Acute febrile illness in Kenya: Clinical characteristics and pathogens detected among patients hospitalized with fever, 2017-2019.

Acute febrile illness (AFI) is a common reason for healthcare seeking and hospitalization in Sub-Saharan Africa and is often presumed to be malaria. However, a broad range of pathogens cause fever, and more comprehensive data on AFI etiology can improve clinical management, prevent unnecessary prescriptions, and guide public health interventions. We conducted surveillance for AFI (temperature ≥38.0°C <14 days duration) among hospitalized patients of all ages at four sites in Kenya (Nairobi, Mombasa, Kakamega, and Kakuma). For cases of undifferentiated fever (UF), defined as AFI without diarrhea (≥3 loose stools in 24 hours) or lower respiratory tract symptoms (cough/difficulty breathing plus oxygen saturation <90% or [in children <5 years] chest indrawing), we tested venous blood with real-time PCR-based TaqMan array cards (TAC) for 17 viral, 8 bacterial, and 3 protozoal fever-causing pathogens. From June 2017 to March 2019, we enrolled 3,232 AFI cases; 2,529 (78.2%) were aged <5 years. Among 3,021 with outcome data, 131 (4.3%) cases died while in hospital, including 106/2,369 (4.5%) among those <5 years. Among 1,735 (53.7%) UF cases, blood was collected from 1,340 (77.2%) of which 1,314 (98.1%) were tested by TAC; 715 (54.4%) had no pathogens detected, including 147/196 (75.0%) of those aged <12 months. The most common pathogen detected was Plasmodium, as a single pathogen in 471 (35.8%) cases and in combination with other pathogens in 38 (2.9%). HIV was detected in 51 (3.8%) UF cases tested by TAC and was most common in adults (25/236 [10.6%] ages 18-49, 4/40 [10.0%] ages ≥50 years). Chikungunya virus was found in 30 (2.3%) UF cases, detected only in the Mombasa site. Malaria prevention and control efforts are critical for reducing the burden of AFI, and improved diagnostic testing is needed to provide better insight into non-malarial causes of fever. The high case fatality of AFI underscores the need to optimize diagnosis and appropriate management of AFI to the local epidemiology.

The UWEZO project-musculoskeletal health training in Kenya.

A major cause of disability and pain, musculoskeletal conditions (MSC) affect all aspects of people's lives and have a significant socioeconomic impact. Access to early diagnosis, effective treatments and rehabilitation enables people with MSCs to maintain their mobility, to work and to have a good quality of life. Despite the significant impact of MSC on health, social and economic well-being in Africa, services for MSC health remain extremely under-resourced. The UWEZO project is a collaboration between Kenyan, UK and Swedish rheumatologists, patients and researchers. It aims to improve access to basic musculoskeletal health care at the local level in communities across Kenya through the development of a sustainable training programme to raise the knowledge and skills of health professionals working in the community in the early detection, diagnosis and management of MSC. A team of physicians and patients have been trained to deliver an MSC education programme to health providers working in 11 locations across Kenya. Over 500 health providers have been trained. The programme has the potential to be adapted for use in other low resource countries where access to care for musculoskeletal conditions is limited.