Access to point-of-care HIV testing shortens turn-around times, time to diagnosis and reduces loss to follow-up hence minimizing barriers to early linkage to care and treatment among HIV infected ...infants. Currently samples for early infant HIV diagnosis are sent to centralized testing facilities which are few and located only at specific regions in Kenya. However, there are Point of Care (POC) early infant diagnosis EID technologies elsewhere such as SAMBA and ALERE-Q that are yet to be evaluated in Kenya despite the urgent need for data to inform policy formulation regarding EID. The Cepheid GeneXpert HIV-1 Qual (GeneXpert) technology for POC EID offers a great opportunity to minimize HIV associated morbidity, mortality and loss to follow-up through decentralization of early infant HIV testing to the clinics. This technology also allows for same-day results thus facilitating prompt linkage to care.
We evaluated the GeneXpert HIV Qual EID POC in Homabay County against the standard of care platform, Roche CAP/CTM HIV-1 qualitative PCR, using dried blood spots (DBS). Between February-July 2016, DBS samples were collected from HIV exposed children <18 months of age enrolled in a cross-sectional study. Samples were collected by qualified nurse counselors, and were tested by trained technicians using field based GeneXpert and conventional laboratory based Roche CAP/CTM HIV-1 qualitative PCR. Sensitivity and specificity were determined.
Overall, 3,814 mother/infant pairs were included in the study, out of which 921 infants were HIV exposed as per the mothers' HIV status and based on the infant's HIV rapid test. A total of 969 PCR tests were performed, out of which 30 (3.3%) infants were concordantly positive using both platforms. GeneXpert HIV-1 Qual yielded a sensitivity of 94.1% and specificity of 99.8% with an overall error rate of 0.7%.
Our findings show that GeneXpert HIV-1 Qual performs well compared to CAP/CTM using DBS samples, suggesting that this technology may be adopted in decentralized laboratories as a near POC device. It may contribute to prompt diagnosis of HIV exposed infants hence enabling early linkage to care, thus advancing further gains in EID.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Elimination of catastrophic costs due to tuberculosis (TB) is one of the three targets of the World Health Organization (WHO) End TB Strategy. Limited data have yet been reported on the ...costs experienced by households of children receiving TB services. We quantified the economic impact on households with children seeking and receiving TB services during the Catalyzing Pediatric TB Innovations (CaP-TB) project in Cameroon and Kenya.
Methods
Within the INPUT stepped-wedge cluster-randomised study evaluating the effect of CaP-TB integration of TB services in paediatric entry points, we designed a cross-sectional facility-based survey with retrospective data collection using a standardised questionnaire adapted from the WHO Global taskforce on TB patient cost generic survey instrument. Caregivers of children receiving TB services (screening, diagnosis and treatment of drug-sensitive TB) during the CaP-TB project were interviewed between November 2020 and June 2021. Direct medical, direct non-medical, and indirect costs for TB services were analysed following WHO Global taskforce recommendations. We used the human capital and output-based approaches to estimating income loss. All costs are presented in 2021 US dollars.
Results
A total of 56 caregivers representing their households (Cameroon, 26, and Kenya, 30) were interviewed. The median household costs for TB services, estimated using the human capital approach, were $255 (IQR; $130-631) in Cameroon and $120 ($65-236) in Kenya. The main cost drivers across both countries were direct non-medical costs (transportation and food), 52%; and medical costs, 34%. Approximately 50% of households reported experiencing dissavings (taking a loan, or selling an asset) to deal with costs related to TB disease. Using a threshold of 20% of annual household income, 50% (95%CI; 37-63%) of households experienced catastrophic costs when using the human capital approach; (46% (95%CI; 29-65%) in Cameroon and 53% (95%CI; 36-70%) in Kenya). Estimated costs and incidence of catastrophic costs increased when using the output-based approach in a sensitivity analysis.
Conclusions
Accessing and receiving TB services for children results in high levels of cost to households, despite the provision of free TB services. Strategies to reduce costs for TB services for children need to address social protection measures or explore decentralisation.
Registration:
https://clinicaltrials.gov/ct2/show/NCT03862261.
