Perceived Barriers to Peritoneal Dialysis Among Kenyan Nephrologists: A Cross-Sectional Descriptive Study.

Background: Peritoneal dialysis (PD) is a well-recognized technique of renal replacement therapy (RRT), with similar efficacy as well as survival outcomes as hemodialysis (HD). Despite its advantages including prolonged preservation of residual renal function, potentially lower cost and advances with automated techniques, and commercialization of more biocompatible solutions, the overall prevalence of patients treated with PD is still very low in developed countries and even more so in Africa and low-middle income countries like Kenya. According to our knowledge, no local studies have been done on prevalence of peritoneal dialysis or on potential barriers to utilization of PD as an RRT modality. Objective: To explore perceptive barriers of nephrologists to PD utilization. Methodology: A computer-base, 22-question questionnaire was formulated using the Delphi technique and sent out to all the nephrologists via emails. There were 30 nephrologists, in clinical practice in Kenya, at the time when the study was conducted. This is according to the registry maintained by the Kenya Renal Association (KRA). Their contacts were obtained from the registry. Design: A cross-sectional descriptive study. Setting: A computer based 22-question questionnaire was administered to 23 nephrologists in Kenya. Results: Among the total number of 23 nephrologists, 39% reported to be looking after patients maintained on PD despite 59% of them reporting that they think patients should be maintained on PD. Only 21% of respondents felt limited training in PD limited their use of PD and only 23% felt poor personal experience contributed to limited use. Other barriers that came up with a relative majority of the respondents included lack of nursing expertise, concerns with PD catheter placement, concerns about long-term viability of continuous peritoneal dialysis, concerns about technique failure and peritonitis, lack of facility support for PD, and lack of dialysis education programs. Conclusion: A significant proportion of nephrologists in this survey felt PD, as a modality of RRT, was underutilized and reported systemic and technical factors as being potential barriers.

Contexte: La dialyze péritonéale (DP) est une modalité bien connue de thérapie de suppléance rénale (TSR) qui présente une efficacité et des résultats de survie similaires à ceux de l'hémodialyse (HD). Malgré ses avantages, notamment la préservation prolongée de la fonction rénale résiduelle, les coûts potentiellement inférieurs, les avancées des techniques automatisées et la commercialisation de solutions plus biocompatibles, la prévalence globale des patients traités par DP demeure très faible dans les pays développés, et plus encore en Afrique et dans les pays à revenu faible et intermédiaire comme le Kenya. À notre connaissance, aucune étude locale n'avait été réalisée sur la prévalence de la DP ou sur les obstacles potentiels à son utilization comme modalité de TSR. Objectif: Explorer les obstacles perçus par les néphrologues quant à l'utilization de la DP. Méthodologie: Un questionnaire informatisé de 22 questions a été formulé à l'aide de la technique Delphi et envoyé à tous les néphrologues par courrier électronique. Il y avait 30 néphrologues, en pratique clinique au Kenya, au moment où l'étude a été menée. C'est selon le registre tenu par la Kenya Renal Association (KRA). Leurs contacts ont été obtenus à partir du registre. Conception: Étude transversale et descriptive. Cadre: Un questionnaire informatisé de 22 questions a été distribué à 23 néphrologues kenyans. Résultats: Parmi les 23 néphrologues sondés, 39 % ont déclaré s'occuper de patients traités par DP. Une majorité des répondants (59 %) était d'avis qu'au moins 20% des patients devraient être traités par DP. Seulement 21 % des répondants estimaient que le peu de formation en matière de DP limitait son utilization, et seulement 23 % jugeaient que leur mauvaise expérience personnelle avait contribué à l'utilization limitée de la DP. Les autres obstacles rapportés par une majorité relative de répondants étaient le manque d'expertise en soins infirmiers, des préoccupations concernant le placement des cathéters, des préoccupations sur la viabilité à long terme de la DP en continu, des préoccupations concernant la péritonite et l'échec de la modalité, le manque de soutien des établissements en lien avec la DP, et le manque de programs d'éducation en dialyze. Conclusion: Une bonne proportion des néphrologues sondés estimait que la DP était sous-utilisée comme modalité de TSR. Plusieurs ont par ailleurs rapporté des facteurs systémiques et techniques comme obstacles potentiels à son utilization.

Genomic surveillance reveals the spread patterns of SARS-CoV-2 in coastal Kenya during the first two waves

BackgroundThe transmission networks of SARS-CoV-2 in sub-Saharan Africa remain poorly understood. MethodsWe undertook phylogenetic analysis of 747 SARS-CoV-2 positive samples collected across six counties in coastal Kenya during the first two waves (March 2020 - February 2021). Viral imports and exports from the region were inferred using ancestral state reconstruction (ASR) approach. ResultsThe genomes were classified into 35 Pango lineages, six of which accounted for 79% of the sequenced infections: B.1 (49%), B.1.535 (11%), B.1.530 (6%), B.1.549 (4%), B.1.333 (4%) and B.1.1 (4%). Four identified lineages were Kenya specific. In a contemporaneous global subsample, 990 lineages were documented, 261 for Africa and 97 for Eastern Africa. ASR analysis identified >300 virus location transition events during the period, these comprising: 69 viral imports into Coastal Kenya; 93 viral exports from coastal Kenya; and 191 inter-county import/export events. Most international viral imports (58%) and exports (92%) occurred through Mombasa City, a key touristic and commercial Coastal Kenya center; and many occurred prior to June 2020, when stringent local COVID-19 restriction measures were enforced. After this period, local virus transmission dominated, and distinct local phylogenies were seen. ConclusionsOur analysis supports moving control strategies from a focus on international travel to local transmission. FundingThis work was funded by Wellcome (grant#: 220985) and the National Institute for Health Research (NIHR), project references: 17/63/and 16/136/33 using UK aid from the UK Government to support global health research, The UK Foreign, Commonwealth and Development Office.

Tracking the introduction and spread of SARS-CoV-2 in coastal Kenya

We generated 274 SARS-CoV-2 genomes from samples collected during the early phase of the Kenyan pandemic. Phylogenetic analysis identified 8 global lineages and at least 76 independent SARS-CoV-2 introductions into Kenyan coast. The dominant B.1 lineage (European origin) accounted for 82.1% of the cases. Lineages A, B and B.4 were detected from screened individuals at the Kenya-Tanzania border or returning travellers but did not lead to established transmission. Though multiple lineages were introduced in coastal Kenya within three months following the initial confirmed case, none showed extensive local expansion other than cases characterised by lineage B.1, which accounted for 45 of the 76 introductions. We conclude that the international points of entry were important conduits of SARS-CoV-2 importations. We speculate that early public health responses prevented many introductions leading to established transmission, but nevertheless a few undetected introductions were sufficient to give rise to an established epidemic.