Snakebite in children can often be severe or potentially fatal, owing to the lower volume of distribution relative to the amount of venom injected, and there is potential for long-term sequelae. In the second of a two paper series, we describe the pathophysiology of snakebite envenoming including the local and systemic effects. We also describe the diagnosis and management of snakebite envenoming including prehospital first aid and definitive medical and surgical care.

AimsInfection remains the leading cause of neonatal mortality in developing countries. In Kenya, about 20% of neonatal deaths are attributable to sepsis. We aim to look at the epidemiological pattern of neonatal sepsis in a county referral hospital in Kenya.MethodRetrospective data was collected for all admissions to the Newborn unit between 2011 to 2014 in a county referral hospital in central Kenya. We calculated monthly rates of neonatal sepsis cases, mortalities, and case fatality rates for all admissions. We then plotted a monthly time series of sepsis cases and mortalities to determine if there was a seasonal trend over the four-year period. The epidemic time series was plotted and smoothed using a seasonal moving average estimator in Stata 12.1. The study was carried out during a Global Links RCPCH placement.ResultsThere were 1262 admissions to the Newborn Unit during the 4 year period. 23.9% of admissions had a diagnosis of neonatal sepsis. The overall mortality rate of admissions was 24.7%, whereas mortality attributed to sepsis was 18.2%. We observed a strong biannual peak in sepsis cases, with peaks in July 2012 and July 2014. Case fatality rates were highest in March 2012 (66.6%), July 2012 (50%), July 2014 (50%) and August 2014 (50%).ConclusionThe overall rate of neonatal mortality due to sepsis in this hospital is comparable to the national average. Our study indicates that sepsis cases correspond to a strong bi-annual pattern rather than a yearly one, with intermediate years yielding few sepsis cases. From this, we predict low sepsis rates in 2015, with a peak of cases in July 2016. This is the first time a bi-annual trend has been demonstrated for neonatal sepsis. We suggest further work should be done to analyse possible causes, including socio-political factors, for this bi-annual pattern for neonatal sepsis and mortality, and whether the same pattern can also be seen in other areas of Kenya over the same time period.

Snakebite disproportionally affects children living in impoverished rural communities. The WHO has recently reinstated snakebites on its list of Neglected Tropical Diseases and launched a comprehensive Strategy for the Prevention and Control of Snakebite Envenoming. In the first of a two paper series, we describe the epidemiology, socioeconomic impact and key prevention strategies. We also explore current challenges and priorities including the production and distribution of safe and effective antivenom.

Acute respiratory infections (ARIs) are a leading cause of under-five mortality globally. In Kenya, the reported prevalence of respiratory syncytial virus (RSV) infections in single-centre studies has varied widely. Our study sought to determine the prevalence of RSV infection in children admitted with ARI fulfilling the WHO criteria for bronchiolitis. This was a prospective cross-sectional prevalence study in five hospitals across central and highland Kenya from April to June 2015. Two hundred and thirty-four participants were enrolled. The overall RSV positive rate was 8.1%, which is lower than in previous Kenyan studies. RSV-positive cases were on average 5 months younger than RSV-negative cases.

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