Effect of strikes by health workers on mortality between 2010 and 2016 in Kilifi, Kenya: a population-based cohort analysis

BACKGROUND: Health workers' strikes are a global occurrence. Kenya has had several strikes by health workers in recent years but their effect on mortality is unknown. We assessed the effect on mortality of six strikes by health workers that occurred from 2010 to 2016 in Kilifi, Kenya. METHODS: Using daily mortality data obtained from the Kilifi Health and Demographic Surveillance System, we fitted a negative binomial regression model to estimate the change in mortality during strike periods and in the 2 weeks immediately after strikes. We did subgroup analyses by age, cause of death, and strike week. FINDINGS: Between Jan 1, 2010, and Nov 30, 2016, we recorded 1 829 929 person-years of observation, 6396 deaths, and 128 strike days (median duration of strikes, 18·5 days [range 9-42]). In the primary analysis, no change in all-cause mortality was noted during strike periods (adjusted rate ratio [RR] 0·93, 95% CI 0·81-1·08; p=0·34). Weak evidence was recorded of variation in mortality rates by age group, with an apparent decrease among infants aged 1-11 months (adjusted RR 0·58, 95% CI 0·33-1·03; p=0·064) and an increase among children aged 12-59 months (1·75, 1·11-2·76; p=0·016). No change was noted in mortality rates in post-strike periods and for any category of cause of death. INTERPRETATION: The brief strikes by health workers during the period 2010-16 were not associated with obvious changes in overall mortality in Kilifi. The combined effects of private (and some public) health care during strike periods, a high proportion of out-of-hospital deaths, and a low number of events might have led us to underestimate the effect. FUNDING: Wellcome Trust and MRC Tropical Epidemiology Group

Infective endocarditis in intravenous drug abusers: an update

Infective endocarditis despite advances in diagnosis remains a common cause of hospitalization, with high morbidity and mortality rates. Through literature review it is possible to conclude that polymicrobial endocarditis occurs mainly in intravenous drug abusers with predominance in the right side of the heart, often with tricuspid valve involvement. This fact can be associated with the type of drug used by the patients; therefore, knowledge of the patient's history is critical for adjustment of the therapy. It is also important to emphasize that the most common combinations of organisms in polymicrobial infective endocarditis are: Staphylococcus aureus, Streptococcus pneumonia and Pseudomonas aeruginosa, as well as mixed cultures of Candida spp. and bacteria. A better understanding of the epidemiology and associated risk factors are required in order to develop an efficient therapy, although PE studies are difficult to perform due to the rarity of cases and lack of prospective cohorts.This work was supported by Portuguese Foundation for Science and Technology (FCT) through the grants SFRH/BPD/47693/2008, SFRH/BPD/20987/2004 and SFRH/BPD/72632/2010 attributed to Claudia Sousa, Claudia Botelho and Diana Rodrigues, respectively

Effects of experimental sedimentation on the phenological dynamics and leaf traits of replanted mangroves at Gazi bay, Kenya

Sedimentation results in the creation of new mudflats for mangroves to colonize among other benefits. However, large sediment input in mangrove areas may be detrimental to these forests. The dynamics of phenological events of three mangrove tree species (Avicennia marina, Ceriops tagal, and Rhizophora mucronata) were evaluated under experimental sediment burial simulating sedimentation levels of 15, 30, and 45 cm. While there was generally no shift in timing of phenological events with sedimentation, the three mangrove tree species each responded differently to the treatments. Partially buried A. marina trees produced more leaves than the controls during the wet season and less during the dry season. Ceriops tagal on the other hand had higher leaf loss and low replacement rates in the partially buried trees during the first 6 months of the experiment but adapted with time, resulting in either equal or higher leaf emergence rates than the controls. Rhizophora mucronata maintained leaf emergence and loss patterns as the unaffected controls but had a higher fecundity and productivity in the 15-cm sedimentation level. The results suggest that under incidences of large sedimentation events (which could be witnessed as a result of climate change impacts coupled with anthropogenic disturbances), mangrove trees may capitalize on "advantages" associated with terrestrial sediment brought into the biotope, thus maintaining the pattern of phenological events. © 2014 The Authors.SCOPUS: ar.jinfo:eu-repo/semantics/publishe