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\n \n \n \nPosted 15/06/2020. Iron deficiency and malaria are common among African children and studies suggest that iron may be critical for the development of humoral immunity. Sarah Atkinson and colleagues found that in 1,794 community-based children in Kenya and Uganda, iron-deficiency was associated with lower levels of P. falciparum-specific antibodies even after adjusting for malaria exposure.
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\n \n \n \nPosted 21/05/2020. HIV-1 transmission patterns within and between risk groups (men who have sex with men, injecting drug users, female sex workers, and heterosexuals) in Kenya are not well understood. Based on 658 HIV-1 pol sequences, George Makau, Eduard Sanders and colleagues showed that 85% of transmission clusters was within risk groups, whereas 15% was shared between risk groups.
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\n \n \n \nPosted 07/05/2020. Information on malaria burden should progressively be based on empirical data rather than models. Alice Kamau and colleagues show that although, in many locations, both local surveillance data and modelled estimates showed declines in malaria burden, there was weak association where stalling in progress or resurgence of malaria burden was observed empirically.
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\n \n \n \nPosted 24/03/2020. This study by Morris Ogero and colleagues was based on over 50,000 patients from 13 referral hospitals in Kenya. Results suggest that >85% of admissions are conducted by pre-registration clinicians who are under experiential training. Although clinical assessment was according to guidelines, there was a major challenge in classification of illness severity leading to overuse of treatment.
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\n \n \n \nPosted 25/06/2019. As investments in health research capacity strengthening (HRCS) consortia increase, it is essential to consider the role of management approaches used. Nadia Tagoe and colleagues present current evidence and discourse on HRCS consortium management, and show that it is critical to pay attention to both relational and operational aspects of consortia to achieve desired outcomes.
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\n \n \n \nPosted 28/02/2020. Estimating the burden of iron deficiency in sub-Saharan Africa is challenging because infections influence iron biomarkers. After correcting for the effects of malaria and inflammation on iron biomarkers, Sarah Atkinson and colleagues show that over half of children are iron deficient and transferrin saturation may more accurately estimate the burden of iron deficiency in African children.
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\n \n \n \nPosted 25/02/2020. The effects of health worker strikes vary depending on strike duration, alternative healthcare available and responses adopted by management. Most strike-related research has focussed on ethical issues and impacts on mortality. Dennis Waithaka, Nancy Kagwanja, Sassy Molyneux and colleagues explore the experience of health managers and community members during two prolonged strike periods, lasting 250 days.
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\n \n \n \nPosted 14/02/2020. The delineation of disease-specific hospital catchments is important to identify populations marginalized from health services, but rarely investigated. Victor Alegana and colleagues set out to estimate the extent of malaria catchments and investigate hospitalisation for two severe malaria syndromes in children. Results suggest distinct geographic catchment for malaria and a reduced rate of hospitalisation outside of this catchment. These findings are useful in identifying communities where very sick children may require emergency care.
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\n \n \n \nPosted 21/01/2020. Naomi Muinga and colleagues report on challenges and the progress made in implementing digital health systems in Kenyan public hospitals. Their focus is on systems used primarily for financial management but are also being used for clinical services. They show that the available infrastructure needs to be strengthened to achieve the full benefits of electronic systems.
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\n \n \n \nPosted 29/11/2019. In this systematic review and meta-analysis of African studies, Sarah Atkinson and colleagues show that vitamin D deficiency is prevalent in many African populations. About one in five individuals living in Africa have vitamin D deficiency (<30 nmol/L), with newborns, women, urban residents and populations from northern and southern Africa being at higher risk.
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\n \n \n \nPosted 15/11/2019. Depression can co-occur with HIV. Moses Kachama and colleagues found high prevalence of depressive symptoms in adult participants living with HIV from Kilifi (14%). Factors associated with participants being depressed include: additional chronic illness to HIV (one or more), shifting to second-line antiretroviral treatment, HIV clinic being far, and experiencing HIV-related stigma.
