Healthcare wastes contain potentially harmful microorganisms, inorganic and organic compounds that pose a risk to human health and the environment. Incineration is a common method employed in healthcare waste manageme...Healthcare wastes contain potentially harmful microorganisms, inorganic and organic compounds that pose a risk to human health and the environment. Incineration is a common method employed in healthcare waste management to reduce volume, quantity, toxicity as well as elimination of microorganisms. However, some of the substances remain unchanged during incineration and become part of bottom ash, such as heavy metals and persistent organic pollutants. Monitoring of pollution by heavy metals is important since their concentrations in the environment affect public health. The goal of this study was to determine the levels of Copper (Cu), Zinc (Zn) Lead (Pb), Cadmium (Cd) and Nickel (Ni) in the incinerator bottom ash in five selected County hospitals in Kenya. Bottom ash samples were collected over a period of six months. Sample preparation and treatment were done using standard methods. Analysis of the heavy metals were done using atomic absorption spectrophotometer, model AA-6200. One-Way Analysis of Variance (ANOVA) was performed to determine whether there were significant differences on the mean levels of Cu, Zn, Pd, Cd and Ni in incinerator bottom ash from the five sampling locations. A post-hoc Tukey’s Test (HSD) was used to determine if there were significant differences between and within samples. The significant differences were accepted at p ≤ 0.05. To standardize the results, overall mean of each metal from each site was calculated. The metal mean concentration values were compared with existing permissible levels set by the WHO. The concentrations (mg/kg) were in the range of 102.27 - 192.53 for Cu, Zn (131.68 - 2840.85), Pb (41.06 - 303.96), Cd (1.92 - 20.49) whereas Ni was (13.83 - 38.27) with a mean of 150.76 ± 77.88 for Copper, 131.66 ± 1598.95 for Zinc, 234.60 ± 262.76 for Lead, 12.256 ± 10.86 for Cadmium and 29.45 ± 18.24 for Nickel across the five sampling locations. There were significant differences between levels determined by one-way ANOVA of Zn (F (4, 25) = 6.893, p = 0.001, p ≤ 0.05) and Cd (F (4, 25) = 5.641, p = 0.02) and none with Cu (F (4, 25) = 1.405, p = 0.261, p ≤ 0.05), Pb (F (4, 25) = 1.073, p = 0.391, p ≤ 0.05) and Ni (F (4, 25) = 2.492, p = 0.069). Results reveal that metal content in all samples exceed the WHO permissible levels for Cu (100 mg/kg), while those for Ni were below the WHO set standards of 50 mg/kg. Levels of Zn in three hospitals exceeded permissible level of 300 mg/kg while level of Pb exceeded WHO set standards of 100 mg/kg in two hospitals. Samples from four hospitals exceeded permissible level for Cd of 3 mg/kg. This study provides evidence that incinerator bottom ash is contaminated with toxic heavy metals to human health and the environment. This study recommends that hospitals should handle the bottom ash as hazardous wastes and there is need to train and provide appropriate personal protective equipment to healthcare workers, waste handlers, and incinerator operators and enforce compliance to existing regulation and guidelines on healthcare waste management to safeguard the environment and human health.展开更多
Healthcare waste management (HCWM) is an important aspect of healthcare delivery globally because of its hazardous and infectious components that have potential for adverse health and environmental impacts. The paper ...Healthcare waste management (HCWM) is an important aspect of healthcare delivery globally because of its hazardous and infectious components that have potential for adverse health and environmental impacts. The paper introduces a set of indicators for assessing HCWM systems in hospitals. These indicators are: HCWM policies and standard operating procedures, management and oversight, logistics and budget support, training and occupational health and safety, and treatment, disposal and waste treatment equipment housing. By plotting a mark on a continuum which is defined as good and poor on the extremes and is connected with all other marks in a spoke arrangement, it’s possible to describe a baseline for HCWM in any specific hospital. This baseline can be used to improve awareness of the actors and policy-makers, compare the same hospital at a different point in time, to compare observations by different evaluators and to track improvements. Results suggest that in Kenya, the application of such indicators is useful for evaluating which priorities should be addressed to improve outcomes in HCWM systems. Systematic sampling technique was used to identify and collect data by use of observational checklist, interviews, visual verification and review of documents and a HCWM assessment tool. The objective is to suggest an integrated management tool as a method to identify prevailing problems with a HCWM system. The method can be replicated in other contexts worldwide, with a focus on the developing world. The integrated indicators focus on management of HCW and not its potential impact on human health and environment, an area recognized to be critical for future research.展开更多
Aflatoxin M1 (AFM1) is a major carcinogenic compound that may be found in milk and dairy products resulting from ingestion of aflatoxin B1 by dairy animals. The study aimed at determining the level of aflatoxin M1 in ...Aflatoxin M1 (AFM1) is a major carcinogenic compound that may be found in milk and dairy products resulting from ingestion of aflatoxin B1 by dairy animals. The study aimed at determining the level of aflatoxin M1 in milk and milk products from Bomet County. A total of 185 samples (150 raw milk and 35 processed milk and milk products) were randomly collected from milk collection sites and randomly selected milk kiosks respectively. The AFM1 was analyzed using a commercial ELISA kit (Ridascreen, aflatoxin M1 R-Biopharm, Product code, R5812, Darmstadt, Germany). Out of 185 samples investigated, 156 samples were positive for AFM1, an overall contamination rate of 84.32%. The samples with levels higher than the tolerance limit of 0.05 μg/l recommended by Food and Agriculture Organization (FAO) and World Health Organization (WHO) limits were 43.8% mainly contributed by the raw milk compared to processed milk (52.0% versus 8.6%). Processed milk had insignificant level of contamination with aflatoxin M1 (Median 0.00 (IQR: 0.00, 0.00 μg/l) with a minimum of 0.00 μg/l and a maximum of 0.69 μg/l. Raw milk showed significant contamination, median 0.09 (IQR: 0.00, 0.50) μg/l with a minimum of 0.00 μg/l and a maximum of 2.93 μg/l. Although there was no significant differences in AFM1 levels with study sites (P = 0.217);the median levels of aflatoxin M1 was high in sites 1, 3, and 7. The sites that had median aflatoxin M1 levels below the WHO/FAO acceptable limits of 0.05 μg/l were sites 2, 4 and 6. Due to high incidence of AFM1 contamination of milk and milk samples in Bomet County, there is need for regular monitoring and regulation of AFM1 contamination in milk and its products in the County.展开更多
This paper examines the history of health care in Cambodia and focuses on the role of traditional healers and their response to the HIV/AIDS epidemic,the use of medicinal plants and their bioscientific importance in t...This paper examines the history of health care in Cambodia and focuses on the role of traditional healers and their response to the HIV/AIDS epidemic,the use of medicinal plants and their bioscientific importance in this tropical country.In conclusion,vital to the management of HIV/AIDS in tropical countries such as Cambodia is the cooperation and collaboration between traditional healers and Western trained medical doctors.Beliefs underlying the cause of HIV/AIDS,divination,cultural-emotional factors,standardization of training,and medicinal packaging and distribution are a few starting points for future discussion.展开更多
Most intestinal parasites are cosmopolitan with the highest prevalence in the tropics and subtopics. Rural-to-urban migration rapidly increases the number of food eating places in towns and their environs. Some of the...Most intestinal parasites are cosmopolitan with the highest prevalence in the tropics and subtopics. Rural-to-urban migration rapidly increases the number of food eating places in towns and their environs. Some of these eating estabishments have poor sanitation and are overcrowded, facilitating disease transmission, especially through food-handling. Our investigations in Nairobi, therefore, were set to determine the presence of intestinal parasites in food-handlers with valid medical certificates. Direct and concentrated stool processing techniques were used. Chisquare test and ANOVA were used for data analysis. The parasites Ascaris lumbricoides, Entamoeba histolytica and Giardia lamblia were observed in certified food-handlers. Significant difference was found in parasite frequency by eating classes and gender （χ^2 = 9.49, P = 0.73）, （F = 1.495, P = 0.297）, but not in parasite occurrence between age brackets （χ^2 = 6.99, P = 0.039）. The six-month medical certificate validity period may contribute significantly to the presence of intestinal parasites in certified food-handlers.展开更多
