Hospital In Kenya Research Articles

Cutaneous Furuncular Myiasis in a Rural Kenyan Hospital: A Case Report

Myiasis is a neglected tropical disease caused by infestation by the larval stages (maggots) of many species of flies, which occur worldwide but are more prevalent in the tropical and subtropical regions. The two main types of flies causing human myiasis are Dermatobia hominis (bot fly) and Cordylobia anthropophaga (tumbu fly). Cases of human myiasis in Kenya are not well documented, but some epidemiological studies show the tumbu fly to be the most prevalent. Transmission and infestation occur in cases of poor personal and environmental hygiene, especially in spaces shared with wild and domestic animals. Cutaneous myiasis, presenting as a furuncular, wound, and migratory disease, is the most common clinical phenotype that may be associated with secondary pyogenic infection and cellulitis, especially when not treated promptly. In this study, we present a case of cutaneous furuncular myiasis in a patient from rural Kenya. We share our experience managing the patient and also provide a literature review on the clinical case management of myiasis, with a call for more epidemiological and clinical work to be done to better understand this neglected disease.

Prevalence, patterns, and factors associated with tobacco use among patients with priority tobacco related illnesses at four Kenyan national referral hospitals, 2022.

Tobacco use is a risk factor for many chronic health conditions. Quantifying burden of tobacco use among people with tobacco-related illnesses (TRI) can strengthen cessation programs. This study estimated prevalence, patterns and correlates of tobacco use among patients with TRI at four national referral hospitals in Kenya. We conducted a cross-sectional study among patients with five TRI (cancer, cardiovascular diseases, cerebrovascular disease, chronic obstructive pulmonary disease, and pulmonary tuberculosis) during January-July 2022. Cases identified from medical records were interviewed on socio-demographic, tobacco use and cessation information. Descriptive statistics were used to characterize patterns of tobacco use. Multiple logistic regression models were used to identify associations with tobacco use. We identified 2,032 individuals with TRI; 46% (939/2,032) had age ≥60 years, and 61% (1,241/2,032) were male. About 45% (923/2,032) were ever tobacco users (6% percent current and 39% former tobacco users). Approximately half of smokers and 58% of smokeless tobacco users had attempted quitting in the last month; 42% through cessation counselling. Comorbidities were present in 28% of the participants. Most (92%) of the patients had been diagnosed with TRI within the previous five years. The most frequent TRI were oral pharyngeal cancer (36% [725/2,032]), nasopharyngeal cancer (12% [246/2.032]) and lung cancer (10% [202/2,032]). Patients >60 years (aOR 2.24, 95% CI: 1.84, 2.73) and unmarried (aOR 1.21, 95% CI: 1.03, 1.42) had higher odds of tobacco use. Female patients (aOR 0.35, 95% CI: 0.30, 0.41) and those with no history of alcohol use (aOR 0.27, 95% CI: 0.23, 0.31), had less odds of tobacco use. Our study shows high prevalence of tobacco use among patients with TRI in Kenya, especially among older, male, less educated, unmarried, and alcohol users. We recommend tobacco use screening and cessation programs among patients with TRI as part of clinical care.

Performance of Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment in screening for cancer-related malnutrition in Nairobi, Kenya