This study examined the effects of Computer Assisted Learning (CAL) on the mastery of Science concepts by learners in universities. Teaching and learning of Science concepts present learners with ...numerous challenges. Of critical concern is the negative perception by learners that Science based subjects are difficult, thus contributing to widespread poor performance by the learners in the national examinations and subsequently poor choice of the subject in the universities. Solomon Four Group experimental design was employed for the study. The target population comprised all first-year students taking science subjects in 8 universities in western Kenya. A sample size of 335 students was determined using Krejcie & Morgan table (1970). The universities were divided into two forming experimental and control groups. The study was carried out in 4 months spanning 16 weeks where pretest was administered after the first 8 weeks of conventional teaching and post-test administered after the next 8 weeks of treatment. Pretest and post-test Science Achievements Test (SAT) on two topics, digestive system and light and optics, were designed and administered by the respective lecturers, and scores recorded. Piloting was carried before the use of the instruments, and a reliability coefficient of 0.85 on SAT was recorded. Data were analyzed using t-test one-way ANOVA. The study found that 171 students taught using CAL achieved significantly higher scores in SAT compared to164 students taught through conventional methods with a mean gain of 2.851. The study demonstrated that CAL enhanced active manipulation of content and promoted interaction with content, and gave reality to abstraction. The study may be significant to educationists, lecturers, researchers, and policy makers as it provides insight on the benefits of applying Computer Assisted Learning in Science Education.
Abstract
Background
Although Shigella is an important cause of diarrhea in Kenyan children, robust research platforms capable of conducting incidence-based Shigella estimates and eventual ...Shigella-targeted clinical trials are needed to improve Shigella-related outcomes in children. Here, we describe characteristics of a disease surveillance platform whose goal is to support incidence and consequences of Shigella diarrhea as part of multicounty surveillance aimed at preparing sites and assembling expertise for future Shigella vaccine trials.
Methods
We mobilized our preexisting expertise in shigellosis, vaccinology, and diarrheal disease epidemiology, which we combined with our experience conducting population-based sampling, clinical trials with high (97%–98%) retention rates, and healthcare utilization surveys. We leveraged our established demographic surveillance system (DSS), our network of healthcare centers serving the DSS, and our laboratory facilities with staff experienced in performing microbiologic and molecular diagnostics to identify enteric infections. We joined these resources with an international network of sites with similar capabilities and infrastructure to form a cohesive scientific network, designated Enterics for Global Health (EFGH), with the aim of expanding and updating our knowledge of the epidemiology and adverse consequences of shigellosis and enriching local research and career development priorities.
Conclusions
Shigella surveillance data from this platform could help inform Shigella vaccine trials.
A diarrhea-specific research platform able to perform population-based enumeration and hospital-based surveillance plus support mentorship of young scientists has been established in western Kenya to support Enterics for Global Health–Shigella surveillance and future vaccine trials.
This study examined the effects of Computer Assisted Learning (CAL) on the mastery of Science concepts by learners in universities. Teaching and learning of Science concepts present learners with ...numerous challenges. Of critical concern is the negative perception by learners that Science based subjects are difficult, thus contributing to widespread poor performance by the learners in the national examinations and subsequently poor choice of the subject in the universities. Solomon Four Group experimental design was employed for the study. The target population comprised all first-year students taking science subjects in 8 universities in western Kenya. A sample size of 335 students was determined using Krejcie & Morgan table (1970). The universities were divided into two forming experimental and control groups. The study was carried out in 4 months spanning 16 weeks where pretest was administered after the first 8 weeks of conventional teaching and post-test administered after the next 8 weeks of treatment. Pretest and post-test Science Achievements Test (SAT) on two topics, digestive system and light and optics, were designed and administered by the respective lecturers, and scores recorded. Piloting was carried before the use of the instruments, and a reliability coefficient of 0.85 on SAT was recorded. Data were analyzed using t-test one-way ANOVA. The study found that 171 students taught using CAL achieved significantly higher scores in SAT compared to164 students taught through conventional methods with a mean gain of 2.851. The study demonstrated that CAL enhanced active manipulation of content and promoted interaction with content, and gave reality to abstraction. The study may be significant to educationists, lecturers, researchers, and policy makers as it provides insight on the benefits of applying Computer Assisted Learning in Science Education.
Only a few studies to evaluate groundwater fluoride in Eastern Africa have been undertaken outside the volcanic belt of the Great Eastern Africa Rift Valley. The extent and impact of water fluoride ...outside these regions therefore remain unclear. The current study evaluated fluoride levels in household water sources in Bondo-Rarieda Area in the Kenyan part of the Lake Victoria Basin (LVB) and highlighted the risk posed by water fluoride to the resident communities. The results, it was anticipated, will contribute to in-depth understanding of the fluoride problem in the region.
