Trends in health facility based maternal mortality in Central Region, Kenya: 2008-2012

Introduction: WHO classifies Kenya as having a high maternal mortality. Regional data on maternal mortality trends is only available in selected areas. This study reviewed health facility maternal mortality trends, causes and distribution in Central Region of Kenya, 2008-2012. Methods: We reviewed health records from July 2008 to June 2012. A maternal death was defined according to ICD-10 criterion. The variables reviewed included socio-demographic, obstetric characteristics, reasons for admission, causes of death and contributing factors. We estimated maternal mortality ratio for each year and overall for the four year period using a standard equation and used frequencies means/median and proportions for other descriptive variables. Results: A total 421 deaths occurred among 344,191 live births; 335(80%) deaths were audited. Maternal mortality ratios were: 127/100,000 live births in 2008/09; 124/100,000 live births in 2009/2010; 129/100,000 live births in 2010/2011 and 111/100,000 live births in 2011/2012. Direct causes contributed majority of deaths (77%, n=234) including hemorrhage, infection and pre-eclampsia/eclampsia. Mean age was 30(±6) years; 147(71%) attended less than four antenatal visits and median gestation at birth was 38 weeks (IQR=9). One hundred ninety (59%) died within 24 hours after admission. There were 111(46%) caesarian births, 95(39%) skilled vaginal, 31(13%) unskilled 5(2%) vacuum deliveries and 1(<1%) destructive operation. Conclusion: The region recorded an unsteady declining trend. Direct causes contributed to the majority deaths including hemorrhage, infection and pre-eclampsia/eclampsia. We recommend health education on individualized birth plan and mentorship on emergency obstetric care. Further studies are necessary to clarify and expand the findings of this study.Pan African Medical Journal 2016; 2

Factors associated with late diagnosis of cervical cancer at two national referral hospitals, Kenya 2017: A case control study.

Background: Cervical cancer is the leading cause of cancer mortality among women in Kenya. Two thirds of cervical cancer cases in Kenya are diagnosed in advanced stages. We aimed to identify factors associated with late diagnosis of cervical cancer, to guide policy interventions. Methods: An unmatched case control study (ratio 1:2) was conducted among women aged ≥ 18 years with cervical cancer at Kenyatta National and Moi Teaching and Referral Hospitals. We defined a case as patients with International Federation of Gynecology and Obstetrics (FIGO) stage ≥ 2A and controls as those with stage ≤ 1B. A structured questionnaire was used to document exposure variables. We calculated adjusted odds ratio (aOR) to identify any associations. Results:We enrolled 192 participants (64 cases, 128 controls). Mean age 39.2 (±9.3) years, 145 (76 %) were married, 77 (40 %) had primary level education, 168 (88 %) had their first pregnancy ≤ 24 years of age, 85 (44 %) were \u3e para 3 and 150 (78 %) used contraceptives. Late diagnosis of cervical cancer was associated with cost of travel to cancer centres \u3e USD 6.1 (aOR 6.43 95% CI [1.30, 31.72]), age \u3e 50 years (aOR 4.71; 95% CI [1.18, 18.80]), anxiety over cost of cancer care (aOR 5.6; 95% CI [1.05, 32.72]) and ultrasound examination during evaluation of symptoms (aO Conclusion: Cost of seeking care and the quality of the diagnostic process were important factors in this study. Decentralization of care, innovative health financing solutions and clear diagnostic and referral algorithms for women presenting with gynecological symptoms could reduce late-stage diagnosis in Kenya

Prevalence and factors associated with metabolic syndrome in an urban population of adults living with HIV in Nairobi, Kenya

Introduction: Metabolic syndrome affects 20-25% of the adult population globally. It predisposes to cardiovascular disease and Type 2 diabetes. Studies in other countries suggest a high prevalence of metabolic syndrome among HIV-infected patients but no studies have been reported in Kenya. The objective of this study was to assess the prevalence and factors associated with metabolic syndrome in adult HIV-infected patients in an urban population in Nairobi, Kenya. Methods: in a cross-sectional study design, conducted at Riruta Health Centre in 2016, 360 adults infected with HIV were recruited. A structured questionnaire was used to collect data on socio-demography. Blood was collected by finger prick for fasting glucose and venous sampling for lipid profile. Results: Using the harmonized Joint Scientific Statement criteria, metabolic syndrome was present in 19.2%. The prevalence was higher among females than males (20.7% vs. 16.0%). Obesity (AOR = 5.37, P < 0.001), lack of formal education (AOR = 5.20, P = 0.002) and family history of hypertension (AOR = 2.06, P = 0.029) were associated with increased odds of metabolic syndrome while physical activity (AOR = 0.28, P = 0.001) was associated with decreased odds. Conclusion: Metabolic syndrome is prevalent in this study population. Obesity, lack of formal education, family history of hypertension, and physical inactivity are associated with metabolic syndrome. Screening for risk factors, promotion of healthy lifestyle, and nutrition counselling should be offered routinely in HIV care and treatment clinics

