Epidemiology of bacterial Septicemia among children under five in Mbita Subcounty, South Nyanza, Kenya

Background: Septicaemia is a major cause of mortality and morbidity, especially in sub-Saharan Africa leading to complications marked by bodily inflammation referred as sepsis. This is a systemic disease associated with presence of pathogenic microorganisms (viral, parasitic and bacterial) or their toxins in the blood. Bacterial septicaemia is the most fatal and prevalent in hospitalised cases. Globally, 76% of children under five years die due to septicaemia. In East Africa a mortality rate of 40% have been reported. In Kenya, South Nyanza regions have reported higher morbidity and mortality cases among children. We hypothesis that apart from immunosuppressive diseases, septicaemia could contribute significantly to this prevalence in the region. Methods: Blood samples were obtained from 248 children whose guardian consented and a detailed sociodemographic questionnaire was administered. Bacterial isolation and characterization were done using the automated BACTEC 9240 system. Results: The mean age of the participants was 27.9 (SD ±20.7) months. The majority (30.6%) were aged between 1 to 12 months, 50.8% were males, 58.9% had body temperatures above 37.6 OC while only 8.1% were HIV seropositive. The mean white blood cells (WBC) of the participants were 17720.9 (SD 8929.1) cells/ml with 5.2% had leucopenia. A total of 84 of the 248 (33.9%) of the children had septicaemia with the majority (28.6%) caused by Staphylococcus epidermidis followed by Staphylococcus aureus and Escherichia coli each at 13.1%. Bacteria that were reported singly included Salmonella Paratyphi B, Citrobacter freundii, Gemella morbillorum, Klebsiella pneumoniae, Lactococcus lactis cremoris, Pantoea spp, and Pseudomonas putida. In multivariate regression analysis, female gender (OR 0.6; 95% confidence interval (CI) 0.4 to 0.9), co-infection with malaria (OR 2.7; 95% CI 1.1 to 6.7) and gastrointestinal disorders (OR 2.9, 95% CI 1.3 – 7.3) were independently associated with bacterial septicemia infection. Conclusion: Significantly higher proportion of the children in this region are infected with septicaemia. Majority of the cases were caused by Gram positive bacteria. Age and other c-infection contribute significantly to septicaemia infection in this region. Rapid testing and etiological characterisation of children with suspected symptoms of septicaemia is key in this region in order to institute appropriate treatment and management. Keywords: bacterial Septicemia, Epidemiology, Children under five, South Nyanza, Kenya DOI: 10.7176/JNSR/10-10-06 Publication date:May 31st 202

Bacterial Vaginosis Associated with Increased Risk of Female-to-Male HIV-1 Transmission: A Prospective Cohort Analysis among African Couples

In a prospective study, Craig Cohen and colleagues investigate the association between bacterial vaginosis and the risk of female-to-male HIV-1 transmission

Log₁₀ HIV-RNA concentration in plasma (baseline and follow-up) and female genital secretions (6-mo follow-up visit) compared by vaginal flora category (normal vaginal flora, intermediate vaginal flora, and BV).

<p>The lower limit of quantification was 240 copies/ml for blood fluid and 240 copies/swab for endocervical samples.</p>*<p>After adjusting for log₁₀ plasma HIV-1 RNA concentration.</p><p>SD, standard deviation.</p

Risk of female-to-male HIV-1 transmission among men whose HIV-1–infected female partners had BV and intermediate vaginal flora in comparison to men whose HIV-1–infected female partners had normal vaginal flora.

a<p>Multivariable Cox proportional hazards analysis (adjusted hazard ratio [AHR]), adjusting for the following: Fixed covariates: age, geographic region (southern Africa versus Eastern Africa), HSV-2 status of male partner at study enrollment, male circumcision, randomization treatment assignment, and both female and male sexual transmitted disease at study enrollment (laboratory confirmed gonorrhea, chlamydia, and trichomonas); Time-dependent covariates (per quarterly visit): pregnancy (current visit), hormonal contraception (current visit), plasma HIV-1 viral load of female partner (from enrollment and month 3, 6, 12, and study exit), unprotected sex act with study partner (current visit) (based on reporting from male partner), CD4 count of female partner (6 monthly), outside partners (current visit, based on reporting from male partner), number of sex acts with their study partner (current visit), and genital ulcer disease (current visit) (based on physical exam from both partners).</p

Incidence of HIV-1 transmission to men, by the vaginal flora category of their female HIV-1–infected partner.

a<p>For the primary analytic approach, vaginal flora from the adjacent previous visit (usually 3 mo prior) was used. If this result was missing, the most recent vaginal flora result from the visit 6 mo prior was used; otherwise the result was considered missing.</p

Enrollment characteristics, prospective study of 2,236 African HIV-1–seropositive women and their HIV-1 uninfected male partners.

a<p>Couple demographic and behavior characteristics as reported by the HIV-1–uninfected man.</p><p>N/A, not applicable.</p

Participant characteristics during quarterly follow-up intervals with BV and intermediate vaginal flora versus normal vaginal flora.

a<p>Comparisons between BV exposure groups are adjusted for correlation by multiple measures from the same participant using generalized estimating equations. The number of data points assessed for each cell is total number of visits with each covariate characteristic during study follow-up.</p>b<p>Comparison of BV intervals to normal vaginal flora interval.</p>c<p>Comparison of intermediate vaginal flora intervals to normal vaginal flora intervals.</p

Sahel, savana, riverine and urban malaria in West Africa: Similar control policies with different outcomes.

The study sites for the West African ICEMR are in three countries (The Gambia, Senegal, Mali) and are located within 750 km of each other. In addition, the National Malaria Control Programmes of these countries have virtually identical policies: (1) Artemisinin Combination Therapies (ACTs) for the treatment of symptomatic Plasmodium falciparum infection, (2) Long-Lasting Insecticide-treated bed Nets (LLINs) to reduce the Entomololgic Inoculation Rate (EIR), and (3) sulfadoxine-pyrimethamine for the Intermittent Preventive Treatment of malaria during pregnancy (IPTp). However, the prevalence of P. falciparum malaria and the status of malaria control vary markedly across the four sites with differences in the duration of the transmission season (from 4-5 to 10-11 months), the intensity of transmission (with EIRs from unmeasurably low to 4-5 per person per month), multiplicity of infection (from a mean of 1.0 to means of 2-5) and the status of malaria control (from areas which have virtually no control to areas that are at the threshold of malaria elimination). The most important priority is the need to obtain comparable data on the population-based prevalence, incidence and transmission of malaria before new candidate interventions or combinations of interventions are introduced for malaria control

Improving malaria control in West Africa: interruption of transmission as a paradigm shift.

With the paradigm shift from the reduction of morbidity and mortality to the interruption of transmission, the focus of malaria control broadens from symptomatic infections in children ≤5 years of age to include asymptomatic infections in older children and adults. In addition, as control efforts intensify and the number of interventions increases, there will be decreases in prevalence, incidence and transmission with additional decreases in morbidity and mortality. Expected secondary consequences of these changes include upward shifts in the peak ages for infection (parasitemia) and disease, increases in the ages for acquisition of antiparasite humoral and cellular immune responses and increases in false-negative blood smears and rapid diagnostic tests. Strategies to monitor these changes must include: (1) studies of the entire population (that are not restricted to children ≤5 or ≤10 years of age), (2) study sites in both cities and rural areas (because of increasing urbanization across sub-Saharan Africa) and (3) innovative strategies for surveillance as the prevalence of infection decreases and the frequency of false-negative smears and rapid diagnostic tests increases