Background Malnutrition is a common feature among oncology patients. It is responsible for poor response and tolerance to anticancer therapy, increased morbidity, and mortality. More than half of malnourished cancer patients remain undetected owing to lack of effective screening. Body mass index is the main indicator for assessing malnutrition in Kenyan public hospitals. However, it underestimates weight loss in patients with chronic illnesses. The Malnutrition Universal Screening Tool and Patient-Generated Subjective Global Assessment have been widely used in research and clinical practice and have both reported good validity and reliability. However, their diagnostic evaluation has not been performed in Kenya. Methods A cross-sectional study was conducted among 138 and 76 cancer outpatients from Kenyatta National Hospital and Texas cancer treatment centres, respectively. Participants had a confirmed disease, stage 1-4 cancer, and aged 18 years and above. They were screened for malnutrition using both Malnutrition Universal Screening Tool and Patient Generated-Subjective Global Assessment. A separate study questionnaire was utilized to gather participant’s socio-demographic and clinical characteristics. A Bayesian latent class modelling framework was employed to infer the tests’ estimates based on participants ‘cumulative scores from the two tests. Results The cut-off value of ≥ 1 and ≥ 4 gave the best combination of sensitivity and specificity of Malnutrition Universal Screening Tool and Patient Generated-Subjective Global Assessment. Both tests yielded statistically similar sensitivities and specificities. Predictive values were comparable between the tests and across the two populations. The posterior median true prevalences of malnutrition were high (˃ 54%) and numerically similar between the studied populations. Conclusions The performance of both tests among patients with cancer is similar. Healthcare workers are therefore at liberty to use either of them to inform treatment. Given the high true prevalence of cancer-related malnutrition, routine screening is critical and should be included as part of cancer care.

Risk Factors Associated with Hypertension among Adults 18-65 Years in Kirinyaga County, Kenya

Hypertension is one of the non-communicable diseases linked with heart disease and accounts for about 64% of stroke cases globally. BP is becoming the leading global public health problem with over 10M death every year. Despite growing evidence that high blood pressure is on the rise, information about its risks factors on patients seeking medical care in Kenyan hospitals is limited. This research investigated the risk factors associated with high blood pressure among adults aged 18-65 in Kirinyaga County, Kenya.
 Analytical cross-sectional study, using quantitative and qualitative methods of data collections, a multistage sampling procedure sampled 380 study participants chi square and logistic regression made deductions about the study population. In qualitative data, deductive approach used research questions as a guide for data analysis. Gender chi-square χ2 (2, N=345=128.640, P=.000), respondent age χ2(5, N=345=158.021, P=.000), education level χ2 (3, N=345=77.677, P=.000), marital status χ2(4, N=345=69.413, P=.000), state of being pregnancy χ2(1, N=345=224.599, P=.000), currently smoking cigarette χ2(1, N=50=28.890, P=.000), currently taking alcohol χ2(1, N=273=16.548, P=.000), engaging in physical activities χ2(3, N=345=58.183, P=.000), and weight status χ2(2, N=184=40.044, P=.000) were statistically significantly associated with the development of hypertension. Routine screening and advocacy by the health worker should be done for early detection, timely treatment, follow up and prevent complications related to hypertension.

Moderating Effect of Organizational Culture on the Relationship between Quality of Work Life and Organizational Commitment Amongst Nurses in Public Hospitals in Bungoma County

Healthcare organisations are in dire need of a culture in which nursing employees are dedicated, motivated, and strongly associated with their sacred profession. This calls for strengthening the quality of the work life of nurses, which is an antecedent of organisational commitment. However, a number of studies that have explored the relationship between quality of work life and organisational commitment as moderated by organisational culture have been conducted in western countries and are very limited in hospital settings, so they cannot be generalised to the Kenyan hospital setting. Thus, the current study focused on the moderating effect of organisation culture on the relationship between quality of work life and organisational commitment of the nurses in the public hospitals in Bungoma County, Kenya. The study adopted a causal research design with a target population of 926 nurses and a sample size of 274 nurses drawn from the county and subcounty hospitals in Bungoma County, calculated by using the Morgan table (1970). Data was collected through a questionnaire and analysed using inferential statistics using SPSS version 25. From the findings, the beta values for safe and healthy working conditions (0.033), work-life balance (0.015), and reward system (0.01) There is a significant moderating effect of organisational culture on the relationship between quality of work life and organisational commitment amongst nurses in public hospitals in Bungoma County. Therefore, amidst the strengthening of quality of work life practices, public hospitals should strive to have their vision, mission, and objectives understood by all employees. Besides, there is a need to create an environment that promotes diversity and inclusion for teamwork and reactions to the concerns of the nurses as a means of enhancing organisational commitment as an outcome of quality of work life.

