Prevalence of acute kidney injury and its characteristics among neonates with suspected sepsis in a tertiary hospital in Kenya.

Introduction: Unique aspects of neonatal renal physiology enhance the occurrence of Acute Kidney Injury (AKI) as a complication of neonatal sepsis. The study sought to determine prevalence of AKI and its characteristics in neonates with suspected sepsis. Methods: A cross-sectional study was conducted at Kenyatta National Hospital among neonates aged 0-28 days. AKI was defined as serum creatinine of more than 100µmmol/l. Results: Among 332 neonates included 120 had AKI giving a prevalence of 36.1% (95% CI 31 to 41.6). Based on RIFLE criteria the commonest AKI presentation was Failure 72 (62.6%, 95% CI 53.6 to 71.6), followed by Injury 26 (22.6%, 95% CI 14.8 to 30.4) and then Risk 17 (14.8%, 95% CI 8.2 to 21.3). AKI was more common in neonates with suspected late onset sepsis (p=0.004). Maternal fever in the preceding week to delivery and presence of either puerperal sepsis or post-partum hemorrhage were significantly associated with severe AKI (p=0.004 and p=0.038). Conclusion: Prevalence of AKI was high; those with suspected late onset sepsis were more likely to develop AKI compared to early onset sepsis. Presence of maternal fever preceding delivery and presence of either puerperal sepsis or postpartum hemorrhage were associated with severe forms of AKI.

Attitudes towards interprofessional education and associated factors among faculty at the college of health sciences in a public university in Kenya: a cross-sectional study.

Introduction: conforming health professional´s curricula and training to emerging needs and exponential growth in medical information and education is key. Interprofessional education is one such conformity. Faculty attitudes towards interprofessional education is a good predictor to their engagement. The study purpose is to determine attitudes of faculty and associated factors towards interprofessional education (IPE) at the College of Health Sciences of Jomo Kenyatta University of Agriculture and Technology. Methods: a cross-sectional study among 71 faculty was conducted. A 5-point Likert scale with three attitude subscales on IPE were used to collect data using stratified sampling method. Attitude was dichotomized with >75% as cut-off for positive attitude. Data was analyzed using SPSS version 25.0 software at 95% confidence level. Logistic regression was used to identify relationship between bio-demographic characteristics and attitude of faculty. Results: there were more male faculty than females and the mean age was 42 years. The overall attitude score was positive (124.46 >75%), with attitudes of faculty towards IPE in academic settings subscale yielding negative attitude score (36.86 <75%). Age, gender, academic position, and expertise level were not significant in influencing faculty´s attitude. Application of interprofessional education was significant (P=0.036), with faculty who had applied Interprofessional education at the college more likely to have positive attitudes. Conclusion: faculty have overall positive attitudes towards interprofessional education but negative attitudes towards subscale 3-interprofessional education in academic settings. Behavior change training and IPE sensitization to avert negative attitudes among faculty is recommended.

Antiretroviral therapy outcomes among adolescents and young adults in a Tertiary hospital in Kenya.

BACKGROUND: Limited data is available on the treatment outcomes of HIV infected adolescents and young adults (AYA) in sub-Saharan Africa. HIV-infected adolescents and young adults (AYA) are at high risk of developing antiretroviral treatment failure. OBJECTIVE: To determine the clinical, immunological and virologic outcomes of AYA at a tertiary hospital in Kenya. METHODOLOGY: A longitudinal study was conducted among AYA age 10-24 years attending Kenyatta National Hospital comprehensive care center. Clinical data was abstracted from electronic medical records for study participants with at least 6 months of follow-up using a structured data abstraction sheet. RESULTS: A total of 250 AYA age 10 to 24 years were included. The median age was 16 years. The median CD4 cell count was 650.6 cells/mm3 (IQR 350.7-884.0). More than half (60.6%) of AYA had a CD4 cell count higher than 500 cells/mm3. Overall, 76.9% of AYA had achieved viral suppression (viral load <1000 copies/ml). There was a significant increase in virologic failure with higher age and late adolescents and young adults were more likely to have a viral load > 1000 copies/ml p<0.012. CONCLUSION: The overall virologic suppression in this cohort of AYA was sub-optimal. Both immunological and virologic outcomes were worse among late adolescents (18-19 years) and young adults (20-24 years).

Erratum to "COVID-19 in children: what did we learn from the first waveË® [Paediatr Child Health 30 (2020) 438-443/1496].

[This corrects the article DOI: 10.1016/j.paed.2020.09.005.].

Empowering children and young people who have asthma.

Asthma is the most common chronic condition of childhood. In this review, we discuss an overview of strategies to empower children and young people with asthma. The key aspects of empowerment are to enable shared decision making and self-management, and help children minimise the impact of asthma on their life. The evidence behind these strategies is either sparse or heterogenous, and it is difficult to identify which interventions are most likely to improve clinical outcomes. Wider determinants of health, in high-resource and low-resource settings, can be disempowering for children with asthma. New approaches to technology could help empower young people with asthma and other chronic health conditions.

COVID-19 in children: what did we learn from the first wave?

A pandemic caused by the novel coronavirus, severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2), has caused high rates of mortality, predominantly in adults. Children are significantly less affected by SARS-CoV-2 with far lower rates of recorded infections in children compared to adults, milder symptoms in the majority of children and very low mortality rates. A suspected late manifestation of the disease, paediatric inflammatory multisystem syndrome - temporally associated with SARS-CoV-2 (PIMS-TS), has been seen in small numbers of children and has a more severe disease course than acute SARS-CoV-2. The pandemic has meant that children around the world have been kept off school, isolated from their extended family and friends and asked to stay inside. The UK has been declared as being in an economic recession and unemployment rates are increasing. These indirect effects of SARS-CoV-2 are likely to have a significant impact on many children for years to come. Consolidating the knowledge that has accumulated during the first wave of this pandemic is essential for recognising the clinical signs, symptoms and effective treatment strategies for children; identifying children who may be at increased risk of severe SARS-CoV-2 infection; planning the safe delivery of healthcare and non-health related services that are important for childrens' wellbeing; and engaging in, and developing, research to address the things that are not yet known. This article summarises the evidence that has emerged from the early phase of the pandemic and offers an overview for those looking after children or planning services.

Knowledge and perceptions on childhood asthma among care-takers of children with asthma at a National Referral Hospital in Western Kenya: a descriptive study.

BACKGROUND: Identifying knowledge gaps in asthma self-management and identifying existing myths is an important step in determining appropriate health education and demystifying the myths so as to enhance asthma control. OBJECTIVE: To identify existing knowledge gaps and perceptions among the caregivers of asthmatic children. METHODS: A cross sectional study was done among caretakers of asthmatic children aged 6-11 years at Moi Teaching and Referral Hospital. Data on knowledge and perceptions among caretakers was collected using a questionnaire. RESULTS: A total of 116 caretakers were recruited of whom 71.6% were mothers. Although 60% of the caretakers had asthma medications at home, only a third felt their children were asthmatic. Eighty four (72.4%) had basic asthma knowledge. Syrups were preferred to inhalers by 70.7%, with 64.7% believing that inhalers were for the very sick. Only 36 (31%) felt preventer medications in asthma were necessary. Acceptance of asthma as a diagnosis and presence of asthma drugs were significantly associated with better knowledge of asthma, p-values 0.015 and 0.009 respectively. CONCLUSION: Most caregivers perceive syrups to be better despite having good basic knowledge on asthma. There is need to address asthma perceptions among caretakers in resource poor settings which is likely to improve control.