MST-Department of Medical Laboratory Sciences

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Diversity and Endosymbionts of Tick Borne Pathogens at Human-Wild Life Livestock Interfaces in Coastal National Reserves, Kenya
(Kenyatta University, 2024-04) Godani, Salim Kobo
Ticks are vectors that can harbor pathogens like viruses, protozoa, and bacteria that can cause zoonotic diseases in humans. Human gets infected through tick bites where the pathogens are passed into the human blood. The lack of surveillance information about tick-borne pathogens and diseases has made it impossible to assess its impact on human and livestock. This study determined the diversity and endosymbionts of tick borne pathogens at human-wild life livestock interfaces in coastal national reserves, Kenya. Ticks were collected from both near Tsavo National Reserve in Taita Taveta County and Shimba hills national gane reserves in Kwale County using sterile forceps from restrained cattle and detected morphologically with the aid of morphological keys. Representative of the morphologicaly identified ticks were molecularly identified. Identity as well as characterization of pathogens carried by ticksand endosymbionts was done by Anaplasma, Ehrlichia, and Rickettsia specific RT-PCR product sequencing and HRM analysis.The sum of 317 (281 adult ticks and 36 nymphs) was sampled near Tsavo National Reserve, which includes seven species. Amblyomma was the most sampled genus withAmblyomma gemma being the most sampled species (n=135, 42.6%). Another Amblyomma species sampled was Amblyomma Variegatum (n= 40, 12.62%). Greatest species diversity was identified in Rhipicephalus genus with four species identified that includes; Rhipicephalus appendiculatus (n=44, 13.9%), Rhipicephalus Averts (n=1, 0.31%), Rhipicephalus Decoloratus (n=5, 1.6%), Rhipicephalus Pulchellus (n= 91, 28.7%). A single species of Hyalomma sp. was sampled. From near Shimba Hill game reserve (SHNR), a total of 240 adult ticks were sampled comprises of eight species. Amblyomma was the most sampled genus and againAmblyomma gemma was the most sampled species (n=156, 65 %). Other Amblyomma species sampled includes; Amblyomma Lepidum (n= 5, 2.1 %), Amblyomma Variegatum (n= 15, 6.3 %). Greatest species diversity was also identified in Rhipicephalus genus with four species identified that includes; Rhipicephalus appendiculatus (n=18, 7.5 %), Rhipicephalus Averts (n=6, 2.5 %), Rhipicephalus Decoloratus (n=4, 1.7 %), Rhipicephalus Pulchellus (n= 34, 14.2 %). The least sampled species was a single species of Hyalomma Scupense (n=2, 0.83 %). At near Tsavo National Reserve (TNR), a total of three pools of Rhipicephaline appendiculatus were positive for Theileria parva, two pools of Rhipicephaline evertsi for Anaplasma platys, and one pool of Amblyomma variegatum nymphs for Rickettsia africae. From near Shimba Hill game reserve (SHNR), , Rickettsia africae pathogen was detected in two pools of Am. variegatum and one pool of Am. Gemma. Rickettsia sp. and Anaplasma sp. were detected in Am. Gemma and Rh. evertsi respective. R. aeschlimannii was isolated in a pool of Am. Gemma.Coxiella spp.endosymbionts were detected in Rhipicephalus ticks in both study area. Robust vector surveillance and biological control programs against ticks should be emphasized in both Tsavo and Shimba Hills National Reserves. Biological control mechanisms for tick endosymbionts should be encouraged for employment as a tick control methods due to their ability to limit vector competency.
Development, Stability Testing, and Performance of Xpert MTB/RIF Proficiency Testing Material in National Tuberculosis Reference Laboratory, Nairobi City County, Kenya
(Kenyatta University, 2024-01) Nganga, Margaret Wairimu
Systematic and ongoing proficiency testing (PT) program is a fundamental element of external quality assurance in diagnosis of TB using Xpert MTB/RIF assay. In many resource-limited setting, particularly in Kenya, PT is poorly covered and largely inconsistent following inadequate supply of dried tube specimens (DTS). This has serious negative implications on patients‘ management and TB control programs. The aim of this study was to develop, assess stability and performance of local DTS panels for Xpert MTB/RIF assay PT in Kenya. This study was conducted at the National Tuberculosis Reference Laboratory (NTRL) and DTS piloting was done in Xpert MTB/RIF sites in Nairobi City County. An experimental study design was adopted to develop and assess stability DTS panels, and a cross sectional study design was adopted to pilot panels. The piloting sites were purposively selected to include all the twenty (20) TB diagnostic laboratories that were using Xpert machine in Nairobi City County, from August 2019 to December 2019.Bacterial strains stored in a -80oC freezer at the NTRL were retrieved and processed following standard bacteriological procedures. The strains were sub-cultured in liquid culture media (MGIT), growth detected by the BACTEC® MGIT 960® system, and their purity confirmed. Bacterial cultures were then heat-inactivated and pre-tested using Xpert MTB/RIF assay before preparing DTS. To assess the effect of drying on the stability of DTS panels, DTS panels were left uncapped inside a biosafety cabinet for 7, 10, and 14 days, and immediately subjected to Xpert MTB/RIF assay. In assessing the stability of the DTS panels at various temperatures as anticipated in TB diagnostic laboratories that use Xpert machine across the Kenya, 36 DTS panels from 7, 10, and 14 days drying periods were held at 18oC, 20oC, 24oC, 33oC, and 40oC for 12 weeks, and subjected to Xpert MTB/RIF weekly. For piloting, a set of 5DTS panels, 5 disposable sterile dispensing pipettes, processing instructions, and PT results evaluation form were delivered to the targeted piloting sites in a sealable transparent bag for testing by the Xpert MTB/RIF personnel who printed the results, entered them into the reporting form, and a scanned image send to the principal investigator for analysis. Data were analyzed using STATA v17 and variables were summed up in medians, interquartile range, means, and standard deviation (SD). Each of the five pilot DTS panels was assigned an accuracy score of 20 points, and individual laboratory scores as follows; incorrect determination of either MTB detection (0 points), unsuccessful result (error, invalid, or no results) (5 points), RIF-indeterminate result (10 points), and correct determination of both MTB detection and RIF resistance (20 points). Total scores for each laboratory were computed, with 100% being considered Excellent, ≥80% Satisfactory, and <80% Unsatisfactory. The DTS panels‘ probe A Ct values were within the expected mean range (16-23) and SD limit (≤3), with100% concordance between those dried for 7, 10 or 14 days and the pretest results. Except for DTS panels held at -80oC, the probe A mean Ct values of panels dried for 7 and 14 days increased with increasing temperature (from -20oC to 40oC) during the 12 weeks‘ study period (p= <0.001), with the greatest mean Ct value increment was at 40ᵒC.Ninety-five per cent (18/20) of piloted laboratories reported the expected, with 10% (2/20) of sites giving discordant results, false MTB detection (5%, 1/20) and error (code 5007) (5%, 1/20). 90% (18/20) of the piloted sites had satisfactory, 80% had excellent, and 10% (2/20) had unsatisfactory results. This study recommends adoption of 7-day DTS drying period, -80oC and 40oC storage up to 2 weeks, and up scaling DTS production for profic
Relationship between Impaired Electrolytes, Glycated Hemoglobin and Poor Adherence to Antidiabetics among Patients Attending Samburu County Referral Hospital, Kenya
(Kenyatta University, 2024-06) Lengeiya, Francis Lengasu
