Reducing the Number of Sputum Samples Examined and Thresholds for Positivity: An Opportunity to Optimise Smear Microscopy.

SETTING: Urban health clinic, Nairobi. OBJECTIVE: To evaluate the impact on tuberculosis (TB) case detection and laboratory workload of reducing the number of sputum smears examined and thresholds for diagnosing positive smears and positive cases. DESIGN: In this prospective study, three Ziehl-Neelsen stained sputum smears from consecutive pulmonary TB suspects were examined blind. The standard approach (A), > or = 2 positive smears out of 3, using a cut-off of 10 acid-fast bacilli (AFB)/100 high-power fields (HPF), was compared with approaches B, > or = 2 positive smears (> or = 4 AFB/100 HPF) out of 3, one of which is > or = 10 AFB/100 HPF; C, > or = 2 positive smears (> or = 4 AFB/100 HPF) out of 3; D, > or = 1 positive smear (> or = 10 AFB/100 HPF) out of 2; and E, > or = 1 positive smear (> or = 4 AFB/100 HPF) out of 2. The microscopy gold standard was detection of at least one positive smear (> or = 4 AFB/100 HPF) out of 3. RESULTS: Among 644 TB suspects, the alternative approaches detected from 114 (17.7%) (approach B) to 123 cases (19.1%) (approach E) compared to 105 cases (16.3%) for approach A (P < 0.005). Sensitivity ranged between 82.0% (105/128) for A and 96.1% (123/128) for E. The single positive smear approaches reduced the number of smears by 36% compared to approach A. CONCLUSION: Reducing the number of specimens and the positivity threshold to define a positive case increased the sensitivity of microscopy and reduced laboratory workload

Added value of bleach sedimentation microscopy for diagnosis of tuberculosis: a cost-effectiveness study.

SETTING: Bleach sedimentation is a method used to increase the diagnostic yield of sputum microscopy for countries with a high prevalence of human immunodeficiency virus (HIV) infection and limited resources. OBJECTIVES: To compare the relative cost-effectiveness of different microscopy approaches in diagnosing tuberculosis (TB) in Kenya. METHODS: An analytical decision tree model including cost and effectiveness measures of 10 combinations of direct (D) and overnight bleach (B) sedimentation microscopy was constructed. Data were drawn from the evaluation of the bleach sedimentation method on two specimens (first on the spot [1] and second morning [2]) from 644 TB suspects in a peripheral health clinic. Incremental cost per smear-positive detected case was measured. Costs included human resources and materials using a micro-costing evaluation. RESULTS: All bleach-based microscopy approaches detected significantly more cases (between 23.3% for B1 and 25.9% for B1+B2) than the conventional D1+D2 approach (21.0%). Cost per tested case ranged between respectively euro 2.7 and euro 4.5 for B1 and B1+D2+B2. B1 and B1+B2 were the most cost-effective approaches. D1+B2 and D1+B1 were good alternatives to avoid using approaches exclusively based on bleach sedimentation microscopy. CONCLUSIONS: Among several effective microscopy approaches used, including sodium hypochlorite sedimentation, only some resulted in a limited increase in the laboratory workload and would be most suitable for programmatic implementation

