Posted 23/06/2020. As the COVID-19 global pandemic escalates in low-income and middle-income countries (LMICs), locally tailored responses addressing socio-economic and health inequities are essential. Edwine Barasa, Sassy Molyneux and colleagues offer five key considerations grounded in principles of social justice to inform decision making, and call for countries to act together, in cooperation, to build resilience.
Posted 19/06/2020. The true burden of malaria in sub-Saharan Africa remains challenging to measure. In Africa, there is increasing use of routine surveillance data to define national strategic targets, estimate malaria case burdens and measure control progress to identify financing priorities. Victor Alegana and colleagues address some of the challenges and prospects related to using routine data which equally apply to other disease surveillance.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 10/01/2020. Our ethnography aimed to describe Nairobi\u2019s inpatient newborn wards and the busy lives of the nurses who work there. They work long hours with little supervision in ill-designed wards, staffed by far too few nurses given the pressing need. Under these difficult conditions, the collective model of nursing that develops reduces nurses\u2019 exposure to stress and anxiety. Jacob McKnight and colleagues describe how these coping methods have implications for the quality of care and limit the potential for a patient-centred approach.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 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.
Posted 21/06/2019: Neglected tropical skin disease caused by sand fleas (tungiasis) inflicts misery on millions of children across the Tropics. Lynne Elson and colleagues show that tungiasis could be controlled through strengthening hygiene practices and sealing house and school floor
Posted 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.
Posted 24/05/2019. As low-income countries\u2019 economies grow and financial support from Gavi (the Vaccine Alliance) diminishes, governments need to consider the value of continuing previously-subsidized vaccine programmes at full cost. Anthony Scott and colleagues assess the incremental cost-effectiveness of continuing pneumococcal vaccination use between 2022 and 2032, and found the programme to be highly cost effective.
Posted 17/05/2019. Undernourished children sustain a high risk of death after discharge from hospital. By examining blood samples taken when children were clinically stable and ready for discharge, Jay Berkley and colleagues found that children who died in the next 60 days had infection-related responses despite following treatment guidelines. Incomplete treatment may underly later mortality.
Posted 09/04/2019. An ethnography work on neonatal nursing, led by Jacinta Nzinga in Nairobi, shows that to cope with incredibly high workloads, informal task shifting is already happening where non-clinical tasks are delegated to students, mothers and support staff. However, nurses are anxious about professional boundaries and the added responsibilities of supervising a potential new cadre.
Posted 15/03/2019. There is increasing recognition that children remain at increased risk of death following discharge from hospital in resource-poor settings. Alison Talbert and colleagues found that admission in children aged under 5 years with diarrhoea alone does not increase 12-month post-discharge mortality compared to admission with other conditions excluding severe pneumonia.
Posted 08/03/2019. Peter Macharia and colleagues used all available census and survey data in Kenya to evaluate subnational changes in child mortality rates between 1965 and 2015. Although Kenya has made huge gains in reducing child mortality, with a 62% reduction, the success remains uneven with considerable disparity. The study also demonstrates suboptimal performance to meet global milestones in child survival. The results are key in tracking SDG 3.2
Posted 22/01/2019. Scientists don\u2019t know which of the malaria parasites\u2019 ~6000 proteins make good vaccines. Conflicting results abound partly due to a lack of standardized tests. To make better vaccines, Professor Faith Osier and colleagues designed KILchip v1.0: a glass slide imprinted with 384 proteins using microarray technology. Coupled with human samples from the SMART Network, we used KILchip to generate data spanning close to 30 years in 3 months.
Posted 18/12/18. Various drivers of treatment-seeking behaviour contribute to disease outcomes. Victor Alegana and colleagues set out to quantify the probability of seeking treatment for fever in 29 sub-Saharan African countries. The probability of seeking-treatment for fever was less than 50% in half the countries. Findings provide insights into public sector utilization at national and subnational levels, and aim to improve planning, resource allocation and disease burden estimation.