This paper sought to analyze the relationship between population growth and development. The motivation is that population growth has been blamed as a cause of being under development in LDS (Least Developed Countries...This paper sought to analyze the relationship between population growth and development. The motivation is that population growth has been blamed as a cause of being under development in LDS (Least Developed Countries). This is a descriptive study employing review of secondary data and reports. There is no direct relationship between population growth and being under development. This is supported by countries which are populous yet their economies are growing fast enabling them to graduate from developing and donor reliant to developed and donating countries. China and India are examples. Again, data show that socio-economic indicators were not any better when population sizes were low in the last 3 to 4 decades. Countries should focus on sound economic management to improve the supply side of goods and services which ultimately will result in reduced population growth as one of the effects. It is concluded that the notion of high population is built on the experienced and anticipated challenges in supplying goods and services that meet the demand and not on any standard measure as to what is standard population size for a country of a given physical size and natural resources.展开更多
Actinomycetes are opportunistic pathogens in immunosuppressive patients. Pulmonary actinomycetes infections display symptoms that mimic Mycobacteria tuberculosis and can be misdiagnosed and treated as pulmonary TB. Ac...Actinomycetes are opportunistic pathogens in immunosuppressive patients. Pulmonary actinomycetes infections display symptoms that mimic Mycobacteria tuberculosis and can be misdiagnosed and treated as pulmonary TB. Actinomycetes can be co-infection with tuberculosis leading to delayed or inappropriate treatment. This study aimed to identify and determine antimicrobial susceptibility profiles of Actinomycetes from the sputum of TB smear negative and re-treatment patients referred to TB reference facilities in Kenya. Sputum specimens were collected and direct smears stained with Gram’s reagents. Culture was done on Mueller Hinton agar and incubated at 35°C for two weeks. Identification was done using phenotypic and biochemical procedures. Confirmation of the isolates was done using Polymerase Chain Reaction. A total of 52/385 (14%) Actinomycetes were isolated and subjected to antimicrobial susceptibility testing using broth microdilution method to determine the Minimum Inhibitory Concentration. Nine antibiotics were tested which included: Amikacin, Amoxicillin/Clavulanic acid, Ceftriaxone, Ciprofloxacin, Clarithromycin, Linezolid, Doxycycline, Trimethoprim-Sulfamethoxazole and Gentamycin. Staphylococcus aureus (ATCC 25923) was used as a control. Most of the isolates were susceptible to the test antibiotics. However, four isolates showed multidrug resistance to Ceftriaxone and Clarithromycin with resistance of 11.5% and 26.9% respectively. Gentamycin and Ciprofloxacin showed the highest susceptibility of 100% and 98.1% respectively. The findings of this study confirm that Actinomycetes are significant pathogens in TB smear-negative cases. Although most antibiotics were susceptible, resistance to few antibiotics was observed;hence, there is a need for proper screening of TB smear-negative cases to detect infections by Actinomycetes and also conduct the antimicrobial susceptibility test to determine which antibiotic is effective.展开更多
Typhoid fever caused by the bacterium Salmonella enterica serovar Typhi (S. Typhi) causes an estimated 25 million illnesses and approximately 200,000 deaths annually mostly in developing countries. Although the manage...Typhoid fever caused by the bacterium Salmonella enterica serovar Typhi (S. Typhi) causes an estimated 25 million illnesses and approximately 200,000 deaths annually mostly in developing countries. Although the management of typhoid fever has been effectively through antibiotic treatment, S. Typhi is increasingly becoming resistant to the currently recommended drugs. This study utilized a quasi-experimental design focusing on archived samples to describe antimicrobial susceptibility patterns of S. Typhi and determine the genetic basis of resistance to the two most commonly used classes of antimicrobials. A total sample size of 287 isolates of S. Typhi isolates stored in -80°C freezer at the Centre for Microbiology Research was utilized. Isolates were subjected to anti-microbial susceptibility testing to commonly available antimicrobials using disk diffusion method, then analyzed for trends in resistance to fluoroquinolones and extended spectrum beta lactams. Among the 287 isolates 158 (55.5%) were found to be Multi Drug Resistant (MDR). This implied that these isolates were resistant to all first line classes of treatment such as ampicillin, chloramphenicol and sulfamethoxazole-trimethroprim. In addition to this, these isolates were also resistant to at least one of the currently recommended drugs of choice, either a β-lactam or a fluoroquinolone. This study observed resistances at 18.2% and 15.4% to fluoroquinolones and cephalosporins respectively. PCR results revealed presence of blaTEM, blaINT and blaCTX-M genes coding for resistance to β-lactams in 80% of the isolates that had combined resistance to β-lactams and fluoroquinolones. It is likely that recent heavy use of these classes of antimicrobials is driving resistances to these antimicrobials.展开更多
Health-care waste contains potentially harmful microorganisms and compounds which can infect and affect hospital patients, healthcare workers, the general public and environment. Therefore, management of health care w...Health-care waste contains potentially harmful microorganisms and compounds which can infect and affect hospital patients, healthcare workers, the general public and environment. Therefore, management of health care waste requires safe handling, treatment and disposal procedures. While incineration reduces the volume and quantity of waste for final disposal, it leads to the production of fly and bottom ashes laden with toxic incomplete combustion products such as Polycyclic Aromatic Hydrocarbons (PAHs), dioxins, furans and heavy metals. This exposes workers who handle and dispose the bottom ashes, hospital patients, the general public and environment. The goal of this study was to determine the total and individual levels of 16 most prevalent and toxic PAHs. Bottom ash samples were collected from incinerators in five county hospitals in Kenya, namely;Moi-Voi, Narok, Kitale, Makindu and Isiolo. Bottom ash samples were collected over a period of six months from the five hospitals. The samples were then sieved, homogenised and stored at 4°C in amber coloured glass containers. The PAHs were extracted using 30 ml of a hexane-acetone solvent (1:1) mixture by ultrasonication at room temperature (23°C) for 45 minutes. The PAHs were then analyzed with a GC-MS spectrophotometer model (Shimadzu GCMS-QP2010 SE) connected to a computer work station was used for the PAHs analysis. The GC-MS was equipped with an SGE BPX5 GC capillary column (30 m × 0.25 mm × 0.25 μm) for the separation of compounds. Helium was used as the carrier gas at a flow rate of 15.5 ml/minute and 14.5 psi. 1 μl of the sample was injected at 280°C, split mode (10:1). The oven programming was set for a total runtime of 40 minutes, which included: 100°C (2-minute hold);10°C /min rise to 200°C;7°C /min rise to 249°C;3°C /min rise to 300°C (2-minute hold). The interface temperature was set at 290°C. Analysis was done in Selected Ion Monitoring (SIM) mode and the peak areas of each of the PAHs were collected from the chromatograph and used for quantification of the 16 PAHs listed by the U.S. Environmental Protection Agency (EPA) which included, BaA (benz[a]anthracene: 4 rings), BaP (benzo[a]pyrene: 5 rings), BbF (benzo [b]fluoranthene: 5 rings), BkF (benzo[k]fluoranthene: 5 rings), Chr (chrysene: 4 rings), DbA (dibenz[a,h]anthracene: 5 rings), InP (indeno[1,2,3 - cd] pyrene: 6 rings) and Acp (acenaphthene: 3 rings), Acpy (acenaphthylene: 3 rings), Ant (anthracene: 3 rings), BghiP (benzo[g,h,i]perylene: 6 rings), Flu (fluorene: 3 rings), FluA (fluoranthene: 4 rings), Nap (naphthalene: 2 rings), PhA (phenanthrene: 3 rings) and Pyr (pyrene: 4 rings). Ion source-interface temperature was set at 200°C - 250°C. Internal standards from Sigma Aldrich were used in the analysis and the acquired mass spectra data were then matched against the NIST 2014 library [1] [2]. The mean PAHs concentration in the bottom ashes of each hospital varied broadly from 0.001 mg/kg to 0.4845 mg/kg, and the mean total concentration levels of individual PAHs ranged from 0.0072 mg/kg to 1.171 mg/kg. Low molecular weight PAHs (Phenanthrene, Naphthalene and Fluorene) were predominant in all the hospital wastes whereas Kitale and Narok presented the lowest PAHs concentrations and the lowest number of individual PAHs. Moi/Voi recorded the highest total PAHs concentration at 1.3129 ± 0.0023 mg/kg from a total of 11 PAHs being detected from the bottom ash samples. Narok had only three PAHs being detected at very low concentrations of 0.0041 ± 0.00 mg/kg, 0.0076 ± 0.00 mg/kg and 0.012 ± 0.00 mg/kg for phenanthrene, anthracene and chrysene respectively. This study presents hospital incinerator bottom ash as containing detectable levels of both carcinogenic and non-carcinogenic PAHs. Continued unprotected exposure of hospital workers (waste handlers) to the bottom ash PAHs could be hazardous to their health because of their cumulative effect. Preventive measures e.g. the use of Personal protective equipment (PPE) should be prioritised to minimise direct contact with the bottom ash. The study recommends an upgrade on incinerator technology for efficient combustion processes thus for better pollution control.展开更多
