Prevalence of early postpartum depression and associated risk factors among selected women in southern Malawi: a nested observational study.

BACKGROUND: The birth of a child should be a time of celebration. However, for many women, childbirth represents a time of great vulnerability to becoming mentally unwell, a neglected maternal morbidity. This study aimed to determine the prevalence of early postpartum depression (PPD) and its associated risk factors among women giving birth at health facilities in southern Malawi. Identifying women vulnerable to PPD will help clinicians provide appropriately targeted interventions before discharge from the maternity ward. METHOD: We conducted a nested cross-sectional study. Women were screened for early PPD using a locally validated Edinburgh Postpartum Depression Scale (EPDS) as they were discharged from the maternity ward. The prevalence of moderate or severe (EPDS ≥ 6) and severe (EPDS ≥ 9) PPD was determined, including 95% confidence intervals (CI). Data on maternal age, education and marital status, income source, religion, gravidity, and HIV status, among others, were collected during the second trimester of pregnancy, and obstetric and infant characteristics during childbirth were examined as potential risk factors for early PPD using univariable and multivariable logistic regression analyses. RESULTS: Data contributed by 636 women were analysed. Of these women, 9.6% (95% CI; 7.4-12.1%) had moderate to severe early PPD using an EPDS cut-off of ≥ 6, and 3.3% (95% CI; 2.1-5.0%) had severe early PPD using an EPDS cut-off of ≥ 9. Multivariable analyses indicated that maternal anaemia at birth (aOR; 2.65, CI; 1.49-4.71, p-value; 0.001) was associated with increased risk for moderate and/or severe early PPD, while live birth outcome (aOR; 0.15, 95% CI; 0.04-0.54, p-value; 0.004), being single compared to divorced/widowed (aOR; 0.09, 95% CI; 0.02-0.55, p-value; 0.009), and lower education level (aOR; 0.36, 95% CI; 0.20-0.65, p-value; 0.001) were associated with decreased risk. Being HIV positive (aOR; 2.88, 95% CI; 1.08-7.67, p-value; 0.035) was associated with severe PPD only. CONCLUSION: The prevalence of early PPD was slightly lower in our selected sample compared to previous reports in Malawi and was associated with maternal anaemia at birth, non-live birth, being divorced/widowed and HIV-positive status. Therefore, health workers should screen for depressive symptoms in women who are at increased risk as they are discharged from the maternity ward for early identification and treatment.

Malnutrition and cachexia among cancer out-patients in Nairobi, Kenya.

Cancer is the third leading cause of death in Kenya. However, there is scarce information on the nutritional status of cancer patients to guide in decision making. The present study sought to assess the risk of malnutrition, and factors associated with malnutrition and cachexia, among cancer out-patients, with the aim of informing nutrition programmes for cancer management in Kenya and beyond. This was a facility-based cross-sectional study performed at Kenyatta National Hospital and Texas Cancer Centre in Nairobi, Kenya. The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool (MUST). Diagnoses of malnutrition and cachexia were done using the European Society of Clinical Nutrition and Metabolism (ESPEN) and Fearon criteria, respectively. A total of 512 participants were assessed. Those at risk of malnutrition were 33·1 % (12·5 % at medium risk, 20·6 % at high risk). Prevalence of malnutrition was 13·4 %. The overall weight loss >5 % over 3 months was 18·2 % and low fat-free mass index was 43·1 %. Prevalence of cachexia was 14·1 % compared with 8·5 % obtained using the local criteria. Only 18·6 % participants had received any form of nutrition services. Age was a predictor of malnutrition and cachexia in addition to site of cancer for malnutrition and cigarette smoking for cachexia. The use of the MUST as a screening tool at the first point of care should be explored. The predictive value of current nutrition assessment tools, and the local diagnostic criteria for malnutrition and cachexia should be reassessed to inform the development of appropriate clinical guidelines and future capacity-building initiatives that will ensure the correct identification of patients at risk for timely care.

COMPARISON OF LOSARTAN AND ENALAPRIL EFFECTS ON RENAL FUNCTION IN HYPERTENSIVE ADULTS WITH CHRONIC KIDNEY DISEASE AT A KENYAN REFERRAL HOSPITAL.

OBJECTIVE: The objective of this study was to compare renal function in diabetic hypertensive chronic kidney disease patients receiving enalapril or losartan. DESIGN: This was a retrospective analytic cohort study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Two hundred adult patients with hypertension and diabetic nephropathy. INTERVENTIONS: One hundred and sixteen participants received an enalapril regimen while 84 were on a losartan regimen. MAIN OUTCOME MEASURES: Time to doubling of serum creatinine and changes in the levels of proteinuria. RESULTS: There was a higher risk of doubling of serum creatinine with losartan (Adjusted HR = 1.572; [95% CI: 1.015-2.434]; p = 0.043) than enalapril. There was a significant difference in time to doubling between the two arms--losartan 18 months, enalapril 36 month (p = 0.046). The changes in the levels of proteinuria between the two arms were not statistically significant for most of the follow up period except at the 15th month from treatment initiation (p = 0.05). CONCLUSIONS: Enalapril was found to be more reno-protective compared to losartan. Where feasible, we suggest local use of enalapril as opposed to losartan for diabetic hypertensive chronic kidney disease patients.