Posted 30/10/18. Isabella Ochola-Oyier and colleagues investigated what impact individuals who carry parasites and show no malaria symptoms (asymptomatics) has on developing clinical malaria. They identified age and transmission intensity as factors that increase the risk of clinical infection. Asymptomatic individuals irrespective of age were at increased risk of clinical malaria at low transmission.
Posted 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.
Posted 12/06/2018. Among people with HIV infection who are starting antitretroviral treatment in Africa, both the amount of HIV virus in the body and the person's nutritional status are risk factors for dying. Professor Jay Berkley and colleagues found that giving a supplementary diet led to weight gain, but did not improve survival or illness. Malnutrition, rather than the severity of HIV, should guide the use of supplementary food.
Posted 22/05/2018. A new Case Study by Naomi Muinga from the Global Health Informatics Group reports on the challenges faced implementing an Open Source Electronic Health Record system in Kenya and the strategies employed by the Ministry of Health and development teams for increasing user adoption as the system is scaled up.
Posted 06/02/2018. Timely access to emergency care can substantially reduce mortality. Work undertaken in Professor Bob Snow\u2019s group in Kenya, has developed the first ever geocoded inventory of public hospitals in Africa. Spatial analysis across 48 countries showed that 29% of people are located more than 2-h travel time from the nearest hospital. With substantial variations within and between countries, innovative targeting of emergency care services is necessary to reduce inequities.
Posted 30/01/2018. Podoconiosis, also known as nonfilarial elephantiasis, is a poorly understood neglected tropical disease. Using a combination of currently available epidemiological data as well as nationwide mapping survey and geostatistical modelling, Dr Abdisalan Noor and colleagues demonstrated that podoconiosis is highly endemic in Ethiopia and interventions need to be scaled-up rapidly.
Posted 23/01/2018. The search is on for good measures of healthcare quality as LMIC health systems focus on effective coverage. In a new publication the Health Services team in Nairobi recently validated the Paediatric Admission Quality of Care (PAQC) score they had earlier developed, showing higher quality scores were associated with lower mortality for hospitalised children in Kenya.
Posted 07/11/2017. Bioinformatics skills have become essential for many research areas and building these skills has many challenges. Dr Etienne de Villiers and colleagues develop the eBioKit as a stand-alone bioinformatics educational and research platform that hosts numerous tools and databases for both bioinformatics research and training in a controlled environment
Posted 31/10/2017. Antimicrobial resistance is a clear and present threat to international health. Dr Phoebe Williams and Professor Jay Berkley reviewed recent data on antimicrobial resistance among children in sub-Saharan Africa since 2005. Research needs to focus on reporting community versus hospital-acquired infections, including patient outcomes, and needs pragmatic clinical trials.
Posted 10/10/2017. Severe malnutrition remains common in low-income countries, principally among young children. It usually arises from poor sanitation and infections, besides food insecurity. This comprehensive review by Professor James Berkley describes how research is needed, using modern clinic and laboratory tools, to better understand changes in metabolism, infections and the immune system to improve treatment.
Posted 08/09/2017. Changing the practices of health care workers in multiple hospitals in low-income settings is a major contemporary challenge that requires people to think about the complex set of influences that affect clinicians\u2019 behaviour. In this report, Professor Mike English describes a multi-layered strategy utilising a new implementation typology linked to overarching theories of change.
Posted 18/08/2017. Malaria transmission is patchy at local levels, and when a group of houses is located in a high transmission patch this is labelled a \"hotspot\". Looking at 19 studies in 7 African Countries, we see that hotspots are the norm, and especially prominent when malaria transmission falls.
Posted 01/08/2017. For more than a decade, Professor Mike English and his team have worked with the Kenyan Ministry of Health and professionals to develop national clinical guidelines. This paper describes how this approach has become both more rigorous and more collaborative while offering lessons to other LMIC on how to develop high quality guidelines with limited resources.
Posted 11/07/2017. We used a qualitative approach to study how public hospitals in Kenya make resource allocation decisions. We found that these decisions were influenced by (1) scarcity of financial resources, and poorly designed financing processes, (2) limited flexibility in resource allocation decisions, and (3) inadequate management and leadership capacity in the hospitals. Read more on Improving priority settting practices in Kenya's hospitals.
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