Background: Anaemia is one of the most common nutritional deficiency diseases observed globally and affects more than a quarter of the world’s population. Globally, 41.8% pregnant women and close to one third of non-...Background: Anaemia is one of the most common nutritional deficiency diseases observed globally and affects more than a quarter of the world’s population. Globally, 41.8% pregnant women and close to one third of non-pregnant women (30.2%) are anaemic. Anaemia during pregnancy contributes to 20% of all maternal deaths and it increases the risks of foetal, neonatal and overall infant mortality. In Kenya, according to the Ministry of Health, the prevalence of anaemia among pregnant women is 55.1%. Objective: To determine the prevalence and associated factors of anaemia among pregnant women attending antenatal clinic (ANC) at Pumwani Maternity Hospital (PMH). Methodology: A hospital based cross-sectional study design was conducted from 8<sup>th</sup> June to 18<sup>th</sup> August, 2015. Systematic random sampling method was used to select 258 pregnant women. Mothers who attended ANC during the study period and who met the inclusion criteria were interviewed and a capillary blood sample was taken. Hemoglobin level was determined by using HemoCue photometer. Data were cleaned, coded and fed into SPSS Version 20.0 for analysis. Descriptive statistics such as frequency, percentage, mean and standard deviation were used to describe selected variables. Pearson’s chi-square test and odds ratio (OR) with corresponding 95% confidence intervals (CI) computed to find association between independent and dependent variables. Multivariate analysis was done to determine factors significantly and independently predicting anaemia during pregnancy. Results: The present study revealed that the prevalence of anaemia among the pregnant women was 57%. Advanced maternal age (>31 years) (AOR = 2.71;95% CI = 1.25 - 5.88;P = 0.012) more than 18 - 24 years, government/private employed women (AOR = 2.94;95% CI = 1.47 - 5.88;P = 0.002) and self-employed women (AOR = 1.91;95% CI = 1.03 - 3.53;P = 0.039) compared to housewives, not taking iron/folic acid supplementation (IFAS) (AOR = 2.04; 95% CI = 1.14 - 3.64;P = 0.016) and mid-upper arm circumference (MUAC) less than 23 cm (AOR = 2.52;95% CI = 1.36 - 4.67;P = 0.003) were found to be predictors of anaemia. Conclusion: Anaemia among pregnant women is found to be severe public health problem based on the World Health Organization classification of anaemia. Advanced age, employment, not taking IFAS during the current pregnancy and MUAC of less than 23 cm were significantly and independently associated with anaemia during pregnancy. Thus, special attention should be given to pregnant women who are employed and advanced in age. Moreover, they should be educated on the importance of taking iron and folic acid during pregnancy.展开更多
The prevalence of TB in sub-Sahara Africa has been reported as 511 per 100,000 populations and a mortality of 74 per 100,000 in year 2009. In the same period, incidence was estimated at 350 cases per 100,000. In this ...The prevalence of TB in sub-Sahara Africa has been reported as 511 per 100,000 populations and a mortality of 74 per 100,000 in year 2009. In the same period, incidence was estimated at 350 cases per 100,000. In this regard, the health system requires strengthening to respond to the rising cases of infection, drug resistance and quality of life lost while continuing to seek interventions that improve adherence to medication and case detection among those infected. Methods: This study sought to determine factors that are associated with sputum positivity after intensive phase of chemotherapy in people with tuberculosis. It was a retrospective case-control study conducted in Rhodes chest clinic, a City Council health unit in Nairobi that specializes in treatment of chest infections. The participants were sampled from clinic attendants who had completed two months of intensive phase TB chemotherapy and met inclusion criteria. Results: Seventy participants of whom 25 (36%) were sputum positive at the end of two (2) months intensive phase were included in the study. Skipping medication doses was significantly associated with sputum positivity (p = 0.01). Patients who were sputum positive at the end of the two-month period were more likely to have taken longer time before seeking treatment compared to those who were sputum negative by median (IQR) 8 (3 - 12) and 4 (3 - 8) weeks respectively although this difference was not significant (p = 0.09). Patients who had not disclosed their infection status had a two-fold possibility of remaining sputum positive at the end of intensive phase. Conclusion: Early diagnosis and treatment of TB, and adherence to medication were important factors that affect sputum conversion during intensive phase of TB treatment. Therefore, public health practitioners should advise patients to seek prompt diagnosis and treatment of signs and symptoms of tuberculosis.展开更多
Background: Condoms offer protection against human immunodeficiency virus (HIV) transmission when used correctly and consistently. Many HIV infected people do not use condom regularly, thus leading to new HIV infectio...Background: Condoms offer protection against human immunodeficiency virus (HIV) transmission when used correctly and consistently. Many HIV infected people do not use condom regularly, thus leading to new HIV infections and reinfections. In Kenya, condom use is considered to be low and HIV prevalence is high among women aged 15 - 49 years where utilization of condoms among HIV positive women has not been studied. Objectives: The study aimed at determining the prevalence of consistent condom use among HIV positive women aged 18 - 49 years and to investigate the variables associated with it. Methods: A mixed method of study design (qualitative and quantitative approaches) was employed. A total of 422 participants were selected randomly and interviewed using a pretested structured questionnaire. Three (3) focus group discussions with 8 participants in each group were conducted. Chi-square test (p < 0.05) and odds ratio with corresponding 95% confidence interval were computed to establish the association between consistent condom use and independent variables. Binary logistic regression model was used to identify variables independently associated with consistent condom use. Qualitative data were transcribed and coded and then analysed thematically. Results: Consistent condom use among sexually active HIV positive women was found to be 57.4% (95%CI: 52.7% - 62.1%). The stepwise logistic regression revealed that attending tertiary education [aOR = 2.54;95%CI = 1.30 - 4.95;P = 0.006], disclosing HIV status [aOR = 2.27;95%CI = 1.27 - 4.06;P = 0.005], having an HIV negative partner [aOR = 4.23;95%CI = 1.99 - 8.98;P < 0.001], not taking alcohol [aOR = 1.72;95%CI = 1.10 - 2.69;P = 0.017], never encountered resistance to use condom by partners [aOR = 1.87;95%CI = 1.15 - 3.03;P = 0.011] and perceived risk of contracting STIs [aOR = 2.11;95%CI = 1.12 - 3.97;P = 0.021] as factors independently associated with consistent condom use. Conclusion: This study shows that there is still low prevalence of consistent condom use among HIV positive women. More education, campaigning and sensitization should be tailored among HIV positive women during counseling so as to avoid re-infection and transmission of infections.展开更多
Rivers can act as reservoirs of highly resistant strains and facilitate the dissemination of resistance, virulence and integron 1 genes. A cross-sectional study was carried out where 318 water samples were collected (...Rivers can act as reservoirs of highly resistant strains and facilitate the dissemination of resistance, virulence and integron 1 genes. A cross-sectional study was carried out where 318 water samples were collected (53 from each site) and from the samples, 318 E. coli isolates were analysed for resistance genes, virulence genes and integron 1 using Polymerase Chain Reaction. 22% of the isolates had blaTEM, 33% had blaCTX-M and 28% had blaCMY. Prevalence of typical Enteropathogenic E. coli strains (carrying both eae and bfp genes) was 5% while the prevalence of atypical Enteropathogenic E. coli (carying only eae) was 1.8%. The prevalence of Enteroaggregative E. coli carrying the aggr genes was 11%. The prevalence of Enterotoxigenic E. coli encoding only lt toxin was 16 (5%) and while those carrying only st toxin was 6.9%. The prevalence of Enteroinvasive E. coli strains encoding as IpaH was 5% while that of strains, adherent invasive E. coli, carrying adherent invasive gene inv was 8.7%. 36% isolates were positive for class 1 integrons which were mostly isolated near the sewage effluent from waste treatment plant. Anthropogenic activities and close proximity to sewage treatment plant were found to play a key role in pollution of water body and accumulation of resistance and virulence genes. These results suggest that waste treatment plant may act as reservoir of resistance, virulence and integron 1 genes and is a potential risk to human and animal health in the region.展开更多
