University of Nairobi

About: University of Nairobi is a education organization based out in Nairobi, Nairobi, Kenya. It is known for research contribution in the topics: Population & Health care. The organization has 6702 authors who have published 10777 publications receiving 231294 citations. The organization is also known as: UoN & IAU-020319.

Mental Health Consequences for Healthcare Workers During the COVID-19 Pandemic: A Scoping Review to Draw Lessons for LMICs

Abstract: Background: The COVID-19 pandemic has had a significant impact on the mental health of healthcare workers (HCWs) particularly in low and middle-income countries (LMICs). This scoping review provides a summary of current evidence on the mental health consequences of COVID on HCWs. Methods: A scoping review was conducted searching PubMed and Embase for articles relevant to mental health conditions among HCWs during COVID-19. Relevant articles were screened and extracted to summarize key outcomes and findings. Results: A total of fifty-one studies were included in this review. Depressive symptoms, anxiety symptoms, psychological trauma, insomnia and sleep quality, workplace burnout and fatigue, and distress were the main outcomes reviewed. Most studies found a high number of symptoms endorsed for depression, anxiety, and other conditions. We found differences in symptoms by sex, age, and HCW role, with female, younger-aged, frontline workers, and non-physician workers being affected more than other subgroups. Conclusion: This review highlights the existing burden of mental health conditions reported by HCWs during COVID-19. It also demonstrates emerging disparities among affected HCW subgroups. This scoping review emphasizes the importance of generating high quality evidence and developing informed interventions for HCW mental health with a focus on LMICs.

Low Plasma Vitamin B-12 in Kenyan School Children Is Highly Prevalent and Improved by Supplemental Animal Source Foods

Abstract: The high prevalence of vitamin B-12 deficiency in many regions of the world is becoming recognized as a widespread public health problem, but it is not known to what extent this deficiency results from a low intake of the vitamin or from its malabsorption from food. In rural Kenya, where a previous study identified a high prevalence of inadequate vitamin B-12 intakes, this study examined whether plasma vitamin B-12 concentrations were associated with dietary sources of the vitamin at baseline and could be increased by supplementation with animal source foods (ASF). The 4 experimental groups in 503 school children were: 1) control (no food provided); 2) githeri (a maize and bean staple with added oil); 3) githeri + meat (githeri + minced beef); or 4) githeri + milk (githeri + milk). Feedings were isocaloric. Dietary data were collected at baseline, and biochemical data at baseline and after 1 and 2 y of feeding. Baseline plasma vitamin B-12 concentration was 193.6 +/- 105.3 pmol/L and correlated with % energy from ASF (r = 0.308, P < 0.001). The odds ratio for low plasma vitamin B-12 (<148 pmol/L), which occurred in 40% of children, was 6.28 [95% CI: 3.07-12.82] for the lowest vs. highest ASF intake tertile (P < 0.001). Feeding ASF (meat or milk) greatly reduced the prevalence of low plasma vitamin B-12 (P < 0.001). The high prevalence of low plasma vitamin B-12 concentrations in these children is predicted by a low intake of ASF, and supplemental ASF improves vitamin B-12 status.

Emergence of multidrug-resistant gram-negative organisms in a neonatal unit and the therapeutic implications

Abstract: Multidrug-resistant organisms are increasing worldwide. Over the years we have noted increasing resistance of organisms isolated in our neonatal unit. There is a need therefore to scrutinize the problem so as to be able to plan for the future. Over a 5-month period, 716 infants were admitted of which 192 were screened for sepsis. Overall, 121 (16.7 per cent) had positive blood cultures. The predominant organisms were Gram negative (73.6 per cent of isolates) with Klebsiella species topping the list at 31 per cent. Case fatality for infants infected with Gram negative organisms was 41 per cent. Resistance to gentamicin was 20 per cent chloramphenicol 23.6 per cent, and amoxicillin/ampicillin 66.3 per cent. Of worry is the resistance to ceftazidime 19.1 per cent, and cefuroxime 21.3 per cent, with the figures rising to 27 per cent when more specialized tests are done (disc approximation and potentiation tests). If these drugs cannot be used in 20-27 per cent of cases then the situation is serious. The contributory factors to increased resistance include: non-investigation of infants put on antibiotics (50 per cent of cases); prolonged (73 per cent) and sometimes unjustified (41.7 per cent) use of antibiotics; and non-utilization of investigations when these are done (52 per cent) together with the delay in getting results back in the ward (6 days).