Anti-tuberculosis drug resistance in Nairobi, Kenya

Background: Drug resistant tuberculosis (TB) which is a state when Mycobaterium tuberculosis (MTB) organisms are resistant to antimicrobial agents at the levels attainable in blood and tissue pose a serious threat to TB control programs. Limited information exists on the exact prevalence of resistance to anti-tuberculosis drugs in populations with high rates of tuberculosis and HIV co-infection such as those in Nairobi, Kenya. Setting: A cross sectional study was conducted among new and previously treated consecutive sputum smear positive pulmonary tuberculosis (PTB) patients of 14 years and older at 16 diagnostic and treatment facilities in Nairobi, Kenya, between February and August 2010. Objective: To determine the magnitude of drug resistance to first line antituberculosis drugs among MTB isolates obtained from a study addressing the diagnosis and epidemiology of drug resistant tuberculosis in Nairobi, Kenya. Methods: Sputum samples from patients with bacteriologically confirmed PTB on microscopy were cultured on Lowenstein Jensen (LJ) media. Participants were offered diagnostic testing and counselling for HIV testing. Strains of MTB complex from Lowenstein Jensen (LJ) slopes were subjected to drug susceptibility testing (DST) to isoniazid (H), rifampicin (R), streptomycin (S), and ethambutol (E) using the proportional method on the Mycobacterium Growth Indicator Tube (MGIT) conventional method. Results: A total of 595 TB patients had their MTB strains DST done. Of the 568 (95.4%) patients who had valid results for analysis, 369 were new and 199 previously treated. About eighty five percent and seventy seven percent of the strains from new patients and previously treated patients were fully sensitive to all the drugs tested respectively. Any resistance to isoniazid, streptomycin, ethambutol and rifampicin was 10.3%, 4.3%, 5.1% and 0.81% respectively among new patients. Among previously treated patients any resistance to isoniazid, streptomycin, ethambutol and rifampicin was 18.1%, 10.5%, 7.03% and 9.04% respectively. The prevalence of MDR TB defined as resistant to at least both isoniazid and rifampicin was 0.54% and 8.54% among new and previously treated patients respectively. Conclusion: The study found high levels of drug resistant TB in Nairobi compared to other previous studies done in the country. MDR TB in Kenya is now a reality and the situation in Nairobi being the largest cosmopolitant city is worrying. The upword trend of MDR TB in Nairobi is course of concern. This calls for urgent concerted efforts to address the problem especially the strenghthening of the implementation of the comprehensive framework of the DOTS-Plus strategy for appropriate management of MDR-TB

Employee fairness perception on performance appraisals in the civil service in Kenya

ABSTRACT This study was aimed at investigating employee fairness perception of performance appraisal among the civil servants in Kenya. Performance management systems are used largely in managing human resources and they contribute to organizational strategy. The introduction and implementation of a performance management system carries profound implications for both employees and organizations. This therefore necessitates the need to establish how the employees perceive the toll and the entire process of the performance appraisal. The study focused on three fairness perceptions which included distributive, procedural and interactional fairness perceptions only. The target population of this study was the civil servants in Kenya. Cross-sectional study design and stratified random sampling procedure were adopted in selecting the study respondents. The study sampled 268 civil servants in the ministry of state for Immigration and Registration of Persons in Kenya as a case study. Questionnaires and interview schedule were used as research instruments. All analyses were done using SPSS. The results of the study revealed that performance appraises of the selected organisation have shown their agreement on five point likert scales measuring respondent perceptions about procedural fairness, distributive fairness and interactional fairness regarding PAS. The overall score of items on each scale was above 3.0 which were classified into &quot;Agree&quot; response category of interpretive scale provided. Key Words: employee fairness perception, performance appraisals, civil service, Kenya Introduction This study was set to investigate employee fairness perception of performance appraisal among the civil service in Kenya. In this chapter, the researcher explains the background information, states the problem and outlines the study objectives and research questions. Also highlighted is the significance and justification of the study as well as the theoretical and conceptual framework

Resistance of Common Circulating Enteric Bacterial Pathogens to Prescribed Antibiotics Among Under Five Years in Selected Public Hospitals in Kenya

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Diversity of Mycobacterium tuberculosis strains in Nairobi, Kenya

Setting: Tuberculosis (TB) patients attending 16 public health facilities in Nairobi, Kenya. Objective: To determine the Mycobacterium tuberculosis (M.tuberculosis) strain families circulating in Nairobi, Kenya. Methods: Sputum specimens from consecutive new and previously treated smear positive pulmonary TB patients were collected between February and August 2010 and cultured on Lowenstein9Jensen media. Spoligotyping was done on DNA extracted from the first isolate of each patient. The international spoligotype data base (SpolDB4) was used to group isolates into strain families. Results: Fourty seven different strain families were identified from 536 isolates. The principal groups were; CAS1_KILI 96/536 (17%), T1 69/536 (12%), Beijing 65/536 (12%), LAM9 46/536 (9% ), LAM3 &amp; S/Conversant 37/536 (7% ), LAM11_ZWE 26/536 (5%), CAS1_DELHI 24/536 (4%) and T2 24/536 (4%). Others identified and are found in the SpolDB4 were 113/536 (21%). A possible new M.tuberculosis strain family was identified with 21/536 (4%) isolates which was designated as Nairobi subtype. Others identified not previously included in the SpolDB4 accounted for 15/536 (3%). Conclusion: We found a diverse array of M.tuberculosis strain families which could be indicative of a cosmopolitant polulation with frequent migration that may suggest that the dorminant strain families may have been present in the population for an extended period of time or on going transmision of closely related strains families. The emergence of the Beijing strains poses a serious threat to TB control due to its high virulence and frequent association with multidrug resistance. We therefore call for strenghthening efforts on early case finding through enhanced public health education campains and provision of accessible diagnostic services with enhanced treatment compliance