Antimicrobial use in agriculture, livestock and human health has increased over the years leading to the increase in antimicrobial resistance that can also find its way to the aquatic environment. Rivers can act as re...Antimicrobial use in agriculture, livestock and human health has increased over the years leading to the increase in antimicrobial resistance that can also find its way to the aquatic environment. Rivers can act as reservoirs of highly resistant strains and facilitate the dissemination of multidrug resistant (MDR) strains to animals and humans using water. A total of 318 water samples were collected from six different sampling points along Athi River and E. coli isolates were subjected to Kirby-Bauer diffusion method for antimicrobial susceptibility testing. The total mean coliform count of the sampled sites was 2.7 × 104 (cfu/mL). E. coli isolates were most resistant to ampicillin (63.8%) and most susceptible to gentamicin (99.4%). MDR strains (resistance to ≥3 classes of antibiotics) accounted for 65.4% of all the isolates. The site recorded to have human industrial and agricultural zone activities had strains that were significantly more resistant to ampicillin, cefoxitin, amoxicillin/clavulanic acid (P ≤ 0.05) than isolates from the section of the river traversing virgin land and land with minimum human activities. This study indicates that E. coli strains isolated from Athi River were highly MDR and most resistant to some antimicrobial classes (ampicillin and cefoxitin) which constitute a potential risk to human and animal health.展开更多
Severe acute malnutrition is a widely prevalent problem in developing countries and a major cause of morbidity and mortality. Traditionally, children with severe acute malnutrition were rehabilitated within inpatient ...Severe acute malnutrition is a widely prevalent problem in developing countries and a major cause of morbidity and mortality. Traditionally, children with severe acute malnutrition were rehabilitated within inpatient services. Advent of ready to use therapeutic food made it possible to treat majority of these children in their homes. However, there is limited data about the outcomes of the program. Objectives: To determine the outcomes (recovery, default, mean weight gain and non-response rates) of severely malnourished children aged 6 - 59 months enrolled in outpatient therapeutic program at Kitui County Hospital. Methodology: A prospective longitudinal study design was carried out for one month. Hundred and four (104) children with SAM were recruited in the study. Anthropometric measurements, physical examination and appetite test of the children were conducted on a weekly basis for 28 days. Descriptive analysis was conducted using means, frequency and proportions. Paired t test was computed for mean weight gain and mid-upper arm circumference between admission and subsequent visits. Results: The findings of the study revealed that the recovery rate was 73.3%, weight gain rate of 5.1 g/kg/day, defaulter rate was 2.9% and non-response rate was 13.9% (WHZ = -3SD). Mean weight increased from 6.8 kg on the 1st visit to 7.5 kg in the 4th visit (P = 0.000) and the meanmid-upper arm circumferenceincreased from 11.1 cm at admission to 11.9 cm at 4th visit (P = 0.000). Conclusion: The recovery and weight gain rates were below the global acceptable SPHERE of minimum standards (recovery rate > 75% and weight gain rate > 8 g/kg/day). The defaulter rate was within the acceptable international standards (展开更多
Background: Tuberculosis is an infectious disease with an estimated 1.45 million deaths every year. Many patients get infected as a result of ignorance of the risk factors that contribute to disease transmission. Meth...Background: Tuberculosis is an infectious disease with an estimated 1.45 million deaths every year. Many patients get infected as a result of ignorance of the risk factors that contribute to disease transmission. Methodology: A descriptive epidemiological study was conducted on 258 patients presenting with pulmonary tuberculosis. Patients’ sputa were collected for laboratory analysis and patients were required to respond to a structured questionnaire on risk factors for transmission. Data among stratified groups were compared using bivariate analysis. Statistical significance was considered at p Results: There were significantly more males than females associated with pulmonary tuberculosis infection (χ2 = 0.963;df = 1;p (64.3%) patients were living in single rooms with 110 (42.6%) living with more than two people with a maximum of 10 people in a single room. Only 73 (28.3%) were living alone in a single room and only 7 families (2.7%) were living in houses with five or more rooms. Alcohol consumers and smokers were 102 (39.5%) and 93 (36%) respectively. Half of the patients (137 (53.3%)) had not completed secondary education with only 16 (6.2%) having completed tertiary education. Recurrent cases were 54 (21%) while those exposed to the disease either at home or working place were 75 (29.2%). Out of 171 patients who agreed to test for HIV, 46 (26.9%) were positive. Marital status had no effect on incidence of disease. Conclusion: Emphasis should be given to creating awareness of the risk factors associated with transmission of tuberculosis in order to reduce the rate of infection.展开更多
Background: Omphalitis (umbilical cord infection) among new-borns is common and a major cause of neonatal deaths in developing countries. Annually about 4 million neonatal deaths occur around the world;of these, more ...Background: Omphalitis (umbilical cord infection) among new-borns is common and a major cause of neonatal deaths in developing countries. Annually about 4 million neonatal deaths occur around the world;of these, more than 30% are caused by infections. Majority of these infections start as umbilical cord infection. Objective: The aim of the present study was to establish cord care practices associated with omphalitis among neonates aged 3-28 days at Pumwani Maternity Hospital, Kenya. Methodology: Cross-sectional descriptive study was employed among 178 mothers with neonates of 3-28 days. Participants were selected systematically and data was collected on new-born cord care practices. Omphalitis was defined as pus discharge, redness with or without pus and swelling of umbilical cord. Pearson’s chi-square test (P < 0.05) was performed to compare the significant discrepancies. Crude and adjusted odds ratios with corresponding 95% confidence interval were also used to determine the strength of association between omphalitis and cord care practices. Results: Among 178 neonates, 67 (37.6%) were diagnosed with omphalitis. In logistic regression analysis, the main predictors of omphalitis were initiation of breastfeeding after one hour of delivery [AOR = 2.47;95%CI = 1.15 - 5.30;P < 0.05] compared to within one hour and application of saliva to the cord [AOR = 6.59;95%CI = 2.02 - 21.46;P < 0.01] compared to dry cord. Conclusion: The prevalence of omphalitis among neonates was high. Health workers need to participate in educating the mothers to initiate breastfeeding within one hour and to avoid application of harmful cord care practices.展开更多
Background: HIV-1 drug resistance is an emerging challenge for HIV-1 infected clients who are on antiretroviral therapy (ART). In Kenya, as in many other developing countries, ART is now accesible to clients who need ...Background: HIV-1 drug resistance is an emerging challenge for HIV-1 infected clients who are on antiretroviral therapy (ART). In Kenya, as in many other developing countries, ART is now accesible to clients who need it. However, they must be done a CD4 test first and if the count is <300, then ART is commenced. With the initiation of ART comes the challenge of adherence to medication, a factor that is impacted greatly by the understanding of the client of the importance?of adherence and the financial ability to keep their appointments, especially if the clients come from a distant location. Objective: To identify HIV-1 drug resistance mutations inclientsfailing1st line antiretroviral therapy in Nairobi, Kenya. Methodology: A cross sectional study was carried out where whole blood samples were collected from clients attending a HIV care and treatment clinic in Nairobi. Clients who had been on ART for more than 6 months and had a viral load greater than 1000 were enrolled in the study. A total of 52 client samples were successfully sequenced in the reverse transcriptase region and analyzed. Results: After analysis of the generated sequences, it was seen that 43 (82.6%) of the clients had HIV-1 drug resistance mutations conferring resistance to one or more nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse-transcriptase inhibitors (NNRTIs). Majority of the clients (46%) were infected with HIV-1 subtype A viruses. Conclusion: The findings of the study showed that a significant proportion of the clients on ART had developed resistance mutations to one or more drugs that are used as 1st line therapy in Kenya. There is need for continuous education of the population on importance of adherence to medication. There is also need for clinicians to be trained on using viral load and HIV drug resistance testing, where available, as methods of monitoring treatment failure so that clients can be switched to alternative medication immediately the need arises, so as to improve their treatment outcomes.展开更多
