p16INK4a/Ki-67 dual stain cytology for cervical cancer screening in Thika district, Kenya

Background: The identification of suited early detection tests is one among the multiple requirements to reduce cervical cancer incidence in developing countries. Methods: We evaluated p16INK4a/Ki-67 dual-stain cytology in a screening population in Thika district, Kenya and compared it to high-risk human papillomavirus (HR-HPV) DNA testing and visual inspection by acetic acid (VIA) and Lugol’s iodine (VILI). Results: Valid results for all tests could be obtained in 477 women. 20.9 % (100/477) were tested positive for HR-HPV DNA, 3.1 % (15/477) had positive VIA/VILI and 8.2 % (39/477) positive p16INK4a/Ki-67 cytology. Of 22 women that showed up for colposcopy and biopsy, 6 women were diagnosed with CIN3 and two with CIN2. All women with CIN2/3 were negative in VIA/VILI screening and positive by HR-HPV DNA testing. But HPV was also positive in 91.7 % (11/12) of women with normal histology. p16INK4a/Ki-67 cytology was positive in all 6 women with CIN3, in one of the two CIN2 and in only 8.3 % (1/12) of women with normal histology. Conclusions: p16INK4a/Ki-67 cytology is an interesting test for further studies in developing countries, since our findings point to a lower fraction of false positive test results using p16INK4a/Ki-67 cytology compared to HPV DNA testing in a Kenyan screening population. VIA/VILI missed all histology-proven CIN2/3

Identifying and quantifying initial post-discharge needs for clinical review of sick, newborns in Kenya based on a large multi-site, retrospective cohort study

BackgroundProgress in neonatal care has resulted in a 51% decrease in global neonatal mortality rates from 1990 to 2017. Enhanced survival will put pressure on health care systems to provide appropriate post-discharge, follow-up care but the scale of need for such care is poorly defined.MethodsWe conducted a retrospective cohort study of newborns discharged from 23 public hospital neonatal units (NBUs) in Kenya between January 2018 and June 2023 to identify initial follow-up needs. We first determined pragmatic follow-up categories based on survivors’ clinical conditions and morbidities. We then used individual phenotypes of individual babies to assign them to needing one or more forms of specialized clinical follow-up. We use descriptive statistics to estimate proportions of those with specific needs and patterns of need.FindingsAmong 136,249/159,792 (85.3%) neonates discharged, around one-third (33%) were low birth weight (<2,500 g), and a similar 33.4% were preterm (<37 weeks). We estimated 131,351 initial episodes of follow-up would be needed across nine distinct follow-up categories: general pediatrics, nutrition, growth & development (40.4%), auditory screening (38.8%), ophthalmology for retinopathy of prematurity (9.6%), neurology (8.0%), occupational therapy (1.3%), specialized nutrition (0.9%), surgery (0.8%), cardiology (0.2%), and pulmonary (<0.1%). Most neonates met the criteria for two (52.3%, 28,733), followed by three (39.6%, 21,738) and one follow-up episodes (5.6%, 3,098). In addition to prematurity and very low birth weight (≤1,500 g), severe infections with extended gentamicin treatment, severe jaundice managed with phototherapy, and hypoxic-ischemic encephalopathy (HIE) contributed substantially to the pattern of need for post-discharge follow-up.ConclusionsAlmost half of surviving NBU infants have multiple specialty post-discharge follow-up needs. More urgent attention needs to be focused on healthcare planning now to guide strategies to address the varied medical and developmental needs that we outline in resource-constrained contexts like Kenya

Hypothermia amongst neonatal admissions in Kenya: a retrospective cohort study assessing prevalence, trends, associated factors, and its relationship with all-cause neonatal mortality

