Factors that influence adequacy of asthma control in children residing in Naivasha, a flower growing area in Kenya

Background: In Kenya, asthma affects 10% of the population. One of the modifiable risk factors contributing to asthma morbidity and mortality is environmental exposure. Naivasha flower farms introduce pesticides persistently into the environment and these may drift onto residential property or other areas where children play. Proximity of households to the pesticide treated farms may also increase exposure of children to the pesticides. Pesticide exposure has been shown to exacerbate already existing asthma, a relationship that has not been studied in Kenya. Objectives: To identify risk factors that exacerbate asthma and influence adequacy of Asthma control in children residing in a flower growing area in Kenya. Methodology: The design was a cross-sectional study that involved 150 asthmatic children aged 5-12 years residing a flower growing area.  The study was conducted between May and July, 2014 in Naivasha, which is home to Kenya’s largest horticultural flower farms.  Participants were interviewed using a structured questionnaire while asthma control was measured using a validated Asthma control tool. Logistic regression was done to identify variables that affected asthma control. Results: Majority of the asthmatic children were males (56.7%) while females were 43.33%. Risk factors that were found to be significantly associated with asthma control were; duration of stay in or near a flower farm (OR = 0.723, 95%CI (0.538-0.975), presence of a smoker in the family (OR = 0.463, 95%CI (0.094-22.629) and presence of household pet (OR = 4.358, 95%CI (1.182-16.057). There was no significant relationship between the child’s asthma control and age of child, sex of child, distance of school from flower, guardian’s level of education, guardian’s income, and guardian’s occupation as a flower farm worker, child’s age of diagnosis and use of indoor pesticides. Conclusion:  The use of Integrated Pest Management (IPM) should be promoted as it keeps environmental exposure pesticides to a minimum. Key words: asthma, household pet, flower farm, pesticide, smokin

Antimicrobial Susceptibility of Bacteria that cause Wound Sepsis in the Paediatric Surgical Patients at Kenyatta National Hospital

Background: Despite improvement in the practice of medicine and attempts to provide aseptic conditions in the surgical wards, the incidence of wound infection is increasing.  Management of wound infection remains a challenge in the surgical areas with the increasing resistance to antimicrobials. Local bacterial sensitivity data is therefore an important guide for antibiotic selection. Objective: To determine the aetiology and antimicrobial sensitivity patterns of bacteria that cause wound sepsis in the paediatric surgical wards at the Kenyatta National Hospital. Methodology: A cross- sectional study was carried out on 150 paediatric patients admitted in the surgical wards from mid April 2014 to mid June, 2014.  The patients were selected by convenient sampling.   Data was abstracted from patient files and specimens from the infected wounds were identified and analyzed for antibiotic susceptibility. Results: The prevalence of wound infection was 82%.   Staphylococcus aureus (52.7%) was the most prevalent infective agent followed by Pseudomonas aeruginosa (17.3%). Staphylococcus aureus was the most resistant organism with susceptibility of less than 50% to most drugs.  About 50.6% of the Staphylococcus isolates were methicillin resistant.  Streptococcus was less resistant with more than 80% susceptibility to all tested drugs except cefuroxime. Escherichia coli were sensitive to ciprofloxacin.  All gram negative bacteria were highly sensitive to ciprofloxacin with the following susceptibilities: Pseudomonas aeruginosa (92.3%), Proteus mirabilis (71.4%) and others 100%.  Imipenem which is a new and relatively expensive monobactam demonstrated reduced activity with the following susceptibilities: Staphylococcus aureus (38%), Streptococcus (80%) and all the gram negative bacteria (70%). Conclusion: The most common causative agent was Staphylococcus aureus and less than 50% of the isolates were susceptible to all tested antibiotics. Key words: Antibiotic, antibiotic resistance, antibiotic susceptibility, wound infection

Effect of Pesticide Exposure on Serum Cholinesterase Levels among Asthmatic Children in Naivasha Sub-County, Kenya

Background: Pesticide exposure is a risk factor for asthma exacerbations in flower farm regions in the world.  Data on levels of serum cholinesterase among asthmatic children exposed to pesticides in Kenya is scanty. Objectives: To compare and identify variables which affect the concentration of serum cholinesterases in children who are exposed and unexposed to pesticides. Methodology: The design was a comparative cross-sectional study that involved exposed and unexposed children.  The study was conducted between May and July, 2014 in Naivasha, Kenya.  Patients were interviewed and serum samples were analysed for cholinesterase levels.  Multi-linear regression was done to identify variables that affected cholinesterase activity. Results: Children who were exposed to pesticides had a lower median ChE activity of 5828 [IQR 4863, 6443] compared to the unexposed arm whose median was 7133 [IQR 6063, 8179].  Five predictor variables were found to be significantly associated with depression of serum cholinesterase levels.  The most important predictor variable for the levels of ChE in children, was not using protective clothing by the parent [adjusted β -1457.0 (95% CI - 2594, 1319.8)].  Others were not using household pesticides [adjusted β 96.3, (95% CI 22.6, 170.0)], female sex [adjusted β -695.7 (95% CI -1296.2, - 95.3)], non school attendance [adjusted β -1676.8 (95% CI -3371.6, 18.1)] and not taking a break after spraying [adjusted β 1105.5 (95% CI (315.0, 1895.2)]. Conclusion: Children who were exposed to pesticides had low cholinesterase levels. Parents should therefore be encouraged to wear protective gear as this conferred protection of children from the effects of pesticide exposure. Key words: asthma, exposure, children, pesticides, cholinesterase