Acute malnutrition affects more than 50 million children worldwide. These children are at an increased risk of morbidity and mortality from infectious disease. However, the pathogenesis of acute malnutrition and mechanisms underlying the increased risk and poor outcomes from infection are not well understood. Our objective was to identify differences in inflammation and inflammatory responses between children with moderate acute malnutrition (MAM) and healthy controls (HCs), and search for environmental, pathophysiological, and metabolic factors that may influence this response. Sixteen children with MAM and 16 HCs aged 18–36 months were studied in Nairobi, Kenya. None of the children had symptoms of an infectious disease (fever, diarrhea, or cough) in the 2 weeks before enrollment and sample collection. Demographic and health data were provided by their primary caregivers. Blood samples were collected to measure various biomarkers and the response to an inflammatory stimulus. Children with MAM were more frequently from households with contaminated water, crowding, and unstable income sources. They also had increases in basal inflammation, circulating bacterial lipopolysaccharide (LPS), markers of intestinal damage, and an exaggerated whole blood inflammatory response to LPS. Metabolic changes in children with MAM led to increased plasma levels of long-chain fatty acids, which were found to contribute to the pro-inflammatory state. These exploratory findings suggest convergence of multiple factors to promote dysregulated inflammatory responses and prompt several mechanistic hypotheses that can be pursued to better understand the pathogenesis of MAM.

Background: Arboviruses often cause widespread morbidity in children in endemic regions. Data on the burden of arboviruses in Kenyan children are limited. Objectives: This study was performed to determine the seroprevalence of yellow fever (YFV), dengue (DENV), West Nile (WNV), and chikungunya (CHIKV) viruses among children 1-12 years of age at two health facilities in Teso South Sub-County in Western Kenya. Methods: In a hospital-based cross-sectional survey, a questionnaire was used to collect sociodemographic information. Serum drawn from the children was tested for IgA/IgM/IgG serocomplex antibodies to selected arboviruses using indirect ELISA and plaque reduction neutralization tests. Results: A total of 182 (27.7%) of the 656 participants tested were positive for any arbovirus antibody. Of these, 4.4% (29/656) tested positive for YFV, 9.6% (62/649) for WNV, 5.6% (36/649) for CHIKV, 1.4% (5/368) for DENV1, 9% (59/656) for DENV2, and 19.7% (40/203) for DENV3. Neutralizing antibodies to CHIKV were found in 77.8% (42/54) of participants, to YFV in 15.8% (3/19), to DENV2 in 58% (29/50), and to WNV in 8% (1/55). Sex, age, urban residence, schooling, and lack of vaccination were associated with arbovirus exposure. Conclusions: This study confirmed that children under 12 years of age in Teso South Sub-County are exposed to ongoing arbovirus infections early in life.

Background Under-five mortality in Kenya has declined over the past two decades. However, the reduction in the neonatal mortality rate has remained stagnant. In a country with weak civil registration and vital statistics systems, there is an evident gap in documentation of mortality and its causes among low birth weight (LBW) and preterm neonates. We aimed to establish causes of neonatal LBW and preterm mortality in Migori County, among participants of the PTBI-K (Preterm Birth Initiative-Kenya) study. Methods Verbal and social autopsy (VASA) interviews were conducted with caregivers of deceased LBW and preterm neonates delivered within selected 17 health facilities in Migori County, Kenya. The probable cause of death was assigned using the WHO International Classification of Diseases (ICD-10). Results Between January 2017 to December 2018, 3175 babies were born preterm or LBW, and 164 (5.1%) died in the first 28 days of life. VASA was conducted among 88 (53.7%) of the neonatal deaths. Almost half (38, 43.2%) of the deaths occurred within the first 24 h of life. Birth asphyxia (45.5%), neonatal sepsis (26.1%), respiratory distress syndrome (12.5%) and hypothermia (11.0%) were the leading causes of death. In the early neonatal period, majority (54.3%) of the neonates succumbed to asphyxia while in the late neonatal period majority (66.7%) succumbed to sepsis. Delay in seeking medical care was reported for 4 (5.8%) of the neonatal deaths. Conclusion Deaths among LBW and preterm neonates occur early in life due to preventable causes. This calls for enhanced implementation of existing facility-based intrapartum and immediate postpartum care interventions, targeting asphyxia, sepsis, respiratory distress syndrome and hypothermia.