Type 2 Diabetes mellitus is a persistent metabolic disorder that can have devastating effects on patients, resulting in numerous healthcare challenges in terms of its management and the associated cost burden. Adherence to antidiabetics has been consistently sub-optimal in previous studies and remains a significant clinical issue in the management of diabetes. Patients having uncontrolled blood glucose levels often exhibit electrolyte imbalance which greatly influences their treatment. Glycated hemoglobin test, assessing average blood glucose levels over a period of roughly three months, is widely regarded as the gold standard for diagnosing diabetes. The aim of this research was to study the relationship between electrolytes and glycated hemoglobin among diabetic patients with poor adherence to antidiabetics. The study was carried out at Samburu County Referral Hospital, employing a descriptive cross-sectional study design and convenience sampling technique involving adult diabetic patients aged 18 years and above who attended the diabetic clinic. Seventy-two patients, (48.6% females, 51.4% males) who were on antidiabetics for at least three months and demonstrated poor adherence, participated in the study. Adherence levels were assessed using the Morisky Medication Adherence Scale-8. Those with adherence scores <6 was categorized as having low adherence and further assessed using a questionnaire to identify factors contributing to poor adherence to antidiabetics. Blood samples were collected to measure glycated hemoglobin levels and serum electrolytes levels, including potassium, sodium, calcium, magnesium, phosphorus, and chloride. Serum electrolytes were analyzed using the Selectra Prom biochemistry analyzer while glycated hemoglobin levels were measured using the standard F200 HbA1c analyzer. The relationship between electrolytes and glycated hemoglobin was visualized using scatter plots, and correlation coefficients were determined using the Karl Pearson correlation method. Several factors contributing to poor adherence were identified, with lack of money to buy drugs being the most frequently reported factor (69%) among study participants. A significant correlation was observed between glycated hemoglobin and calcium (r=-0.2398 P ≤0.05) as well as sodium (r=-0.31369 P≤0.05). However, no significant correlation (P≥0.05) was observed between phosphorus, magnesium, chloride and potassium r=, -0.04, -0.07,0.05 and -0.01 respectively, with HbA1c levels. This study revealed that calcium and sodium electrolytes imbalances were significantly present in diabetic patients with poor adherence to antidiabetics. Therefore, routine monitoring of serum electrolytes levels among diabetic patients is paramount. The results highlight the importance of comprehensive diabetes management strategies that address both glycemic control and electrolyte status. The findings from this study can inform policy makers on ways to enhance management of Type 2 Diabetes mellitus as well as inform into causes of non-compliance with antidiabetic medications.
Molecular Diversity of Hepatitis B Virus in HIV Infected Patients at Mbagathi District Hospital, Nairobi City County.
(Kenyatta University, 2024-06) Khaemba, Samuel Barasa
With increasing access to antiretroviral therapy (ART) across Sub-Saharan Africa, HIV-infected individuals live longer and are frequently co-infected with HBV due to similar transmission routes. Persons with Hepatitis B Virus and HIV dual-infection advance more swiftly to end-stage hepatic disease. With 8-15% genomic divergence by DNA sequence, HBV is currently classified into 10 genetic variants, from A to J with numerous subtypes. HBV genotypes have been clarified as influencing the clinical outcome of the chronic disease in hosts. Considering paucity of data on HBV genotypes among HBV/HIV co-infected individuals in Kenya and the significance of HBV variants in antiretroviral therapy response, a cross-sectional study on the molecular diversity of Hepatitis B virus genotypes and the risk factors among HIV infected patients in Kenya was undertaken. The systematic random sampling was used to recruit 180 HIV seropositive male and female individuals attending routine CD4+ T-lymphocyte and viral load laboratory monitoring. A structured questionnaire was administered to capture socio-epidemiological data while an ELISA for qualitative testing of HBsAg in human serum was used and HBV DNA was extracted from 9 HBsAg seropositive samples and HBV genotypes established in 5 nucleic acids by nested-PCR of pre-S gene, direct sequencing and phylogenetic tree clustering. The HBV prevalence was found to be 5.0% serologically and 2.8% by PCR. Drug injection, heavy alcohol consumption, low use of protection during sexual intercourse and increased frequency of sexually transmitted infections were found to be direct risk factors for increased HBV infection. This study reveals that HBV genotype A1 (60%) and D (D6 and D7) were the most prevalent and they showed very low genetic diversity. In addition, these strains indicated very close phylogenetic relationship to those isolated from Sudan, S. Africa, Botswana and Tunisia. The five isolate genotypes were found to have susceptible mutations in S gene for Lamivudine, Adefovir, Entecavir and Tenofovir. In conclusion, the HBV/A1 was predominant variant and this imply the possibility of increased incidence of the HBV genotype A1 in Kenya and indeed across the region due to increased migration and regional interaction of human populations
Reproducibility and Stability of Stabilization Agents for Cd4 Cells Storage in HIV Positive Samples at Kilifi County Referral Hospital, Kenya
(Kenyatta University, 2023-03) Nella, Raphael Kalama; Margaret Muturi; Scholastica Mathenge
Abstract
Lipid Profiles Cardiovascular Disease AND Dyslipidemia in HIV Positive Patients in Machakos level 5 hospital Machakos, Kenya
(Kenyatta University, 2023-10) Syengo, Sarah M; Scholastica G Mathenge and Nelson C Menza
Human Immunodeficiency Virus infection is a worldwide pandemic that has been controlled and managed through the use of highly active antiretroviral therapy drugs. However, long-term use of antiretrovirals is linked with dyslipidemia and cardiovascular disease, which are major issues for public health. In developing countries such as Kenya, there is a gap in knowledge regarding the prevalence of dyslipidemia and risk of cardiovascular disease among persons on antiretroviral medication who have the Human Immunodeficiency Virus. Thus, this study determined the lipid profiles, the prevalence of dyslipidemia, the likelihood of acquiring cardiovascular disease, and the risk factors associated with dyslipidemia and cardiovascular disease in people who are positive for the Human Immunodeficiency Virus on antiretrovirals. The research was undertaken at Machakos Level V Hospital, Machakos County, Kenya for four months. The study applied a cross- sectional design. Systematic sampling was used to choose 406 study participants living with the Human Immunodeficiency Virus on antiretrovirals. Blood samples were obtained from each participant, and the serum obtained was used for the lipid profile test. The results were then used to determine the prevalence of dyslipidemia for the study participants. The study also applied the Framingham Risk Score in assessing cardiovascular disease risk in the next ten years. The Framingham Risk Score was based on seven coronary risk aspects: high-density lipoprotein, total cholesterol, age, sex, systolic blood pressure, time on antiretrovirals, and cigarette smoking. The risk factors were collected through structured questionnaires. Data on the lipid profiles, Framingham risk score, and prevalence of dyslipidemia and cardiovascular risk alongside assessed risk factors were presented using tables. A bivariable analysis was conducted to identify significant exposure variables linked to dyslipidemia and cardiovascular disease. Multivariate analysis was conducted, including exposure variables with p < 0.2. The findings showed that the total cholesterol to high-density lipoprotein cholesterol ratio was significantly linked with antiretroviral regimens p<0.05. Those using protease inhibitors were 4 times more expected to have a high ratio than those using non-nucleoside reverse transcriptase inhibitors (OR = 4.19), 95% CI: 1.03 - 17.02, p<0.05. Based on the Framingham Risk Score, 289(71.2%) had low cardiovascular disease risk, 75(18.5%) had moderate risk, 40(9.8%) had moderately high risk while 2(0.5%) had high risk. The results established that age, low high-density lipoprotein, cigarette smoking, and high systolic pressure were significantly linked with a high Framingham Risk Score (p<0.001). Gender and duration on Highly Active Antiretroviral Therapy were also significantly linked with a high Framingham Risk Score (p=0.001). High total cholesterol values were not significantly linked with a high Framingham Risk Score (p=0.313). The general occurrence of dyslipidemia in the study was 74.1%, with 301 participants having dyslipidemia. The findings showed that age was significantly linked with dyslipidemia (p = 0.005). High systolic pressure was significantly linked with dyslipidemia (p=0.049). Hypertension was significantly linked with dyslipidemia (p<0.001). Gender, age, high systolic pressure, history of hypertension, cigarette smoking, and cardiovascular disease family history were significantly linked with the risk of developing cardiovascular disease (p<0.001). Diastolic pressure was not statistically significant (p = 0.861). People living with the Human Immunodeficiency Virus on antiretrovirals are still at a high risk of developing dyslipidemia and cardiovascular disease. The study offered information that will inform the policymakers on better approaches to employ in addressing the health outcomes for people living with the Human Immunodeficiency Virus under treatment with antiretrovirals while addressing the cardiovascular diseases that may be confounding by the use of antiretrovirals.
