant bacteria and antibiotic residues. The present study aimed at profiling antibiotic resistant bacteria and antibiotic residues in raw chicken products sold around Kenyatta University, Kenya. A total of 32 meat and egg samples were randomly collected from two study sites; KM and KU. Antibiotic residues in the study samples were detected using two microbiological techniques with Bacillus subtilis, Staphylococcus aureus, Escherichia coli, and Salmonella typhi as test organisms. Selective and differential media were used to isolate Escherichia coli, Salmonella and Shigella from the samples. Antibiotic susceptibility testing of these isolates against commonly used antibiotics was done using Kirby-Bauer antibiotic discs diffusion method. Of the total samples tested, 87.50% meat and 100% egg samples showed presence of antibiotic residues. The mean colony forming units (CFUs) of meat samples from KM (190.25 x 10² CFU) was higher than that of KU (104.96 x 10² CFU). Eggs from KM showed contamination (158.88 x 10² CFU) than those sampled (108.29 x 10² CFU) within the university outlets. Escherichia coli, Salmonella and Shigella, were resistant to ampicillin. Escherichia coli showed intermediate resistance to tetracycline while Escherichia coli and Shigella showed intermediate resistance to amikacin. This study reveals the presence of antibiotic residues and antibiotic resistant bacteria in chicken meat and eggs sold in the study area. Knowledge generated from this study is helps to develops effective strategies to control antibiotic resistance.Keywords: antibiotics; antibiotic resistance; antibiotic residue

Manager and Provider Perspectives of the Work Environment Experienced by Associate Clinicians, Nurses and Midwives Who Deliver Emergency Obstetric Care in Tanzania

Positive practice environments promote the health, safety and well-being of health workers by supporting professionalism, acknowledging performance and ensuring opportunities for professional growth. According to the International Collaborating Partners of the Positive Practice Environments Campaign, positive practice environments foster a motivated, productive and high-performing pool of workers who deliver high quality care. Research shows that achieving positive practice environments for health care professionals is problematic worldwide. In Tanzania, the capacity of human resources for health managers to implement deliberate and strategic action to plan for and effectively deploy health workers, as well as safeguard their practice environments, is severely diminished. The basic strategic human resources management (SHRM) components model was used to guide understanding of the relationship between people management practices and the practice environment. This dissertation examined the people management practices that have been implemented in Tanzania and their impact on the practice environment experienced by associate clinicians (ACs), nurses and midwives who deliver emergency obstetric care (EmOC). Interview and survey data obtained from frontline ACs, nurses and midwives and members of Council Health Management Teams (CHMTs) tasked with planning for and deploying health human resources offered provider and managerial perspectives of the practice environment within which EmOC is delivered in Tanzania. The eight people management practices specified in the basic SHRM components model were applied in varying extents across the 48 districts assessed. Partial implementation contributed to loss of motivation and undermined the performance of ACs, nurses and midwives who deliver the essential interventions constituting EmOC in Tanzania

Profit efficiency among Kenyan smallholders milk producers: A case study of Meru-South district, Kenya

Production inefficiency is usually analyzed by economical efficiency, which is composed of two components-technical and allocative efficiencies. This study provided a direct measure of production efficiency of the smallholder milk producers in Kenya using a stochastic profit frontier and inefficiency model. The primary data were collected, using IMPACT (intergrated modeling platform for mixed animal crops systems) structured questionnaire and includes four conventional inputs and socio-economic factors affecting production. The result showed that profit efficiencies of the sampled farmers varied widely between 26% and 73% with a mean of 60% suggesting that an estimated 40% of the profit is lost due to a combination of both technical and allocative inefficiencies in the smallholder dairy milk production. This study further observed that level of education, experience, and the size of the farm influenced profit efficiency positively while profit efficiency decreased with age. This implies that profit inefficiency among smallholder dairy milk producers can be reduced significantly with improvement in the level of education of sampled farmer

The "New" East African community : effects on trade, welfare and productive activities in East Africa