Blood donors in Kenya: a comparison of voluntary and family replacement donors based on a population-based survey.

BACKGROUND AND OBJECTIVES: Blood safety and sufficiency are major challenges in Kenya and other sub-Saharan African countries forcing many countries to rely on family replacement donors (FRD). We analysed data from a national AIDS indicator survey to describe blood donors in Kenya and potential risks of transfusion transmissible infections (TTI) comparing voluntary donors and FRD. MATERIALS AND METHODS: A population-based, cross-sectional survey was conducted in 2007 among 15- to 64-year-olds. Consenting participants were interviewed about blood donation history and were tested for HIV, HSV-2 and syphilis. RESULTS: Of the 17,940 people surveyed, 445 (2·3%) reported donating blood in the prior 12 months. Sixty-four per cent were voluntary donors, and the rest were FRD. Compared to FRD, the majority of voluntary donors were <25 years old (59% versus 18%), from the highest wealth quintile (57% versus 42%) and single (64% versus 23%). In addition, voluntary donors were less likely to have been sexually active than replacement donors (43% versus 13%). HIV prevalence was lower among voluntary donors than among FRD (2·6% versus 7·4%, P-value=0·07). CONCLUSIONS: The majority of blood donors in Kenya are voluntary with lower potential risk of TTI.

Fungal infections among diabetic foot ulcer- patients attending diabetic clinic in Kenyatta National Hospital, Kenya.

OBJECTIVE: To isolate and identify fungal pathogens associated with dermatophytoses in diabetic patients and identify the spectrum of yeasts colonising diabetic foot ulcers at Kenyatta National Hospital. DESIGN: A cross sectional Laboratory based study. SETTING: The Kenyatta National Hospital diabetic clinic. SUBJECTS: Sixty one patients with diabetic foot ulcers from August to November 2009. RESULTS: The five most occurring pathogens were Biopolaris hawaiiensis (5.5%), Trichophyton schoenleinii (3.7%), Aspergillus niger (3.0%), Trichophyton rubrum (3.0%), Fusarium oxysporum (3.0%). Other moulds accounted forless than 3.0%. One suspected case (0.6%) of Penicilium marneffei was isolated although it couldnotbe ascertained due to its high containment requirement. Among the dermatophytes, the most occurring mould was Trichophyton schoenleinii (3.7%) while innon-dermatophyte was Biopolaris hawaiiensis (5.5%). Eight pathogenic yeasts were identified with C. parapsilosis (6.1%) being the most common followed by C. famata (3.0%). Fungal infestation was highest in callus formation (78.6%). CONCLUSION: Fungal aetiological agents are significant cause of diabetic woundinfection and may require antifungal intervention for successful management of diabetic foot ulcers.

Lidar measurements taken with a large-aperture liquid mirror. 2. Sodium resonance-fluorescence system.

Sodium resonance-fluorescence lidar is an established technique for measuring atmospheric composition and dynamics in the mesopause region. A large-power-aperture product (6.6-W m(2)) sodium resonance-fluorescence lidar has been built as a part of the Purple Crow Lidar (PCL) at The University of Western Ontario. This sodium resonance-fluorescence lidar measures, with high optical efficiency, both sodium density and temperature profiles in the 83-100-km region. The sodium lidar operates simultaneously with a powerful Rayleigh- and Raman-scatter lidar (66 W m(2)). The PCL is thus capable of simultaneous measurement of temperature from the tropopause to the lower thermosphere. The sodium resonance-fluorescence lidar is shown to be able to measure temperature to an absolute precision of 1.5 K and a statistical accuracy of 1 K with a spatial-temporal resolution of 72 (km s) at an altitude of 92 km. We present results from three nights of measurements taken with the sodium lidar and compare these with coincident Rayleigh-scatter lidar measurements. These measurements show significant differences between the temperature profiles derived by the two techniques, which we attribute to variations in the ratio of molecular nitrogen to molecular oxygen that are not accounted for in the standard Rayleigh-scatter temperature analysis.

Comparison of indirect fluorescent antibody test and enzyme linked immunosorbent assay in the detection of exposure of cattle to Theileria parva in Kenya.

Appraisal of the indirect fluorescent antibody test (IFAT) and antigen enzyme linked immunosorbent assay (ELISA) serological tests as carried out to detect cattle exposed to Theileria parva at the National Veterinary Research Centre, Muguga (NVRC), Kenya is reported. Using sera from T. parva naive cattle and cattle experimentally exposed to T. parva, the two tests were appraised in terms of their sensitivity and specificity. IFAT and ELISA had the same sensitivity of 90% while ELISA had a higher specificity (90%) than IFAT (80%). A comparison was also made of the capability of the two tests to detect exposure of dairy cattle to T. parva prior to immunization against East Coast fever (ECF). The positive outcome from the IFAT was significantly higher (chi 2 = 30.36; P < 0.001) than that from the ELISA. The agreement between the two tests was low (Kappa = 0.21). The two tests indicated a higher risk of ECF in the study area than was expected. Indications are that the ELISA has been effectively adopted at NVRC.