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\n \n \n \nPosted 29/10/2019. The unyielding rise in non-communicable diseases like diabetes presents a threat to many resource-constrained health systems. Robinson Oyando and colleagues demonstrate that medicine costs account for more than 50% of diabetes patient costs in Kenya. While hypertension comorbid patients incur higher costs overall, unaffordability of care is intensified by transport costs.
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\n \n \n \nPosted 04/10/2019. Severe anaemia is common and life-threatening for children in sub-Saharan Africa. Previous research found that micronutrient deficiencies might be important causes of severe anaemia. In this trial, Kathryn Maitland and colleagues show that children do not benefit from either antibiotic prophylaxis or vitamin/mineral supplements. Future trials should focus on strategies to prevent the need for readmission.
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\n \n \n \nPosted 24/09/2019. Sarah Atkinson and colleagues show that the iron export mutation Q248H that primarily occurs in populations of African ancestry may protect from iron deficiency and anemia. Data from over 18,000 children show little evidence that the mutation protects against malaria, nor is the mutation evolutionary selected in African populations due to malaria exposure. This mutation does not protect from bloodstream bacterial infections either.
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\n \n \n \nPosted 30/07/2019. Malaria has been falling in Africa over the last few decades. This reduces the number of children with infection, but the lowered exposure to malaria could change the clinical picture. Work in KEMRI-Wellcome Programme shows this leads to more cerebral malaria and in older children, but fortunately no increase in death rates.
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\n \n \n \nPosted 26/07/2019. Although WHO rehydration management guidelines (Plan C) for severe dehydration are widely practiced in resource-poor settings, they have never formally been tested in a clinical trial, despite poor outcomes (mortality). Kathryn Maitland and colleagues evaluated current recommendations versus a slower rehydration regime in Ugandan/Kenyan with severe dehydration secondary to gastroenteritis. We found the slower regime giving rehydration therapy over 8 hours to be safe. For clinicians it was easier to implement than the two-stage Plan C regime. Time correct signs of dehydration and hospital stay was similar in the two groups. Future large trials with mortality as the primary endpoint are warranted.
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\n \n \n \nPosted 19/07/2019. Pro-poor health financing reforms have the potential to improve access to health services among the poor in Kenya. However, Evelyn Kabia and colleagues show that, for these reforms to be effective, they need to be accompanied by interventions that address barriers across other access dimensions such as geographical accessibility, availability, and acceptability of care.
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\n \n \n \nPosted 14/06/2019. Insufficient nurses caring for sick babies on hospitals\u2019 neonatal units in Kenya seriously undermine efforts to deliver high quality, safe care and make reducing neonatal mortality rates very difficult. Led by David Gathara, the Kenyan and Oxford team conducted the first ever direct observational study of which tasks nurses were able to perform and quantified how much care is missed. Previous work on missed nursing care largely conducted in rich countries has relied on questionnaires so this new work is an important advance.
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\n \n \n \nPosted 28/06/2019. Children with severe disease seen at an outpatient department of Kenyan hospital often have elevated procalcitonin, a biomarker for bacterial infection. Samuel Akech and colleagues show that it\u2019s still premature to recommend the use of procalcitonin to guide antibiotic administration unless clinical trials investigating the use of procalcitonin levels to guide antibiotic treatment are done.
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\n \n \n \nPosted 21/08/18. Globally, approximately 40-75% tuberculosis cases are missed, mostly due to under-reporting and under-diagnosis. Jacquie Oliwa and colleagues describe TB case notification rates, patterns of distribution and use of diagnostic tests as per Kenyan guidelines. There is an under-use of TB diagnostics tests, especially in children, which results in a notification rate eight times smaller than that of adults. New strategies are needed to increase the use of diagnostics, including innovations to improve access and overcome local barriers to the adoption of guidelines and technologies.
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