Background:Maternal anemia, low birth weight, intrauterine growth retardation and premature births are complications associated with malaria in pregnancy (MIP). In order to prevent malaria, Wold Health Organization (WHO) recommends at least three doses of Sulphadoxine Pyrimethamine (SP) for Intermittent Preventive Treatment of Malaria in Pregnancy (IPTp-SP3+) during the antenatal period. This study aimed to determine the prevalence and the health system determinants of uptake of three or more doses (IPTp 3+) in Busia County, Kenya. Methods:A facility-based cross-sectional study conducted at Busia County Referral Hospital between June and July 2023. Mothers' in the Maternity Unit with term deliveries were consecutively sampled. Data on health system factors was collected using interviewer administered semi-structured questionnaires and interview guides. The statistical significance of health system factors affecting IPTp-SP3+ was dertemined using the odds ratio (OR) and adjusted OR. Results:The prevalence of IPTp-SP 3+ uptake was 43.0%. Health system factors significantly associated with IPTp-SP 3+ uptake were facility being too far (aOR = 0.575, 95% CI: 0.351- 0.941, p = 0.028) and waiting time being too long (aOR = 0.606, 95% CI: 0.385-0.955, p = 0.031). Conclusion:Prevalence of uptake of IPTp 3+ is still low, with less than half of the pregnant mothers complying. The County and National Ministries of Health should make a concerted effort to ensure availability and affordability of SP drugs and also ensure access to and customer satisfaction at the healthcare facilities.
Background: Skin and soft tissue infections (SSTIs) are conditions resulting from the inflammatory microbial invasion of the epidermis, dermis and sub-cutaneous tissue. They are very common infections, being the second most common indication for antibiotic prescription.Objective: To determine the antimicrobial susceptibility of bacterial organisms causing SSTIs and the antimicrobial management of SSTIs at the Moi Teaching and Referral Hospital (MTRH).Design: A cross sectional descriptive study.Setting: The study was carried out at Moi Teaching and Referral Hospital in Eldoret, KenyaSubjects/Participants: Patients admitted at MTRH, whose primary diagnosis was a bacterial SSTI (cutaneous abscess, purulent cellulitis and wound infection), identified based on clinical criteria.Result: Out of 84 bacteria cultured, Staphylococcus aureus constituted 47.6%. Methicillin Resistant Staphylococcus aureus (MRSA) constituted 45% of Staphylococcus aureus. Over 80% of Staphylococcus aureus were susceptible to vancomycin and ceftazidime. Likewise, other gram-positive bacteria, including Enterococcus spp., coagulase negative staphylococci and Streptococcus pyogenes were susceptible to vancomycin and clindamycin. Gram-negative bacteria were 25, and most were susceptible to meropenem and amikacin (>80%). However, Acinetobacter baumanii were not susceptible to any antimicrobial tested. Flucloxacillin and metronidazole were most used as empiric therapy, which was effective against the etiologic bacteria in 18%.Conclusion: The most common cause of SSTIs was Staphylococcus aureus, which were susceptible to vancomycin and clindamycin. Gram-negative bacteria were susceptible to meropenem and amikacin. Most empiric therapy was not appropriate.
Objective: To determine the impact of and adherence to hydroxyurea use over a 6-month period on the frequency of blood transfusion among children (1-18 years) with sickle cell disease (SCD).Study design, setting and duration: A retrospective quasi-experimental study conducted in a public (Kenyatta National Hospital) and a private (Gertrude’s Garden Children Hospital) hospital setting in Kenya from February to May 2017.Subjects: Participants were children aged 1-18 years with a diagnosis of sickle cell anaemia confirmed by serum electrophoresis who had been on hydroxyurea treatment for at least 6 months.Interventions and outcomes: The main intervention and outcome measures were hydroxyurea treatment and frequency of blood transfusion respectively.Results: A total of 64 children were studied. The mean age was 7.6 years (SD ±3.7). The mean decrease in the number of blood transfusions during the 6–12-month period after adequate use of hydroxyurea was 0.9 (95% CI 0.7 - 1.2; p < 0.001). Majority of the participants received hydroxyurea dosages of < 20mg/kg/day (51/64; 79.7%), took hydroxyurea as per the prescription (50/64;78.1%), and didn’t experience any side effects (56/64; 87.5%).Conclusion: This study suggests that hydroxyurea significantly reduces the frequency of blood transfusions in children aged 1-18 years with minimal sideeffects.
