Pattern of bacterial infections and antimicrobial susceptibility at the Kenyatta National Hospital, Nairobi, Kenya.

To monitor clinically significant isolates and their antimicrobial susceptibilities, all specimens sent to microbiology laboratory of the Kenyatta National Hospital were cultured on appropriate media. The susceptibility of the isolates was performed on Muller Hinton or diagnostic sensitivity test (DST) agar using comparative discs diffusion technique. The results were then entered into Microbe Base 2 computer programme. A total of 7416 clinically significant isolates were collected from 1991 to 1995. The most commonly isolated organisms were E.coli, Klebsiella and Staphylococcus aureus. Most of these hospital acquired infections had multiple resistance to conventional antimicrobials, namely, penicillin, tetracyclines, gentamicin, trimethoprim/sulphamethoxazole and ampicillin. The resistance pattern was high among both gram negative and positive bacteria isolates. Beta-lactamase production amongst them were 51%, 69.3%, 79.6% respectively. Prevalence of methicillin resistant Staphylococcus aureus was 39.8%. Addition of clavulanic acid to amoxycillin increased Staphylococcus aureus susceptibility three fold. The emergence of multiple drug resistance calls for a continuous monitoring and reviewing of antibiotic policy in the hospital and the country at large.

Survey of penicillin resistant pneumococci at Kenyatta National Hospital, Nairobi.

During a four year period, a survey of antibiotic sensitivity patterns in clinical isolates of pneumococci was conducted at Kenyatta National Hospital, Nairobi. The isolation and characterisation of Streptococcus pneumoniae was done using standard laboratory procedures. Sensitivity testing was by disc diffusion method using discs supplied by Oxoid. During the period, 45 clinical isolates were recorded. This figure is somewhat lower than the expected rate of pneumococcal isolation at the hospital. Penicillin resistance of 24% among the pneumococcal isolates was recorded. Among the antibiotics tested, amoxycillin/clavulanic acid, ceftazidime, erythromycin and chloromphenicol had highest activity against the pneumococci. Surprisingly low sensitivity rates were recorded for trimethoprim/ sulphamethoxazole and cefuroxime. Implications of these findings in the management of pneumococcal infections are discussed.

Community acquired bacterial infections and their antimicrobial susceptibility in Nairobi, Kenya.

The purpose of the study was to determine the pattern and antimicrobial sensitivity on community acquired bacterial strains in Nairobi, Kenya. Clinical specimens collected from out-patient clinics at the Kenyatta National Hospital were cultured on appropriate media and identified according to Cowen and Steel's manual. The antimicrobial sensitivity was determined using comparative disc diffusion techniques. Between 1991 and 1995, there were a total of 1659 positive cultures comprising 30 different bacterial species. Out of the overall gram negative isolates (61.9%), E.coli and Klebsiella spp formed over 70%. Among the gram positive, Staphylococcus aureus, Enterococcus and coagulase negative staphylococcus spp constituting 41%, 26% and 18% respectively were the most common. Most organisms showed multiple resistance patterns to commonly used antimicrobials similar to hospital acquired infections. The gram negative isolates were resistant to cotrimoxazole, ampicillin, tetracyclines, chloramphenicol, and sulphamethoxazole. However, the sensitivity of these organisms to gentamicin and kanamycin was between 60 and 90%. Among the gram positive isolates, there was a high resistance to penicillin and tetracyclines (60-90%) while the resistance to lincomycin, minocycline and chloramphenicol was low (5-50%). All isolates were, however, highly sensitive to cephalosporins and fluoroquinolones. Beta-lactamase production among, E.coli, Klebsiella spp and Staphylococcus aureus was 48.9%, 76.7%, 76.1% respectively. Methicillin resistance for Staphylococcus aureus was 59.2%. Indiscriminate use of antibiotics in the community may have selected for resistant strains. This calls for urgent need to review policies on prescription practices.

Human immunodeficiency virus infection in long-distance truck drivers in east Africa.

BACKGROUND: A cross-sectional survey was performed to determine the seroprevalence and correlates of human immunodeficiency virus (HIV) infection among long-distance truck drivers in Kenya. METHODS: Truck drivers along the Mombasa-Nairobi highway were enrolled at a roadside research clinic. A standardized interview and serologic evaluation for HIV and syphilis were conducted. RESULTS: We enrolled 970 truck drivers and their assistants of whom 257 (27%) had HIV antibodies. In univariate analysis, HIV infection was correlated with older age, non-Kenyan nationality, Christian religion, longer duration of truck driving, travel outside of Kenya, less frequent visits to wives, and more frequent visits to prostitutes. Uncircumcised status, history of genital ulcer disease or urethritis during the previous 5 years, and a positive Treponema pallidum hemagglutination assay for syphilis were each associated with positive HIV serostatus. Univariate correlates of uncircumcised status included younger age, non-Kenyan nationality, Christian religion, travel outside of Kenya, and less frequent visits to prostitutes. There was a significant association between uncircumcised status and 5-year history of genital ulcer disease or serologic evidence of syphilis, but not with 5-year history of urethritis. In multivariate analysis, HIV infection was independently associated with uncircumcised status (adjusted odds ratio [OR], 4.9; 95% confidence interval [CI], 2.8 to 8.4), history of genital ulcer disease (adjusted OR, 2.4; 95% CI, 1.5 to 4.1), history of urethritis (adjusted OR, 1.8; 95% CI, 1.1 to 2.9), more frequent sex with prostitutes (more than once per month; adjusted OR, 1.7; 95% CI, 1.1 to 2.8), and positive T pallidum hemagglutination assay (adjusted OR, 1.2; 95% CI, 1.0 to 1.4). The attributable risk percentage for the association between HIV and uncircumcised status was 70%, and the population attributable risk was 25%. CONCLUSIONS: Truck drivers in east Africa are at high risk of HIV infection. The strongest correlates of HIV seropositivity were uncircumcised status and history of both ulcerative and nonulcerative sexually transmitted diseases.