Assessing user preferences for design characteristics of oral dissolvable strips for pediatric HIV medication: a qualitative study

BackgroundCurrent infant antiretroviral therapy formulations pose barriers to daily adherence due to complex weight-based dosing, conspicuous preparation, and poor palatability. These adherence barriers jeopardize adherence, making patients vulnerable to virologic failure, development of drug resistance, and preventable mortality. Our team has previously established proof-of-principle for multi-drug oral dissolvable strips as alternative pediatric antiretroviral formulations with the potential to overcome these challenges and improve pediatric ART adherence and outcomes. The objective of this study was to assess caregiver and provider preferences for oral dissolvable strips and its packaging to inform its development.MethodsGuided by concepts of user-centered design, we conducted key informant interviews with 30 HIV care providers and focus group discussions targeting caregivers of children < 10 years of age living with HIV at 3 Kenyan hospitals. Key informant interviews and focus group discussions were audio recorded, translated/transcribed verbatim, and hand coded for a-priori and emergent themes.ResultsA total of 30 providers and 72 caregivers (caring for 83 children, aged 5 months to 18 years) participated in the study. Caregivers and providers expressed a strong desire for an easier way to administer medication, especially among children too young to swallow tablets whole, and expressed enthusiasm around the idea of oral dissolvable strips. Key preferences included a pleasant taste; one strip per dose; small size with rapid dissolution; clear markings and instructions; and no special storage requirements. For packaging, stakeholders preferred individually wrapped strips within a dispenser. The individual packaging should be durable, waterproof, and easy to dispose of in communal spaces. They should also be easy to open, with clear indications where to open. The packaging holding the strips should be durable, re-usable, accommodating of various refill frequencies, and easy to use for children as young as 6.DiscussionThe concept of oral dissolvable strips was highly acceptable to caregivers of children living with HIV and HIV care providers. By engaging stakeholders in an iterative design process starting from the early phases of design and development, we will maximize the likelihood of developing a product that is acceptable to the caregiver and infant, therefore leading to sustainable adherence.

Patterns and determinants of antibiotic prescription among children admitted to public hospitals in Kenya: A cross-sectional observational study

Background: Sick children frequently have antibiotics prescribed as part of their treatment. Inappropriate use of antibiotics, especially broad-spectrum antibiotics, can result in the development of antibiotic resistance and the consequences of antibiotic resistance. In this study, we use routinely collected data to describe the patterns and identify factors influencing antibiotic prescription among admitted children. Methods: Routine data collected from medical records of children aged 2 months or older admitted between 2014 and 2020 to paediatric wards of 12 hospitals which are part of a Clinical Information Network (CIN) are used. Multivariable mixed effects logistic regression is used to assess determinants of antibiotic prescription with a random slope and intercept for hospital level. Results: A total of 127,984 antibiotic prescriptions were made in 107,500 participants included in the study where 81.1% (87,183/107,500) had one or more antibiotic prescriptions. The commonly prescribed antibiotics were a combination of benzylpenicillin and gentamicin (37,939/127,984 - 29.6%), ceftriaxone (31,172/127,984 - 24.6%) and oral amoxicillin (12,593 /127,984 - 9.8%). Factors associated with antibiotic prescription were history of cough (adjusted odds ratio (aOR), = 2.06, 95% confidence interval (CI):1.966 - 2.152), bloody diarrhoea (aOR=5.6, CI:4.453 - 7.036), diagnoses of pneumonia (aOR=27.66, CI:21.768 - 35.154), malnutrition (aOR=6.3, CI:4.558 - 8.701) and meningitis (aOR=11.85, CI:9.502 - 14.779). Antibiotic prescription was less likely in children diagnosed only with severe anaemia (aOR=0.8, CI:0.742 - 0.870), malaria (aOR:0.22, CI:0.201 - 0.231), diarrhoea (aOR:0.36, CI:0.331 - 0.398), and dehydration (aOR=0.4, CI:0.347 - 0.464). Conclusion: Antibiotics are prescribed in approximately four of every five children admitted to paediatric wards of Kenyan hospitals. Prescriptions are mainly in patients who fulfil syndromic clinical criteria where antibiotics are indicated. Without the introduction of reliable pathogen diagnostics, it will be difficult to reduce antibiotic prescriptions among admitted children.