Multidrug-Resistant Acinetobacter Baumannii among Patients Admitted to Intensive Care Unit at Moi Teaching and Referral Hospital, Uasin Gishu County, Kenya
(Kenyatta University, 2023-11) Kipsang, Fred; Abednego Musyoki; Nelson Menza
Abstract
Spectrum, Antimicrobial Susceptibility Profiles, and Molecular Characteristics of Bacterial Pathogens from Severely Ill Covid-19 Patients in Kenyatta National Hospital, Kenya
(Kenyatta University, 2023-06) Mutua, Jeniffer Munyiva; Abednego Musyoki; John Mwaniki njeru
Bacterial infections are among the leading causes of morbidity and mortality among patients with viral respiratory infections. Because distinguishing between viral and bacterial pneumonia based on clinical presentation can be challenging and bacterial pathogens’ epidemiology varies geographically, Coronavirus Disease 2019 patients are prescribed antibiotics frequently, even without laboratory-based evidence of bacterial infection. This has a serious negative implication on antimicrobial resistance situation that is expected to worsen, causing a staggering number of 10 million fatalities and economic setback of 100 billion USD by 2050. Information on bacterial infections among Coronavirus Disease 2019 patients in many developing nations, including Kenya, is limited. This study aimed to determine the spectrum, antimicrobial susceptibility profiles and molecular characteristics of pathogenic bacteria among patients with COVID-19 at Kenyatta National Hospital, Kenya. The research utilized an analytical cross-sectional study design and a total of 120 participants purposively recruited among laboratory-confirmed severely ill Coronavirus Disease 2019 patients who gave informed consent through a legally authorized representative. Socio-demographic, clinical and outcome data were gathered using case report forms and structured sample collection forms. Nasopharyngeal and oropharyngeal swabs, tracheal aspirates and blood samples were collected, transported to KNH microbiology laboratory, and analyzed following the standard bacteriological methods. Bacterial isolation was done on selected culture media, whereas isolates identification and susceptibility testing were done using MALDI-TOF (VITEK ® MS) and VITEK® 2 COMPACT system, respectively. The AST data was interpreted based on 2021 CLSI standards. The screening for ESBLproduction was conducted using the Double-Disc Synergy Tests, which was subsequently confirmed through Phenotypic Confirmatory Disc Diffusion Test. ESBL-resistant genes were PCR-detected from all ESBL-producers at the Centre for Microbiology Research, KEMRI. An overall prevalence of 44.2% (53/120) bacterial infections was found among the study participants, with a 31.7% (38/120) mortality rate. Isolates of Gram-negative bacteria (GNB) exhibited greater prevalence, (73.1%, 49/67). Majority (69.6%, 32/46) of multidrug resistant (MDR) bacteria were GNB. K. pneumoniae (45.5%, 15/33) was the dominant ESBL producer and most of MDRGNB harboring the TEM (83%, n=10/12) and SHV resistance gene (100%, n=7/7) were resistant to beta lactamase inhibitors including amoxicillin/clavulanate but susceptible to piperacillin/tazobactam (60%, n=6/10). Male patients were more likely to have bacterial infections (aOR = 2.61, 1.2 – 5.65), including those caused by ESBL producing bacteria (aOR=0.21, 0.06 - 0.68). Individuals with pre-existing comorbidities were found to have a five-fold increased likelihood of harboring ESBLproducing bacteria (cOR=5.46, 1.37 - 21.67). Patients: aged 25 to 44 years (aOR = 0.13, 0.02 – 0.6), hospitalized in the IDU ward (aOR=3.27, 1.08– 6.89), vaccinated for Coronavirus Disease 2019 (aOR = 0.2, 0.05 – 0.83) and hospitalized for short duration (0 -5 days) (aOR=14.28, 3.25 - 62.76) had a positive hospitalization outcome. These results highlight a significant burden of bacterial infections among Coronavirus Disease 2019 patients, with males at higher risk. Those: not vaccinated, admitted to CCU, aged over 60 years, and with pre-existing comorbidities had poor outcome. There is urgent need for systematic and continuous AMR surveillance at KNH and beyond to inform prevention interventions in accordance with national and global action plans.
