Knowledge and practice of exclusive breastfeeding among women with children aged between 9 and 12 months in Al-Sabah Children Hospital, Juba, South Sudan

Introduction: Breastfeeding is an important tool for preventing childhood illnesses, and obesity, and hypertension later on in life, and it reduces the cost of food for the family and the country. Appropriate practices that support exclusive breastfeeding in the first six months reduce childhood morbidity and mortality.Methodology: 384 mothers with children aged 9 to 12 months attending the immunization and paediatric outpatient clinics were interviewed. Statistical Package for Social Sciences (SPSS) was used for data handling. Descriptive statistics and univariate logistic regression were used to analyse the data.Results: The majority of mothers were aged between 21 – 25 years (43.5%), had 2 - 4 children (55.5%) and primary education (48.2%). Most mothers had started breastfeeding within the first hour of delivery (76.8%), and knew that breastfeeding was nutritious to the baby. Parity and mother`s level of education were significant factors associated with exclusive breastfeeding (p<0.05). There was no statistically significant association between occupation, age of the mother, mode of delivery and exclusive breastfeeding (p>0.05). There was no statistical difference in rate of exclusive breastfeeding in mothers attending the OPD and the immunization clinic (p value=0.09).Conclusion: Most mothers knew the benefits and definitions of exclusive  breastfeeding. The early measures supporting breastfeeding are well practiced. Parity and mothers` education significantly affected exclusive breastfeeding.Keys words: Exclusive breast feeding, child, nutritio

Associations of Sociodemographic and Clinical Factors with Late Presentation for Early Infant HIV Diagnosis (EID) Services in Kenya

Background: Understanding the missed opportunities in early infant HIV testing within the PMTCT program is essential to address any gaps. The study set out to describe the clinical and sociodemographic characteristics of the infants presenting late for early infant diagnosis in Kenya. Methods: We abstracted routinely collected clinical and sociodemographic characteristics, in a cross-sectional study, on all HIV-infected infants with a positive polymerase chain reaction (PCR) test from 1,346 President’s Emergency Plan for AIDS Relief (PEPFAR) supported health facilities for the period October 2016 to September 2018. We used multivariate logistic regression to examine the association of sociodemographic and clinical characteristics with late (>2 months after birth) presentation for infant HIV testing. Results: Of the 4,011 HIV-infected infants identified, the median infant age at HIV diagnosis was 3 months [interquartile range (IQR), 1-16 months], and two-thirds [2,669 (66.5%)] presented late for infant HIV testing. Factors that were associated with late presentation for infant testing were: maternal ANC non-attendance, adjusted odds ratio (aOR) 1.41 (95% confidence interval (CI) 1.18 -1.69); new maternal HIV diagnosis, aOR 1.45, (95%CI 1.24 -1.7); and lack of maternal antiretroviral therapy(ART), aOR 1.94, (95% CI 1.64 - 2.30). There was a high likelihood of identifying HIV-infected infants among infants who presented for medical services in the outpatient setting (aOR 18.9; 95% CI 10.2 - 34.9) and inpatient setting (aOR 12.2; 95% CI 6.23-23.9) compared to the infants who presented late in maternity. Conclusion and Global Health Implications: Gaps in early infant HIV testing suggest the need to increase maternal pre-pregnancy HIV diagnosis, timely antenatal care, early infant diagnosis services, early identification of mothers who seroconvert during pregnancy or breastfeeding and improved HIV screening in outpatient and inpatient settings. Early referral from the community and access to health facilities should be strengthened by the implementation of national PMTCT guidelines.publishedVersio

Exploring acceptability, opportunities, and challenges of community-based home pregnancy testing for early antenatal care initiation in rural Kenya

Background: Many women in low- and middle-income countries, including Kenya, access antenatal care (ANC) late in pregnancy. Home pregnancy testing can enable women to detect pregnancy early, but it is not widely available. Our study explored the acceptability and potential of home pregnancy testing delivered by community health volunteers (CHV) on antenatal care initiation in rural Kenya. Methods: This study was part of a public health intervention to improve uptake and quality of ANC. Between November and December 2020, we conducted 37 in-depth interviews involving women who tested positive or negative for a urine pregnancy test provided by CHVs; CHVs and their supervisors involved in the delivery of the pregnancy tests; facility healthcare workers; and key informants. Using Sekhon et al.‘s framework of acceptability, the interviews explored participants’ perceptions and experiences of home pregnancy testing, including acceptability, challenges, and perceived effects on early ANC uptake. Data were analysed thematically in NVivo12 software. Results: Home pregnancy testing was well-received by women who trusted test results and appreciated the convenience and autonomy it offered. Adolescents cherished the privacy, preferring home testing to facility testing which could be a stigmatising experience. Testing enabled earlier pregnancy recognition and linkage to ANC as well as reproductive decision-making for those with undesired pregnancies. Community delivery of the test enhanced the reputation and visibility of the CHVs as credible primary care providers. CHVs in turn were motivated and confident to deliver home pregnancy testing and did not find it as an unnecessary burden; instead, they perceived it as a complement to their work in providing ANC in the community. Challenges identified included test shortages, confidentiality and safeguarding risks, and difficulties accessing facility-based care post-referral. Newly identified pregnant adolescents hesitated to seek ANC due to stigma, fear of reprimand, unwanted parental notification, and perceived pressure from healthcare workers to keep the pregnancy. Conclusion: Home pregnancy testing by CHVs can improve early ANC initiation in resource-poor settings. Mitigating privacy, confidentiality, and safeguarding concerns is imperative. Additional support for women transitioning from pregnancy identification to ANC is essential to ensure appropriate care. Future research should focus on integrating home pregnancy testing into routine community health services

SARS-CoV-2 seroprevalence in three Kenyan health and demographic surveillance sites, December 2020-May 2021

Background Most of the studies that have informed the public health response to the COVID-19 pandemic in Kenya have relied on samples that are not representative of the general population. We conducted population-based serosurveys at three Health and Demographic Surveillance Systems (HDSSs) to determine the cumulative incidence of infection with SARS-CoV-2. Methods We selected random age-stratified population-based samples at HDSSs in Kisumu, Nairobi and Kilifi, in Kenya. Blood samples were collected from participants between 01 Dec 2020 and 27 May 2021. No participant had received a COVID-19 vaccine. We tested for IgG antibodies to SARS-CoV-2 spike protein using ELISA. Locally-validated assay sensitivity and specificity were 93% (95% CI 88–96%) and 99% (95% CI 98–99.5%), respectively. We adjusted prevalence estimates using classical methods and Bayesian modelling to account for the sampling scheme and assay performance. Results We recruited 2,559 individuals from the three HDSS sites, median age (IQR) 27 (10–78) years and 52% were female. Seroprevalence at all three sites rose steadily during the study period. In Kisumu, Nairobi and Kilifi, seroprevalences (95% CI) at the beginning of the study were 36.0% (28.2–44.4%), 32.4% (23.1–42.4%), and 14.5% (9.1–21%), and respectively; at the end they were 42.0% (34.7–50.0%), 50.2% (39.7–61.1%), and 24.7% (17.5–32.6%), respectively. Seroprevalence was substantially lower among children (&lt;16 years) than among adults at all three sites (p≤0.001). Conclusion By May 2021 in three broadly representative populations of unvaccinated individuals in Kenya, seroprevalence of anti-SARS-CoV-2 IgG was 25–50%. There was wide variation in cumulative incidence by location and age. </jats:sec

Knowledge and practice of exclusive breastfeeding among women with children aged between 9 and 12 months in Al Sabah Hospital, Juba, South Sudan

Introduction: Breastfeeding is an important tool for preventing childhood illnesses, and obesity, and hypertension later on in life, and it reduces the cost of food for the family and the country. Appropriate practices that support exclusive breastfeeding in the first six months reduce childhood morbidity and mortality. Aim: To assess mothers’ knowledge and practice of breastfeeding at El Sabbah Children’s hospital. Methodology: 384 mothers with children aged 9 to 12 months attending the immunization and paediatric outpatient clinics were interviewed. Statistical Package for Social Sciences (SPSS) was used for data handling. Descriptive statistics and univariate logistic regression were used to analyse the data. Results: The majority of mothers were aged between 21 – 25 years (43.5%), had 2 - 4 children (55.5%) and primary education (48.2%). Most mothers had started breastfeeding within the first hour of delivery (76.8%), and knew that breastfeeding was nutritious to the baby. Parity and mother`s level of education were significant factors associated with exclusive breastfeeding (p0.05). There was no statistical difference in rate of exclusive breastfeeding in mothers attending the OPD and the immunization clinic (p value=0.09). Conclusion: Most mothers knew the benefits and definitions of exclusive breastfeeding. The early measures supporting breastfeeding are well practiced. Parity and mothers` education significantly affected exclusive breastfeeding

Associations of Sociodemographic and Clinical Factors with Late Presentation for Early Infant HIV Diagnosis (EID) Services in Kenya

Background: Understanding the missed opportunities in early infant HIV testing within the PMTCT program is essential to address any gaps. The study set out to describe the clinical and sociodemographic characteristics of the infants presenting late for early infant diagnosis in Kenya. Methods: We abstracted routinely collected clinical and sociodemographic characteristics, in a cross-sectional study, on all HIV-infected infants with a positive polymerase chain reaction (PCR) test from 1,346 President’s Emergency Plan for AIDS Relief (PEPFAR) supported health facilities for the period October 2016 to September 2018. We used multivariate logistic regression to examine the association of sociodemographic and clinical characteristics with late (>2 months after birth) presentation for infant HIV testing. Results: Of the 4,011 HIV-infected infants identified, the median infant age at HIV diagnosis was 3 months [interquartile range (IQR), 1-16 months], and two-thirds [2,669 (66.5%)] presented late for infant HIV testing. Factors that were associated with late presentation for infant testing were: maternal ANC non-attendance, adjusted odds ratio (aOR) 1.41 (95% confidence interval (CI) 1.18 -1.69); new maternal HIV diagnosis, aOR 1.45, (95%CI 1.24 -1.7); and lack of maternal antiretroviral therapy(ART), aOR 1.94, (95% CI 1.64 - 2.30). There was a high likelihood of identifying HIV-infected infants among infants who presented for medical services in the outpatient setting (aOR 18.9; 95% CI 10.2 - 34.9) and inpatient setting (aOR 12.2; 95% CI 6.23-23.9) compared to the infants who presented late in maternity. Conclusion and Global Health Implications: Gaps in early infant HIV testing suggest the need to increase maternal pre-pregnancy HIV diagnosis, timely antenatal care, early infant diagnosis services, early identification of mothers who seroconvert during pregnancy or breastfeeding and improved HIV screening in outpatient and inpatient settings. Early referral from the community and access to health facilities should be strengthened by the implementation of national PMTCT guidelines

Replication Data for: Comparative performance of the InBios SCoV-2 DetectTM IgG ELISA and the in-house KWTRP ELISA in detecting SARS-CoV-2 spike IgG antibodies in Kenyan populations

This is a replication dataset for the manuscript titled "Comparative performance of the InBios SCoV-2 DetectTM IgG ELISA and the in-house KWTRP ELISA in detecting SARS-CoV-2 spike IgG antibodies in Kenyan populations." The SARS-CoV-2 seroprevalence estimates have been carried out by institutions under the Kenya Multi-Site Sero-surveillance (KEMIS) collaboration using both the InBios SCoV-2 DetectTM IgG ELISA and in house KWTRP ELISA. For the comparability of data collected using both tests by KEMIS participating sites, we conducted a direct comparison of these assays. We directly used pre-pandemic serum/plasma collected in 2018 from 454 blood donors and 173 malaria cross-sectional survey participants designated gold standard negatives. As gold standard positives, we assayed serum/plasma from 159 SARS-CoV-2 PCR-positive patients and 166 vaccination-confirmed participants.We obtained ODs(Optical density) from the samples' reactivity to SARS-CoV-2 antigen on both ELISA assays. We then expressed the OD into a ratio using the control samples. The ratios from both assays were then used to determine specificity, sensitivity, and prevalence. Pairwise comparisons between the InBios and KWTRP was done and assays’ reproducibility was assesed by examining the raw ODs and coefficient of variation (CV) for the negative, positive and cut-off controls