Asymptomatic gastrointestinal carriage of multidrug-resistant carbapenemase-producing Enterobacteriaceae among children under five years in a Kenyan hospital

ObjectivesAsymptomatic gastrointestinal carriage of carbapenem-resistant Enterobacteriaceae (CRE) is a threat to global health in developing countries with inadequate safe drinking water, poor hygiene, and weak antimicrobial stewardship; however, epidemiological data to guide CRE infection prevention and control is limited in these settings. We assessed asymptomatic CRE and carbapenem-producing Enterobacteriaceae (CPE) fecal carriage rates and associated risk factors among hospitalized children aged under 5 years. MethodsWe adopted a cross-sectional study at Mama Lucy Kibaki Hospital in Nairobi-City County, Kenya, between June and September 2022. We collected demographic and clinical characteristics using a structured questionnaire and clinical reports and analyzed stool/rectal swab samples by standard and automated bacteriological methods. ResultsAsymptomatic CRE and CPE fecal carriage rate was 2.25% (6/267), with six isolates recovered, predominated by Escherichia coli (33.33%) and Enterobacter cloacae subsp dissolvens (33.33%). Third-generation cephalosporin and ciprofloxacin resistance were highest in Citrobacter farmer and E. cloacae subsp cloacae. All CRE and CPE were multidrug-resistant, and except E. cloacae subsp cloacae, were 100% colistin-resistant. ConclusionsAsymptomatic gastrointestinal carriage of multidrug-resistant-CRE among hospitalized children under 5 years, presents a substantial public health threat. This calls for continuous surveillance including molecular characterization of isolates, to inform infection prevention and antimicrobial stewardship adherence in line with local and global plans on AMR.

Developing A Training Model to Promote Utilization of Partograph by Midwives Working in Labour Ward at selected Kenyan Hospitals

Developing A Training Model to Promote Utilization of Partograph by Midwives Working in Labour Ward at selected Kenyan Hospitals

Delayed breast cancer presentation, diagnosis, and treatment in Kenya.

In this mixed-methods study, we evaluated the factors that contribute to delayed breast cancer (BC) diagnosis and treatment at a Kenyan hospital. Individuals with a diagnosis of BC, either as a referral or index patient, were recruited to participate in this study through convenience sampling. Data were collected on sociodemographics, health history, and cancer history, diagnosis, and treatment of patients at Kenyatta National Hospital (KNH). For the quantitative analyses, the relationship between sociodemographic and health history factors with stage at diagnosis, number of visits before diagnosis, time to diagnosis, and time to initial intervention, stratified by time to onset of symptoms, were examined using regression analyses. For the qualitative analysis, in-depth interviews of every fifth patient were completed to assess reasons for delayed diagnosis and treatment. The final analytic sample comprised of 378 female BC patients with an average age of 50. These females were generally of lower SES: 49.2% attained no or only primary-level education, 57.4% were unemployed, and the majority (74.6%) had a monthly household income of < 5000 Kenyan shillings (equivalent to ~ $41 USD). The median time from BC symptom onset to presentation at KNH was 13 (IQR = 3-36) weeks, from presentation to diagnosis was 17.5 (IQR = 7-36.5) weeks, and from diagnosis to receipt of the initial intervention was 6 (IQR = 3-13) weeks. Female BC patients who were never/unmarried, less educated, less affluent, users of hormonal contraception, and had ≥ 3 children were more likely to experience diagnosis and treatment delays. Qualitative data showed that financial constraints, lack of patient BC awareness, andhealthcare practitioner misdiagnosis and/orstrikes delayed patient diagnosis and treatment. BC patients experience long healthcare system delays before diagnosis and treatment. Educating communities and providers about BC and expediting referrals may minimize such delays and subsequently BC mortality rates in Kenya.