ABSTRACTBackgroundNeonatal bacterial infections have been associated with rising antimicrobial resistance levels. This has led to increasing neonatal morbidity and mortality in poorly resourced health facilities located in low income countries. Local studies on neonatal antibiotic sensitivity patterns and its associated risk factors could inform empirical antibiotic therapy and hospital infection control strategies.PurposeThe study aimed at determining the causative organisms, antibiotic sensitivity patterns and risk factors associated with neonatal sepsis at a tertiary teaching hospital in Western Kenya.Materials and MethodsCross-sectional study among neonates suspected to have sepsis and undergoing treatment at Moi Teaching and Referral Hospital (MTRH’s) newborn unit (NBU) between September 2017 and July 2018. Blood culture tests isolated bacteria and determined their antimicrobial sensitivity. Neonatal and maternal characteristics were obtained through medical chart reviews. Descriptive statistics, Pearson chi-square test of association and odds ratios were adopted.ResultsThe study enrolled 141 neonates, majority (57.4%) of whom were female. The median gestational age and birth weight were 37 (IQR: 22-45) weeks and 2400g (IQR: 800 - 4700) respectively. Of the 151 bacterial isolates identified, 46.4% were Klebsiella spp. followed by Coagulate negative staphylococcus (CoNS) at 27.8%. Klebsiella spp. was sensitive to meropenem, amikacin and cefepime but resistant to ceftriaxone, gentamycin and cefotaxime. However, CoNS was sensitive to vancomycin and penicillin. Both the neonatal and maternal risk factors assessed were not associated with neonatal sepsis.ConclusionThe main bacterial causes of neonatal sepsis were Klebsiella spp. and CoNS which were both sensitivity to meropenem and amikacin.
Background:HIV diagnosis is the gateway to antiretroviral therapy. However, 20-50% of HIV-infected individuals are unaware of their HIV status, derailing epidemic control.Objective:To increase awareness of HIV status and enrollment into HIV care & treatment (C&T) services through a national HIV testing services (HTS) rapid results initiative (RRI) campaign in Kenya.Design:This cross-sectional analysis presents yield of undiagnosed people living with HIV (PLHIV) and their enrollment into HIV C&T resulting from HTS RRI implemented in July-August 2013 as an example of utilizing RRIs to catalyze achievement of UNAIDS targets.Results:During the campaign 1,462,378 persons received HTS, of whom 220,902 (15%) were children (aged <15 years), 55,088 (7%) couples and 116,126 (8%) key populations. A total of 37,630 (2.6%) HIV+ individuals were identified. Among children who received HTS, 3,244 (1.5%) tested HIV positive, compared to 34,386 (2.8%) among adults. Of the eight regions in Kenya: Nyanza, Rift-valley and Nairobi contributed 73.3% of all HIV+ individuals identified. HTS at health facility settings yielded the highest proportion (69%) of HIV+ and key populations had the highest prevalence (4.8%). Of those infected, 29,851 (79.3%) were enrolled into HIV C&T. Sex, age and setting of HTS were significantly associated with enrollment into HIV C&T (p<0.0001).Conclusion:National HTS campaigns have the potential of increasing knowledge of HIV status. Targeted provision of HTS at health facility settings, to key populations and high burden geographical regions would narrow the gap of undiagnosed PLHIV towards achieving UNIADS 90-90-90 targets for HIV epidemic control.