Lipid Profiles, Cardiovascular Disease Risk and Dyslipidemia in HIV-Positive Patients on HAART at Machakos Level Five Hospital, Machakos County, Kenya
(Kenyatta University, 2023-10) Syengo, Sarah Malinda; Scholastica G. Mathenge; Nelson C. Menza
Human Immunodeficiency Virus infection is a worldwide pandemic that has been controlled and managed through the use of highly active antiretroviral therapy drugs. However, long-term use of antiretrovirals is linked with dyslipidemia and cardiovascular disease, which are major issues for public health. In developing countries such as Kenya, there is a gap in knowledge regarding the prevalence of dyslipidemia and risk of cardiovascular disease among persons on antiretroviral medication who have the Human Immunodeficiency Virus. Thus, this study determined the lipid profiles, the prevalence of dyslipidemia, the likelihood of acquiring cardiovascular disease, and the risk factors associated with dyslipidemia and cardiovascular disease in people who are positive for the Human Immunodeficiency Virus on antiretrovirals. The research was undertaken at Machakos Level V Hospital, Machakos County, Kenya for four months. The study applied a cross-sectional design. Systematic sampling was used to choose 406 study participants living with the Human Immunodeficiency Virus on antiretrovirals. Blood samples were obtained from each participant, and the serum obtained was used for the lipid profile test. The results were then used to determine the prevalence of dyslipidemia for the study participants. The study also applied the Framingham Risk Score in assessing cardiovascular disease risk in the next ten years. The Framingham Risk Score was based on seven coronary risk aspects: high-density lipoprotein, total cholesterol, age, sex, systolic blood pressure, time on antiretrovirals, and cigarette smoking. The risk factors were collected through structured questionnaires. Data on the lipid profiles, Framingham risk score, and prevalence of dyslipidemia and cardiovascular risk alongside assessed risk factors were presented using tables. A bivariable analysis was conducted to identify significant exposure variables linked to dyslipidemia and cardiovascular disease. Multivariate analysis was conducted, including exposure variables with p = ≤ 0.2. The findings showed that the total cholesterol to high-density lipoprotein cholesterol ratio was significantly linked with antiretroviral regimens p<0.05. Those using protease inhibitors were 4 times more expected to have a high ratio than those using non-nucleoside reverse transcriptase inhibitors (OR = 4.19), 95%CI: 1.03 - 17.02, p<0.05. Based on the Framingham Risk Score, 289(71.2%) had low cardiovascular disease risk, 75(18.5%) had moderate risk, 40(9.8%) had moderately high risk while 2(0.5%) had high risk. The results established that age, low high-density lipoprotein, cigarette smoking, and high systolic pressure were significantly linked with a high Framingham Risk Score (p<0.001). Gender and duration on Highly Active Antiretroviral Therapy were also significantly linked with a high Framingham Risk Score (p= 0.001). High total cholesterol values were not significantly linked with a high Framingham Risk Score (p= 0.313). The general occurrence of dyslipidemia in the study was 74.1%, with 301 participants having dyslipidemia. The findings showed that age was significantly linked with dyslipidemia (p = 0.005). High systolic pressure was significantly linked with dyslipidemia (p =0.049). Hypertension was significantly linked with dyslipidemia (p<0.001). Gender, age, high systolic pressure, history of hypertension, cigarette smoking, and cardiovascular disease family history were significantly linked with the risk of developing cardiovascular disease (p = <0.001). Diastolic pressure was not statistically significant (p = 0.861). People living with the Human Immunodeficiency Virus on antiretrovirals are still at a high risk of developing dyslipidemia and cardiovascular disease. The study offered information that will inform the policymakers on better approaches to employ in addressing the health outcomes for people living with the Human Immunodeficiency Virus under treatment with antiretrovirals while addressing the cardiovascular diseases that may be confounding by the use of antiretrovirals.
Determination and Characterization of Occult Hepatitis B in High-Risk Populations in Kenya
(kenyatta university, 2023) Kiptoon, Beatrice Jepkemei; George Gachara; Carla Oswioy
Occult hepatitis B virus (OBI) refers to the detection of HBV DNA in the serum or liver of individuals lacking the HBV surface antigen (HBsAg). It is often described among individuals having antibody to the core antigen as the sole serological marker of infection ("anti-HBc only"). However, it has also been observed in the absence of any serological markers ("seronegative OBI"). In cases of "seropositive" OBI, the presence and quantity of anti-HBs may provide an indication of putative risk for OBI, as isolated studies have shown absent or low levels (≤100 mIU/mL) of anti-HBs are more frequently associated with OBI. This has important consequences for blood donation screening and vaccination policy. The lack of HBsAg detection maybe attributed to the window period during acute infection, the virus's low replication phenotype, or a flaw in the expression or release of HBsAg. Mutations within the surface antigen-coding region have also been associated with loss of immunoassay detection for HBsAg. OBI often results in a non-symptomatic or benign infection, although it has been allied to serious hepatic disease, particularly in those co-infected with HCV or HIV, in which occult HBV is more frequently detected. The prevalence and characteristics of OBI in high-risk groups remain unknown in Kenya. Relying solely detection of HBV surface antigen (HBsAg) may lead to under-diagnosis of OBI cases, emphasizing the need for a comprehensive investigation to inform targeted public health interventions and strategic policies to combat HBV in Kenya. This study aimed at investigating the prevalence and molecular characterization of OBI in high-risk Kenyan populations. Sera from 65 HBsAg-negative patients presenting with jaundice at Kenyan medical facilities and 99 male sex workers (MSM-SW), along with 13 non-MSM men having HIV-positive partners were analyzed. Testing included HBV serological markers and additional hepatitis C virus (HCV) screening for MSM-SW patients. HBV DNA was extracted and analyzed using real-time polymerase chain reaction (rt-PCR). Of the 166 HBsAg-negative samples, 31 (18.7%; 95% CI 13.5 – 25.3) tested positive for HBV DNA, classifying them as OBI positive with an overall prevalence of 18.7%. Notably, 64.5% (20/31) of these cases were found to have HBV core protein antibody (anti-HBc positive). Among the MSM-SW cohort, a 10.1% (10/99; 95% CI 5.6 – 17.6) HBsAg positivity rate was observed. All samples tested negative for HCV. HBV genotype A predominated, with distinct genetic clustering patterns observed among the study cases, indicating potential common networks or non-African sources. The high prevalence of OBI across examined cohorts, along with the occurrence of chronic HBV infection in the MSM-SW population, highlights the necessity for targeted screening programs to enable preventive measures, including HBV vaccination, and ensure access to treatment and care.
