Antimicrobial Susceptibility Patterns of Urinary Bacteria Amongst Paediatric Patients at The Nairobi Hospital, Kenya

Objective: To determine the antimicrobial susceptibility patterns of urinary tract infections in the paediatric age group at The Nairobi Hospital.Design: A retrospective cross-sectional descriptive study.Setting: The Nairobi Hospital records department.Results: A total of 31 organisms were isolated consisting of Escherichia coli (n=132; 44.3%), Klebsiella species (n=59; 17.8%), Proteus species (n=28; 9.4%), Staphylococcus aureus (n=14; 5.7%), Pseudomonas species (n=14; 4.7%) and Enterococcus species (n=12; 4%). Others were less frequently isolated making up a total of 14.1%. Girls were more affected than boys with a ratio 6:4. Amongst the E.coli and Klebsilla isolates which were the most commonly isolated, resistance was high to commonly used antimicrobials such as trimethoprim/sulfamethoxazole (75%-80%) and amoxicillin clavulanate (50%). There was no statistical significance in the difference in the organisms isolated (p= 0.775) or their susceptibilities to tested  antimicrobials, between inpatients and outpatients.Conclusion: The change in the susceptibility patterns of the isolated organisms to the most commonly used antimicrobials points to a need for revision of the current guidelines, prudent use of antibiotics and regular surveillance of uropathogens and antimicrobial susceptibility patterns on a larger scale

The Influence of Problem Solving Style on Team Dynamics When Building Consensus

Issues facing the agricultural and natural resource (ANR) sector can be contentious due to opposing viewpoints, with people working against one another rather than working together to come to consensus on what will benefit the industry as a whole. Without a consistent message, the ANR industry will struggle when trying to gain support from decision makers. Therefore, opinion leaders need the skills to bring individuals and organizations together when facing critical issues that require groups to reach consensus. Agricultural leadership programs can offer educational opportunities for individuals to build problem-solving and team-building skills that will enable them to lead discussions when facing current issues. Unfortunately, little is known about how opinion leaders in the ANR sector work together when facing critical issues or how diverse cognitive styles influence this process. This study explored how cognitive style influenced team dynamics while ANR opinion leaders built consensus around critical ANR issues. Results illustrated that grouping participants by cognitive style influenced how the teams progressed through the consensus building process. The findings and resulting recommendations can assist educators in being selective when assigning groups and developing team-building activities that will prepare ANR opinion leaders to lead cognitively-diverse teams when building consensus

The survey of Lake Victoria's fishers

The findings are presented of a survey conducted regarding the fishers of Lake Victoria, which examined the relationships affecting supply flows of raw material on to the market, and also the characteristics of fishing activities and their effects on fish quality and distribution. Fish marketing plays a vital role in the lives of much of the lake basin's population, both in terms of employment and nutrition. The results of the survey comprise, in part, a base-line data set which will facilitate further research, analysis and management decision-making in relation to stakeholders of the lake's resources. Data collection, methods and research difficulties encountered are described and details given of a profile of a boat owner/renter and aslo of a profile of a crew member. The survey shows that Lake Victoria's fishery is one of very limited diversity. The fishers recount that they consistently target one or more of the 3 most common species within the lake (Nile perch, tilapia and dagaa) and very rarely consider any other species type. The largest proportion of fishers on the lake are Nile perch fishers; there is considerable demand for this species, and hence fishers have little incentive to either target alternative fish species, not to try and establish firm marketing outlets through the creation of arrangements with their principal buyers. In Kenyan waters, however, the number of Nile perch fishers is equaled by the number of dagaa fishers; this fish now commands a considerable portion of the market for fish from Lake Victoria through its availability as well as its relatively low prices. The tilapia fishery is in decline, and all 3 riparian states would not appear to be attracting investment almost certainly as a result of declining catches. For many of those working in Lake Victoria's fishery, the problems faced appear most often to be associated with the vagaries of an unstable market which may rise or fall depending on the state of the international market or the state of access roads to fish landings. (PDF contains 42 pages

Impact of elemental composition of particulate matter in the airshed of a University Farm on the local air quality.