Marketing Crisis Management and Hotel Performance: Evidence from Hotels in Mombasa County, Kenya

Purpose: Tourism is crucial in driving economies and preserving cultural heritage worldwide. The sustainability of tourist destinations depends on their ability to effectively manage and recover from marketing crises that can damage their attractiveness and reputation. Despite the allure of tourist destinations, they are susceptible to various marketing crises, challenging their hospitality industries and local economies. These crises can disrupt visitor flows and tarnish reputations. This study explored the impacts of marketing crisis management practices on hotel performance in Mombasa County, Kenya, within a global context of vulnerable tourist destinations.&#x0D; Methodology: This study employed partial least squares structural equation modeling (PLS-SEM) embedded in the causal-comparative research design to explore the relationship between marketing crisis management practices and hotel performance. Data were collected through questionnaires distributed to management staff in 18 star-rated hotels in Mombasa County. Confirmatory composite analysis (CCA) validated the measurement models, and demographics were considered as potential influencers on the relationship. Data were presented in Table format and interpreted using percentages.&#x0D; Findings: The findings revealed that communication and public relations (β = 0.417, p &lt; 0.05), marketing strategy adjustment (β = 0.336, p &lt; 0.05), and reputation management (β = 0.186, p &lt; 0.05) significantly and positively affected hotel performance. The three combined practices explained 75.1% of the variance in hotel performance. Based on these findings, hotels in Mombasa County and the broader Kenyan hospitality industry must prioritize effective communication and public relations, agile marketing strategy adjustment, and proactive reputation management as integral components of their crisis management strategies to enhance resilience, foster customer loyalty, and maintain competitiveness, especially in times of crises, such as the ongoing COVID-19 pandemic.&#x0D; Recommendations: Effective communication and public relations positively impact hotel performance by fostering emotional connections, repeat business, and positive reviews. Dynamic marketing strategy adjustment enhances resilience and adaptability, attracting safety-conscious and adventurous travelers. Reputation management safeguards trust, credibility, and customer loyalty, mitigating negative perceptions during crises. Combining these practices contributes to substantial positive impacts on hotel performance.

Chalasia Cardia in Pregnancy Presenting as Hyperemesis Gravidarum in A Rural Kenyan Hospital: A Case Report and Literature Review

Achalasia cardia is a motility disorder of the esophagus characterized by failure of relaxation of the lower esophageal sphincter (LES) during swallowing, resulting in dysphagia, regurgitation symptoms, vomiting, fluid losses, and malnutrition. Achalasia cardia is rare in pregnancy and is often misdiagnosed as hyperemesis gravidarum due to similar symptomatology, usually with significant morbidity and mortality. Definitive management is by surgical myotomy, which should be delayed until after delivery due to concerns about maternal and fetal safety. In this study, we present a case of achalasia cardia in a young primigravida in rural Kenya in the third trimester of pregnancy.

Visual outcome after small incision cataract surgery of patients in a Kenyan Hospital Contributors.

The visual outcome and the effect of cataract surgery on existent and surgically induced refractive errors are a concern of interest that the eye care expert must deal with. The aim of the study was to investigate the visual outcome after small incision cataract surgery of patients in a Kenyan hospital. A descriptive retrospective study covering 3 years (2015 to 2017). Total of 1104 files of patients aged > 50 years who had undergone small incision cataract surgery at Sabatia eye hospital were purposively selected. Information on demographics, clinical aspects and outcome was collected using a ministry of health structured form. Statistical package for social sciences version 24 was used to analyse the data. Of the 1104 patients, 55% (n=606) were females. The mean age of patients was 70.6 ± 9.8 years. Most patients were from the hospital neighbourhood. Visual acuity improved by 38.9%, 28.9%, 19.8% and 11.5% in patients aged 50-59, 60-69, 70-79, and 80-89 years old, respectively. Small incision cataract surgery improved visual acuity in all patients' groups, but the outcome is influenced by age, refractive error particularly astigmatism.

