Posted 22/09/2021. Kelvin Mokaya, Sarah Atkinson and colleagues found that children with severe malaria anaemia have higher risk of non-typhoidal Salmonella bacteraemia, and lower levels of the iron-regulating hormone, hepcidin (even with Salmonella coinfection) compared to other forms of malaria. Reduced hepcidin may increase iron availability for bacterial growth in the Salmonella-containing vacuole.
Posted 01/09/2021. Rob Paton, Alice Kamau and colleagues analysed a data series of over 6000 hospital records of malaria admissions among children aged 3 months to 9 years. A 25% reduction in transmission halved the rate of severe malaria hospitalization. Severe malaria remains a burden predominantly in children under 5 years, regardless of the level of malaria transmission.
Posted 27/08/2021. Demographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for paediatric complex and chronic conditions, however such expansion is threatened by workforce shortages. Yingxi Zhao and colleagues reviewed how task sharing could support expanded paediatrics services provision in LMICs, especially beyond acute infectious diseases and malnutrition that are widely and historically shifted.
Posted 30/07/2021. A reliable catchment area is essential to define community needs (education, health care and social care) and population denominators. However, catchments are often implemented based on convenience disregarding implications on accuracy, planning and service seeking behaviour. Peter Macharia and colleagues revisit the issue by considering common approaches, key issues, and best practices in defining a reliable service catchment area
Posted 23/07/2021. Effective management and leadership are essential for everyday health system resilience, but health managers are often under-prepared and under-supported in these roles. Particular challenges have been observed in communication skills, emotional competence and supportive oversight. Jacinta Nzinga and colleagues share their learning from implementing a package of leadership development interventions in Kenya
Posted 13/07/2021. The overwhelming COVID-19 case numbers and deaths expected in African countries, as seen elsewhere following identification of the first COVID-19 cases, have not materialised. However, through serosurveillance of blood donors, Ifedayo Adetifa, Sophie Uyoga and colleagues demonstrate widespread SARS-CoV-2 infection in Kenya despite the lower COVID-19 cases and associated mortality.
Posted 22/06/2021. Diagnosis of bacterial meningitis in low- and middle-income countries is challenging due to limited laboratory capacity. Christina Obiero and colleagues conducted a revalidation study of previously identified signs of meningitis in children aged \u226560 days and found that KCH-2002 signs had lower sensitivity. Although bacterial meningitis is now uncommon following conjugate vaccination in Kenya, identifying cases is more difficult and support for basic cerebrospinal fluid analysis is crucial.
Posted 18/06/2021. Grace Irimu and colleagues show that newborns account for 46% of admissions and 66% of deaths among children 0-13years in Kenyan hospitals. Most deaths are caused by preventable and treatable causes. The authors call for need to prioritize newborn care for Kenya to achieve the SDGs target.
Posted 16/06/2021. The progress made in treatment of malaria is threatened by the emergence of resistance to current first line treatments artemisinin-based combination therapies (ACTs). There are currently no good alternatives for the treatment of uncomplicated malaria in the African setting in the event of resistance emerging to antimalarials that are in the ACTs. Mainga Hamaluba, Rob van der Pluijm and colleagues demonstrate that triple artemisinin combination therapies (TACTs) can potentially be used safely to prevent, delay or manage uncomplicated malaria in our setting.
Posted 08/06/2021. Alice Kamau and colleagues show that passively collected routine health facility data does offer opportunities to detect malaria \u2018hotstops\u2019 down to the village level, at an affordable cost. It will be important, however, to refine the current surveillance tools such that they have the potential of collecting information at sufficiently precise scale.
Posted 28/05/2021. Reagan Mogire, Sarah Atkinson and colleagues show that the prevalence of vitamin D deficiency (<50\u2009nmol/L) is low (7.8%) in African children, although 37.1% have insufficient levels (50\u201375\u2009nmol/L). Risk factors for vitamin D deficiency include high latitude, older age, winter and rainy seasons, Gc2 vitamin D binding protein genotype and malaria.
Posted 12/05/2021. Jacob Kazungu, Edwine Barasa and colleagues examined the level and inequality in health insurance coverage in 36 sub-Saharan African countries. They found that insurance coverage in sub-Saharan Africa is both low and pro-rich; only 8 of the 36 countries examined had a mean level of insurance coverage of above 10%.
Posted 28/04/2021. While Health and Demographic Surveillance Systems (HDSS) involving verbal autopsy provide essential data on deaths, births and other health-related events in LMICs where alternative sources are limited, Vicki Marsh and colleagues argue that current regulatory frameworks do not sufficiently recognise their nature as a form of non-traditional epidemiological research. Ethical challenges include risks of uncompensated burdens that alternative regulatory approaches may more successfully identify.
Posted 23/04/2021. COVID-19 case management is one of the key interventions in country responses to the pandemic. Angela Kairu, Edwine Barasa and colleagues estimate the unit costs for COVID-19 case management in Kenya useful in informing policy decisions around resource allocation, planning and budgeting, and development of appropriate healthcare purchasing arrangements. The findings illustrate that COVID-19 case management costs are substantial, ranging between two and four times the average claims value reported by Kenya\u2019s public health insurer.
Posted 31/03/2021. Patient safety is a key goal of WHO but identifying harms and developing strategies to deliver safe care has been given little attention. Mike English and colleague describe a \u2018portfolio\u2019 approach to safety improvement in four broad categories: prioritising critical processes, improving the organisation of care, control of risks and enhancing responses to hazardous situations that we believe is relevant to low resource settings. We focus attention on the possible roles of practitioner groups and professional associations as key to advancing patient safety through collaboration and skill development in this field
Posted 26/02/2021. Malaria and iron deficiency are common in Africa and malaria may cause iron deficiency through a hepcidin-mediated block in iron absorption. Using sickle cell trait to proxy malaria exposure, John Muriuki, Sarah Atkinson and colleagues found that an intervention that halves malaria incidence would also reduce iron deficiency by approximately 50% in African children.