Multidrug-resistant acinetobacter baumannii among patients admitted to intensive care unit at Moi Teaching and Referral Hospital, Uasin Gishu County, Kenya
(Kenyatta University, 2023-11) Kipsang, Fred; Abednego Musyoki; Nelson Menza
Multidrug-resistant Acinetobacter baumannii infections pose a formidable challenge worldwide, especially in developing countries like Kenya. Despite limited treatment options, comprehensive data on Acinetobacter baumannii susceptibility profile at Moi Teaching and Referral Hospital remains scarce. This study therefore aimed to elucidate on the local epidemiology and clinical implications of these resistant strains among intensive care unit patients at this Kenyan tertiary teaching and referral hospital. This study adopted a cross-sectional study, purposefully enrolled 132 patients admitted to the intensive care unit between July 2019 and July 2020. Clinical specimens, including blood, urine, and tracheal aspirates, were systematically collected following standard bacteriological procedures. Microbiological isolation and identification were performed using culture, while antibiotic susceptibility testing utilized the VITEK®2 Compact system following the 2019 Clinical Laboratory Standards Institute guidelines. Descriptive statistics and multinomial logistic regression were conducted on the data to establish susceptibility trends and compare subject characteristics with carbapenem effectiveness. The statistical significance level for all analyses was set at a 95% confidence interval. The study revealed remarkably high rates of resistance among the sampled subjects, with 100% (n=30) showing multidrug-resistant infections and 83.3% (n=25) exhibiting carbapenem-resistant Acinetobacter baumannii infections. Among the total isolates, 83.3% (n=25) were insensitive to carbapenems, like Imipenem (IPM) and Meropenem (MPM) with 70% resistance each, Doripenem (DPM) with 86.7% resistance, Ertapenem (EPM) with 93.3% resistance, and Biapenem (BPM) with 96.7% resistance. However, alternative antibiotics such as Colistin (COL) showed a relatively lower resistance rate of 16%, and Tigecycline (TIG) demonstrated a resistance rate of 30%. The study also found significant associations between resistance to carbapenems and hospital stays of more than 10 days (aOR) = 2.11, 95% CI: 1.31 – 5.12, p = 0.002), as well as the presence of comorbidities (aOR = 2.26, 95% CI: 0.63 - 8.17, p = 0.212). Being married was significantly associated with a 4-fold higher likelihood of death (aOR = 8.56, 95% CI: 2.37 - 15.82, p = 0.011), while overweight or obese patients had about 4-fold increased risk of mortality compared to those with a normal BMI (aOR = 11.2, 95% CI: 3.57 - 21.11, p = 0.004). Additionally, each additional day of hospital stay was associated with a 41% higher likelihood of death (aOR). This study revealed alarming results of multidrug-resistant and carbapenem-resistant Acinetobacter baumannii isolates in the intensive care unit of Moi Teaching and Referral Hospital. The high resistance against common antibiotics calls for urgent implementation of strategies like enhanced surveillance and antimicrobial stewardship programs. Exploring new regimens like COL and TIG is crucial. Collaborative efforts among healthcare professionals, policymakers and researchers are essential to mitigate the spread of multidrugresistant and carbapenem-resistant Acinetobacter baumannii strains, safeguard patients' health, and preserve antimicrobial effectiveness at Moi Teaching and Referral Hospital.
Survival rates and blood meal patterns of aedes aegypti and aedes simpsoni mosquitoes in Kerio Valley and Rabai Arbovirus Ecologies, Kenya
(Kenyatta university, 2022) Kamau, Winnie W.; Nelson Menza; Rosemary Sang; David Tchouassi
Understanding the vectorial capacity for arboviruses transmission can allow for improved prediction and of arboviral disease outbreaks and control. Like other vector-borne diseases, transmission of arboviruses is influenced by vector bionomic traits including age structure and vector feeding habits. The current study investigated the survival rates, blood meal patterns and the human blood feeding habits in field collected populations of Aedes aegypti and Aedes simpsoni mosquitoes, which are vectors of dengue virus (DENV) and yellow fever virus (YFV), respectively, in East Africa. Adult female mosquitoes analysed were trapped during the day using CO2-baited BG Sentinel traps from peri-urban Rabai, Kilifi County (dengue-endemic) and rural Kerio Valley, Baringo County (with a history of yellow fever outbreak) during the period between August 2019 to February 2020. The mean parity rates following dissection and microscopic examination of ovarian tracheoles was high for Ae. simpsoni (85% (n=539) that did not vary between the trapping periods, while in Ae. aegypti was 74.9% (n=735) but varied between the trapping periods. Assuming a 3-day gonotrophic cycle, these translated to a high daily survival rate and longevity ranging between 15.8-19.7 days and 7.7-12.4 days in Ae. simpsoni and Ae. aegypti, respectively. Analysis of blood fed cohorts through DNA sequencing of the12S mitochondrial rRNA fragment showed a diverse host feeding range for Ae. aegypti with estimated human blood index (HBI) of 0.53. HBI did not vary between mitochondrial lineages indicative of domestic and forest genetic forms of Ae. aegypti. The genetic forms of Ae. aegypti were determined by PCR of a cox1 gene fragment and then sequencing followed by phylogenetic reconstruction. Similarly, Ae. simpsoni complex also exhibited a broad host feeding range, with Ae. bromeliae being the most predominant sub-species as determined using Internal Transcribed Spacer 2 (ITS2) PCR sequences, which exhibited a low HBI (0.18 and 0.33 in Rabai and Kerio Valley, respectively). Phylogenetic analysis also suggested the presence of a species which is yet to be described within the Ae. simpsoni complex, demonstrating human blood feeding tendency. The species diversity in the Ae. simpsoni complex may well be greatly higher than earlier thought, which requires more studies. Overall, both species exhibited high survival/longevity that could lead to high vectorial capacity for YFV and DENV transmission. Additionally, the low human blood meals of both Ae. aegypti and Ae. simpsoni cohorts indicated a high capacity for zoonotic transmission of other pathogen and therefore a need for continued efforts to control these vectors. These findings demonstrated the applicability to include other bionomic parameters such as vector competence, which defines vectorial capacity, for an effective understanding of spread and recurrence risk of these arboviruses. In addition to enhance cost effectiveness interventions (e.g. vaccines) and prediction of diseases occurrence, there is urgency to generate surveillance information of vector population founded on genotype analyses
Survival Rates and Blood Meal Patterns of Aedes aegypti and Aedes simpsoni Mosquitoes in Kerio Valley and Rabai Arbovirus Ecologies, Kenya
(Kenyatta University, 2022) Kamau, Winnie W.; Nelson C. Menza; David P. Tchouassi; Rosemary Sang
Understanding the vectorial capacity for arboviruses transmission can allow for improved prediction and of arboviral disease outbreaks and control. Like other vector-borne diseases, transmission of arboviruses is influenced by vector bionomic traits including age structure and vector feeding habits. The current study investigated the survival rates, blood meal patterns and the human blood feeding habits in field collected populations of Aedes aegypti and Aedes simpsoni mosquitoes, which are vectors of dengue virus (DENV) and yellow fever virus (YFV), respectively, in East Africa. Adult female mosquitoes analysed were trapped during the day using CO2-baited BG Sentinel traps from peri-urban Rabai, Kilifi County (dengue-endemic) and rural Kerio Valley, Baringo County (with a history of yellow fever outbreak) during the period between August 2019 to February 2020. The mean parity rates following dissection and microscopic examination of ovarian tracheoles was high for Ae. simpsoni (85% (n=539) that did not vary between the trapping periods, while in Ae. aegypti was 74.9% (n=735) but varied between the trapping periods. Assuming a 3-day gonotrophic cycle, these translated to a high daily survival rate and longevity ranging between 15.8-19.7 days and 7.7-12.4 days in Ae. simpsoni and Ae. aegypti, respectively. Analysis of blood fed cohorts through DNA sequencing of the12S mitochondrial rRNA fragment showed a diverse host feeding range for Ae. aegypti with estimated human blood index (HBI) of 0.53. HBI did not vary between mitochondrial lineages indicative of domestic and forest genetic forms of Ae. aegypti. The genetic forms of Ae. aegypti were determined by PCR of a cox1 gene fragment and then sequencing followed by phylogenetic reconstruction. Similarly, Ae. simpsoni complex also exhibited a broad host feeding range, with Ae. bromeliae being the most predominant sub-species as determined using Internal Transcribed Spacer 2 (ITS2) PCR sequences, which exhibited a low HBI (0.18 and 0.33 in Rabai and Kerio Valley, respectively). Phylogenetic analysis also suggested the presence of a species which is yet to be described within the Ae. simpsoni complex, demonstrating human blood feeding tendency. The species diversity in the Ae. simpsoni complex may well be greatly higher than earlier thought, which requires more studies. Overall, both species exhibited high survival/longevity that could lead to high vectorial capacity for YFV and DENV transmission. Additionally, the low human blood meals of both Ae. aegypti and Ae. simpsoni cohorts indicated a high capacity for zoonotic transmission of other pathogen and therefore a need for continued efforts to control these vectors. These findings demonstrated the applicability to include other bionomic parameters such as vector competence, which defines vectorial capacity, for an effective understanding of spread and recurrence risk of these arboviruses. In addition to enhance cost effectiveness interventions (e.g. vaccines) and prediction of diseases occurrence, there is urgency to generate surveillance information of vector population founded on genotype analyses.