This research seeks to examine the effects of the establishment of regional trade agreements (RTAs) among developing nations on trade, welfare and production activities. The focus here is on the “new” East African Community (EAC) formed between Kenya, Uganda and Tanzania and established in 1999. The formation of the “new” EAC raises the important question of whether this regionally based trading agreement is of economic merit to its members. This study begins by reviewing trends in regional trade flows and the extent to which regional integration has affected trade patterns and productive activities. Using a gravity model augmented with several sets of dummy variables, I estimate the effect of the EAC-RTA on trade and welfare on members and non-members. The results show that intra-bloc trade is on average 18 times higher than what would be expected in the absence of the agreement. However, this trend does not seem to be influenced by the official lowering of trade barriers with the formation of the EAC. Model results also show a decline in bloc exports to the rest of the world suggesting that the bloc has trade diverting tendencies. Since static gains from the EAC-RTA are quite low, possibly dynamic gains from regional integration lend more support to the economic merit of the EAC

Professional practice models for nurses in low-income countries: an integrative review

Background: Attention is turning to nurses, who form the greatest proportion of health personnel worldwide, to play a greater role in delivering health services amidst a severe human resources for health crisis and overwhelming disease burden in low-income countries. Nurse leaders in low-income countries must consider essential context for nurses to fulfill their professional obligation to deliver safe and reliable health services. Professional practice models (PPMs) have been proposed as a framework for strategically positioning nurses to impact health outcomes. PPMs comprise 5 elements: professional values, patient care delivery systems, professional relationships, management approach and remuneration. In this paper, we synthesize the existing literature on PPMs for nurses in low-income countries. Methods: An integrative review of CINAHL-EBSCO, PubMed and Scopus databases for English language journal articles published after 1990. Search terms included nurses, professionalism, professional practice models, low-income countries, developing countries and relevant Medical Subject Heading Terms (MeSH). Results: Sixty nine articles published between 1993 and 2014 were included in the review. Twenty seven articles examined patient care delivery models, 17 professional relationships, 12 professional values, 11 remuneration and 1 management approach. One article looked at comprehensive PPMs. Conclusions: Adopting comprehensive PPMs or their components can be a strategy to exploit the capacity of nurses and provide a framework for determining the full expression of the nursing role

Hereditary gingival fibromatosis: report of family case series

Hereditary gingival hyperplasia (HGF) is a rare condition characterised by hyperplastic, dense fibrous connective tissue with acanthotic gingival epithelium. A family presented at the School of Dental Sciences, University of Nairobi with a complaint that some of the children developed swollen gums very early in life and that this got worse with eruption of the permanent teeth. The first born, a 23- year- old male, had had the swellings for over ten years. Other siblings aged 5,9 and 12 years were also affected. The swellings had affected the appearance, speech and the psychosocial wellbeing of the children. The parents were unaffected with apparently negative family histories. Following oral examination and appropriate investigations, conventional gingivectomy was performed of the maxillary and the mandibular gingivae for the siblings: the 23 -12- and the nine- year olds. The fourth affected child, a five- year- old, was still in primary dentition and had just started showing mild signs of gingival hyperplasia. The histopathological examination of the specimens from the present cases confirmed features consistent with those of HGF. This article highlights a familial presentation of HGF

External root morphology of maxillary first premolars in Kenyan Africans

Objective: To determine the external root morphology of the maxillary first premolars in Kenyan Africans.Design: In vitro descriptive cross-sectional study.Setting: School of Dental Sciences, University of Nairobi.Subjects: One hundred and fifty five extracted maxillary first premolar teeth obtained from patients aged between 13-30 years attending dental clinics within Nairobi.Main outcome measures: Number of roots, direction of root curvature and tooth length.Results: A total of 155 maxillary first premolars were studied, 77 from males and 78 from females. Overall, there were 83.2% two-rooted teeth (mean tooth length: buccal root 22.3 mm; lingual root 21.2 mm), 10.3% one-rooted (mean tooth length-22.6 mm) and 6.5% three-rooted. Three roots occurred more commonly in males than females and this was a statistically significant gender difference (P0.05).Conclusions: Maxillary first premolars were mostly two-rooted with straight roots. Males presented with two or three roots more often than females and had significantly larger mean tooth lengths

Comparison of the prevalence of dental caries in 12-15 year-old children with dental fluorosis and those without dental fluorosis from Juja in rural Kenya