A total of 128 water samples were collected from different water sources from the entire study area and analyzed for fluoride content using ion-selective electrodes.
Lake Victoria was the main water source in the area but dams and open pans (39.5%), boreholes and shallow wells (23.5%), and streams (18.5%) were the principal water sources outside walking distances from the lake. The overall mean fluoride content of the water exceeded recommended limits for drinking water. The mean water fluoride was highest in Uyoma (1.39±0.84 ppm), Nyang'oma (1.00±0.59 ppm) and Asembo (0.92±0.46 ppm) and lowest in Maranda Division (0.69±0.42 ppm). Ponds (1.41±0.82 ppm), springs (1.25±0.43 ppm), dams and open pans (0.96±0.79 ppm), and streams (0.95±0.41 ppm) had highest fluoride levels but lake and river water did not have elevated fluoride levels. Groundwater fluoride decreased with increasing distance from the lake indicating that water fluoride may have hydro-geologically been translocated into the region from geochemical sources outside the area.
Lake Victoria was the main water source for the residents of Bondo-Rarieda Area. Majority of in-land residents however used water from dams, open pans, boreholes, shallow wells, ponds and streams, which was generally saline and fluoridated. It was estimated that 36% of children living in this area, who consume water from ground sources from the area could be at the risk of dental fluorosis.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Streptococcus agalactiae (group B streptococcus, GBS) causes neonatal disease and stillbirth, but its burden in sub-Saharan Africa is uncertain. We assessed maternal recto-vaginal GBS colonization ...(7,967 women), stillbirth and neonatal disease. Whole-genome sequencing was used to determine serotypes, sequence types and phylogeny. We found low maternal GBS colonization prevalence (934/7,967, 12%), but comparatively high incidence of GBS-associated stillbirth and early onset neonatal disease (EOD) in hospital (0.91 (0.25-2.3)/1,000 births and 0.76 (0.25-1.77)/1,000 live births, respectively). However, using a population denominator, EOD incidence was considerably reduced (0.13 (0.07-0.21)/1,000 live births). Treated cases of EOD had very high case fatality (17/36, 47%), especially within 24 h of birth, making under-ascertainment of community-born cases highly likely, both here and in similar facility-based studies. Maternal GBS colonization was less common in women with low socio-economic status, HIV infection and undernutrition, but when GBS-colonized, they were more probably colonized by the most virulent clone, CC17. CC17 accounted for 267/915 (29%) of maternal colonizing (265/267 (99%) serotype III; 2/267 (0.7%) serotype IV) and 51/73 (70%) of neonatal disease cases (all serotype III). Trivalent (Ia/II/III) and pentavalent (Ia/Ib/II/III/V) vaccines would cover 71/73 (97%) and 72/73 (99%) of disease-causing serotypes, respectively. Serotype IV should be considered for inclusion, with evidence of capsular switching in CC17 strains.
Abstract
Background
Antimicrobial stewardship (AMS) programmes can improve the use of antimicrobial agents. However, there is limited experience in the implementation of such programmes in low- and ...middle-income countries (LMICs).
Objectives
To assess the effect of AMS measures in south-east Liberia on the quality of antimicrobial use in three regional hospitals.
Methods
A bundle of three measures (local treatment guideline, training and regular AMS ward rounds) was implemented and quality indicators of antimicrobial use (i.e. correct compounds, dosage and duration) were assessed in a case series before and after AMS ward rounds. Primary endpoints were (i) adherence to the local treatment guideline; (ii) completeness of the microbiological diagnostics (according to the treatment guideline); and (iii) clinical outcome. The secondary endpoint was reduction in ceftriaxone use.
Results
The majority of patients had skin and soft tissue infections (n = 108) followed by surgical site infections (n = 72), pneumonia (n = 64), urinary tract infection (n = 48) and meningitis (n = 18). After the AMS ward rounds, adherence to the local guideline improved for the selection of antimicrobial agents (from 34.5% to 61.0%, P < 0.0005), dosage (from 15.2% to 36.5%, P < 0.0005) and duration (from 13.2% to 31.0%, P < 0.0005). In total, 79.7% of patients (247/310) had samples sent for microbiological analysis. Overall, 92.3% of patients improved on Day 3 (286/310). The proportion of patients receiving ceftriaxone was significantly reduced after the AMS ward rounds from 51.3% to 14.2% (P < 0.0005).
Conclusions
AMS measures can improve the quality of antimicrobial use in LMICs. However, long-term engagement is necessary to make AMS programmes in LMICs sustainable.
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