Investigation of a typhoid fever epidemic in Moyale Sub-County, Kenya, 2014\u20132015

Aim: Typhoid fever is a vaccine-preventable bacterial disease that causes significant morbidity and mortality throughout Africa. This paper describes an upsurge of typhoid fever cases in Moyale Sub-County (MSC), Kenya, 2014\u20132015. Methods: We conducted active hospital and health facility surveillance and laboratory and antimicrobial sensitivity testing for all patients presenting with headache, fever, stomach pains, diarrhea, or constipation at five MSC health facilities between December 2014 and January 2015. We also conducted direct observation of the residential areas of the suspected cases to assess potential environmental exposures and transmission mechanisms. Demographic, clinical, and laboratory data were entered into, and descriptive statistics were calculated with, MS Excel. Results: A total of 317 patients were included in the study, with mean age 24 \ub1 8.1 years, and 51% female. Of the 317 suspect cases, 155 (49%) were positive by Widal antigen reaction test. A total of 188 (59%) specimens were subjected to culture and sensitivity testing, with 71 (38%) culture positive and 54 (76%), 43 (60%), and 33 (46%) sensitive to ceftriaxone, cefuroxime, and ciprofloxacin, respectively. Environmental assessments through direct observations showed that commercial and residential areas had limited (1) clean water sources, (2) latrines, and (3) hygiene stations for street food hawkers and their customers. Conclusions: Typhoid fever is endemic in MSC and causes significant disease across age and sex groups. The local health department should develop policies to (1) assure community access to potable water and hygiene stations and (2) vaccinate specific occupations, such as food and drink handlers, against typhoid

Perinatal Mortality in Emergency Obstetric Health Care Facilities, Nakuru County, Kenya, 2014–2017: A descriptive cross sectional surveillance data analysis

Introduction: Perinatal mortality is a major global public health problem. In 2016, 2.6 million perinatal deaths were reported globally, in Kenya, it accounted for 22.6 deaths/1000 live births. We sought to describe perinatal mortality in Nakuru County. Methods: We reviewed “perinatal mortality” on System data report between 2014–2017. Perinatal death was defined as any record of death in the first seven days of life and stillbirths that occurred in health facilities that provided emergency obstetric care. We assessed age, time and place of death occurrence, neonatal and maternal clinical characteristics. We calculated the perinatal mortality rate (PNMR), trends, frequencies and proportions for characteristics of interest. Results: A total of 59,152 births were reported in 9 facilities from 2014–2017, 929 of these births were subsequently classified as perinatal deaths. Overall PNMR was 15 deaths/1000 live births. Among those who died their mean age was 0.83±0.05 day. Early neonatal deaths: 533(57.6%), Stillbirths: 382(41.0%) and 14(1.4%) cause of deaths were not recorded. Nakuru Level-5 Hospital recorded 835(90%) perinatal 15 deaths. In 2014, PNMR was 25.1 deaths/1000 live births which reduced to 12.5 deaths/1000 live births in 2017. Of the infants who died 570(61.4%) were <1 day old. Partograph was not used in 464(49.9%) of the pregnant women. Reported contributors of perinatal deaths were birth asphyxia 275(29.6%), prematurity 267(28.7%) and low-birth-weight 252(27.1%). Conclusion: Nakuru County PNMR was higher compared to WHO recommendation of < 12 deaths/1000 live births, therefore, there is need to identify strategies to reduce incidences of asphyxia, prematurity and low birth weight. Comprehensive antenatal coverage, adequate care of infants at birth is likely to improve quality of life among the survivors and reduce PNMR

Perinatal mortality in emergency obstetric health care facilities, Nakuru County, Kenya, 2014–2017: A descriptive cross sectional surveillance data analysis