Objective: To determine any association between varying degrees of dental fluorosis and dental caries in children aged 12-15 years in a rural community in Kenya.Design: Descriptive cross-sectional study.Setting: A rural school in the central province of Kenya.Subjects: Two hundred and twenty five primary school children aged 12-15 years consisting of 100 males and 125 females.Results: A total of 225 children were included in the study, of these 125 were males and 100 were females and the age range was 12-15 years with a mean of 13.28 + 1.11SD. The prevalence of caries was 39.1% and the mean DMFT of the sample population was 1.51 + 2.25SD. The mean decayed component was 1.48 and none of the children had any filled teeth. The mean DMFT of the children with fluorosis and those without fluorosis was 1.44 and 1.55 respectively.Conclusion: There was no association between dental fluorosis and dental caries. Though there was no association between dental fluorosis and caries experience

Quality of glycaemic control in ambulatory diabetics at the out-patient clinic of Kenyatta National Hospital, Nairobi

Background: Treatment of diabetes mellitus is based on the evidence that lowering blood glucose as close to normal range as possible is a primary strategy for reducing or preventing complications or early mortality from diabetes. This suggests poorer glycaemic control would be associated with excess of diabetes-related morbidity and mortality. This presumption is suspected to reach high proportions in developing countries where endemic poverty abets poor glycaemic control. There is no study published on Kenyan patients with diabetes mellitus about their glycaemic control as an audit of diabetes care. Objective: To determine the glycaemic control of ambulatory diabetic patients. Design: Cross-sectional study on each clinic day of a randomly selected sample of both type I and 2 diabetic patients. Setting: Kenyatta National Hospital. Methods: Over a period of six months, January 1998 to June 1998. During routine diabetes care in the clinic, mid morning random blood sugar and glycated haemoglobin (HbAI c)were obtained. Results: A total of 305 diabetic patients were included, 52.8% were females and 47.2% were males. 58.3% were on Oral Hypoglycaemic Agent (OHA) only, 22.3% on insulin only; 9.2% on OHA and insulin and 4.6% on diet only. 39.5% had mean HbAlc £ 8% while 60.5% had HbAlc ³ 8%. Patients on diet-only therapy had the best mean HbAlc=7.04% while patients on OHA-only had the worst mean HbAlc=9.06%. This difference was significant (p=0.01). The former group, likely, had better endogenous insulin production. The influence of age, gender and duration of diabetes on the level of glycaemic control observed did not attain statistically significant proportions. Conclusion: The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin production. Poor glycaemic control was presumed to be due to sub-optimal medication and deteriorating diabetes. There is need to empower patients with knowledge and resources to enhance their individual participation in diabetes self-care. Diabetes care providers and facilities also need capacity building to improve care of patients with diabetes. East African Medical Journal Vol.80(8) 2003: 406-41

Factors Associated With Uptake of Skilled Attendants’ Services During Child Delivery In Garissa Town, Kenya

Objective: To identify the factors that are associated with uptake of skilled delivery services during child delivery among women of reproductive age in Garissa town.Design: Cross sectional study.Setting: Garissa townSubject: Three hundred and thirty four women aged 15-49 years who had had at least one delivery in their lifetime were asked about the type of delivery services they had during their last child delivery.Results: The study found that 47% of the last deliveries women were attended by skilled persons and the rest of the deliveries were provided by TBAs. The predictors of skilled delivery uptake in this study were found to be; having knowledge on skilled delivery service providers (AOR = 17.2; 95% CI: 1.05 – 281.12; p = 0.046), child deliveries numbering one to three (AOR = 116.95; 95% CI: 26.68 – 512.64; p = 0.001) and four to six (AOR = 16.75; 95% CI: 4.44 – 62.87; p = 0.001), presence of previous delivery complication (AOR = 11.71; 95% CI: 3.96 – 34.60; p = 0.001), disapproval of TBA services (AOR = 27.19; 95% CI: 6.67 – 110.76; p = 0.001), lack of preference for gender of skilled delivery service provider (AOR = 6.51; 95% CI: 1.08 – 39.37; p = 0.041), and positive view on service related factors such as time to nearest facility (AOR = 3.91; 95% CI: 1.24 – 12.34; p = 0.020), hygiene (AOR = 5.03; 95% CI: 1.49 – 17.05; p = 0.009) and operation time of health facility (AOR = 4.67; 95% CI: 1.59 – 13.76; p = 0.005).Conclussion: The findings show that cultural and maternal factors as well as quality of services at facility level play major role in determining uptake of skilled services among women in Garissa as compared to social  demographic and economic factors