BackgroundUnder-five mortality in Kenya has declined over the past two decades. However, the reduction in the neonatal mortality rate has remained stagnant. In a country with weak civil registration and vital statistics systems, there is an evident gap in documentation of mortality and its causes among low birth weight (LBW) and preterm neonates. We aimed to establish causes of neonatal LBW and preterm mortality in Migori County, among participants of the PTBI-K (Preterm Birth Initiative-Kenya) study.MethodsThis was a cross sectional study whereby Verbal and social autopsy (VASA) interviews were conducted with caregivers of deceased LBW and preterm neonates delivered within selected 17 health facilities in Migori County, Kenya. The probable cause of death was assigned using the WHO International Classification of Diseases (ICD-10). ResultsBetween January 2017 to December 2018, 3175 babies were born preterm or LBW, and 162 (5.1%) died in the first 28 days of life in 17 participating health facilities in the PTBI-K project. VASA was conducted among 88 (53.7%) neonatal deaths. Almost half (38, 43.2%) of the deaths occurred within the first 24 hours of life. Birth asphyxia (45.5%), neonatal sepsis (26.1%), respiratory distress syndrome (12.5%) and hypothermia (11.0%) were the leading causes of death. In the early neonatal period, majority (54.3%) of the neonates succumbed to asphyxia while in the late neonatal period majority (66.7%) succumbed to sepsis. Delay in seeking medical care was reported for 4 (5.8%) of the neonatal deaths. ConclusionDeaths among LBW and preterm neonates occur early in life due to preventable causes. This calls for enhanced intrapartum and immediate postpartum care interventions targeting asphyxia, sepsis, respiratory distress syndrome and hypothermia.

Arboviruses are responsible for epidemics and are emerging and re-emerging in sub-Saharan Africa. However, the risk factors for arboviral diseases are poorly described in Kenyan children. Knowledge of risk factors can facilitate earlier diagnosis and better treatment and implementation of effective prevention in children. This study determined risk factors for seropositivity to Yellow fever (YFV), Dengue (DENV), Chikungunya (CHIKV) and West Nile (WNV) viruses among children at two facilities in Teso Sub-County in Western Kenya. In a hospital-based cross-sectional survey, the risk factors for seropositivity to the arboviruses were assessed. Eligible children aged 1 to 12 (n = 656) who visited Alupe Sub County Hospital and KEMRI Alupe Clinic in Teso Sub County were recruited. Socio-demographic, environmental, behavioural and medical information was collected using a questionnaire. Blood drawn from these children was screened for antibodies to YFV, DENV, CHIKV and WNV using Indirect Enzyme-Linked Immunosorbent Assays. Descriptive statistics were used to summarise seroprevalence, socio-demographic, clinical and environmental variables. Binomial logistic regression described the relationship between the risk factors and arbovirus seropositivity.  Seropositivity to at least one arbovirus was found in 27.7%, with 15.7% being positive for DENV, 9.6% for WNV, 5.6% for CHIKV and 4.4% for YFV. The factors that significantly increased the risk to at least one of the arboviruses were: age 6-9 years (by 18%, p=0.006) compared to those 1-3 years, school attendance (by 66%, p=0.000) compared to none, the primary caregiver being “Other” (by 17%, p=0.026) and not the parent, the use of Olyset (by 7%, p=0.039), or an unknown mosquito net (by 26%, p=0.020) compared to Permanet. The risk of yellow fever seropositivity was increased where vegetation was close to the house (by 5%, p=0.042) compared to where vegetation was far. The risk was decreased by the use of an unknown bed net (by 4%, p=0.046) compared to Permanet and having a past history of rash (by 6%, p=0.018). For Dengue Fever, females were at an increased risk (by 8%, p=0.002) compared to males and having water bodies near the house (7%, p=0.030). The risk of chikungunya was increased by school attendance (by 25%, p=0.021) compared to not, the use of mosquito repellents (by 10%, p=0.006) compared to no interventions and having had a rash in the past (by 6%, p=0.043). The risk was decreased by roofing with iron sheets (by 3%, p=0.048) compared to grass-thatching. WNV seropositivity risk was higher in those aged 3-6 years (by 8%, p=0.004) and 6-9 years (by 15%, p=0.004) than in those aged 1-3 years. It was increased in those attending school (by 37%, p=0.006) compared to those not, and those using Olyset (by 11%, p=0.000) or an unknown bed net (by 30%, p=0.001) compared to Permanet. The risk was lower by between 25% and 33% (p<0.003) in those in pre-school, in lower and upper primary compared to those not in school. These factors are amenable to interventions that can be implemented to prevent and reduce arbovirus infections in children in endemic areas in Kenya.