Objective: To determine the prevalence and aetiology of dermatophyte infections in relation to social economic factors in primary school children in Kibera. Design: A Cross-sectional descriptive study. Setting: City council sponsored schools namely Olympic, Kibera, Ayany and Mbagathi way all in Kibera, the largest of the informal settlement within Nairobi which is home to between 700,000 -1,000,000 inhabitamts. The study was conducted between September 2006 and February 2007. Subjects: A total of 422 primary school children from the ages of five years to 15 years were selected for the study. Results: The prevalence of dermatophytoses was 11.2% with tinea capitis being the most common type while the grey patch form being the dominant clinical manifestation. There was a significant difference (p=0.001) in dermatophytoses in different schools with Olympic primary school registering the highest prevalence (22.6%). The highest infection rate occurred among six to eight years age bracket in both sexes compared to other age brackets (p=0.002). The genera of fungi associated with dermatophytoses were isolated indicating the number in each species as follows; T. violecium (35), T. mentagrophytes(3), T. terestre(3), T. schoenleinii(2), and T. interdigitale(1), M. canis(2), M. equinum(1) and E. flocossum(1). T. violecium was the predominant species isolated, at 35/48(71%) followed by T. mentagrophytes and T. terrestre at 3/48 (6%) each. Conclusion: The study indicates high prevalence of 11.2% dermatophyte infection among the school children in Kibera. Factors contributing to the high frequency and chronic occurrences of ring worm in this area may include poor living environment, children interaction patterns and poor health seeking behaviour. There is need for health education and public awareness campaigns among the communities in urban informal settlements on healthy seeking behaviors and hygiene in order to reduce transmission and severe clinical manifestations.
The purpose of this study was to determine nurse's knowledge, attitude and practice on the initial management of acute poisoning among adult casualties seen at Accident and Emergency Department (AED), Kenyatta National Hospital (KNH). The study was cross sectional. Both qualitative and quantitative methods of data collection were employed. The target population were all nurses working at AED, KNH. Purposive sampling was used to select study subjects. Sample size included all Accident and Emergency (A&E) nurses who met subject's inclusion criteria. Structured questionnaires, observation checklist and interview were used to collect the data. Sixty eight (82%) of A&E nurses participated in this study. The study found out that with higher nursing qualification and training on courses related to emergency care, knowledge and skills of A&E nurses on the initial management of acute poisoning is enhanced. A&E nurses with lower education level had a higher mean score of positive attitude compared with nurses with higher nursing qualification. Majority 60 (88.2%) of the A&E nurses indicated that, they required more training on the initial management of acute poisoning. Study recommends that A&E nurses should be trained on various types of poisoning including; assessment, clinical presentations and management to include gut decontaminations. In addition, refresher courses should be organised for those already trained. Flowcharts that will enhance easy identification and management of poisoned casualties should be put in place and utilized accordingly.
Objective: Social distancing and hand washing with soap and water have been advocated as the main proactive measures against the spread of coronavirus. We sought to find out what other alternative materials and methods would be used among populations without running water and who may not afford alcohol-based sanitizers. Results: We reviewed studies that reported use of sand, soil, ash, soda ash, seawater, alkaline materials, and sunlight as possible alternatives to handwashing with soap and water. We identified the documented mechanism of actions of these alternative wash methods on both inanimate surfaces and at cellular levels. The consideration of use of these alternative locally available in situations of unavailability of soap and water and alcohol-based sanitizers is timely in the face of coronavirus pandemic. Further randomized studies need to be carried out to evaluate the effectiveness of these alternatives in management of SARS-Cov-2.
There is paucity of data on prevalence of hypertension and its effects on HIV/AIDS progression among patients at Kenyatta National Hospital (KNH), Kenya. This was a cross sectional study conducted between January and May 2015 at the KNH HIV Care Centre. Ethical approval was obtained from institutional ethics review board. HIV positive adult patients were recruited sequentially, and written informed consent obtained from each participant. Systematic sampling was used to select participants who were screened for blood pressure, body mass index (BMI) and lifestyle characteristics. Data on clinical parameters were extracted from patient records. A total of 297 participants (89 males and 208 females) were enrolled in the study. The participants were socially diverse in cultural beliefs, religious practices and lifestyles. Their ages ranged from 30 to 57 years, and the average age of males (M = 44.56, SD = 6.05) was higher than females (M = 42.29, SD = 6.16), p < .01. The prevalence of hypertension was found to be 23.2%. The relation between CD4 counts and creatinine was statistically significant, p < .01, as was the association between CD4 counts and BMI, p < .01. Hypertension is a highly prevalent co-morbidity in HIV patients. The risk factors include prolonged use of ART as well as increased body mass index. The effects of hypertension on HIV progression include low CD4+ T cell counts which complicate the underlying immunosuppression.
Human immunodeficiency virus (HIV) infection affects around 37 million people worldwide, and in Kenya, key populations especially female sex workers (FSW), are thought to play a substantial role in the wider, mostly heterosexual HIV-1 transmission structure. Notably, HIV tropism has been found to correlate with HIV-1 transmission and disease progression in HIV-infected patients. In this study, recently infected FSWs from Nairobi, Kenya, were assessed for HIV tropism and the factors related to it. We used a crosssectional study design to analyze 76 HIV-1 positive plasma samples obtained from FSWs enrolled in sex worker outreach program clinics in Nairobi between November 2020 and April 2021. The effects of clinical, demographic, and viral genetic characteristics were determined using multivariable logistic regression. HIV-1 subtype A1 accounted for 89.5% of all cases, with a prevalence of CXCR4-tropic viruses of 26.3%. WebPSSMR5X4 and Geno2Pheno [G2P:10-15% false positive rate] showed high concordance of 88%. Subjects infected with CXCR4-tropic viruses had statistically significant lower baseline CD4 + T-cell counts than those infected with CCR5-tropic viruses (P = .044). Using multivariable logistic regression and adjusting for potential confounders, we found that net charge, the amino acid at position 22 of the V3 loop, and the geographic location of the subject were associated with tropism. A unit increase in V3 loop's net-charge increased the odds of a virus being CXCR4-tropic by 2.4 times (OR = 2.40, 95%CI = 1.35-5.00, P = .007). Second, amino acid threonine at position 22 of V3 loop increased the odds of a strain being X4 by 55.7 times compared to the alanine which occurred in CCR5-tropic strains (OR = 55.7, 95%CI = 4.04-84.1, P < .003). The Kawangware sex worker outreach program clinic was associated with CXCR4-tropic strains (P = .034), but there was there was no evidence of a distinct CXCR4-tropic transmission cluster. In conclusion, this study revealed a high concordance of WebPSSMR5X4 and Geno2Pheno in predicting HIV tropism. The most striking finding was that amino acid position 22 of the V3 loop is linked to tropism in HIV-1 subtype A1. Additional studies with a large dataset are warranted to confirm our findings.Abbreviations: CCR5 = C-C motif chemokine receptor 5, CXCR4 = CXCR4 C-X-C motif chemokine receptor 4, env = envelope gene, FPR = false positive rate, G2P = geno2pheno, FSW = female sex worker; HIV-1 = human immunodeficiency virus type 1, PSSM = position specific scoring matrix, SWOP = sex work outreach program, V3 = third variable region of gp120.
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