Operational Research Project Management, Experiences, Challenges and Lessons Learnt

Introduction: Effective project management revolves around Strategic Management. Logistics seem simple and straight forward but, often the role&nbsp; it plays in scientific undertakings is overlooked. It is usually assumed that research starts and ends in the laboratory. It is a fact that, for research activities to be successful, it requires exceptional planning to ensure that, resources are available as per the approved work-plan. This entails&nbsp; determination of what, when, who, why and how it is to be done. Recent studies indicate that, logistics-related activities' impact on research&nbsp; undertakings significantly. Objective: To document the project management experiences and lessons learnt in coordinating and implementation of East Africa Public Health Laboratories Networking Project –Operational Research (EAPHLNP-OR) activities in five East African countries, namely: Kenya, Rwanda, Burundi, Uganda and Tanzania. Methodology: The operational research component of the EAPHLNP, KEMRI established an OR Secretariat to coordinate the project activities in&nbsp; Kenya and provide leadership to regional principal investigators. In consultation with the project Secretariat, the role of the administrator involved Work plan and budget preparation, planning, organizing, communicating, coordinating local and regional meetings, linking KEMRI research team with the study site (Hospital Administration) and Research Teams in the various counties. The site Teams obtained informed consent, recruited respondents, collected specimens, analyzed the specimens and shipped a portion of the same together with the results to KEMRI. Key Activities Of The Project: Managing financial aspects (budget and financial report preparations), logistical coordination, and procurement of training materials, organizing for meeting venues, taking minutes, travel arrangements and participation in scientific report writing. Control mechanism such as dairies, ledger books, work plan charts and schedules, managing and monitoring the progress of the project activities. Lesson Learnt &amp; Challenges: Interpersonal skills were essential at all stages of the project. The critical stage was the forming, storming, and&nbsp; norming stages. Here, group dynamics and conflicts took center stage. This threatened to stall the OR Project. Timely and constant communication with the study site coordinators, prioritization of scheduled project activities, was essential. Ensuring all parties are kept informed on the progress of the OR activities. The information in user-friendly format dairies and schedules provided the necessary feedback at administrative level, on project performance and at research findings. Key challenges included fluctuating funding, group dynamic conflicts and staff transfers. Discussion: EAPHLNP-OR was a Seven (7) years project undertaking, which for effective management involved understanding of the operating environment, strategic planning for short and long term goals, constant communication, review of priorities, documentation and practise of goodinterpersonal skills. Conclusion: Successful project management in OR required an administrator to coordinate the utilization of the available resources both capital and human. This is the second supplement in this issue only aspects on findings from TB and Enteric studies done in Kenya have been addressed.Three regional policy briefs on TB Enteric and malaria have been included

Performance of LED-Based Fluorescence Microscopy to Diagnose Tuberculosis in a Peripheral Health Centre in Nairobi.

Sputum microscopy is the only tuberculosis (TB) diagnostic available at peripheral levels of care in resource limited countries. Its sensitivity is low, particularly in high HIV prevalence settings. Fluorescence microscopy (FM) can improve performance of microscopy and with the new light emitting diode (LED) technologies could be appropriate for peripheral settings. The study aimed to compare the performance of LED-FM versus Ziehl-Neelsen (ZN) microscopy and to assess feasibility of LED-FM at a low level of care in a high HIV prevalence country

Experience and Lessons Learnt on Health Care Personnel Participating In the Implementation of TB Operational Research at (EAPHLNP -OR) Malindi, Kenya

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