Diarrhea is among the leading causes of morbidity and mortality in children aged Escherichia coli (DEC) accounts for 30% - 40% of childhood diarrhea cases. To identify the pathotypes involved in diarrheal outbreaks in...Diarrhea is among the leading causes of morbidity and mortality in children aged Escherichia coli (DEC) accounts for 30% - 40% of childhood diarrhea cases. To identify the pathotypes involved in diarrheal outbreaks in Kenya, we analyzed archived E. coli isolates from children E. coli confirmation and antimicrobial susceptibility testing were done using the VITEK<sup>®</sup>2 instrument. Pathotype identification was performed via conventional polymerase chain reaction. Of 175 E. coli isolates, 48 (27%) were DEC pathotypes, with enteroaggregative E. coli (EAEC) predominating (71%, 34/48). Enterohemorrhagic (EHEC) and enteropathogenic E. coli (EPEC) represented 19% and 10% of isolates, respectively. Enteroinvasive and enterotoxigenic pathotypes were not identified. All DEC isolates were susceptible to amikacin, ertapenem, imipenem, meropenem and tigecycline. Conversely, most (>80%) isolates were resistant to ampicillin, ampicillin-sulbactam and sulfamethoxazole-trimethoprim. Half of all EAEC and EPEC strains were resistant to cefazolin while half of EHEC isolates were resistant to ciprofloxacin and moxifloxacin. In total, 18 resistance phenotypes were identified with “ampicillin-cefazolin-ampicillin/ sulbactam-sulfamethoxazole/trimethoprim” predominating (33%, 16/48). The majority (81%) of DEC isolates were multidrug-resistant, with extended-spectrum beta-lactamase production identified in 8% of these isolates. This study highlights the predominance of Enteroaggregative E. coli and multidrug resistance of DEC pathotypes. Studying the epidemiology of diarrheal disease and antimicrobial resistance surveillance, will aid in identifying dominant etiological agents of diarrhea and newly emerging resistant strains in informal settlements.展开更多
文摘Healthcare wastes contain potentially harmful microorganisms, inorganic and organic compounds that pose a risk to human health and the environment. Incineration is a common method employed in healthcare waste management to reduce volume, quantity, toxicity as well as elimination of microorganisms. However, some of the substances remain unchanged during incineration and become part of bottom ash, such as heavy metals and persistent organic pollutants. Monitoring of pollution by heavy metals is important since their concentrations in the environment affect public health. The goal of this study was to determine the levels of Copper (Cu), Zinc (Zn) Lead (Pb), Cadmium (Cd) and Nickel (Ni) in the incinerator bottom ash in five selected County hospitals in Kenya. Bottom ash samples were collected over a period of six months. Sample preparation and treatment were done using standard methods. Analysis of the heavy metals were done using atomic absorption spectrophotometer, model AA-6200. One-Way Analysis of Variance (ANOVA) was performed to determine whether there were significant differences on the mean levels of Cu, Zn, Pd, Cd and Ni in incinerator bottom ash from the five sampling locations. A post-hoc Tukey’s Test (HSD) was used to determine if there were significant differences between and within samples. The significant differences were accepted at p ≤ 0.05. To standardize the results, overall mean of each metal from each site was calculated. The metal mean concentration values were compared with existing permissible levels set by the WHO. The concentrations (mg/kg) were in the range of 102.27 - 192.53 for Cu, Zn (131.68 - 2840.85), Pb (41.06 - 303.96), Cd (1.92 - 20.49) whereas Ni was (13.83 - 38.27) with a mean of 150.76 ± 77.88 for Copper, 131.66 ± 1598.95 for Zinc, 234.60 ± 262.76 for Lead, 12.256 ± 10.86 for Cadmium and 29.45 ± 18.24 for Nickel across the five sampling locations. There were significant differences between levels determined by one-way ANOVA of Zn (F (4, 25) = 6.893, p = 0.001, p ≤ 0.05) and Cd (F (4, 25) = 5.641, p = 0.02) and none with Cu (F (4, 25) = 1.405, p = 0.261, p ≤ 0.05), Pb (F (4, 25) = 1.073, p = 0.391, p ≤ 0.05) and Ni (F (4, 25) = 2.492, p = 0.069). Results reveal that metal content in all samples exceed the WHO permissible levels for Cu (100 mg/kg), while those for Ni were below the WHO set standards of 50 mg/kg. Levels of Zn in three hospitals exceeded permissible level of 300 mg/kg while level of Pb exceeded WHO set standards of 100 mg/kg in two hospitals. Samples from four hospitals exceeded permissible level for Cd of 3 mg/kg. This study provides evidence that incinerator bottom ash is contaminated with toxic heavy metals to human health and the environment. This study recommends that hospitals should handle the bottom ash as hazardous wastes and there is need to train and provide appropriate personal protective equipment to healthcare workers, waste handlers, and incinerator operators and enforce compliance to existing regulation and guidelines on healthcare waste management to safeguard the environment and human health.
文摘Healthcare waste management (HCWM) is an important aspect of healthcare delivery globally because of its hazardous and infectious components that have potential for adverse health and environmental impacts. The paper introduces a set of indicators for assessing HCWM systems in hospitals. These indicators are: HCWM policies and standard operating procedures, management and oversight, logistics and budget support, training and occupational health and safety, and treatment, disposal and waste treatment equipment housing. By plotting a mark on a continuum which is defined as good and poor on the extremes and is connected with all other marks in a spoke arrangement, it’s possible to describe a baseline for HCWM in any specific hospital. This baseline can be used to improve awareness of the actors and policy-makers, compare the same hospital at a different point in time, to compare observations by different evaluators and to track improvements. Results suggest that in Kenya, the application of such indicators is useful for evaluating which priorities should be addressed to improve outcomes in HCWM systems. Systematic sampling technique was used to identify and collect data by use of observational checklist, interviews, visual verification and review of documents and a HCWM assessment tool. The objective is to suggest an integrated management tool as a method to identify prevailing problems with a HCWM system. The method can be replicated in other contexts worldwide, with a focus on the developing world. The integrated indicators focus on management of HCW and not its potential impact on human health and environment, an area recognized to be critical for future research.
文摘Aflatoxin M1 (AFM1) is a major carcinogenic compound that may be found in milk and dairy products resulting from ingestion of aflatoxin B1 by dairy animals. The study aimed at determining the level of aflatoxin M1 in milk and milk products from Bomet County. A total of 185 samples (150 raw milk and 35 processed milk and milk products) were randomly collected from milk collection sites and randomly selected milk kiosks respectively. The AFM1 was analyzed using a commercial ELISA kit (Ridascreen, aflatoxin M1 R-Biopharm, Product code, R5812, Darmstadt, Germany). Out of 185 samples investigated, 156 samples were positive for AFM1, an overall contamination rate of 84.32%. The samples with levels higher than the tolerance limit of 0.05 μg/l recommended by Food and Agriculture Organization (FAO) and World Health Organization (WHO) limits were 43.8% mainly contributed by the raw milk compared to processed milk (52.0% versus 8.6%). Processed milk had insignificant level of contamination with aflatoxin M1 (Median 0.00 (IQR: 0.00, 0.00 μg/l) with a minimum of 0.00 μg/l and a maximum of 0.69 μg/l. Raw milk showed significant contamination, median 0.09 (IQR: 0.00, 0.50) μg/l with a minimum of 0.00 μg/l and a maximum of 2.93 μg/l. Although there was no significant differences in AFM1 levels with study sites (P = 0.217);the median levels of aflatoxin M1 was high in sites 1, 3, and 7. The sites that had median aflatoxin M1 levels below the WHO/FAO acceptable limits of 0.05 μg/l were sites 2, 4 and 6. Due to high incidence of AFM1 contamination of milk and milk samples in Bomet County, there is need for regular monitoring and regulation of AFM1 contamination in milk and its products in the County.
基金Grants No.P20 MD000173 from NCMHD. and No.G12RR003061 from NCRR.
文摘This paper examines the history of health care in Cambodia and focuses on the role of traditional healers and their response to the HIV/AIDS epidemic,the use of medicinal plants and their bioscientific importance in this tropical country.In conclusion,vital to the management of HIV/AIDS in tropical countries such as Cambodia is the cooperation and collaboration between traditional healers and Western trained medical doctors.Beliefs underlying the cause of HIV/AIDS,divination,cultural-emotional factors,standardization of training,and medicinal packaging and distribution are a few starting points for future discussion.
