Clinical risk index for babies (CRIB) II score as a predictor of neonatal mortality among low birth weight babies at Kenyatta National Hospital.

BACKGROUND: Neonatal deaths, especially among the Low Birth Weight (LBW) babies, are of major concern in the Newborn Unit (NBU) of Kenyatta National Hospital (KNH). Several instruments have been developed to predict initial mortality risk among the LBW babies. Among them is the scoring system Clinical Risk Index for Babies also known as CRIB II score. OBJECTIVE: To evaluate the use of CRIB II score as a tool to predict the risk for neonatal mortality among the LBW babies at KNH. DESIGN: A prospective cohort study. SETTING: Newborn Unit of Kenyatta National Hospital. SUBJECT: A total sample of 135 low birthweight babies were followed up from admission till discharge, the 28th day of life or death whichever came first. RESULTS: One hundred and thirty five newborns were enrolled into the study. Birth weight ranged from 600-2500 g, with a median of 1600g. Total CRIB II score ranged from 1-15, with a median of 5.5. Gestational age ranged from 26 - 38 weeks. Total mortality was 45.9%. Birth weight < 1500 g, gestational age < 30 weeks, base excess <-12 mmol/l, temperature at admission > 37.5 or < 35 (all components of CRIB II) and total CRIB II score of > 4 were all found to be significantly associated with hospital neonatal mortality. Using a cut off point of 4, CRIB II score was found to have a sensitivity of 80.6%, specificity of 75.3%, and a predictive value of 77.7% compared to 72.5, 71.2, and 71.8% respectively for birthweight. Gestational age was found to have even lower figures; 56, 75 and 66% for sensitivity, specificity and predictive values respectively. CONCLUSION: CRIB II score of > 4 was found to have better prediction for mortality among the LBW babies at KNH-NBU compared to the traditionally used predictors and can be used to prioritise care for such neonates for better outcome.

Growth and development of abandoned babies in institutional care in Nairobi.

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants.

PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

Survey of knowledge, behaviour and attitudes relating to HIV infection and AIDS among Kenyan secondary school students.

To evaluate the knowledge, attitudes and sexual behaviour with respect to HIV and AIDS among Kenyan secondary school students, a questionnaire was issued to 3,018 students of mean age 16.3 years in 11 Kenyan schools. Questions of knowledge were answered correctly by an average of 77.1% of students. Areas where students' knowledge was less complete included the inability of mosquitoes to transmit the virus, the protective effect of condoms, the lack of protection from medications, the fatal and incurable nature of AIDS, and the fact that those infected with HIV may appear healthy. No prior sexual experience was reported by 71.3% of females and 25.2% of males. Multiple sexual partners were reported by 41.2% of males and 7.3% of females. Sixty per cent of students denied ever using condoms during sex and only 6.8% of those with multiple partners used them all the time. A prior sexually-transmitted disease was reported by 5.6% of students. Although a high level of knowledge regarding HIV and AIDS is evident among Kenyan students there is a sizable number who admit to extensive sexual experience, but who are not using condoms, thereby putting themselves at risk.