Determinants of HIV positive status at first PCR test among toddlers seeking early infant diagnosis (EID) services in selected hospitals in Nairobi County, Kenya

Introduction: Early Infant Diagnosis (EID) is the practice of testing infants for HIV within the first 4­6 weeks of life or at the earliest opportunity possible so as to promptly link HIV-infected infants to healthcare and treatment. In the absence of timely HIV testing and Antiretroviral Therapy (ART) initiation, one-third of infants living with HIV die before their first birthday and more than half die before 2 years. Worldwide, Mother To Child Transmission (MTCT) rates accounted for 8.9% of all HIV infections by the end of 2015, with Sub-Saharan Africa accounting for 12% of these infections. In Kenya, MTCT infection rates were at 14%, accounting for 7% of all new infant infections globally by the same period. Objection: The objectives of this study was to establish the determinants of HIV positive status at first PCR Test among infants seeking EID services in some selected hospitals in the Nairobi County, Kenya. Materials and Methodology: A longitudinal cohort study employing a mixed-method approach was used. Quantitative data was collected from pairs of 163 mother-infant using interviewer administered, pre-tested, and semi-structured questionnaires. While qualitative data was collected using Focus Group Discussion (FGDs) guides, it was coded, cleaned and analyzed using STATA Version 14. Quantitative data was analyzed using Fisher's exact test (p= 0.1) and Poisson Regression (p= 0.05) at bivariate and multivariable levels respectively. Thematic analysis was undertaken for qualitative data. Results: The findings from the adjusted parsimonious model revealed that, three variables influenced the infant HIV status at first PCR test. The study participants who had been administered with ART during pregnancy had a lower risk (RR= 0.06) of getting HIV positive infants relative to those who hadn't received ARVs during pregnancy (95% CI 0.014, 0.213 p= 0.000). Respondents who had been initiated on ART during the first trimester had lower risk (RR= 0.1) of getting an HIV positive infant than respondents who were administered with ARVs in the third trimester (95% CI 0.014, 0.021, p= 0.001). Respondents on first-line regimen had a lower risk (RR= 0.04) of getting HIV infected infants compared to those who were on the second line regimen (95% CI 0.012, 0.114, p= 0.000) confirming all the three significant variables as protective factors. Conclusion: The study corroborate that, first line ART regimen administered before pregnancy or during the first trimester of pregnancy was effective in lowering the risk of getting an HIV positive infant. Pediatric HIV infection, disease progression is quite rapid and without prompt treatment, most infants might not survive their second birthday

Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia

Objective:To describe the implementation and feasibility of an innovative mass vaccination strategy ­ based on single-dose oral cholera vaccine ­ to curb a cholera epidemic in a large urban setting.Method:In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.Findings:Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign ­ 2.31 United States dollars (US$) per dose ­ included the relatively low cost of local delivery ­ US$ 0.41 per dose.Conclusion:We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered

Review on the use of dexamethasone and its impact on fertility and pregnancy

Purpose: Although benefit/risk analysis is usually undertaken prior to starting a treatment, some conditions will inevitably require the use of drugs with known side effects even during pregnancy. This is the case with dexamethasone use in ante natal care. The purpose of this review was to provide an overview of the uses of dexamethasone and its impacts on pregnancy and fertility in humans. Data source: The review is based on literature searches using PubMed and MeSH and authors' personal manuscript/abstract files and citations of known references. Study selection: The selection of articles reflects the authors' opinion as to originality and importance in the context of the review. The review included human and some aspects of animal study.Data extraction: The electronic searches were scrutinized and full manuscripts of all quotes considered relevant to the study were obtained. All the articles whose abstracts were not available were excluded.Results: Dexamethasone use has evolved over the years to include fertility treatment in both males and females in addition to its use in pregnancy to prevent respiratory distress syndrome in neonates despite its side effects due to the fact that its benefits outweigh the risks. Conclusions: Dexamethasone use has evolved over the years to include fertility treatment in addition to use in the prevention of respiratory distress syndrome. Low doses have no major adverse effects; however, repeated doses and long-term therapy are associated with more serious sequelae. It is recommended that dexamethasone therapy be incorporated into maternal and neonatal health care services

Prevalence, aetiology and antibiotic sensitivity profile of asymptomatic bacteriuria isolates from pregnant women in selected antenatal clinic from Nairobi, Kenya