Disk diffusion antimicrobial assays of agents used in respiratory tract infections in intubated patients admitted to the intensive care unit (ICU) of Kenyatta National Hospital from November to December 1990.

Sensitivity patterns of bacterial isolates from respiratory tract infections to benzylpenicillin, gentamicin and ceftazidime were studied. In a period covering 8 weeks from November to December 1990, tracheal aspirates from a total of 22 intubated patients aged 6-54 years were taken. The duration of stay of patients in the unit by the time of specimen collection ranged from 2-92 days. Respiratory tract infections by pathogenic organisms set in earliest on day 4. Elevated temperatures (equal to or greater than 38 degrees C) and/or purulence in sputum were used as diagnostic indicators of respiratory tract infections. A total of 12 pathogenic organisms were obtained: Proteus spp, Pseudomonas spp, Klebsiella spp, Acinetobacter spp, Escherichia coli and Staphylococcus aureus. None of the 12 pathogens isolated was sensitive to benzylpenicillin; 50% of organisms were sensitive to gentamicin and all were sensitive to ceftazidime.

Long distance truck drivers. 2: Knowledge and attitudes concerning sexually transmitted diseases and sexual behaviour.

Three hundred and thirty seven truck drivers, in transit from Mombasa to destinations within east and central Africa were interviewed on their knowledge on AIDS and sex practices using a pre-defined questionnaire. Nearly all of them, 99% (3.7/321), had heard of AIDS through mass media and from friends. When asked for a definition of AIDS, 87% (336/485 responses) described it as a sexually transmitted disease (STD) which causes body wasting and death. The majority were aware of the correct risk reducing behaviours: 76% (228/300) knew that use of condoms can prevent the transmission/acquisition of STDs but only 32% (90/295) had ever used them. This was in spite of the fact that 61% (226/309) admitted to visiting prostitutes. Various reasons were given for not using condoms. About 32% (34/188) claimed that they did not sleep with prostitutes while 18% (34/188) did not see the need for using condoms. Condoms were unavailable to another 18% (34/188). The data obtained show a clear lack of correlation between the correct knowledge of AIDS and application in the prevention of acquisition and transmission of STD.

Long distance truck-drivers: 1. Prevalence of sexually transmitted diseases (STDs).

A cross section study was conducted among long distance truck drivers to determine the prevalence of sexually transmitted diseases (STDs) and antibodies to human immunodeficiency virus (HIV). A total of 8 drivers and their assistants en route from port of Mombasa to countries in East and Central Africa were enrolled into the study. Blood was taken for HIV and syphilis serology. Discharges from urethra and genital ulcer disease (GUD) were cultured. Seroprevalence for HIV was 18% and 4.6% for syphilis. Fifty percent of Neisseria Gonorrhea cultured were penicillinase producers. Most of the men with urethral discharge and all the GUD were culture negative, probably due to prior treatment. Lack of circumcision, past history of GUD and urethritis were significantly associated with HIV seroconversion.

PIP: This article reports the findings of a study of HIV and STDs prevalence among long-distance truck drivers from East and Central Africa. Similar to prostitutes, truck drivers and a highly mobile population, characterized by having multiple sex partners. The researchers established a tent clinic at the Athi River Weighbridge Police Station near Nairobi, Kenya, where convoys of trucks stop for 3-5 days. 331 men from several East and Central African countries participated in the study. The participants completed a standard questionnaire about their medical history, knowledge, attitudes, and sex practices, and underwent a physical examination and blood test. Their ages ranged from 18-61 years, with a mean age of 31 years. 18% of the participants tested positive for HIV. Additionally, 4.6% tested positive for syphilis, and 4.5% and 4.3% suffered from urethral discharge ranked as the highest risk factor, followed by lack of circumcision. The study found no difference in the HIV prevalence rate between married and single men. The prevalence rate was far higher among Central Africans (31.75%) than among East Africans (16.65%), possibly explained by the hypothesis that says that HIV was first introduced in Central Africa, from where it spread to East Africa. Older drivers where more likely to be infected with HIV than younger drivers, with the age group of 40-49 having the highest prevalence rate. Researchers suspect that this is due to the fact that older drivers have been exposed longer and have more money with which to purchase sex. The report concludes that truck drivers constitute a high risk group, and should be targeted accordingly, with education and condom use campaigns.

An analysis of communication policies in Kenya.

PIP: Although Kenya's current 5-Year National Development Plan cites communications as a public policy issue in terms of the establishment of basic infrastructural facilities, little attention has been given to this area. At the national level, a more specific approach to communication policy demands the formulation of coherent policies and their implementation through adequate institutional bodies. However, most policymakers are poorly equipped to deal with communication questions since they are interdisciplinary, technically complex, and politically sensitive. Policymaking must be based on a database that allows a minimal level of resource assessment, an inventory of locally available resources, a projection of needs for imported resources, and a scenario for resource development. The institutional location and accountability of communication need to be defined. Moreover, in promoting the strategies of self-reliance and decentralization, communication policy must consider the 4 aspects of a national information system: function, resource inventory, structure content, an control. The 1st task is to carry out a needs assessment exercise that determines what is required from a communications policy. A related task is audience analysis. Also essential is the analysis of policies that guide and constrain system development and the distribution and nature of political and economic power. Finally, feedback mechanisms must be devised for the determination of policy impact. Methods helpful in analyzing policy impact include systems analysis, resource assessment, trend extrapolation, the Delphi technique, and brainstorming.^ieng