The impact of particulate matter on the ambient air quality of Landmark University Farm was assessed using deposition fluxes of Trace elements (TEs) in the airshed of the farm. Deposition gauges were employed to collect both dry and wet deposition samples of particulate matter between 2018 and 2019. Elemental compositions of particulates collected during the sampling period were analyzed using Energy Dispersive X-ray Fluorescence Spectroscopy (ED-XRF). The deposition fluxes of crustal and anthropogenic trace elements were also determined using standard methods. Results showed that in dry season, iron has the highest mean concentration (3283.61 mg/kg), while chromium has the lowest (0.023 mg/kg). On the other hand, in wet season, silicon and nickel have the highest and lowest mean concentrations of 159.34 mg/kg and 0.01 mg/kg respectively. Although the concentrations of these metals were higher in the dry season than wet season, there was no statistical significant difference between the mean concentrations of the elements measured in each season of the year (p > 0.05). The compositions of some of the elements in the particulate matters were found to be far above the recommended exposure limits prescribed by OSHA. The study concluded that the elemental composition of particulate matter in the airshed of the University Farm adversely impacts the ambient air quality of the Communit

The prevalence, clinical features, risk factors and outcome associated with cryptococcal meningitis in HIV positive patients in Kenya

Objectives: To determine the prevalence, clinical features, risk factors and outcomes associated with cryptococcal meningitis (CM) in human immunodeficiency virus (HIV) positive patients at two referral hospitals in Nairobi, Kenya.Design: Prospective, observational study.Setting: Kenyatta National Hospital (KNH) and Mbagathi District Hospital (MDH), Nairobi, KenyaSubjects: Three hundred and forty HIV patients presenting with suspected CM.Results: Of three hundred and forty suspected CM patients, 111 (33%) were diagnosed with CM by CrAg. Among CM patients, in-hospital mortality was 36% (38/106), median age was 35 years (range, 19-60 years) and median CD4 count was 41 cells/μL (n=89, range 2-720 cells/μL). Common clinical manifestations among CM patients included headache 103 (93%), neck stiffness 76 (69%) and weight loss 53 (48%). Factors independently associated with CM were male sex, headache, blurred vision and previous antifungal drug use. Night sweats and current use of anti-retroviral therapy were associated with reduced risk for CM.Conclusions: There is a high prevalence of CM and CM-associated mortality in HIV patients at KNH and MDH despite treatment with antifungal and anti-retroviral drugs. This study demonstrates the need to address the existing inadequacies of CM patient outcomes in Kenya

Conditional cash transfers to retain rural Kenyan women in the continuum of care during pregnancy, birth and the postnatal period: protocol for a cluster randomized controlled trial.

