Understanding the Relationship between Social Cognition and Word Difficulty. A Language Based Analysis of Individuals with Autism Spectrum Disorder.

BACKGROUND: Few quantitative studies have been conducted on the relationship between society and its languages. Individuals with autistic spectrum disorder (ASD) are known to experience social hardships, and a wide range of clinical information about their quality of life has been provided through numerous narrative analyses. However, the narratives of ASD patients have thus far been examined mainly through qualitative approaches. OBJECTIVES: In this study, we analyzed adults with ASD to quantitatively examine the relationship between language abilities and ASD severity scores. METHODS: We generated phonetic transcriptions of speeches by 16 ASD adults at an ASD workshop, and divided the participants into 2 groups according to their Social Responsiveness Scale(TM), 2nd Edition (SRS(TM)-2) scores (where higher scores represent more severe ASD): Group A comprised high-scoring ASD adults (SRS(TM)-2 score: ≥ 76) and Group B comprised low- and intermediate-scoring ASD adults (SRS(TM)-2 score: < 76). Using natural language processing (NLP)-based analytical methods, the narratives were converted into numerical data according to four language ability indicators, and the relationships between the language ability scores and ASD severity scores were compared. RESULTS AND DISCUSSION: Group A showed a marginally negative correlation with the level of Japanese word difficulty (p < .10), while the "social cognition" subscale of the SRS(TM)-2 score showed a significantly negative correlation (p < .05) with word difficulty. When comparing only male participants, Group A demonstrated a significantly lower correlation with word difficulty level than Group B (p < .10). CONCLUSION: Social communication was found to be strongly associated with the level of word difficulty in speech. The clinical applications of these findings may be available in the near future, and there is a need for further detailed study on language metrics designed for ASD adults.

Physical and sexual abuse in orphaned compared to non-orphaned children in sub-Saharan Africa: a systematic review and meta-analysis.

This systematic review assessed the quantitative literature to determine whether orphans are more likely to experience physical and/or sexual abuse compared to non-orphans in sub-Saharan Africa (SSA). It also evaluated the quality of evidence and identified research gaps. Our search identified 10 studies, all published after 2005, from Zimbabwe, South Africa, Kenya and Uganda. The studies consisted of a total 17,336 participants (51% female and 58% non-orphans). Of those classified as orphans (n=7,315), 73% were single orphans, and 27% were double orphans. The majority of single orphans were paternal orphans (74%). Quality assessment revealed significant variability in the quality of the studies, although most scored higher for general design than dimensions specific to the domain of orphans and abuse. Combined estimates of data suggested that, compared to non-orphans, orphans are not more likely to experience physical abuse (combined OR=0.96, 95% CI [0.79, 1.16]) or sexual abuse (combined OR=1.25, 95% CI [0.88, 1.78]). These data suggest that orphans are not systematically at higher risk of experiencing physical or sexual abuse compared to non-orphans in sub-Saharan Africa. However, because of inconsistent quality of data and reporting, these findings should be interpreted with caution. Several recommendations are made for improving data quality and reporting consistency on this important issue.

Characteristics of HIV-infected children seen in Western Kenya.

OBJECTIVES: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya. DESIGN: A retrospective descriptive study. SETTING: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya. SUBJECTS: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya. INTERVENTIONS: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART). MAIN OUTCOME MEASURES: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive statistical analyses and chi square tests were performed. RESULTS: Four thousand and seventeen HIV-infected children seen between June 2002 and April 2008. Median age at enrollment was four years (0-14.2 years), 51% girls, 25% paternal orphans, 10% total orphans and 13% maternal orphans. At enrollment, 25% had weight-for-Age Z scores (WAZ) > or = -1 and 21% had WAZ scores < or = 3. Orphaned children had worse WAZ scores (p=0.0001). Twenty five per cent of children were classified as WHO clinical stage 3 and 4, 56% were WHO clinical stages 1 and 2 with 19% missing clinical staging at enrollment. Cough (25%), gastroenteritis (21%), fever (15%), pneumonia (10%) were the commonest presenting features. Twenty six per cent had been diagnosed with tuberculosis and only 25% started on cotrimoxazole preventive therapy (CPT). Median CD4% at enrollment was 16% (0-64%); latest recorded values were 22% (0-64). Sixty four per cent were on cART (cART+), median age at start was 5.4 (014.4 years). The median initial CD4% among cART+ was 13 (0-62) compared to 24 (0-64) for those not on ART (cART-). Median CD4% for cART+ improved to 22% (0-59); whereas cART- was 23% (0-64) at last appointment. During the period of follow-up, one fifth (19%) of children on cART were lost to follow-up compared to slightly over one third (37%) for those not on cART. Thirty four percent were hospitalised; 41% diagnosed with pneumonia. Six per cent of 4017 were confirmed dead. CONCLUSIONS: HIV-infected children were enrolled in care early in childhood. Orphanhood was prevalent in these children as were gastroenteritis, fever, pneumonia and advanced immuno-suppression. Orphans were more likely to be severely malnourished. Only a quarter of children were put on cotrimoxazole preventive therapy. Children commenced on cART late but responded well to treatment. Loss to follow-up was less prevalent among those on cART.

Training needs for mid-level managers and immunisation coverage in Western Kenya.

OBJECTIVES: To determine the current status of immunisation coverage in Western Kenya before intervention, to identify strengths and weaknesses of the existing programme in order to design educational interventions that could improve the services provided and find out the training needs of the mid-level managers of Kenya Expanded Programme of Immunisation. DESIGN: Cross-sectional descriptive study. SETTING: All thirty nine districts in Rift Valley, Western and Nyanza provinces. SUBJECTS: Mid-level managers of Kenya Expanded Programme on Immunisation in the 39 districts and the provinces. These included Provincial Logisticians, Provincial Medical Officers of Health, District Medical Officers of Health, District Public Health Nurses, District Records and Health Information Officers, District Disease Surveillance Officers, and District Public Health Officers. MAIN OUTCOME MEASURES: Number of staff trained on EPI, coverage rates and perceived training needs of the mid-level managers. RESULTS: A total of eighty eight mid-level managers participated in the interviews. Most of these were District Public Health Nurses (40.9%) and District Health Information and Records Officers (23.9%). Only 49 (25%) of the District Health Management Team members had undergone training at the supervisory level. Eighteen districts (43.6%) had no member of the District Health Management Team that had ever been trained at the supervisory level. Using rates of Pentavalent 1 and measles coverage, Nyanza Province had the highest immunisation dropout rate (Pentavalent 1--measles) whereas Rift Valley Province had the lowest. The annual cumulative coverage for all the provinces by antigen was 80% for Pentavalent 1 and 2 and 60% for measles. The most requested need for inclusion in the training curriculum was maintenance of the cold chain equipment. CONCLUSIONS: Most of the members in the study area have not been trained on Expanded Programme on Immunisation and may be ill-equipped to manage the complicated programmes needed to maximise delivery of services. The immunisation coverage in this area is low while the dropout rates are high. We therefore recommend that all the mid-level managers of Expanded Programme on Immunisation in this area be trained comprehensively through the Merck Vaccine Network--Africa programme using the World Health Organisation approved mid-level managers course.

Socio-economic factors predisposing under five-year-old children to severe protein energy malnutrition at the Moi Teaching and Referral Hospital, Eldoret, Kenya.

BACKGROUND: Malnutrition is one of the leading causes of morbidity and mortality in children aged five years and below. Risk factors for severe protein energy malnutrition (PEM) have been identified as ignorance, family size, mothers and fathers education, poverty, residence, chronic infections, and congenital defects or malformations. The role of such social factors as the caretaker, extended family, homestead surroundings, and family cohesiveness have not been studied in Kenya. OBJECTIVE: To determine the social and economic factors that predispose children to severe PEM as seen at the Moi Teaching and Referral Hospital (MTRH), Eldoret. DESIGN: Prospective and case control study. SETTING: The MTRH, Eldoret, Paediatric wards, outpatient and MCH clinics over a 12 month period (June 2001 to June 2002). SUBJECTS: Sixty six children aged 3 to 36 months with severe PEM attending the MTRH outpatient clinics and those admitted in the Paediatric wards were age-matched with 66 controls. METHODS: A standard pretested questionnaire was used to interview caretakers with severely malnourished children and age-matched controls. The children were weighed after interviewing the caretakers. The data was entered on a computer and analysed using the statistical package for social sciences (SPSS) programme. RESULTS: The social risk factors for PEM were single mothers (Odds Ratio) OR 14.93, p= 0.00001), young mothers aged 15-25 years (OR 3.95, p= 0.00020), the child's living conditions such as living in a temporary house (OR 3.627 p= 0.00257), caretaker who was not married to the child's parent (OR 0.10, p= 0.00005) and not staying with both parents in the past six months (OR 0.28606, p=0.00101). The economic risk factors were father's lack of ownership of land (OR 0.401, p= 0.01732), cattle (OR 0.24, p=0.00022), not growing maize (OR 0.15, p=0.00013), not growing beans (OR 0.36, p=0.00484) and ownership of small piece of land by grandfather (OR 6.00, p= 0.02274). Other risk factors were incomplete immunization (OR 3.87, p= 0.00151) and female sex (p=0.03721). CONCLUSION: Poverty, social conditions under which the child was living, sex of the child and incomplete immunizations were risk factors for the severe protein energy malnutrition.

Perinatal mortality in the Special Care Nursery of Moi Teaching and Referral Hospital, Eldoret, Kenya.

OBJECTIVES: To determine the mortality rate and causes of death of all infants admitted to the Special Care Nursery (SCN) of a tertiary referral hospital in rural Kenya. DESIGN: Prospective and Cross-sectional study SETTING: Special Care Nursery, Moi Teaching and Referral Hospital, Eldoret, Kenya. SUBJECTS: All infants admitted to the Special Care Nursing (SCN). MAIN OUTCOME MEASURES: Survival status at seven postnatal days; major causes of mortality and morbidity. RESULTS: Three hundred and thirty five babies were studied between February and September 1999. Out of these 167 (49.9%) were male. There were 50 (15%) preterm and 124 (37.3%) low birth weight babies. There were 198 (76.2%) appropriate for gestational age (AGA), 46 (17.7%) small for gestational age and 16 (6.2%) large for gestational age babies. The seven day mortality rate of infants admitted to the Special Care Nursery was 66 (19.7%). Birth asphyxia and respiratory distress accounted for most deaths. Infants who were admitted primarily because the mother remained under general anesthesia generally did well. Logistic factors, including inadequate training for neonatal resuscitation in ward cadre of staff, unavailability of trained paediatricians and obstetricians, and inadequate operating theatre supplies were all found to delay treatment and likely to increase mortality. CONCLUSION: Morbidity and mortality of infants born at the MTRH remain high. The most common cause of mortality remains birth asphyxia. Some causative factors, such as lack of resources or personnel, are logistic and could be rectified. Antenatal care had a significant positive impact on both morbidity and mortality.

Knowledge, attitudes, and practices of private medical practitioners on tuberculosis among HIV/AIDS patients in Eldoret, Kenya.

BACKGROUND: Tuberculosis (TB) is one of the major communicable diseases afflicting mankind today. Its prevalence is increasing with increase in HIV infection. It is important that doctors be able to correctly diagnose and institute proper management of patients with TB. OBJECTIVES: To determine the knowledge, attitudes, and practices (KAP) of private medical practitioners in Eldoret on the management of TB. DESIGN: Cross-sectional descriptive qualitative study. SETTING: Private medical practitioners' clinics and the outpatient departments of private hospitals in Eldoret town, western, Kenya. Eldoret is a cosmopolitan town 350-km north west of Nairobi. It is the main town in the north Rift Valley with such infrastructure as roads, international airport, and banks. SUBJECTS: Private medical practitioners in Eldoret. RESULTS: Fifty three out of 70 private doctors were interviewed. Of these 84.9% were male. Only 5.7% knew that sputum for AAFBs is collected on spot, early morning, and spot, whereas 69.8% and 13.2% said it should be collected on three and six consecutive early mornings respectively. Sputum and chest X-ray were the most common investigations used to diagnose TB. Few doctors knew that the clinical features considered as suspicious for TB in children were failure to thrive (FTT) (20.6%), contact with open TB case (12.8%), and cough for more than two or more weeks (7.8%). Others wrongly considered cough for four or more weeks (9.2%). Features correctly considered of diagnostic value by a few of the private doctors in paediatric TB were: chest X-ray (19.8%), FTT (8.7%), positive sputum for AAFBs (8.7%), and history of contact with TB case (8.7%). A small number of doctors based their diagnosis on chest X-ray (38%), AAFBs (19%), and Keith-Jones criteria (6.3%). There were 16 regimes mentioned and used for the treatment of TB. The NLTP recommended regimes such as 2RHZ/4RH, 2RHZE/6HE, 2RHZ/6HE and 2SHRZE/1RHZE/5HRE, were used by 9(19.6%), 2(4.3%), 0% and 0% of the doctors respectively. The rest used unrecommended regimes and no doctor used the re-treatment regime of 2SHRZE/1RHZE/5RHE. Similar regimes were used for the HIV as for the non-HIV-infected patients. None of the interviewees had appropriate knowledge on all the areas of diagnosis, treatment, case recording, and follow up. CONCLUSION: Most doctors were not aware of the correct diagnosis and treatment of TB and many used unrecommended treatment regimes. They were generally unfamiliar with the recording system of TB cases. Most doctors did not know the definitions of the various re-treatment cases. Continuing medical education on clinical management of TB patients is needed for doctors in private practice.

Prevalence of asthma, allergic rhinitis and dermatitis in primary school children in Uasin Gishu district, Kenya.

OBJECTIVE: To establish the relative increase in the prevalence of asthma, allergic rhinitis and eczema in primary school children aged 13-14 years over a six year interval. DESIGN: Cross sectional comparative study. SETTING: Primary schools in three rural divisions at Uasin Gishu district in the Rift Valley Province of Kenya. METHODS: Three thousand two hundred and fifty eight children aged 13-14 years from seventy two primary schools in Uasin Gishu district were studied using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. All children in the selected schools in this age range whose parents gave consent were included. RESULTS: There were 47.4% males and 52.6% females as compared to 48.7% and 51.3% respectively in 1995. The cumulative prevalence for wheezing, rhinitis, itchy eyes and dermatitis was 23.6%, 43%, 24.1% and 28.5% respectively which were higher than for 1995 which were 21.2%, 32.4%, 11.8% and 13.8% respectively (p = 0.001). The period prevalence rates for wheezing, rhinitis and eczema were 13.8%, 31.4% and 21.3% respectively as compared to 10.2%, 25.3% and 14.4% respectively for 1995 (p = 0.001). The prevalence of asthma, allergic rhinitis and eczema was 12.6%, 38.6% and 28.5% respectively in 2001 compared to 6.6%, 14.9% and 13.9% respectively in 1995 (p = 0.001). CONCLUSION: There was a significant increase in the prevalence of asthma, allergic rhinitis and eczema in children in the study population over the last six years.

Aetiology of tinea capitis in school children.

BACKGROUND: Tinea capitis is a superficial fungal infection of the scalp and hair of the head which is common in children aged between two and eleven years. An endothrix infection is best treated using parenteral antifungal drugs while an ectothrix one may be treated by parenteral or topical antifungal drugs. The organism that commonly causes tinea capitis in the Western world is Trichophyton tonsurans while there is inadequate information on the actual causative agent in Kenya. OBJECTIVES: To determine the prevalence and the aetiology of tinea capitis and the fungal agents responsible for it and; to recommend the correct mode of treatment in school children attending a primary school near Eldoret. DESIGN: Prospective and descriptive study. SETTING: Private primary school near Eldoret town. SUBJECTS: Sixty eight primary school children aged between six and 14 years in classes 1 to 5. RESULTS: Of the 68 pupils included in the study, 60.9% and 39.1% were males and females, respectively. Prevalence of tinea capitis in the school was 33.3%. Peak age of infection was 10 years. Ratio of infected males to females was 2:1. There was a growth on culture in 76.1% of the cases all of which were endothrix. T. tonsurans was isolated in 77.8%, T. rubrum in four per cent of the cases. CONCLUSION: The prevalence of tinea capitis in this school was high. The most common cause of tinea capitis was T. tonsurans. Males were more infected than the females. RECOMMENDATIONS: Oral antifungal drugs with griseofulvin being the first line of treatment should be adopted. Health education on the aetiology, treatment and prevention of tinea capitis should be given.

Perinatal morbidity at the Moi Teaching and Referral Hospital, Eldoret.

BACKGROUND: Perinatal morbidity (PNM) is highest in the developing countries including Kenya. Studies on the perinatal morbidity in Moi Teaching and Referral Hospital (MTRH) have not been carried out. Furthermore, factors associated with PNM are unknown at the MTRH. OBJECTIVE: To establish the causes and incidence of perinatal morbidity at the MTRH NewBorn Unit (NBU). DESIGN: A retrospective study using case notes. SETTING: The NBU of the MTRH in Eldoret, Kenya. SUBJECTS: Babies who were admitted to the MTRH's Newborn Unit from January to December 1997. RESULTS: The perinatal morbidity was 667 per 1000 babies admitted to the NBU. The most common reason for admission was mother under anaesthesia. The most common cause of morbidity was asphyxia. The mean maternal age was 24 years. The mean level of education was 1.7 years. More than fifty five per cent of the mothers were housewives. The mean birthweight was 2.75 kg (+/- 0.9 SD), 55.9% had normal birthweight, 37% were low birthweight and three per cent were large babies. The mean duration of stay in the NBU was 3.8 days. CONCLUSION: Most of the admissions were Caesarean section babies who did not require admission. Younger mothers were more likely to have babies with neonatal sepsis, convulsions, pneumonia and asphyxia.

Health problems of street children in Eldoret, Kenya.

BACKGROUND: The street children phenomenon is an increasing problem in most cosmopolitan cities of the world including Eldoret, which is a fast growing town. With the growth of the town so is the increasing number of street children. It is therefore important to have baseline data on their health problems. OBJECTIVE: To determine the health problems of street children in Eldoret. DESIGN: A prospective and descriptive study. SETTING: Eldoret Town, Kenya. SUBJECTS: Eldoret street children aged 5-21 years. Type 1 street children were the "on" the street children who spent most of their time on the streets but went home in the evenings, type 2 were the "of" the street children who spent all their time in the streets and had severed their links with their families and did not have a home to go to, type 3 were abandoned children staying in a shelter and type 4 were normal primary school children. RESULTS: One hundred and ninety one children were studied. There were 38, 47, 56 and 50 types 1, 2, 3 and 4 children, respectively. The most common symptom was cough (28.9%) while frequent diagnosis was upper respiratory tract infection (URTI) (12.1%) followed by skin disease (50.9%) as the leading disease category. The common drug of addiction was cigarette (37.6%) and none of the school children was taking any drug of addiction. The prevalence of disease was 467 per 1000 children. Type 2 street children had the highest prevalence of disease (833 per 1000 children). Shelter children had the least disease prevalence (474 per 1000). Factors determining prevalence of disease were the same as in normal children. The malnutrition rate was high with 31.1% and 41.9% of the children being stunted and underweight, respectively. Type 3 children had the highest rate of malnutrition with 51.8% and 64.3% being stunted and underweight. CONCLUSION: Street children have a high incidence of childhood diseases. Factors determining occurrence of disease among street children are as in normal children. Respiratory and skin diseases were the leading causes of morbidity. Drug abuse was rampant among the street children but none of the school children abused any drug. Sexually transmitted infections were not prevalent. Most of the shelter children were malnourished. RECOMMENDATIONS: The government of Kenya should provide free health care for street children in public hospitals. Further studies should be carried out on the prevalence of sexually transmitted diseases based on laboratory testing and on the causes of the injuries suffered by the street children. The reasons for the poor nutritional status of the shelter children should be analysed and appropriate measures taken.