Background. Preoperative fasting (POF) is physiologically and precautionary important during anesthesia and surgery. POF from midnight has been practiced despite the recommended shorter practice. Objective. Assessing preoperative fasting among adult patients scheduled for elective surgery at Kenyatta National Hospital (KNH). Methods. A descriptive cross-sectional study involving 65 surgical patients. A questionnaire of mixed questions on demographics, reasons, source of instructions, opinion on instructions, time, premedication practices, outcome, and complains on NPO was used. Analysis was quantitatively done with SPSS v. 22. Ethical approval was obtained from KNH-UoN ERC. Results. Of the respondents 93.8% lacked knowledge on the correct reasons for POF and felt that the instructions were unclear and less important <50%. POF instructions were administered by nurses 80%, anesthetists 15%, and surgeons 5%. Most of respondents (73.8%) fasted > 15 hours. The POF outcomes were rated moderately challenging as follows: prolonged wait for surgery 44.6%, thirst 43.1%, hunger 36.9%, and anxiety 29.2%. Conclusion. Nurses are critical in providing POF instructions and care, and patient knowledge level is a mirror reflection of the quality of interventions. This underscores the need to build capacity for nurses and strengthen the health system to offer individualized preoperative interventions as well as monitoring and clinical auditing of fasting practices.

Safely managed water, sanitation, and hygiene (WASH) are fundamental for human health and wellbeing and are thought to contribute to a range of positive outcomes related to education, livelihoods, dignity, safety, and gender equality. However, gender and other social categories (e.g. age, ethnicity, caste, disability, marital status) can mediate who benefits from WASH services and in which ways. As progress in gaining access to safe WASH services has not occurred equally, there has been a focus on mainstreaming gender equality and social inclusion (GESI) in interventions. Despite awareness in the sector of the importance of promoting gender and socially inclusive WASH services, evaluations of interventions focus largely on technical or health outcomes, while social outcomes are not included. This systematic evidence synthesis aimed to collate evidence on the impact of WASH interventions on GESI outcomes in low- and middle-income countries (LMICs). It also aimed to synthesise evidence on violence-related outcomes, and to advance understanding of barriers to, and facilitators of, change in violence-related outcomes in the context of WASH interventions.

Plastic waste management and recycling activities have the potential to reduce the environmental impacts of plastic production and to tap the economic value of would-be waste materials through circular economy approaches. This report focuses on the framework for establishing effective practices in Mombasa, Kenya, with policymaking, institutional support and regulations, and with implications for similar contexts elsewhere.

Background Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being increasingly obligatory. Perspectives and insights of health managers on antimicrobial stewardship (AMS), complementary health services and building blocks are imperative towards implementation of robust AMS programs. This study aimed to understand perspectives of hospital managers on AMS and identify areas of management engagement while addressing potential blockades to change. Methods A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant interviews on perspectives on AMS were administered to hospital managers. Qualitative data was captured using audio tapes and field notes, transcribed and managed using NVivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants. Results Perspectives on AMS are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of antimicrobial formulary and usage surveillance systems, laboratory competency and recommendations for infection prevention and management, educational resources and communications channels available, building blocks and low-lying fruits for Antimicrobial Stewardship Committees. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There lacked contextualized, hospital specific antimicrobial formulary and adequate laboratory competency. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education, and training platforms (Continuous Medical Education and Continuous Professional Development activities) and hospital leadership commitment. Conclusions The practice of antimicrobial stewardship is not implemented and well developed as demonstrated by lack of core AMS complementary health services. However, the health managers are aware of the fundamental importance of antimicrobial stewardship programs and the vast benefits of implementation and institutionalization of AMS to hospitals and their clients. The findings underpin the importance of understanding and incorporating perspectives of health managers on existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against antimicrobial resistance.

No abstract

Localization of the Sustainable Development Goals (SDGs) refers to the process of defining, implementing, and monitoring strategies at the local level to achieve global, national, and subnational sustainable development goals and targets. The key question addressed by this baseline document is how SDG localization can be practically, efficiently, and effectively implemented in what remains of the Decade of Action.

Consumption of alcohol is a practice world over that dates back to 10,000 Before Christ. Evaluation on the damages caused by the alcohol on the human organs such as the liver is paramount. There is no direct evaluation to liver parenchyma before admission rather blood samples are evaluated to show damage or no damage to the liver cells. The outcome of the blood samples denote the health status of the liver cells before admission. Alcohol biomarkers are usually elevated when there is damage to the liver parenchyma. This was a quantitative descriptive cross sectional study. Purpose sampling was used to select two Counties with the highest number of alcohol consumers. Simple Random sampling method was used to select participants for liver biomarkers. Participants were requested to consent for blood donation and confidentiality was maintained. Blood samples collected were separated for serum and cells using centrifuge within one hour after donation. The samples were transported for storage using cool boxes and temperature was maintained between -8 and +8 degrees during transportation. The blood samples were stored at -8 and +8 degrees in the deep freezer. Majority (97%) of the participants had alanine aminotransferase levels of 41 to 80 IU/L. Eighty eight percent of the participants had aspartate aminotransferase elevated to between 35 and 68 IU/L. Gamma Glutamyl aminotransferase was elevated in all of the participants while alanine phosphatase was elevated in 99% of the participants. Most participants had elevated liver biomarkers before admission to rehabilitation centre.

Background: Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being obligatory now more than ever. The perspectives and insights of health managers on antimicrobial stewardship, the complementary health services and building blocks are imperative towards implementation of robust antimicrobial stewardship programs.Methods: A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant, face-to-face interviews with hospital health managers were carried out on their perspectives on antimicrobial stewardship. Qualitative data was captured using audio tapes and field notes, transcribed and managed using QSR Nvivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants.Results: Perspectives on antimicrobial stewardship are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of an antimicrobial formulary and usage surveillance systems, Laboratory competency and recommendations for infection prevention and management, Educational resources and communications channels available, Building blocks and low-lying fruits for ASCs. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There was no contextualized, hospital specific antimicrobial formulary based on the local antibiograms in any of the hospitals. Lack of adequate laboratory competency was a major deficit with most hospitals lacking culture and sensitivity testing services. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education and training platforms (CMEs and CPDs) and hospital leadership commitment towards antimicrobial stewardship.Conclusions: The findings underpin the importance of understanding and incorporating the perspectives of health managers on the existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against AMR.