文摘Most intestinal parasites are cosmopolitan with the highest prevalence in the tropics and subtopics. Rural-to-urban migration rapidly increases the number of food eating places in towns and their environs. Some of these eating estabishments have poor sanitation and are overcrowded, facilitating disease transmission, especially through food-handling. Our investigations in Nairobi, therefore, were set to determine the presence of intestinal parasites in food-handlers with valid medical certificates. Direct and concentrated stool processing techniques were used. Chisquare test and ANOVA were used for data analysis. The parasites Ascaris lumbricoides, Entamoeba histolytica and Giardia lamblia were observed in certified food-handlers. Significant difference was found in parasite frequency by eating classes and gender （χ^2 = 9.49, P = 0.73）, （F = 1.495, P = 0.297）, but not in parasite occurrence between age brackets （χ^2 = 6.99, P = 0.039）. The six-month medical certificate validity period may contribute significantly to the presence of intestinal parasites in certified food-handlers.
文摘This paper sought to analyze the relationship between population growth and development. The motivation is that population growth has been blamed as a cause of being under development in LDS (Least Developed Countries). This is a descriptive study employing review of secondary data and reports. There is no direct relationship between population growth and being under development. This is supported by countries which are populous yet their economies are growing fast enabling them to graduate from developing and donor reliant to developed and donating countries. China and India are examples. Again, data show that socio-economic indicators were not any better when population sizes were low in the last 3 to 4 decades. Countries should focus on sound economic management to improve the supply side of goods and services which ultimately will result in reduced population growth as one of the effects. It is concluded that the notion of high population is built on the experienced and anticipated challenges in supplying goods and services that meet the demand and not on any standard measure as to what is standard population size for a country of a given physical size and natural resources.
文摘Actinomycetes are opportunistic pathogens in immunosuppressive patients. Pulmonary actinomycetes infections display symptoms that mimic Mycobacteria tuberculosis and can be misdiagnosed and treated as pulmonary TB. Actinomycetes can be co-infection with tuberculosis leading to delayed or inappropriate treatment. This study aimed to identify and determine antimicrobial susceptibility profiles of Actinomycetes from the sputum of TB smear negative and re-treatment patients referred to TB reference facilities in Kenya. Sputum specimens were collected and direct smears stained with Gram’s reagents. Culture was done on Mueller Hinton agar and incubated at 35°C for two weeks. Identification was done using phenotypic and biochemical procedures. Confirmation of the isolates was done using Polymerase Chain Reaction. A total of 52/385 (14%) Actinomycetes were isolated and subjected to antimicrobial susceptibility testing using broth microdilution method to determine the Minimum Inhibitory Concentration. Nine antibiotics were tested which included: Amikacin, Amoxicillin/Clavulanic acid, Ceftriaxone, Ciprofloxacin, Clarithromycin, Linezolid, Doxycycline, Trimethoprim-Sulfamethoxazole and Gentamycin. Staphylococcus aureus (ATCC 25923) was used as a control. Most of the isolates were susceptible to the test antibiotics. However, four isolates showed multidrug resistance to Ceftriaxone and Clarithromycin with resistance of 11.5% and 26.9% respectively. Gentamycin and Ciprofloxacin showed the highest susceptibility of 100% and 98.1% respectively. The findings of this study confirm that Actinomycetes are significant pathogens in TB smear-negative cases. Although most antibiotics were susceptible, resistance to few antibiotics was observed;hence, there is a need for proper screening of TB smear-negative cases to detect infections by Actinomycetes and also conduct the antimicrobial susceptibility test to determine which antibiotic is effective.
文摘Typhoid fever caused by the bacterium Salmonella enterica serovar Typhi (S. Typhi) causes an estimated 25 million illnesses and approximately 200,000 deaths annually mostly in developing countries. Although the management of typhoid fever has been effectively through antibiotic treatment, S. Typhi is increasingly becoming resistant to the currently recommended drugs. This study utilized a quasi-experimental design focusing on archived samples to describe antimicrobial susceptibility patterns of S. Typhi and determine the genetic basis of resistance to the two most commonly used classes of antimicrobials. A total sample size of 287 isolates of S. Typhi isolates stored in -80°C freezer at the Centre for Microbiology Research was utilized. Isolates were subjected to anti-microbial susceptibility testing to commonly available antimicrobials using disk diffusion method, then analyzed for trends in resistance to fluoroquinolones and extended spectrum beta lactams. Among the 287 isolates 158 (55.5%) were found to be Multi Drug Resistant (MDR). This implied that these isolates were resistant to all first line classes of treatment such as ampicillin, chloramphenicol and sulfamethoxazole-trimethroprim. In addition to this, these isolates were also resistant to at least one of the currently recommended drugs of choice, either a β-lactam or a fluoroquinolone. This study observed resistances at 18.2% and 15.4% to fluoroquinolones and cephalosporins respectively. PCR results revealed presence of blaTEM, blaINT and blaCTX-M genes coding for resistance to β-lactams in 80% of the isolates that had combined resistance to β-lactams and fluoroquinolones. It is likely that recent heavy use of these classes of antimicrobials is driving resistances to these antimicrobials.
文摘Health-care waste contains potentially harmful microorganisms and compounds which can infect and affect hospital patients, healthcare workers, the general public and environment. Therefore, management of health care waste requires safe handling, treatment and disposal procedures. While incineration reduces the volume and quantity of waste for final disposal, it leads to the production of fly and bottom ashes laden with toxic incomplete combustion products such as Polycyclic Aromatic Hydrocarbons (PAHs), dioxins, furans and heavy metals. This exposes workers who handle and dispose the bottom ashes, hospital patients, the general public and environment. The goal of this study was to determine the total and individual levels of 16 most prevalent and toxic PAHs. Bottom ash samples were collected from incinerators in five county hospitals in Kenya, namely;Moi-Voi, Narok, Kitale, Makindu and Isiolo. Bottom ash samples were collected over a period of six months from the five hospitals. The samples were then sieved, homogenised and stored at 4°C in amber coloured glass containers. The PAHs were extracted using 30 ml of a hexane-acetone solvent (1:1) mixture by ultrasonication at room temperature (23°C) for 45 minutes. The PAHs were then analyzed with a GC-MS spectrophotometer model (Shimadzu GCMS-QP2010 SE) connected to a computer work station was used for the PAHs analysis. The GC-MS was equipped with an SGE BPX5 GC capillary column (30 m × 0.25 mm × 0.25 μm) for the separation of compounds. Helium was used as the carrier gas at a flow rate of 15.5 ml/minute and 14.5 psi. 1 μl of the sample was injected at 280°C, split mode (10:1). The oven programming was set for a total runtime of 40 minutes, which included: 100°C (2-minute hold);10°C /min rise to 200°C;7°C /min rise to 249°C;3°C /min rise to 300°C (2-minute hold). The interface temperature was set at 290°C. Analysis was done in Selected Ion Monitoring (SIM) mode and the peak areas of each of the PAHs were collected from the chromatograph and used for quantification of the 16 PAHs listed by the U.S. Environmental Protection Agency (EPA) which included, BaA (benz[a]anthracene: 4 rings), BaP (benzo[a]pyrene: 5 rings), BbF (benzo [b]fluoranthene: 5 rings), BkF (benzo[k]fluoranthene: 5 rings), Chr (chrysene: 4 rings), DbA (dibenz[a,h]anthracene: 5 rings), InP (indeno[1,2,3 - cd] pyrene: 6 rings) and Acp (acenaphthene: 3 rings), Acpy (acenaphthylene: 3 rings), Ant (anthracene: 3 rings), BghiP (benzo[g,h,i]perylene: 6 rings), Flu (fluorene: 3 rings), FluA (fluoranthene: 4 rings), Nap (naphthalene: 2 rings), PhA (phenanthrene: 3 rings) and Pyr (pyrene: 4 rings). Ion source-interface temperature was set at 200°C - 250°C. Internal standards from Sigma Aldrich were used in the analysis and the acquired mass spectra data were then matched against the NIST 2014 library [1] [2]. The mean PAHs concentration in the bottom ashes of each hospital varied broadly from 0.001 mg/kg to 0.4845 mg/kg, and the mean total concentration levels of individual PAHs ranged from 0.0072 mg/kg to 1.171 mg/kg. Low molecular weight PAHs (Phenanthrene, Naphthalene and Fluorene) were predominant in all the hospital wastes whereas Kitale and Narok presented the lowest PAHs concentrations and the lowest number of individual PAHs. Moi/Voi recorded the highest total PAHs concentration at 1.3129 ± 0.0023 mg/kg from a total of 11 PAHs being detected from the bottom ash samples. Narok had only three PAHs being detected at very low concentrations of 0.0041 ± 0.00 mg/kg, 0.0076 ± 0.00 mg/kg and 0.012 ± 0.00 mg/kg for phenanthrene, anthracene and chrysene respectively. This study presents hospital incinerator bottom ash as containing detectable levels of both carcinogenic and non-carcinogenic PAHs. Continued unprotected exposure of hospital workers (waste handlers) to the bottom ash PAHs could be hazardous to their health because of their cumulative effect. Preventive measures e.g. the use of Personal protective equipment (PPE) should be prioritised to minimise direct contact with the bottom ash. The study recommends an upgrade on incinerator technology for efficient combustion processes thus for better pollution control.