BackgroundReports on hypothermia from high-burden countries like Kenya amongst sick newborns often include few centers or relatively small sample sizes.ObjectivesThis study endeavored to describe: (i) the burden of hypothermia on admission across 21 newborn units in Kenya, (ii) any trend in prevalence of hypothermia over time, (iii) factors associated with hypothermia at admission, and (iv) hypothermia's association with inpatient neonatal mortality.MethodsA retrospective cohort study was conducted from January 2020 to March 2023, focusing on small and sick newborns admitted in 21 NBUs. The primary and secondary outcome measures were the prevalence of hypothermia at admission and mortality during the index admission, respectively. An ordinal logistic regression model was used to estimate the relationship between selected factors and the outcomes cold stress (36.0°C–36.4°C) and hypothermia (<36.0°C). Factors associated with neonatal mortality, including hypothermia defined as body temperature below 36.0°C, were also explored using logistic regression.ResultsA total of 58,804 newborns from newborn units in 21 study hospitals were included in the analysis. Out of these, 47,999 (82%) had their admission temperature recorded and 8,391 (17.5%) had hypothermia. Hypothermia prevalence decreased over the study period while admission temperature documentation increased. Significant associations were found between low birthweight and very low (0–3) APGAR scores with hypothermia at admission. Odds of hypothermia reduced as ambient temperature and month of participation in the Clinical Information Network (a collaborative learning health platform for healthcare improvement) increased. Hypothermia at admission was associated with 35% (OR 1.35, 95% CI 1.22, 1.50) increase in odds of neonatal inpatient death.ConclusionsA substantial proportion of newborns are admitted with hypothermia, indicating a breakdown in warm chain protocols after birth and intra-hospital transport that increases odds of mortality. Urgent implementation of rigorous warm chain protocols, particularly for low-birth-weight babies, is crucial to protect these vulnerable newborns from the detrimental effects of hypothermia

MOESM2 of Plasmid profiling and incompatibility grouping of multidrug resistant Salmonella enterica serovar Typhi isolates in Nairobi, Kenya

Additional file 2: Fig. S2. MacConkey culture plates showing the morphology of the recipient, donor and the transconugant. (A): Colonies of the recipient strain (E. coli K12) in presence of nalidixic acid; (B): Colonies of the donor strain (S. Typhi) on culture plate containing ampicillin; (C): Colonies of transconjugants on culture plate containing both ampicillin and nalidixic acid

Seroprevalence of Hepatitis B among HIV Infected Persons Receiving Care in a HIV Clinic in Kisumu Kenya

Background: Hepatitis B infection among HIV infected persons is of clinical importance because it’s a leading cause of morbidity and mortality. Hepatitis B leads to liver cirrhosis and liver cancer. In Kenya Hepatitis B testing is not presently part of routine care for HIV infected patients despite that HIV increases the progression of HBV related liver disease due to immunosuppression. Objective: To determine the seroprevalence of Hepatitis B virus infection and Alanine aminotransferase; ALT levels among HIV infected persons in a HIV care clinic. Methodology: Cross-sectional descriptive study conducted at Family Aids Care and Education Services (FACES) Kisumu, Kenya. A sample size of 136 HIV infected persons above the age of 18 years were recruited. A questionnaire collecting information on the socio demographic characteristic and exposure factors to Hepatitis B infection was administered, 4mls of blood was collected for the detection of HBsAg (Hepatitis B surface Antigens) by Enzyme Immunoassay with the Murex HBsAg kit. The ALT test was done using COBAS INTEGRAL® 400 plus, Roche. Statistical analysis was done using SPSS v.16. Results: The seroprevalence of Hepatitis B infection among HIV infected persons was 13%. Patients with elevated liver enzyme ALT among HIV/HBV co infected persons was 11.76%. A possible association between elevated ALT and Hepatitis B was found (Fishers exact test p=0.044). Exposure factors such as lack of vaccination and having more than one sexual partner were considered to be significantly associated with the Infection ( P<0.005) Conclusion: There is need for increased screening and awareness of HBV infection for individuals who are HIV positive as the prevalence of the Hepatitis B infection is comparatively high as compared to the prevalence of HBsAg in the general population. The government through the ministry of medical services should look into the policy of making vaccination against Hepatitis B accessible

MOESM1 of Plasmid profiling and incompatibility grouping of multidrug resistant Salmonella enterica serovar Typhi isolates in Nairobi, Kenya

Additional file 1: Fig. S1. Plasmids extracted from the transconjugants. Lane M plasmids of E. coli 39 (NCTC 50192); Lane 1–10 transconjugants resistant to chloramphenicol, tetracycline and ampicillin; Lane 5 non-conjugative transconjugant