Introduction: Asymptomatic bacteriuria (ASB) is the presence of bacteria in urine without apparent symptoms of urinary tract infections. The importance of asymptomatic bacteriuria lies in the insight it provides into symptomatic infections. To determine prevalence, bacterial isolates and Antibiotic Sensitivity Profile of asymptomatic bacterial urinary tract infection in pregnant women in selected clinics in Nairobi.Methods: This was a cross-sectional study involving women attending antenatal clinic at selected clinics of Nairobi County. The women who met the inclusion criteria were included in the study. The midstream urine samples of these women were subjected to microscopy, culture and sensitivity.Results: A total of 1020 of women on their first antenatal clinic visit participated in the study; 219 of them had ASB, giving a prevalence of 21.5 % at 95% confidence level. Escherichia coli were the common organism isolated at 38.8%. The majority of the organisms were sensitive to imipenem and gentamycin.Conclusion: There is a high prevalence of ASB among pregnant women included in the study from the Nairobi county clinics. Therefore, routine ASB screening of pregnant women is recommended among the women attending antennal clinics in Nairobi county clinics

Serum lipid profiles and atherogenic index in pregnant sahel goats: public health implications

Background: Goat meat is very popular and has a great demand all over Nigeria. However, the slaughter of pregnant goats in abattoirs and slaughter slabs for meat is becoming a serious concern not only for future livestock population, but also for public health.Dyslipidaemia of pregnancy in meat animals may constitute threat to consumers in terms of cardiovascular risks. Objectives: The purpose of this study was to investigate the concentrations of serum lipids at different stages of gestation in Sahel goats and to evaluate the atherogenic capacity of the lipid profile. Materials and Methods: Serum lipids profiles and atherogenic indices in pregnant and nonpregnant Sahel goats were studied. Fourteen apparently healthy adult Sahel goats comprising 12 does with mean gestation length of 148.33 ± 1.52 days and 2 bucks were used for the study. They were managed in the University of Maiduguri livestock research farm on low fat diet. Sera samples were collected biweekly for 5 months and were used for the analysis of total Cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL-c), low density lipoprotein (LDL-c) and very low density lipoprotein (VLDL-c). Atherogenic indices were calculated as base 10 log (TG/HDL-c). Results: Serum TG and VLDL-c concentrations increased significantly (p < 0.05) in pregnant does compared to non-pregnant. HDL-c and LDL-c concentrations did not vary significantly (p > 0.05) between the two groups. Atherogenic indices increased progressively with advancing pregnancy compared to non-pregnant. Conclusion: It was concluded that atherogenic capacity of the lipid profile in pregnant Sahel goats is high and therefore consumption of meat from pregnant animals has high potential for atherogenic risk. Routine antemortem inspection should be conducted at abattoirs to identify pregnant animals for restriction against slaughter. Legislation prohibiting the slaughter of pregnant animals should be enforced

Prevalence and risk factors for hepatitis c and human immunodeficiency virus co-infection among children in Enugu, Nigeria

Background: Hepatitis C virus (HCV) and Human Immunodeficiency virus (HIV), are major public health challenges in the developing world especially sub-Saharan Africa. The aim of this study was to determine the prevalence and risk factors of Hepatitis C virus infection among children infected with HIV. Methods: This was a cross-sectional study conducted at the Paediatric HIV Clinic, UNTH, Enugu between July and December 2009. Antibodies to HCV were analyzed by newer generation rapid chromatographic immunoassay method using the Chromatest one step HCV test kit. The data was analysed using the Statistical Package for Social Sciences (SPSS) version 15 statistical software. The chi squared test was used to test for significant association of categorical variables. A p-value of <0.05 was accepted as significant. Results: One hundred and eighteen children HIV-infected children, aged between eighteen months to fifteen years were included in the data analysis. Eight of the HIV infected subjects were positive for HCV, giving an HIV-HCV co-infection prevalence of 6.8%. Co-infection was more prevalent among males and in those in age group 11-15 years. Blood transfusion, irrespective of frequency (p<0.015), and injections for immunization (p<0.049) were the significant risk factors noted Conclusion: There is need for strengthening of existing preventive strategies against HCV and HIV infections such as screening of donor blood and safe injection practices in our locality

Nutritional Status of Adolescent Girls from Rural Communities of Tigray; Northern Ethiopia

Background: Addressing the nutritional needs of adolescents could be an important step towards breaking the vicious cycle of intergenerational malnutrition. Objective: Assess nutritional status of rural adolescent girls. Design: Cross-sectional. Methods: Anthropometric and socio-demographic information from 211 adolescent girls representing 650 randomly selected households from thirteen communities in Tigray was used in data analysis. Height-for-age and BMI-for-age were compared to the 2007 WHO growth reference. Data were analyzed using SAS; Version 9.1. Results: None of the households reported access to adolescent micronutrient supplementation. The girls were shorter and thinner than the 2007 WHO reference population. The cross-sectional prevalence of stunting and thinness were 26.5and 58.3; respectively. Lack of latrine facilities was signifi- cantly associated with stunting (p = 0.0033) and thinness (p0.0001). Age was strong predictor of stunting (r2