Posted 22/02/2021. Paper continues to be an important medium for recording inpatient care in low\u2010 and middle\u2010income countries. Naomi Muinga and colleagues synthesise evidence on how paper\u2010based nursing records have been developed within inpatient settings to support documentation of nursing care, and that a human\u2010centred design approach might better meet users' needs
Posted 12/02/2021. The majority of digital health projects have failed to translate into scaled, routine services, leaving many health leaders cautious and uncertain of how to proceed. Chris Paton and colleagues identify factors that can influence successful and sustainable integration of digital health within local health systems in low resource settings.
Posted 05/02/2021. Measles immunity gaps have widened following disruptions of routine immunisation and supplementary activities due to COVID-19 pandemic in Kenya. While COVID-19 restrictions temporarily reduced the risk of a measles outbreak, Caroline Mburu, Ifedayo Adetifa and colleagues estimate that this risk will rapidly rise once the restrictions are lifted. Implementing delayed supplementary immunisation activities will be critical for prevention of measles outbreaks.
Posted 26/01/2021. Appropriate and well-resourced medical internship training is important to ensure psychological health and well-being of doctors in training and also to recruit and retain these doctors. Yingxi Zhao and colleagues identified and described a large number of tools designed for measuring medical internship experience, to help medical educators and human resource managers make an evidence-based decision on designing surveys to understand interns\u2019 experience of training.
Posted 15/01/2021. Yellow Fever is a re-emerging disease whose incidence has increased globally in the last three decades. Although very successful, the stocks of the YF vaccine are often insufficient. Derick Kimathi, George Warimwe and colleagues assessed the immunogenicity and safety of fractional (1/5th) doses. Our results support fractional dosing of all four WHO-prequalified YF vaccines in general adult population as a dose-sparing strategy.
Posted 08/01/2021. Patient safety is much less well studied in low-resource settings than in higher income settings. Mike English and colleagues suggest how concepts being employed to advance patient safety thinking in higher income settings could be usefully applied by practitioners in low-resource settings. The ability to diagnose system weaknesses should become a core skill for those leading teams, wards, departments or facilities in low-resource settings
Posted 31/10/2020. Existing neonatal prognostic models are suited for advanced care settings; however, they use parameters that are not available in low-resource settings. Jalemba Aluvaala and colleagues demonstrate that two novel models - NETS and SENSS - using basic routine data can accurately predict in-hospital mortality which may allow us to better understand neonatal mortality.
Posted 09/10/2020. Children with severe anaemia are more likely to get bacterial infections. Kelvin Mokaya, Sarah Atkinson and colleagues discuss how severe anaemia interferes with iron regulation, and how this promotes bacterial growth in blood and dampens immune responses to these bacteria. The authors also suggest possible studies that can be used to explore their hypothesis.
Posted 29/09/2020. In a collaborative effort to investigate the mechanism of protection conferred by the rare Dantu blood group variant, found at highest frequency in East Africa, Silvia Kariuki and colleagues found a strong correlation between red blood cell membrane tension and parasite invasion ability. Increased membrane tension led to resistance to parasite invasion, and Dantu red blood cells had higher average membrane tension, meaning that a greater proportion resisted invasion. The findings from this study could inform the design of drugs that imitate this increased membrane tension to prevent or treat malaria.
Posted 03/09/2020. Cian Wade, Mike English and colleagues brought together a large body of evidence to inform recommendations for Kenya on neonatal analgesic guidelines for routine procedures. They describe the process by which a group of local experts translated systematic review and meta-analysis findings into context-specific clinical guidelines. The work emphasises the value of breastfeeding or breast milk as an important and feasible therapeutic strategy for alleviating neonatal pain.
Posted 18/08/2020. In November 2018 twenty-nine participants, representing 21 institutions from 11 countries, participated in a first international \u201cschool engagement\u201d workshop hosted by the KEMRI-Wellcome Research Programme in Kilifi, Kenya. Alun Davies and colleagues report on the broad range of goals and approaches for engagement between health researchers and school students.
Posted 17/07/2020. In this editorial, Sam Kinyanjui and colleagues argue that establishing science preparedness, which is an integral component of emergency preparedness, should be embedded within long-term investment in research capacity. They illustrate how African-led research capacity building consortia including IDeAL have contributed to Africa\u2019s preparedness for the COVID-19 pandemic.
Posted 07/07/2020. In a country with 25 million newborns, children and adolescents, how many paediatricians are there and where are they? This paper by Mike English and colleagues seeks to start a debate on how to deliver paediatric services in LMIC in the future.
Posted 03/07/2020. Under declining malaria transmission on the Kenyan coast Kilifi, Alice Kamau, Bob Snow and colleagues show that children continue to bear the brunt of mild and severe disease. There was no significant malaria disease or mortality burden in adults. This is contrary to current modelled approaches to malaria disease burden among African adults.
Posted 30/06/2020. Interferon-gamma (IFN-g) is upregulated during malaria infection and influences erythropoiesis and iron status. Kelvin Mokaya, Sarah Atkinson and colleagues found that children carrying the IFNG+2200C allele, a variant previously associated with higher IFN-g levels, had a modestly increased risk of anaemia and iron deficiency after the malaria season. Larger studies are needed to validate this finding.
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.
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