文摘Background: Anaemia is one of the most common nutritional deficiency diseases observed globally and affects more than a quarter of the world’s population. Globally, 41.8% pregnant women and close to one third of non-pregnant women (30.2%) are anaemic. Anaemia during pregnancy contributes to 20% of all maternal deaths and it increases the risks of foetal, neonatal and overall infant mortality. In Kenya, according to the Ministry of Health, the prevalence of anaemia among pregnant women is 55.1%. Objective: To determine the prevalence and associated factors of anaemia among pregnant women attending antenatal clinic (ANC) at Pumwani Maternity Hospital (PMH). Methodology: A hospital based cross-sectional study design was conducted from 8<sup>th</sup> June to 18<sup>th</sup> August, 2015. Systematic random sampling method was used to select 258 pregnant women. Mothers who attended ANC during the study period and who met the inclusion criteria were interviewed and a capillary blood sample was taken. Hemoglobin level was determined by using HemoCue photometer. Data were cleaned, coded and fed into SPSS Version 20.0 for analysis. Descriptive statistics such as frequency, percentage, mean and standard deviation were used to describe selected variables. Pearson’s chi-square test and odds ratio (OR) with corresponding 95% confidence intervals (CI) computed to find association between independent and dependent variables. Multivariate analysis was done to determine factors significantly and independently predicting anaemia during pregnancy. Results: The present study revealed that the prevalence of anaemia among the pregnant women was 57%. Advanced maternal age (>31 years) (AOR = 2.71;95% CI = 1.25 - 5.88;P = 0.012) more than 18 - 24 years, government/private employed women (AOR = 2.94;95% CI = 1.47 - 5.88;P = 0.002) and self-employed women (AOR = 1.91;95% CI = 1.03 - 3.53;P = 0.039) compared to housewives, not taking iron/folic acid supplementation (IFAS) (AOR = 2.04; 95% CI = 1.14 - 3.64;P = 0.016) and mid-upper arm circumference (MUAC) less than 23 cm (AOR = 2.52;95% CI = 1.36 - 4.67;P = 0.003) were found to be predictors of anaemia. Conclusion: Anaemia among pregnant women is found to be severe public health problem based on the World Health Organization classification of anaemia. Advanced age, employment, not taking IFAS during the current pregnancy and MUAC of less than 23 cm were significantly and independently associated with anaemia during pregnancy. Thus, special attention should be given to pregnant women who are employed and advanced in age. Moreover, they should be educated on the importance of taking iron and folic acid during pregnancy.
文摘The prevalence of TB in sub-Sahara Africa has been reported as 511 per 100,000 populations and a mortality of 74 per 100,000 in year 2009. In the same period, incidence was estimated at 350 cases per 100,000. In this regard, the health system requires strengthening to respond to the rising cases of infection, drug resistance and quality of life lost while continuing to seek interventions that improve adherence to medication and case detection among those infected. Methods: This study sought to determine factors that are associated with sputum positivity after intensive phase of chemotherapy in people with tuberculosis. It was a retrospective case-control study conducted in Rhodes chest clinic, a City Council health unit in Nairobi that specializes in treatment of chest infections. The participants were sampled from clinic attendants who had completed two months of intensive phase TB chemotherapy and met inclusion criteria. Results: Seventy participants of whom 25 (36%) were sputum positive at the end of two (2) months intensive phase were included in the study. Skipping medication doses was significantly associated with sputum positivity (p = 0.01). Patients who were sputum positive at the end of the two-month period were more likely to have taken longer time before seeking treatment compared to those who were sputum negative by median (IQR) 8 (3 - 12) and 4 (3 - 8) weeks respectively although this difference was not significant (p = 0.09). Patients who had not disclosed their infection status had a two-fold possibility of remaining sputum positive at the end of intensive phase. Conclusion: Early diagnosis and treatment of TB, and adherence to medication were important factors that affect sputum conversion during intensive phase of TB treatment. Therefore, public health practitioners should advise patients to seek prompt diagnosis and treatment of signs and symptoms of tuberculosis.
文摘Background: Condoms offer protection against human immunodeficiency virus (HIV) transmission when used correctly and consistently. Many HIV infected people do not use condom regularly, thus leading to new HIV infections and reinfections. In Kenya, condom use is considered to be low and HIV prevalence is high among women aged 15 - 49 years where utilization of condoms among HIV positive women has not been studied. Objectives: The study aimed at determining the prevalence of consistent condom use among HIV positive women aged 18 - 49 years and to investigate the variables associated with it. Methods: A mixed method of study design (qualitative and quantitative approaches) was employed. A total of 422 participants were selected randomly and interviewed using a pretested structured questionnaire. Three (3) focus group discussions with 8 participants in each group were conducted. Chi-square test (p < 0.05) and odds ratio with corresponding 95% confidence interval were computed to establish the association between consistent condom use and independent variables. Binary logistic regression model was used to identify variables independently associated with consistent condom use. Qualitative data were transcribed and coded and then analysed thematically. Results: Consistent condom use among sexually active HIV positive women was found to be 57.4% (95%CI: 52.7% - 62.1%). The stepwise logistic regression revealed that attending tertiary education [aOR = 2.54;95%CI = 1.30 - 4.95;P = 0.006], disclosing HIV status [aOR = 2.27;95%CI = 1.27 - 4.06;P = 0.005], having an HIV negative partner [aOR = 4.23;95%CI = 1.99 - 8.98;P < 0.001], not taking alcohol [aOR = 1.72;95%CI = 1.10 - 2.69;P = 0.017], never encountered resistance to use condom by partners [aOR = 1.87;95%CI = 1.15 - 3.03;P = 0.011] and perceived risk of contracting STIs [aOR = 2.11;95%CI = 1.12 - 3.97;P = 0.021] as factors independently associated with consistent condom use. Conclusion: This study shows that there is still low prevalence of consistent condom use among HIV positive women. More education, campaigning and sensitization should be tailored among HIV positive women during counseling so as to avoid re-infection and transmission of infections.
文摘Rivers can act as reservoirs of highly resistant strains and facilitate the dissemination of resistance, virulence and integron 1 genes. A cross-sectional study was carried out where 318 water samples were collected (53 from each site) and from the samples, 318 E. coli isolates were analysed for resistance genes, virulence genes and integron 1 using Polymerase Chain Reaction. 22% of the isolates had blaTEM, 33% had blaCTX-M and 28% had blaCMY. Prevalence of typical Enteropathogenic E. coli strains (carrying both eae and bfp genes) was 5% while the prevalence of atypical Enteropathogenic E. coli (carying only eae) was 1.8%. The prevalence of Enteroaggregative E. coli carrying the aggr genes was 11%. The prevalence of Enterotoxigenic E. coli encoding only lt toxin was 16 (5%) and while those carrying only st toxin was 6.9%. The prevalence of Enteroinvasive E. coli strains encoding as IpaH was 5% while that of strains, adherent invasive E. coli, carrying adherent invasive gene inv was 8.7%. 36% isolates were positive for class 1 integrons which were mostly isolated near the sewage effluent from waste treatment plant. Anthropogenic activities and close proximity to sewage treatment plant were found to play a key role in pollution of water body and accumulation of resistance and virulence genes. These results suggest that waste treatment plant may act as reservoir of resistance, virulence and integron 1 genes and is a potential risk to human and animal health in the region.
