Tuberculosis infection among health care workers: a case series in two district hospitals, Kenya, August 2013.

INTRODUCTION: health care workers (HCWs) have an increased risk of M. tuberculosis infection and tuberculosis (TB) disease compared to the general population. We evaluated the magnitude of TB disease among HCWs in two District Hospitals in Kenya. METHODS: retrospective review of TB laboratory registers was performed at Makindu and Kiambu district hospitals. Cases were HCWs with confirmed TB diagnosis working at either hospital from 2010 to 2013. Cases were interviewed using structured questionnaire to collect clinical and epidemiologic information. Infection prevention (IP) practices were observed and recorded. RESULTS: Makindu and Kiambu had 91 and 450 HCWs respectively. As from the registers, 6,275 sputum smears were examined with 1,122 (18%) acid alcohol fast bacilli smear positive. Kiambu and Makindu reported 11 and five cases of TB among HCWs respectively. Of the 16, 57% were male; mean age was 45 (SD 5.32) years. HCWs affected were: four (25%) laboratory technicians, four (25%) nurses, two (13%) occupation therapists, two (13%) clinical officers and one pharmacist, telephone operator, driver and casual worker. Mean working time lost recuperating was 14 (range: 0-28) weeks. Both facilities lacked high-efficiency particulate air filters and Kiambu hospital lacked a biosafety cabinet too. Windows at both facilities were often closed and suspected TB patients shared common crowded outpatient waiting area where sputum was also collected. No standard reporting tool for TB disease among HCWs was in place at both facilities. CONCLUSION: TB disease was distributed across professional cadres with long working time lost recuperating. Inadequate IP measures exposed HCWs to occupational risk of acquiring TB disease.

Knowledge and practices towards rabies and determinants of dog rabies vaccination in households: a cross sectional study in an area with high dog bite incidents in Kakamega County, Kenya, 2013.

INTRODUCTION: An estimated 55,000 people die from rabies annually. Factors promoting dog vaccination, estimates of vaccination coverage and knowledge on rabies are important for effective rabies control. We sought to establish these estimates at household (HH) level and whether rabies knowledge is associated with proper control practices. METHODS: Cross-sectional cluster survey with two-stage sampling was employed in Kakamega County to enroll HH members above 18 years. A set of questions related to rabies knowledge and practice were used to score participant response. Score above the sample mean was equated to adequate knowledge and proper practices respectively. Independent t-test was used to evaluate the differences of sample mean scores based on dog vaccination status. Bivariate analysis was used to associate knowledge to practices. RESULTS: Three hundred and ninety HHs enrolled and had a population of 754 dogs with 35% (n = 119) HH having vaccinated dogs within past 12 months. Overall mean score for knowledge was 7.0 (±2.8) with range (0-11) and 6.3 (±1.2) for practice with range (0-8). There was a statistically significant difference in mean knowledge (DF = 288, p < 0.01) and practice (DF = 283, p = 0.001) of HH with vaccinated dogs compared to ones with unvaccinated dogs. Participants with adequate rabies knowledge were more likely to have proper health seeking practices 139 (80%) (OR = 3.0, 95% CI = 1.4-6.8) and proper handling practices of suspected rabid dog 327 (88%) (OR = 5.4, 95% CI = 2.7-10.6). CONCLUSION: Rabies vaccination below the 80% recommended for herd immunity. Mass vaccination campaign needed. More innovative ways of translating knowledge into proper rabies control practice are warranted.