Maternal HLA Homozygosity and Mother-Child HLA Concordance Increase the Risk of Vertical Transmission of HIV-1

Abstract: Vertical transmission of HIV-1 may occur during gestation, delivery, or breast-feeding when the fetus or infant is exposed to free virus or infected maternal cells. Despite probable exposure, HIV-1 acquisition rates in infants are relatively low, even in the absence of antiretroviral prophylaxis. Host factors such as maternal or infant genetics and immunity may influence the ability of a fetus or infant to avoid HIV-1 infection. These factors may be maternal or infant specific or may be shared because of similar HLA genes. An increased degree of HLA gene sharing between a mother and infant differentiates vertical transmission of HIV-1 from sexual transmission. HLA class I and II loci are the most polymorphic genes known in humans [1]. HLA class I genes, located at the HLA-A, -B, and -C loci, encode molecules that differentially present endogenous viral peptides to CD8+ T lymphocytes. As a result of differential peptide binding, specific HLA molecules may influence susceptibility to HIV-1 infection and progression. Differential peptide binding leads to activation of cellular immune responses directed toward specific viral epitopes, exerting immune pressure on HIV-1 and resulting in viral mutations that increase the ability of HIV-1 to escape immune responses [2, 3]. For HLA alleles that an infant shares with his or her mother, the same mutations that allow HIV-1 to escape maternal responses will allow it to evade infant responses. Infants who share more alleles with their mother may also be at risk for more rapid HIV-1 disease progression if infected. Mother-child HLA discordance could be favorable by diversifying the immune response against maternal virus. HLA discordance might also protect against the perinatal transmission of viruses via infant alloimmune responses against HLA alloantigens expressed on maternally infected cells and, in the case of enveloped viruses, free virions. Rather than targeting viral antigens, the infant alloimmune response is directed at maternal cells expressing HLA antigens that are different from the infant’s own. When a mother is homozygous for specific HLA alleles, the infant’s immune responses will also be less vigorous in proportion to the number of shared alleles. Infants of HLA homozygous mothers may be more susceptible to HIV-1 infection because of dampened alloimmune responses that lead to less rapid clearance of maternal cells, including those infected with HIV-1. Additionally, HLA homozygous women present less diverse arrays of viral peptides to CD8+ T cells, resulting in more rapid HIV-1 disease progression [4, 5]. Because HIV-1 disease progression influences the risk of transmission, HLA homozygous mothers may be more likely to transmit HIV-1 to their offspring. Past studies have found that greater HLA concordance was associated with increased risk of vertical transmission; however, only a single study was conducted in a breast-feeding African cohort, and women did not receive antiretrovirals to prevent transmission [6, 7]. There are fewer data on maternal HLA homozygosity and transmission because studies of HLA homozygosity have focused on disease progression [4]. We built on these existing studies by analyzing the effect of mother-child HLA concordance and maternal HLA homozygosity on transmission risk among HIV-1—infected mothers receiving zidovudine in Kenya. In this cohort we were able to determine the timing of transmission. This enabled us to examine separately whether HLA concordance and maternal homozygosity increased the risk of HIV-1 acquisition in infants, including overall, in utero, and peripartum transmission and transmission via breast milk.

Assessment of neonatal care in clinical training facilities in Kenya.

Abstract: Objective An audit of neonatal care services provided by clinical training centres was undertaken to identify areas requiring improvement as part of wider efforts to improve newborn survival in Kenya. Design Cross-sectional study using indicators based on prior work in Kenya. Statistical analyses were descriptive with adjustment for clustering of data. Setting Neonatal units of 22 public hospitals. Patients Neonates aged 20% in prescriptions for penicillin (11.6%, 95% CI 3.4% to 32.8%) and gentamicin (18.5%, 95% CI 13.4% to 25%), respectively. Conclusions Basic resources are generally available, but there are deficiencies in key areas. Poor documentation limits the use of routine data for quality improvement. Significant opportunities exist for improvement in service delivery and adherence to guidelines in hospitals providing professional training.