文摘Antimicrobial use in agriculture, livestock and human health has increased over the years leading to the increase in antimicrobial resistance that can also find its way to the aquatic environment. Rivers can act as reservoirs of highly resistant strains and facilitate the dissemination of multidrug resistant (MDR) strains to animals and humans using water. A total of 318 water samples were collected from six different sampling points along Athi River and E. coli isolates were subjected to Kirby-Bauer diffusion method for antimicrobial susceptibility testing. The total mean coliform count of the sampled sites was 2.7 × 104 (cfu/mL). E. coli isolates were most resistant to ampicillin (63.8%) and most susceptible to gentamicin (99.4%). MDR strains (resistance to ≥3 classes of antibiotics) accounted for 65.4% of all the isolates. The site recorded to have human industrial and agricultural zone activities had strains that were significantly more resistant to ampicillin, cefoxitin, amoxicillin/clavulanic acid (P ≤ 0.05) than isolates from the section of the river traversing virgin land and land with minimum human activities. This study indicates that E. coli strains isolated from Athi River were highly MDR and most resistant to some antimicrobial classes (ampicillin and cefoxitin) which constitute a potential risk to human and animal health.
文摘Severe acute malnutrition is a widely prevalent problem in developing countries and a major cause of morbidity and mortality. Traditionally, children with severe acute malnutrition were rehabilitated within inpatient services. Advent of ready to use therapeutic food made it possible to treat majority of these children in their homes. However, there is limited data about the outcomes of the program. Objectives: To determine the outcomes (recovery, default, mean weight gain and non-response rates) of severely malnourished children aged 6 - 59 months enrolled in outpatient therapeutic program at Kitui County Hospital. Methodology: A prospective longitudinal study design was carried out for one month. Hundred and four (104) children with SAM were recruited in the study. Anthropometric measurements, physical examination and appetite test of the children were conducted on a weekly basis for 28 days. Descriptive analysis was conducted using means, frequency and proportions. Paired t test was computed for mean weight gain and mid-upper arm circumference between admission and subsequent visits. Results: The findings of the study revealed that the recovery rate was 73.3%, weight gain rate of 5.1 g/kg/day, defaulter rate was 2.9% and non-response rate was 13.9% (WHZ = -3SD). Mean weight increased from 6.8 kg on the 1st visit to 7.5 kg in the 4th visit (P = 0.000) and the meanmid-upper arm circumferenceincreased from 11.1 cm at admission to 11.9 cm at 4th visit (P = 0.000). Conclusion: The recovery and weight gain rates were below the global acceptable SPHERE of minimum standards (recovery rate > 75% and weight gain rate > 8 g/kg/day). The defaulter rate was within the acceptable international standards (
文摘Background: Tuberculosis is an infectious disease with an estimated 1.45 million deaths every year. Many patients get infected as a result of ignorance of the risk factors that contribute to disease transmission. Methodology: A descriptive epidemiological study was conducted on 258 patients presenting with pulmonary tuberculosis. Patients’ sputa were collected for laboratory analysis and patients were required to respond to a structured questionnaire on risk factors for transmission. Data among stratified groups were compared using bivariate analysis. Statistical significance was considered at p Results: There were significantly more males than females associated with pulmonary tuberculosis infection (χ2 = 0.963;df = 1;p (64.3%) patients were living in single rooms with 110 (42.6%) living with more than two people with a maximum of 10 people in a single room. Only 73 (28.3%) were living alone in a single room and only 7 families (2.7%) were living in houses with five or more rooms. Alcohol consumers and smokers were 102 (39.5%) and 93 (36%) respectively. Half of the patients (137 (53.3%)) had not completed secondary education with only 16 (6.2%) having completed tertiary education. Recurrent cases were 54 (21%) while those exposed to the disease either at home or working place were 75 (29.2%). Out of 171 patients who agreed to test for HIV, 46 (26.9%) were positive. Marital status had no effect on incidence of disease. Conclusion: Emphasis should be given to creating awareness of the risk factors associated with transmission of tuberculosis in order to reduce the rate of infection.
文摘Background: Omphalitis (umbilical cord infection) among new-borns is common and a major cause of neonatal deaths in developing countries. Annually about 4 million neonatal deaths occur around the world;of these, more than 30% are caused by infections. Majority of these infections start as umbilical cord infection. Objective: The aim of the present study was to establish cord care practices associated with omphalitis among neonates aged 3-28 days at Pumwani Maternity Hospital, Kenya. Methodology: Cross-sectional descriptive study was employed among 178 mothers with neonates of 3-28 days. Participants were selected systematically and data was collected on new-born cord care practices. Omphalitis was defined as pus discharge, redness with or without pus and swelling of umbilical cord. Pearson’s chi-square test (P < 0.05) was performed to compare the significant discrepancies. Crude and adjusted odds ratios with corresponding 95% confidence interval were also used to determine the strength of association between omphalitis and cord care practices. Results: Among 178 neonates, 67 (37.6%) were diagnosed with omphalitis. In logistic regression analysis, the main predictors of omphalitis were initiation of breastfeeding after one hour of delivery [AOR = 2.47;95%CI = 1.15 - 5.30;P < 0.05] compared to within one hour and application of saliva to the cord [AOR = 6.59;95%CI = 2.02 - 21.46;P < 0.01] compared to dry cord. Conclusion: The prevalence of omphalitis among neonates was high. Health workers need to participate in educating the mothers to initiate breastfeeding within one hour and to avoid application of harmful cord care practices.
文摘Background: HIV-1 drug resistance is an emerging challenge for HIV-1 infected clients who are on antiretroviral therapy (ART). In Kenya, as in many other developing countries, ART is now accesible to clients who need it. However, they must be done a CD4 test first and if the count is <300, then ART is commenced. With the initiation of ART comes the challenge of adherence to medication, a factor that is impacted greatly by the understanding of the client of the importance?of adherence and the financial ability to keep their appointments, especially if the clients come from a distant location. Objective: To identify HIV-1 drug resistance mutations inclientsfailing1st line antiretroviral therapy in Nairobi, Kenya. Methodology: A cross sectional study was carried out where whole blood samples were collected from clients attending a HIV care and treatment clinic in Nairobi. Clients who had been on ART for more than 6 months and had a viral load greater than 1000 were enrolled in the study. A total of 52 client samples were successfully sequenced in the reverse transcriptase region and analyzed. Results: After analysis of the generated sequences, it was seen that 43 (82.6%) of the clients had HIV-1 drug resistance mutations conferring resistance to one or more nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse-transcriptase inhibitors (NNRTIs). Majority of the clients (46%) were infected with HIV-1 subtype A viruses. Conclusion: The findings of the study showed that a significant proportion of the clients on ART had developed resistance mutations to one or more drugs that are used as 1st line therapy in Kenya. There is need for continuous education of the population on importance of adherence to medication. There is also need for clinicians to be trained on using viral load and HIV drug resistance testing, where available, as methods of monitoring treatment failure so that clients can be switched to alternative medication immediately the need arises, so as to improve their treatment outcomes.
文摘Diarrhea is among the leading causes of morbidity and mortality in children aged Escherichia coli (DEC) accounts for 30% - 40% of childhood diarrhea cases. To identify the pathotypes involved in diarrheal outbreaks in Kenya, we analyzed archived E. coli isolates from children E. coli confirmation and antimicrobial susceptibility testing were done using the VITEK<sup>®</sup>2 instrument. Pathotype identification was performed via conventional polymerase chain reaction. Of 175 E. coli isolates, 48 (27%) were DEC pathotypes, with enteroaggregative E. coli (EAEC) predominating (71%, 34/48). Enterohemorrhagic (EHEC) and enteropathogenic E. coli (EPEC) represented 19% and 10% of isolates, respectively. Enteroinvasive and enterotoxigenic pathotypes were not identified. All DEC isolates were susceptible to amikacin, ertapenem, imipenem, meropenem and tigecycline. Conversely, most (>80%) isolates were resistant to ampicillin, ampicillin-sulbactam and sulfamethoxazole-trimethoprim. Half of all EAEC and EPEC strains were resistant to cefazolin while half of EHEC isolates were resistant to ciprofloxacin and moxifloxacin. In total, 18 resistance phenotypes were identified with “ampicillin-cefazolin-ampicillin/ sulbactam-sulfamethoxazole/trimethoprim” predominating (33%, 16/48). The majority (81%) of DEC isolates were multidrug-resistant, with extended-spectrum beta-lactamase production identified in 8% of these isolates. This study highlights the predominance of Enteroaggregative E. coli and multidrug resistance of DEC pathotypes. Studying the epidemiology of diarrheal disease and antimicrobial resistance surveillance, will aid in identifying dominant etiological agents of diarrhea and newly emerging resistant strains in informal settlements.