Acute Viral Respiratory Infections in Intensive Care Unit and Ventilator Support Patients in Moi Teaching and Referral Hospital, Uasin-Gishu County, Kenya.
(Kenyatta University, 2022) Kipsang, K. Amos; Washingtone Arodi; Marion Burugu
Acute respiratory tract infections (ARTIs) are among the five most common causes of morbidity and mortality globally, accounting for approximately 3.9 million deaths annually. Most of these deaths occur among young children in developing countries Mechanical ventilation supports the breathing system but does not change any pre-existing condition. Associated challenges include viral and bacterial infections. The prevalence of these infections is high, however these infections mimic bacterial infections. There is no documentation of these infections in many healthcare facilities In Africa. This study aimed at assessing the prevalence rates of Influenza virus, HRV, RSV, HPIV, hMPV, Human Adenovirus and HCoV in study subjects on ventilator support as well as those on critical care in the intensive care unit. The study was done at MTRH in Uasin Gishu County. Samples were collected from April 2017 to August 2017. 200 samples of bronchoalveolar lavage were collected. The samples were then transported to KEMRI Nairobi at 2-8°C for analysis. The RNA/DNA of the viruses was detected using real time PCR and multiplex PCR. Data analysis as well as coding and entry were done using statistical package for social studies (SPSS). The results were log-transformed to obtain equal distribution. The results were also expressed as mean±standard deviation. The results were then compared with respect to whether in ICU or on mechanical ventilation as well age using ANOVA with Bonferroni’s post-test using GenStat Release 14.1 (PC/Windows). Presentation of the data was done using graphs, pie charts and tables/figures. The samples that tested positive for Influenza A virus, HPIV-1, HPIV-2, HPIV-3, RSV, Adenovirus, HRV Human Metapneumovirus and HCoV was 33 (16.5%) 12 (6%), 8 (4%), 11 (5.5%), 19 (9.5%), 5(2.5%), 42(21%), 22 (11%) and 9(4.5%) respectively. However significant difference in viral infection among study participants in the intensive care unit and those on ventilator support in the different age groups of the patients analyzed was noted. There was noted difference among the patients in different age categories based on whether in ICU or ventilator support by Influenza A Virus, HPIV-1, HRV and hMPV viral infections at P-Value ≤0.05. Highest infection means were indicated in age group >65 for Influenza A Virus, HPIV-1 and HRV and age group <5 for hMPV in both ICU and those on ventilator support. Lowest infection means were also observed only in age group 20-34 for Influenza A Virus HPIV-1, HRV and Human metapneumovirus in the intensive care unit and also those on ventilator support. There were 34 cases of multiple viral infections. 20 cases were in those on ventilator support while 14 cases were present in those in the intensive care unit. It is evident that these infections are common in patients in ICU and those under ventilator support at MTRH. It is also clear that these infections are common in the various age categories. Those below 5 years and those above 50 years have higher prevalence of majority of the infections in comparison to other age groups. Surveillance for viral respiratory infections should be improved in order to implement treatment and also understand seasonality of these viruses and other new respiratory viruses. Co-infections should be closely monitored especially in mechanical ventilation in order to understand the impact of ventilator support on infection rates by these viruses. More studies needs to be done focusing on nosocomial respiratory viral infections.
Blood Cell Count Changes and Haemoglobin Genotypes in Children with Malaria and Bacteraemia in Siaya County Referral Hospital, Kenya
(Kenyatta University, 2022) Ogulla, Godfrey Adongo; Margaret Muturi; Collins Ouma
Malaria and bacteraemia co-infection in children, normally produce changes in blood cellular components. Full blood count results from children whose haemoglobin genotypes and bacteraemia is not known can greatly influence the reporting of the cellular components results from automated cell counter and this formed the aim of the on the clinical management and interpretation of the results. Nevertheless, there was missing information on the role of malaria and bacteraemia co-infection on cellular components of normal haemoglobin and sickle cell trait in children. A total number of 384 children were recruited and complete blood count test were analyzed by automated cell counter machine. Other tests done included malaria smear microscopy, blood culture by Bactec 9050 machine and haemoglobin genotype determined by Helena Haemoglobin electrophoresis method. Children were stratified into two study groups; Malaria positive and bacteraemia negative and malaria positive and bavteraemia positive. Across groups analysis against region established normal ranges, showed lymphocytopnia and thrombocytopenia. Bacteria isolated were all from children with Hb genotype AS with malaria and bacteraemia co-infection with bacteraemia prevalence of 8.1% (31,of 384). The isolated bacteria species included non-typhi salmonella (NTS) (32%), Escherichia coli (3%) Enterobacter cloacae (6.5%), Staphylococcus aureus (39), Listeria monocytogenes (10%), Streptococcus pyogenes (3%) and viridans streptococci (6.5%). Obtained results indicated that salmonella species and staphylococcus aureus bacteria as the most prevalent isolates associated with bacteraemia in children with haemoglobin genotype AS with malaria infection. Haemoglobin genotypes AS children are seen to be prone to malaria and bacteraemia co-infection and lymphocytopenia and thrombocytopenia being the common cellular changes seen in full blood count results. Staphylococcus aureus and salmonella spp were the most prevalent bacterial isolates. Recommended that haemoglobin electrophoresis should be considered for all paediatric patients admitted with malaria and bacteraemia co-infection with complete blood count indicating lymphocytopenia.
Effects of Schistosomiasis on Haemoglobin Concentration and Nutritional Status in Children under 5 Years, Taita/Taveta County, Kenya.