Health care provider decision-making and the quality of maternity care: An analysis of postpartum care in Kenyan hospitals

Evidence suggests that health care providers' non-adherence to clinical guidelines is widespread and contributes to poor patient outcomes across low- and middle-income countries. Through observations of maternity care in Kenya, we found limited adherence to guideline-recommended active monitoring of patients for signs of postpartum hemorrhage, the leading cause of maternal mortality, despite providers' having the necessary training and equipment. Using survey vignettes conducted with 144 maternity providers, we documented evidence consistent with subjective risk and perceived uncertainty driving providers' decisions to actively monitor patients. Motivated by these findings, we introduced a simple model of providers' decision-making about whether to monitor a patient, which may depend on their perceptions of risk, diagnostic uncertainty, and the value of new information. The model highlights key trade-offs between gathering diagnostic information through active monitoring versus waiting for signs and symptoms of hemorrhage to manifest. Our work provides a template for understanding provider decision-making and could inform interventions to encourage more proactive obstetric care.

Treatment outcomes of pediatric acute myeloid leukemia in Western Kenya before and after the implementation of the SIOP PODC treatment guideline.

The Pediatric Oncology in Developing Countries (PODC) committee of the International Society of Pediatric Oncology (SIOP) published a pediatric acute myeloid leukemia (AML)-specific adapted treatment guideline for low- and middle-income countries. We evaluated the outcomes of children with AML at a large Kenyan academic hospital before (period 1) and after (period 2) implementing this guideline. Records of children (≤17 years) newly diagnosed with AML between 2010 and 2021 were retrospectively studied. In period 1, induction therapy comprised two courses with doxorubicin and cytarabine, and consolidation comprised two courses with etoposide and cytarabine. In period 2, a prephase with intravenous low-dose etoposide was administered prior to induction therapy, induction course I was intensified, and consolidation was adapted to two high-dose cytarabine courses. Probabilities of event-free survival (pEFS) and overall survival (pOS) were estimated using the Kaplan-Meier method. One-hundred twenty-two children with AML were included - 83 in period 1 and 39 in period 2. Overall, 95 patients received chemotherapy. The abandonment rate was 19% (16/83) in period 1 and 3% (1/39) in period 2. The early death, treatment-related mortality, complete remission, and relapse rates in periods 1 and 2 were 46% (29/63) versus 44% (14/32), 36% (12/33) versus 47% (8/17), 33% (21/63) versus 38% (12/32), and 57% (12/21) versus 17% (2/12), respectively. The 2-year pEFS and pOS in periods 1 and 2 were 5% versus 15% (p = .53), and 8% versus 16% (p = .93), respectively. The implementation of the SIOP PODC guideline did not result in improved outcomes of Kenyan children with AML. Survival of these children remains dismal, mainly attributable to early mortality.

Prevalence of Antimicrobial Resistance and Association with Patient Outcomes in a Rural Kenyan Hospital.

Data on antimicrobial resistance (AMR) and association with outcomes in resource-variable intensive care units (ICU) are lacking. Data currently available are limited to large, urban centers. We attempted to understand this locally through a dual-purpose, retrospective study. Cohort A consisted of adult and pediatric patients who had blood, urine, or cerebrospinal fluid cultures obtained from 2016 to 2020. A total of 3,013 isolates were used to create the Kijabe Hospital's first antibiogram. Gram-negative organisms were found to be less than 50% susceptible to third- and fourth-generation cephalosporins, 67% susceptible to piperacillin-tazobactam, 87% susceptible to amikacin, and 93% susceptible to meropenem. We then evaluated the association between AMR and clinical characteristics, management, and outcomes among ICU patients (Cohort B). Demographics, vital signs, laboratory results, management data, and outcomes were obtained. Antimicrobial resistance was defined as resistance to one or more antimicrobials. Seventy-six patients were admitted to the ICU with bacteremia during this time. Forty complete paper charts were found for review. Median age was 34 years (interquartile range, 9-51), 26 patients were male (65%), and 28 patients were older than 18 years (70%). Septic shock was the most common diagnosis (n = 22, 55%). Six patients had AMR bacteremia; Escherichia coli was most common (n = 3, 50%). There was not a difference in mortality between patients with AMR versus non-AMR infections (P = 0.54). This study found a prevalence of AMR. There was no association between AMR and outcomes among ICU patients. More studies are needed to understand the impact of AMR in resource-variable settings.

Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals.

Culture is the gold-standard diagnosis for urinary tract infections (UTIs). However, most hospitals in low-resource countries lack adequately equipped laboratories and relevant expertise to perform culture and, therefore, rely heavily on dipstick tests for UTI diagnosis. In many Kenyan hospitals, routine evaluations are rarely done to assess the accuracy of popular screening tests such as the dipstick test. As such, there is a substantial risk of misdiagnosis emanating from inaccuracy in proxy screening tests. This may result in misuse, under-use or over-use of antimicrobials. The present study aimed to assess the accuracy of the urine dipstick test as a proxy for the diagnosis of UTIs in selected Kenyan hospitals. A hospital-based cross-sectional method was used. The utility of dipstick in the diagnosis of UTIs was assessed using midstream urine against culture as the gold standard. The dipstick test predicted 1416 positive UTIs, but only 1027 were confirmed positive by culture, translating to a prevalence of 54.1 %. The sensitivity of the dipstick test was better when leucocytes and nitrite tests were combined (63.1 %) than when the two tests were separate (62.6 and 50.7 %, respectively). Similarly, the two tests combined had a better positive predictive value (87.0 %) than either test alone. The nitrite test had the best specificity (89.8 %) and negative predictive value (97.4 %) than leucocytes esterase (L.E) or both tests combined. In addition, sensitivity in samples from inpatients (69.2 %) was higher than from outpatients (62.7 %). Furthermore, the dipstick test had a better sensitivity and positive predictive value among female (66.0 and 88.6 %) than male patients (44.3 and 73.9 %). Among the various patient age groups, the dipstick test's sensitivity and positive predictive value were exceptionally high in patients ≥75 years old (87.5 and 93.3 %). Discrepancies in prevalence from the urine dipstick test and culture, the gold standard, indicate dipstick test inadequacy for accurate UTI diagnosis. The finding also demonstrates the need for urine culture for accurate UTI diagnosis. However, considering it is not always possible to perform a culture, especially in low-resource settings, future studies are needed to combine specific UTI symptoms and dipstick results to assess possible increases in the test's sensitivity. There is also a need to develop readily available and affordable algorithms that can detect UTIs where culture is not available.

Environmental contamination across multiple hospital departments with multidrug-resistant bacteria pose an elevated risk of healthcare-associated infections in Kenyan hospitals

BackgroundHealthcare-associated infections (HAIs) are often caused by multidrug-resistant (MDR) bacteria contaminating hospital environments which can cause outbreaks as well as sporadic transmission.MethodsThis study systematically sampled and utilized standard bacteriological culture methods to determine the numbers and types of MDR Enterococcus faecalis/faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, and Escherichia coli (ESKAPEE) from high-touch environments of five Kenyan hospitals; level 6 and 5 hospitals (A, B, and C), and level 4 hospitals (D and E), in 2018. Six hundred and seventeen high-touch surfaces across six hospital departments; surgical, general, maternity, newborn, outpatient and pediatric were sampled.Results78/617 (12.6%) of the sampled high-touch surfaces were contaminated with MDR ESKAPEE; A. baumannii, 23/617 (3.7%), K. pneumoniae, 22/617 (3.6%), Enterobacter species, 19/617 (3.1%), methicillin resistant S. aureus (MRSA), 5/617 (0.8%), E. coli, 5/617 (0.8%), P. aeruginosa, 2/617 (0.3%), and E. faecalis and faecium, 2/617 (0.3%). Items found in patient areas, such as beddings, newborn incubators, baby cots, and sinks were the most frequently contaminated. Level 6 and 5 hospitals, B, 21/122 (17.2%), A, 21/122 (17.2%), and C, 18/136 (13.2%), were more frequently contaminated with MDR ESKAPEE than level 4 hospitals; D, 6/101 (5.9%), and E, 8/131 (6.1%). All the sampled hospital departments were contaminated with MDR ESKAPEE, with high levels observed in newborn, surgical and maternity. All the A. baumannii, Enterobacter species, and K. pneumoniae isolates were non-susceptible to piperacillin, ceftriaxone and cefepime. 22/23 (95.6%) of the A. baumannii isolates were non-susceptible to meropenem. In addition, 5 K. pneumoniae isolates were resistant to all the antibiotics tested except for colistin.ConclusionThe presence of MDR ESKAPEE across all the hospitals demonstrated gaps in infection prevention practices (IPCs) that should be addressed. Non-susceptibility to last-line antibiotics such as meropenem threatens the ability to treat infections.

Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Kenya. The aim of this study was to measure quality and timeliness of care for PPH in a sample of deliveries in referral hospitals in Kenya. We conducted direct observations of 907 vaginal deliveries in three Kenyan hospitals from October 2018 through February 2019, observing the care women received from admission for labor and delivery through hospital discharge. We identified cases of "suspected PPH", defined as cases in which providers indicated suspicion of and/or took an action to manage abnormal bleeding. We measured adherence to World Health Organization and Kenyan guidelines for PPH risk assessment, prevention, identification, and management and the timeliness of care in each domain. The rate of suspected PPH among the observed vaginal deliveries was 9% (95% Confidence Interval: 7% - 11%). Health care providers followed all guidelines for PPH risk assessment in 7% (5% - 10%) of observed deliveries and all guidelines for PPH prevention in 4% (3% - 6%) of observed deliveries. Lowest adherence was observed for taking vital signs and for timely administration of a prophylactic uterotonic. Providers did not follow guidelines for postpartum monitoring in any of the observed deliveries. When suspected PPH occurred, providers performed all recommended actions in 23% (6% - 40%) of cases. Many of the critical actions for suspected PPH were performed in a timely manner, but, in some cases, substantial delays were observed. In conclusion, we found significant gaps in the quality of risk assessment, prevention, identification, and management of PPH after vaginal deliveries in referral hospitals in Kenya. Efforts to reduce maternal morbidity and mortality from PPH should emphasize improvements in the quality of care, with a particular focus on postpartum monitoring and timely emergency response.

Development of a small and sick newborn clinical audit tool and its implementation guide using a human-centred design approach newborn clinical audit process and design.

Clinical audits are an important intervention that enables health workers to reflect on their practice and identify and act on modifiable gaps in the care provided. To effectively audit the quality of care provided to the small and sick newborns, the clinical audit process must use a structured tool that comprehensively covers the continuum of newborn care from immediately after birth to the period of newborn unit care. The objective of the study was to co-design a newborn clinical audit tool that considered the key principles of a Human Centred Design approach. A three-step Human Centred Design approach was used that began by (1) understanding the context, the users and the available audit tools through literature, focus group discussions and a consensus meeting that was used to develop a prototype audit tool and its implementation guide, (2) the prototype audit tool was taken through several cycles of reviewing with users on real cases in a high volume newborn unit and refining it based on their feedback, and (3) the final prototype tool and the implementation guide were then tested in two high volume newborn units to determine their usability. Several cycles of evaluation and redesigning of the prototype audit tool revealed that the users preferred a comprehensive tool that catered to human factors such as reduced free text for ease of filling, length of the tool, and aesthetics. Identified facilitators and barriers influencing the newborn clinical audit in Kenyan public hospitals informed the design of an implementation guide that builds on the strengths and overcomes the barriers. We adopted a Human Centred Design approach to developing a newborn clinical audit tool and an implementation guide that we believe are comprehensive and consider the characteristics of the context of use and the user requirements.