BACKGROUND: Antenatal care (ANC), facility delivery and postnatal care (PNC) are proven to reduce maternal and child mortality and morbidity in high-burden settings. However, few pregnant rural women use these services sufficiently. This study aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased contact between pregnant women or women who have recently given birth and the formal healthcare system in Kenya. METHODS: The intervention tested is a conditional cash transfer to women for ANC health visits, a facility birth and PNC visits until their newborn baby reaches 1 year of age. The study is a cluster randomized controlled trial in Siaya County, Kenya. The trial clusters are 48 randomly selected public primary health facilities, 24 of which are in the intervention arm of the study and 24 in the control arm. The unit of randomization is the health facility. A target sample of 7200 study participants comprises pregnant women identified and recruited at their first ANC visit over a 12-month recruitment period and their subsequent newborns. All pregnant women attending one of the selected trial facilities for their first ANC visit during the recruitment period are eligible for the trial and invited to participate. Enrolled mothers are followed up at all health visits during their pregnancy, at facility delivery and for a number of visits after delivery. They are also contacted at three additional time points after enrolling in the study: 5-10days after enrolment, 6 months after the expected delivery date and 12 27 months after birth. If they have not delivered in a facility, there is an additional follow-up 2 wees after the expected due date. The impact of the conditional cash transfers on maternal healthcare services and utilization will be measured by the trial's primary outcomes: the proportion of all eligible ANC visits made during pregnancy, delivery at a health facility, the proportion of all eligible PNC visits attended, the proportion of referrals attended during the pregnancy and the postnatal period, and the proportion of eligible child immunization appointments attended. Secondary outcomes include; health screening and infection control, live birth, maternal and child survival 48 h after delivery, exclusive breastfeeding, post-partum contraceptive use and maternal and newborn morbidity. Data sources for the measurement of outcomes include routine health records, an electronic card-reader system and telephone surveys and focus group discussions. A full economic evaluation will be conducted to assess the cost of delivery and cost effectiveness of the intervention and the benefit incidence and equity impact of trial activities and outcomes. DISCUSSION: This trial will contribute to evidence on the effectiveness and cost-effectiveness of conditional cash transfers in facilitating health visits and promoting maternal and child health in rural Kenya and in other comparable contexts. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03021070 . Registered on 13 January 2017

Pilot assessment of the sensitivity of the malaria thin film

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Wp index: A new substorm index derived from high-resolution geomagnetic field data at low latitude

Geomagnetic field data with high time resolution (typically 1 s) have recently become more commonly acquired by ground stations. Such high time resolution data enable identifying Pi2 pulsations which have periods of 40–150 s and irregular (damped) waveforms. It is well-known that pulsations of this type are clearly observed at mid- and low-latitude ground stations on the nightside at substorm onset. Therefore, with 1-s data from multiple stations distributed in longitude around the Earth's circumference, substorm onset can be regularly monitored. In the present study we propose a new substorm index, the Wp index (Wave and planetary), which reflects Pi2 wave power at low-latitude, using geomagnetic field data from 11 ground stations. We compare the Wp index with the AE and ASY indices as well as the electron flux and magnetic field data at geosynchronous altitudes for 11 March 2010. We find that significant enhancements of the Wp index mostly coincide with those of the other data. Thus the Wp index can be considered a good indicator of substorm onset. The Wp index, other geomagnetic indices, and geosynchronous satellite data are plotted in a stack for quick and easy search of substorm onset. The stack plots and digital data of the Wp index are available at the Web site (http://s-cubed.info) for public use. These products would be useful to investigate and understand space weather events, because substorms cause injection of intense fluxes of energetic electrons into the inner magnetosphere and potentially have deleterious impacts on satellites by inducing surface charging

Caregiver perceptions of children who have complex communication needs following a home-based intervention using augmentative and alternative communication in rural Kenya: an intervention note:Home-based intervention using AAC in rural Kenya

A high level of unmet communication need exists amongst children with developmental disabilities in sub-Saharan Africa. This study investigated preliminary evidence of the impact associated with a home-based, caregiver-implemented intervention employing AAC methods, with nine children in rural Kenya who have complex communication needs. The intervention used mainly locally-sourced low-tech materials, and was designed to make use of the child's strengths and the caregiver's natural expertise. A pretest-posttest design was used in the study. Data were gathered using an adapted version of the Communication Profile, which was based on the International Classification of Functioning, Disability, and Health (ICF) framework. The non-parametric Wilcoxon signed-rank test was applied to data from the first two sections of the Communication Profile-Adapted. Qualitative analysis was conducted on the final section. The data provided evidence of statistically significant positive changes in caregiver perceptions of communication at the levels of Body Structure and Function, and Activities for Communication. Also, analysis of the Participation for Communication section revealed some expansion to the children's social activities. The potential impact of the home-based intervention would benefit from investigation on a larger scale. Limitations of the study are discussed