Introduction: Perinatal mortality is a major global public health problem. In 2016, 2.6 million perinatal deaths were reported globally, in Kenya, it accounted for 22.6 deaths/1000 live births. We sought to describe perinatal mortality in Nakuru County. Methods: We reviewed “perinatal mortality” on System data report between 2014–2017. Perinatal death was defined as any record of death in the first seven days of life and stillbirths that occurred in health facilities that provided emergency obstetric care. We assessed age, time and place of death occurrence, neonatal and maternal clinical characteristics. We calculated the perinatal mortality rate (PNMR), trends, frequencies and proportions for characteristics of interest. Results: A total of 59,152 births were reported in 9 facilities from 2014–2017, 929 of these births were subsequently classified as perinatal deaths. Overall PNMR was 15 deaths/1000 live births. Among those who died their mean age was 0.83±0.05 day. Early neonatal deaths: 533(57.6%), Stillbirths: 382(41.0%) and 14(1.4%) cause of deaths were not recorded. Nakuru Level-5 Hospital recorded 835(90%) perinatal 15 deaths. In 2014, PNMR was 25.1 deaths/1000 live births which reduced to 12.5 deaths/1000 live births in 2017. Of the infants who died 570(61.4%) were <1 day old. Partograph was not used in 464(49.9%) of the pregnant women. Reported contributors of perinatal deaths were birth asphyxia 275(29.6%), prematurity 267(28.7%) and low-birth-weight 252(27.1%). Conclusion: Nakuru County PNMR was higher compared to WHO recommendation of < 12 deaths/1000 live births, therefore, there is need to identify strategies to reduce incidences of asphyxia, prematurity and low birth weight. Comprehensive antenatal coverage, adequate care of infants at birth is likely to improve quality of life among the survivors and reduce PNMR

Investigation of a typhoid fever epidemic in Moyale Sub-County, Kenya, 2014–2015

Abstract Aim Typhoid fever is a vaccine-preventable bacterial disease that causes significant morbidity and mortality throughout Africa. This paper describes an upsurge of typhoid fever cases in Moyale Sub-County (MSC), Kenya, 2014–2015. Methods We conducted active hospital and health facility surveillance and laboratory and antimicrobial sensitivity testing for all patients presenting with headache, fever, stomach pains, diarrhea, or constipation at five MSC health facilities between December 2014 and January 2015. We also conducted direct observation of the residential areas of the suspected cases to assess potential environmental exposures and transmission mechanisms. Demographic, clinical, and laboratory data were entered into, and descriptive statistics were calculated with, MS Excel. Results A total of 317 patients were included in the study, with mean age 24 ± 8.1 years, and 51% female. Of the 317 suspect cases, 155 (49%) were positive by Widal antigen reaction test. A total of 188 (59%) specimens were subjected to culture and sensitivity testing, with 71 (38%) culture positive and 54 (76%), 43 (60%), and 33 (46%) sensitive to ceftriaxone, cefuroxime, and ciprofloxacin, respectively. Environmental assessments through direct observations showed that commercial and residential areas had limited (1) clean water sources, (2) latrines, and (3) hygiene stations for street food hawkers and their customers. Conclusions Typhoid fever is endemic in MSC and causes significant disease across age and sex groups. The local health department should develop policies to (1) assure community access to potable water and hygiene stations and (2) vaccinate specific occupations, such as food and drink handlers, against typhoid

Burden and risk factors of cutaneous leishmaniasis in a peri-urban settlement in Kenya, 2016.

BACKGROUND:Cutaneous leishmaniasis is a neglected disease known to cause significant morbidity among the poor. We investigated a suspected outbreak to determine the magnitude of cases, characterize the cases and identify risk factors of cutaneous leishmaniasis in Gilgil, a peri-urban settlement in Central Kenya. METHODS:Hospital records for the period 2010-2016 were reviewed and additional cases were identified through active case search. Clinical diagnosis of cutaneous leishmaniasis was made based on presence of ulcerative, nodular or papular skin lesion. The study enrolled 58 cases matched by age and neighbourhood to 116 controls in a case control study. Data was collected using structured questionnaires and simple proportions, means and medians were computed, and logistic regression models were constructed for analysis of individual, indoor and outdoor risk factors. RESULTS:Of the 255 suspected cases of cutaneous leishmaniasis identified, females constituted 56% (142/255) and the median age was 7 years (IQR 7-21). Cases occurred in clusters and up to 43% of cases originated from Gitare (73/255) and Kambi-Turkana (36/255) villages. A continuous transmission pattern was depicted throughout the period under review. Individual risk factors included staying outside the residence in the evening after sunset (OR 4.1, CI 1.2-16.2) and visiting forests (OR 4.56, CI 2.04-10.22). Sharing residence with a case (OR 14.4, CI 3.8-79.3), residing in a thatched house (OR 7.9, CI 1.9-45.7) and cracked walls (OR 2.3, CI 1.0-4.9) were identified among indoor factors while sighting rock hyraxes near residence (OR 5.3, CI 2.2-12.7), residing near a forest (OR 7.8, CI 2.8-26.4) and having a close neighbour with cutaneous leishmaniasis (OR 6.8, CI 2.8-16.0) were identified among outdoor factors. CONCLUSIONS:We identify a large burden of cutaneous leishmaniasis in Gilgil with evidence of individual, indoor and outdoor factors of disease spread. The role of environmental factors and rodents in disease transmission should be investigated further