A consensus on malnutrition in Africa: A report from the micronutrient deficiency awareness forum (Nairobi 2017)

While most forms of malnutrition are easy to identify at an early age, micronutrient deficiency also manifests in form of “Hidden Hunger”, where children could seem to be well fed, but still suffer from deficiencies due to lack of key micronutrients in their diets whose absence is hard to detect. While the symptoms of micronutrient deficiency may not be obvious in the short-term, they translate into cognitive deficiencies in the longterm that negatively affect the economic productivity of these infants when they become adults, perpetuating the malnutrition cycle. The Micronutrient Deficiency Awareness Forum was held in April 2017 in Nairobi Kenya, comprising seven specialties from across sub-Saharan Africa. The forum was convened to discuss how to increase awareness of conditions associated with micronutrient deficiencies developing from early childhood, especially those impacting brain development, identify sections of the population that were at high risk of micronutrient deficiencies, outline available guidelines on diagnostic tools, assessment and management of deficiencies, and develop a consensus on best practices in diagnosing, managing, and preventing micronutrient deficiency and malnutrition. It is estimated that 40% of the children in sub-Saharan Africa are affected by stunting, which is the most prevalent form of malnutrition, and an estimated 69-82% of malnutrition cases are not properly treated. This phenomenon is not without a cost, as malnutrition greatly undermines cognitive development, and ultimately economic productivity. A 2014 study revealed that Ethiopia lost the equivalent of 12% of its GDP to malnutrition in 2009. Studies in different countries across the world have shown that focused interventions work. For instance, early childhood macronutrient intervention led to a 46% higher wage in adult years in Guatemala. The Micronutrient Deficiency Awareness Forum 2017 Consensus Report provides suggestions on policy design and implementation strategies that may lead to early detection, treatment, and ultimately prevalence reduction of malnutrition across the region

Microvascular Complications of Type 1 Diabetes Mellitus Screening in Children, Adolescents and Young Adults: Report from a Small Center in a Limited Resource Setting, Brazzaville - Congo

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Glycaemic Control in Kenyan Children and Adolescents with Type1 Diabetes Mellitus

The study demonstrate that the prevalence of poor control in type 1 diabetic children and adolescents in Kenyan children is far to be acceptable and the great majority of patients may be at high risk for the precocious development of microvascular complications. Adolescent patients have particularly poor control so comprise a special high risk group in the diabetes clinic. The data strongly support the necessity that children and adolescents with T1DM in Kenya receive more aggressive management and follow-up than is currently being provided.Probably the possiblity to obtain analog long acting insulin could be important to improve metabolic control

Kawasaki disease in Kenya and review of the African literature

Abstract Background Kawasaki disease has been described across the globe, although publications from Africa are limited. To our knowledge, there are no publications on Kawasaki disease from Kenya, which triggered this report. Methods A retrospective cross-sectional study was undertaken to identify in-patients with a discharge diagnosis of Kawasaki disease, over 2 different 5-year periods, at two pediatric hospitals in Nairobi, Kenya. We reviewed the medical records of all patients and report their clinical findings, diagnostic workup and treatment. In addition, we undertook a detailed review of the literature. Results Twenty-three patients with Kawasaki disease were identified, of those 12 (52.2%) had incomplete disease. The mean age was 2.3 years (SD+/-2.2) (range 0.3–10.3) with a male to female ratio of 1:1. The mean duration of fever at diagnosis was 8.3 days (SD+/-4.7) (range 2–20). Oral changes were the most common clinical feature and conjunctivitis the least common. Thrombocytosis at diagnosis was seen in 52% (12/23). Twenty-one patients (91.3%) were treated with intravenous immunoglobulin and all except 1 received aspirin. Baseline echocardiograms were performed in 95.7% (22/23) and found to be abnormal in 3 (13.6%). Follow-up data was limited. Our literature review identified 79 publications with documented cases of Kawasaki disease in children from 22 countries across the African continent with a total of 1115 patients including those from this report. Only 153 reported cases, or 13.7%, are from sub-Saharan Africa. Conclusions This is the first publication on Kawasaki disease from Kenya and one of the largest reports from sub-Saharan Africa. It is the first to have a complete review of the number of published cases from the African continent. Challenges in the diagnosis and management of Kawasaki disease in many African countries include disease awareness, infectious confounders, access and cost of intravenous immunoglobulin, access to pediatric echocardiography and follow-up. Increasing awareness and health care resources are important for improving outcomes of Kawasaki disease in Africa

Behind the data: establishing the Network for Surveillance of Pneumococcal Disease in the East African Region.

In a region with high rates of mortality among children aged <5 years, the underfunded health care systems of sub-Saharan Africa have few resources available to perform surveillance activities that can help determine the causes of morbidity and mortality in the region. At present, there are few examples of attempts to promote public health care surveillance that might inform current debates about how to expand and improve surveillance, particularly for bacterial diseases. Driven by this gap in knowledge, we attempted to explore the successes and failures of the Network for Surveillance of Pneumococcal Disease in the East African Region and to share the experiences of what are essentially nonresearch public-sector hospitals in East Africa, with the hopes that surveillance systems for other diseases, especially those that require complex diagnostic support, may be informed by these experiences. The state of services essential for surveillance and the measures taken to overcome any shortcomings are described, as is the progress made in improving clinical diagnosis, laboratory processing, and data management. For surveillance to play a role in public health care, ministries of health and associated institutions must own and push forward the surveillance agenda, with support from global partners, and take advantage of the developments that have been achieved within the institutions

Additional file 1 of Kawasaki disease in Kenya and review of the African literature

Supplementary Material

The paediatrician workforce and its role in addressing neonatal, child and adolescent healthcare in Kenya

Objective: To examine the availability of paediatricians in Kenya and plans for their development. Design: Review of policies and data from multiple sources combined with local expert insight. Setting: Kenya with a focus on the public, non-tertiary care sector as an example of a low-income and middle-income country aiming to improve the survival and long-term health of newborns, children and adolescents. Results: There are 305 practising paediatricians, 1.33 per 100 000 individuals of the population aged Discussion: The scale of the paediatric workforce challenge seriously undermines the ability of the Kenyan health system to deliver on the emerging survive, thrive and transform agenda that encompasses more complex health needs. Addressing this challenge may require innovative workforce solutions such as task-sharing, these may in turn require the role of paediatricians to be redefined. Professional paediatric communities in countries like Kenya could play a leadership role in developing such solutions.</p