Determinants of Neonatal Mortality in Kenya: Evidence From Kenya Demographic Health Surveys, 2008 and 2014

Background: This paper analyses the contribution of socio demographic, neonatal, maternal and health facility related factors to the neonatal mortality in Kenya.  Methods: Data from the Kenya demographic and health survey 2008 and 2014 was analyzed.  Results: Logistic regression showed that in 2008, newborns with a short interval of <2 years (OR=1.938, p=0.000), very small babies, (OR 2.25, p=0.160), low birth weight (OR=6.677, p=0.000), male children (OR=1.243, p=0.028) and neonates not breastfed immediately after birth (OR=2.768, p=0.005) increased the risk of mortality.  In 2014, being born in urban areas (OR=1.323, p=0.028), low birth weight (OR=2.354, p=0.008), birth interval of <2 years (OR=1.549, p=0.028, boys (OR=1.443, 0.014), mothers who did not attend ANC and those who had <3 ANC visits had (OR=4.668, p=0.000) and (OR=1.572, p=0.003) respectively as associated with neonatal mortality.  Conclusion: This paper emphasizes on mother nutrition education, immediate initiation of breast feeding, attending 4 ANC and hospital delivery for better birth outcomes. Key words: Determinants, Neonatal, Mortality, logistic regression, breastfeeding, birth weight DOI: 10.7176/JHMN/65-06 Publication date: August 31st 201

Determinants of diarrhea among young children under the age of five in Kenya, evidence from KDHS 2008-09

This paper examines the relative contribution of household, demographic and maternal characteristics to the incidence of diarrhea in young Kenyan children. Data from the Kenya Demographic and Health Survey 2008- 09 was used with a total of 3838 women included in the study. The measure of diarrhea in children was derived from woman’s questionnaire. Logistic regression analysis showed that age of child [AOR, 0.796; 95% CI, 0.559-1.134] and residence of mother [AOR, 0.538; 95% CI, 0.324-0.895] are more likely to influence childhood diarrhea. Higher education level of mother was associated with lower incidence of childhood diarrhea [AOR, 0.187; 95% CI, 0.609-0.573]. Household characteristics that had statistically significant influence on childhood diarrhea included sources of drinking water [AOR, 1.644; 95% CI, 1.040-2.599] and household size [AOR, 1.334; 95% CI, 1.000-1.780]. This paper emphasizes the importance of mothers being literate and access to good quality drinking water sources in reducing childhood diarrhea

Organ Pathology and Associated IFN-γ and IL-10 Variations in Mice Infected with Toxoplasma gondii Isolate from Kenya

Toxoplasma gondii is an important foodborne opportunistic pathogen that causes a severe disease in immunocompromised patients. The pathology and immune responses associated with the ensuing disease have not been well described in strains from different parts of the world. The aim of the present study is to determine the IFN-γ and IL-10 variations and organ pathology in immunocompetent and immunocompromised mice infected with T. gondii isolated from a Kenyan chicken. Two groups of BALB/c mice were infected with T. gondii cysts and administered with dexamethasone (DXM) in drinking water. Other two groups: infected untreated and uninfected mice were kept as controls. The mice were euthanized at various time points: blood collected for serum and assayed for IFN-γ and IL-10 variations. After infection, significant (p<0.05) elevated levels of IFN-γ and IL-10 were observed. A significant decline in IFN-γ and IL-10 levels (p<0.05) was observed after dexamethasone treatment. Histological sections in the liver, heart, and spleen of the mice administered with DXM revealed various degrees of inflammation characterized by infiltration of inflammatory cells. The dexamethasone-treated mice presented with progressively increased (p<0.001) inflammatory responses is compared with the infected untreated mice

A Fatal Outbreak of Campylobacter jejuni Enteritis in a Colony of Vervet Monkeys in Kenya

In a group of 50 wild-caught vervet monkeys trapped for experimental studies, 23 developed severe diarrhoea  during the quarantine period. While 10 of these responded well to routine treatment with metronidazole,  kaomycin and oral electrolytes, 13 initially showed slight improvement but later relapsed. Five of  these failed to respond altogether and were euthanised. Fresh faecal samples were collected from the surviving  eight monkeys and analysed for microbiology and drug sensitivity. Campylobacter jejuni, sensitive  to erythromycin, was isolated from all the faecal samples. Following treatment with erythromycin, seven  monkeys recovered fully within ten days but one died before the end of therapy. This study indicates that  wild non-human primates may play a significant role as a reservoir of C. jejuni, whereby they may act as  natural carriers of this human pathogen. Screening for Campylobacter sp in newly acquired monkeys is  advisable as part of the quarantine procedures.

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

A Review on the Present Advances on Studies of Toxoplasmosis in Eastern Africa

Toxoplasmosis is a zoonotic infection caused by the protozoan parasite, Toxoplasma gondii. It was discovered over 100 years ago and is credited as the most successful parasitic organism worldwide, able to infect and multiply in all warm blooded animals including an estimated 2.3 billion people. Toxoplasmosis is asymptomatic in immunocompetent individuals. Infection in the developing fetus and immunocompromised individuals can cause severe clinical disease. Toxoplasmosis is also a major cause of reproductive failure in livestock. The economic impact of toxoplasmosis is believed to be substantial. Factors associated with toxoplasmosis infection have been defined. Eastern Africa region is a high-risk area mainly due to the close association of humans and livestock as well as sociocultural practices, poor environmental hygiene, and poverty. The present paper provides a narrative review of published data on toxoplasmosis in Eastern Africa

Detection of Natural Toxoplasma gondii Infection in Chicken in Thika Region of Kenya Using Nested Polymerase Chain Reaction

The detection of Toxoplasma gondii in free-range chickens is a good indicator of possible risk to human beings. The aim of this study was to investigate the occurrence of T. gondii in free-range chicken using polymerase chain reaction (PCR). Brain samples from 105 free-range chickens from three administrative areas in Thika region, Kenya, were collected, DNA-extracted, and analyzed using PCR to detect presence of T. gondii. The overall prevalence of T. gondii in all the three areas was 79.0% (95% CI: 70.0–86.4%) and the prevalence across the three areas was not significantly different (P=0.5088; χ2=1.354). Female chickens had higher (79.4%) prevalence than males (78.6%), although the difference was not significant (P=0.922, χ2 = 0.01). However, chickens that were more than 2 years old had significantly (P=0.003; χ2 = 11.87) higher prevalence compared to younger ones. The study indicates that there was a high occurrence of T. gondii infection in free-range chickens from Thika region and that the infection rate is age dependent. Further studies should be carried out to determine the possible role of roaming chickens in the epidemiology of the disease among humans in the area

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit