p16INK4a/Ki-67 dual stain cytology for cervical cancer screening in Thika district, Kenya

Background: The identification of suited early detection tests is one among the multiple requirements to reduce cervical cancer incidence in developing countries. Methods: We evaluated p16INK4a/Ki-67 dual-stain cytology in a screening population in Thika district, Kenya and compared it to high-risk human papillomavirus (HR-HPV) DNA testing and visual inspection by acetic acid (VIA) and Lugol’s iodine (VILI). Results: Valid results for all tests could be obtained in 477 women. 20.9 % (100/477) were tested positive for HR-HPV DNA, 3.1 % (15/477) had positive VIA/VILI and 8.2 % (39/477) positive p16INK4a/Ki-67 cytology. Of 22 women that showed up for colposcopy and biopsy, 6 women were diagnosed with CIN3 and two with CIN2. All women with CIN2/3 were negative in VIA/VILI screening and positive by HR-HPV DNA testing. But HPV was also positive in 91.7 % (11/12) of women with normal histology. p16INK4a/Ki-67 cytology was positive in all 6 women with CIN3, in one of the two CIN2 and in only 8.3 % (1/12) of women with normal histology. Conclusions: p16INK4a/Ki-67 cytology is an interesting test for further studies in developing countries, since our findings point to a lower fraction of false positive test results using p16INK4a/Ki-67 cytology compared to HPV DNA testing in a Kenyan screening population. VIA/VILI missed all histology-proven CIN2/3

Seroprevalence of Hepatitis B among HIV Infected Persons Receiving Care in a HIV Clinic in Kisumu Kenya

Background: Hepatitis B infection among HIV infected persons is of clinical importance because it’s a leading cause of morbidity and mortality. Hepatitis B leads to liver cirrhosis and liver cancer. In Kenya Hepatitis B testing is not presently part of routine care for HIV infected patients despite that HIV increases the progression of HBV related liver disease due to immunosuppression. Objective: To determine the seroprevalence of Hepatitis B virus infection and Alanine aminotransferase; ALT levels among HIV infected persons in a HIV care clinic. Methodology: Cross-sectional descriptive study conducted at Family Aids Care and Education Services (FACES) Kisumu, Kenya. A sample size of 136 HIV infected persons above the age of 18 years were recruited. A questionnaire collecting information on the socio demographic characteristic and exposure factors to Hepatitis B infection was administered, 4mls of blood was collected for the detection of HBsAg (Hepatitis B surface Antigens) by Enzyme Immunoassay with the Murex HBsAg kit. The ALT test was done using COBAS INTEGRAL® 400 plus, Roche. Statistical analysis was done using SPSS v.16. Results: The seroprevalence of Hepatitis B infection among HIV infected persons was 13%. Patients with elevated liver enzyme ALT among HIV/HBV co infected persons was 11.76%. A possible association between elevated ALT and Hepatitis B was found (Fishers exact test p=0.044). Exposure factors such as lack of vaccination and having more than one sexual partner were considered to be significantly associated with the Infection ( P<0.005) Conclusion: There is need for increased screening and awareness of HBV infection for individuals who are HIV positive as the prevalence of the Hepatitis B infection is comparatively high as compared to the prevalence of HBsAg in the general population. The government through the ministry of medical services should look into the policy of making vaccination against Hepatitis B accessible

Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study

Background Most of the deaths among neonates in low-income and middle-income countries (LMICs) can be prevented through universal access to basic high-quality health services including essential facility-based inpatient care. However, poor routine data undermines data-informed efforts to monitor and promote improvements in the quality of newborn care across hospitals.Methods Continuously collected routine patients’ data from structured paper record forms for all admissions to newborn units (NBUs) from 16 purposively selected Kenyan public hospitals that are part of a clinical information network were analysed together with data from all paediatric admissions ages 0–13 years from 14 of these hospitals. Data are used to show the proportion of all admissions and deaths in the neonatal age group and examine morbidity and mortality patterns, stratified by birth weight, and their variation across hospitals.Findings During the 354 hospital months study period, 90 222 patients were admitted to the 14 hospitals contributing NBU and general paediatric ward data. 46% of all the admissions were neonates (aged 0–28 days), but they accounted for 66% of the deaths in the age group 0–13 years. 41 657 inborn neonates were admitted in the NBUs across the 16 hospitals during the study period. 4266/41 657 died giving a crude mortality rate of 10.2% (95% CI 9.97% to 10.55%), with 60% of these deaths occurring on the first-day of admission. Intrapartum-related complications was the single most common diagnosis among the neonates with birth weight of 2000 g or more who died. A threefold variation in mortality across hospitals was observed for birth weight categories 1000–1499 g and 1500–1999 g.Interpretation The high proportion of neonatal deaths in hospitals may reflect changing patterns of childhood mortality. Majority of newborns died of preventable causes (>95%). Despite availability of high-impact low-cost interventions, hospitals have high and very variable mortality proportions after stratification by birth weight