(Kenyatta University, 2022) Nyika, Paul Ngaluma; Washingtone Arodi; George Gachara
Bilharziasis is a common parasitic disease caused by flatworms called schistosomes. Generally, this infection is common and prevalent disease in Sub-Saharan Africa Middle East, Asia and the Caribbean. With slowed down treatment, the infection in young children (under 5 years) can potentially cause long term harm health effects. This disease causes unsatisfactory development and advancement in this early critical phase of life. This study was meant to attest to the burden of schistosomiasis in Taita Taveta County, by unmasking the prevalence and intensity of the disease among 5 years and below of age. The study recruited children under 5 years from six villages using stratified random technique. The selected children were referred to the nearest health facility for specimen collection. Stool and urine specimens were examined microscopically for helminths. Blood specimens were analyzed for malaria parasites and hemoglobin concentration. Data on anthropometric indices were also collected. Analysis were done using WHO Anthros and IBM SPSS. 132 participants were admitted in the study, predominant sex (53.8%) being males. The age of the participants ranged from 7 to 59 complete months with a median age of 48 (39 – 59) months. The number of participants who tested positive for bilharziasis was 37 (28%; 95% CI 21.1% - 36.2%). Cases of haematobium and mansoni were discovered in 18.9 percent (95% CI 13.2% - 26.5%) and 15.9 percent (95% CI 10.7% - 23.1%) of the sampled participants sequentially. Participants who were positive for other intestinal nematodes 6.8 percent; 95% CI 3.6% - 12.5%. The other STH infections were: ascariasis (6.8%), hookworm infection (4.5%) and trichuriasis (1.5%). The proportion of study participants whohad heavy intensity infections of urinary schistosomiasis were 16.0%. Heavy intensity infections were not detected in STH and S. mansoni. Bilharziasis was associated with nutritional aspects which comprises of stunting (odds ratio (OR) 3.665 (95% CI 1.443 - 9.309), p=0.006) and underweight (OR 12.698 (95% CI 3.107 - 51.900, p<0.001). Anemia was evidenced among the participants with schistosome infection when compared with the schistosome-negative participants (57.1 percent versus 42.9 percent respectively, OR 7.897 (95% CI 3.383 – 18.438), p<0.001). This survey confirmed a significant burden of schistosomiasis among population aged 5 years and below in the study area. Additionally, this study indisputable demonstrated that a lot of concerted efforts need to be prioritized for interventions including treatment and deworming to the pre-school age children (PSAC) in the study area. For example, in line with WHO exhortation, since the ova patent prevalence of schistosomiasis in this age group is within the range of more than 10% but not exceeding 50%, then biennial treatment with praziquantel should be conducted. With the great ambitious goal of World health organization of outstretching 75% coverage of prophylactic chemotherapy with a target of major helminthiases among PSAC, the findings from this study emphasizes the need for quick implementation of specific interventions to avoid accelerated morbidity while improving the general health of the population. Our data support the call for institutionalized mass treatment in lieu of school-based approaches only. This will ensure that deserving PSAC are reached by pertinent interventions via alternative delivery platforms such as through the Integrated Management of Childhood Illnesses and through Early Childhood Development and Education Centers. This work equally revealed the connection between flatworm’s infections, anemia and nutritional stature in the preferred population.
Seroprevalence of Hepatitis E Virus among Healthy Blood Donors in Nairobi City County, Kenya
(Kenyatta University, 2022) Fardolo, Ezekiel K.; George Gachara; Wallace D.Bulimo
Hepatitis E disease is caused by Hepatitis E virus (HEV). The virus is an enteric virus that is transmitted via fecal contaminated food, water, blood transfusion, and organ transplants. HEV causes approximately twenty million infections globally, of which over three million are asymptomatic. In 2015, The World Heal Organization (WHO) reported that this virus accounted for approximately 55,000 deaths representing a 3.3% mortality rate. HEV is classified into at least four human infecting genotypes. Out of these known genotypes, genotypes one and two are endemic in Asia and Africa, while genotypes three and four are sporadically described in developed countries. Two previous studies in Kenya have reported a seroprevalence of 25.7% and 77 % among acute febrile illness and jaundice patients. Despite these reports, most African countries, including Kenya, do not screen for the virus during blood donation. Besides, the seroprevalence, and the molecular characteristics of this virus in blood donors in Nairobi, Kenya, remain unknown. Therefore, this study aimed to determine the seroprevalence of Hepatitis E virus circulating genotypes and the relationship between socio-demographic risk factors and the HEV on voluntary blood donors in Nairobi using a retrospective study design. Archived plasma samples from 358 voluntary blood donors were used. The obtained blood plasmas were screened for Hepatitis E virus IgM and IgG antibodies using a qualitative membrane-based immunoassay (Biopanda reagents, Belfast, UK). The collected blood donors' socio-demographic characteristics were analyzed using Chi-square in SPSS software version 20 to determine the relationship between the blood donor's socio-demographics and HEV infection. The total virus RNA from the seropositive samples was extracted using the ThermoFisher PureLinkTM Viral RNA/DNA Mini kit and used as a template to synthesize cDNA. A nested PCR was performed to amplify the HEV ORF2 gene. The blood donors recruited in this study were between 16-60 years and had a mean age of 29±14 years. Out of the 358 subjects, 36% (n = 130) were females, while 64% were male. In addition, 10.6% of the tested samples were HEV IgG seropositive, while 7.8% were HEV IgM seropositive. The Anti-HEV was distributed in all the study age groups. The blood donors aged 20-29 years reported of 4.5% IgM and 5.5% IgG seroprevalence rate compared to other age groups. HEV seroprevalence was statistically significant higher in males and donors with tertiary level of education. Based on RT-PCR, all the seropositive samples were HEV RNA negative. Therefore, the study was unable to determine the Hepatitis E virus genotypes circulating in Kenya. This study shows that in Nairobi, there is high HEV seroprevalence among healthy blood donors. Further studies among other population groups are desirable to evaluate the potential benefits of incorporating screening of HEV among blood donors.
Genotypic Characterization of Hepatitis B Virus among Voluntary Blood Donors in Nairobi Regional Blood Transfusion Centre, Kenya
(Kenyatta University, 2021) Aluora, Okoti Patrick; George Gachara; Margaret Muturi
Hepatitis B virus (HBV) is one of the smallest DNA viruses that infects humans. Because of its ability to cause hepatocellular carcinoma (HCC), liver cirrhosis and hepatitis, HBV is one of the global causes of a high morbidity and consequently mortality. Most studies on HBV in Kenya have focused on its sero-epidemiology. HBV genome is prone to mutations which can lead to occult HBV infection that has been linked to Cirrhotic liver development and HCC. The mutations can also lead to drug resistance among individuals. The genotypic diversity within HBV results to varied characteristics from one genotype to another. To screen for HBV, the Kenya national blood transfusion services (KNBTS) use the chemiluminescent microparticle immunoassay (CMIA) method to detect the Hepatitis B surface antigen (HBsAg). This is a serological test that does not show the actual HBV presence in the blood or its genotypic traits. Those who may present with false negative results remain at risk of disease progression in future whose consequences may be liver cirrhosis or HCC. These HBV false negative donors may as well pass the infection to the recipients of their blood and blood products. This study sought to determine the HBV genetic diversity in Nairobi blood transfusion center among the voluntary blood donors and their susceptibility to anti-HBV drugs in current usage. The prevalence of occult HBV, overt HBV and the correlation between HBV infection and the demographic factors were also determined. Testing samples were collected in vacutainers at the point of donation. The samples were transported to the lab in cooler boxes. Sera and plasma were separated from plain and EDTA vacutainers respectively. Serum was used for testing for the HBsAg using CMIA method while the circulating genotypes were analyzed from the HBV DNA extracted from the plasma. The extracted genetic material was then subjected to a nested polymerase chain reaction (PCR) for amplification and sequencing done using Sanger’s method. The Circulating genotypes and P and S gene mutations were analyzed from the resulting sequences. Data analysis involved bivariate statistical analysis. Where p value <0.05, this was used to indicate association between HBV infection and demographic factors. A prevalence of 2.3% (7/300) overt HBV infection and 2.4% (7/293) occult HBV infection was reported. HBV infection and age, particularly age between 19-28 years, were significantly associated. Nine samples had HBV DNA; 7 HBsAg negative samples and 2 HBsAg positive samples. Several mutations were described among the samples including in the “a” determinant segment of the MHR as well as outside the S gene’s “a” determinant region. Sub genotype A1 was exclusively described in this population. Mutations were as well described in the P gene with varied resistance to several ʟ-nucleoside drugs. Occult HBV infections prevalence is high in this population due to the circulating mutations; an evidence that S gene mutations affect HBsAg detection. The study recommends the revision of the testing platform currently in use to incorporate molecular testing.
Group B Streptococcus Prevalence, Antibiotic Susceptibility and Risk Factors for Colonization among Antenatal Women at Mbagathi Hospital, Nairobi City County, Kenya
(Kenyatta University, 2021) Mwambia, Munene Tony; Nelson C. Menza; Scholastica G. Mathenge
Group B Streptococcus is recognized as the leading cause of neonatal sepsis as well as a significant cause of maternal post-partum sepsis globally. Maternal genitourinary colonization with the bacteria in pregnancy is the most significant risk factor for neonatal infection due to the risk of transmission to neonates during delivery. There is a gap in knowledge in the developing countries, Kenya included, regarding the prevalence of group B Streptococcus among the antenatal women. Therefore this study determined the prevalence of group B Streptococcus isolates and their antibiotic susceptibility patterns as well as identified the risk factors associated with group B Streptococcus colonization among antenatal women. The study was conducted at Mbagathi hospital, Nairobi City County, over a period of three months, adopting a cross- sectional study design. It included 323 systematically selected pregnant women. These participants provided 30-40 mls of mid-stream urine specimens which were then enriched in Todd-Hewitt broth and later cultured in strep B chromogenic agar and blood agar for bacteria isolation. The isolates were later identified using Gram staining and microscopy as well as a series of biochemical tests including the Christie Atkins and Munch Petersen test, catalase and pyrollidonyl arylamidase tests. The vitek 2 system was used to carry out antibiotic susceptibility testing and the resulting minimum inhibitory concentration values interpreted as either sensitive, intermediate or resistant with reference to Clinical and Laboratory Standards Institute 2020 guidelines. A questionnaire was used to collect data regarding the risk factors associated with maternal colonization with group B Streptococcus. The data was analyzed using the statistical packages for social sciences version 17. Percentages were used to show the prevalence of group B Streptococcus among participants and the differences in antibiotic susceptibility patterns of the isolates towards the various antibiotics that they were tested against. The Chi square test was used to test the association between the risk factors associated with maternal colonization with group B Streptococcus and the colonization status of the participants. The overall prevalence of group B Streptococcus established by this study was 15.2%, with 49 participants testing positive for group B Streptococcus. All isolates were 100% sensitive to Penicillin, Ampicillin, Ceftriaxone, Cefipime, Cefuroxime, Linezolid and Vancomycin. However, the isolates exhibited resistance towards Erythromycin 15 (30.6%), Azithromycin 9 (18.4%), Levofloxacin 7 (14.3%), Clindamycin 10 (20.4%) and Tetracycline 4 (8.2%). In addition, 10 (20.4%) of the isolates exhibited intermediate susceptibility towards Tetracycline. Age of a participant, place of residence and marital status (P= 0.000) were found to be significant. All obstetric related risk factors were also found to be significant; having a history of neonatal sepsis (P= 0.017), the parity status, history of: still birth, miscarriage, neonatal death and preterm delivery (P= 0.000). The human immunodeficiency virus status and dysuria (P= 0.000), lower abdominal pain (P= 0.001) and any form of vaginal infection (P=0.009) were also found to have significant associations with GBS colonization. No significant associations were found with the level of education of participants (P= 0.075) and the number of sexual partners (P= 0.083). Penicillin remains the antibiotic of choice for treatment of GBS infections and risk factors without individual routine screening are not sufficient for identifying candidates for intrapartum antibiotic prophylaxis. The study provided information regarding the most current effective antibiotics for group B streptococcal infections and advised on the criteria to identify candidates for intrapartum antibiotic prophylaxis. Further research is recommended to come up with a vaccine that would prevent women from being colonized with group B Streptococcus during pregnancy.
Antibiotic Susceptibility Patterns of Bacteria Isolated from Wards, Operating Room and Post-Operative Wound Infections among Patients Attending Mama Lucy Hospital, Kenya.
(Kenyatta University, 2021) Auna, Amulioto Johnstone; Margaret Muturi; Scholastica Mathenge
Surgical site infections are a worldwide problem in the field of surgery contributing to increased mortality and morbidity. However, despite advances in the control of surgical site infections, the risk of acquiring these infections has not fully been eliminated due to the emergence and spread of resistant bacteria pathogens. In Kenya, there were scanty published reports on the antibiogram of surgical site infection pathogens lurking in the hospitals. The objective of this research was to determine the prevalence and antibiotic susceptibility patterns of bacteria isolated from the wards, operating room, and surgical site infections among patients attending Mama Lucy Hospital. This was a cross-sectional descriptive study of patients with post-operative wound infections in the hospital wards. Purposive sampling was employed and a total of 126 samples collected. Of these, 58 came from surgical site infected patients and 68 were obtained from predefined areas of the wards and operating room of the facility. The samples were processed through Gram stain, culture, and an array of biochemical tests. Subsequently, antibiotic susceptibility tests by Kirby bauer disc diffusion technique were performed on the isolated bacteria. Data collected was analyzed using a statistical package for the social sciences (SPSS) version 20 and chi-square (p<0.05). A total of 137 bacteria were isolated from the culture positive swabs, 78 of these came from the wound pus swabs while 59 were recovered from the hospital surface swabs. Among the SSI bacteria, Staphylococcus aureus (28.2%) was the preponderant bacteria followed by E.coli (15.4%). In the wards and operating room, the main bacterial contaminant was Staphylococcus aureus. Based on the sensitivity report, all the SSI bacteria isolates were sensitive to Chloramphenicol (69.2%). Wherease the environmental bacteria isolates had sensitivity to Ciprofloxacin (86.4%), Doxycycline (88.1%), Chloramphenicol (93.2%) and Vancomycin (100%). Majority of the environmental isolates were highly resistant to Ampicillin/cloxacillin. In conclusion, the most prevalent SSI bacteria was Staphylococcus aureus, while Chloramphenicol was seen as the best drug for treating SSI at the hospital. The facility therefore needs to identify the most frequent bacteria associated with SSI. In addition, they need to monitor the bacteria that frequently contaminate the wards and operating room. The current antibiogram profile will help policy makers in the healthcare sector and the current setting to improve the current local guidelines on antibiotic prophylaxis for treatment of surgical site infection. The profiling will also assist in monitoring bacteria resistance trends within the institution and the country. Information generated from the hospital environment will help the infection control team at the current set-up to improve on the prevention of healthcare associated infections by carrying out active monitoring of hospital contaminants.

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