Impact Evaluation of the Kenya Frontline Field Epidemiology Training Program: Repeated-Measures Study.

BACKGROUND: In 2014, Kenya's Field Epidemiology and Laboratory Training Program (FELTP) initiated a 3-month field-based frontline training, Field Epidemiology Training Program (FETP-F), for local public health workers. OBJECTIVE: This study aimed to measure the effect of FETP-F on participant workplace practices regarding quality and consistency of public health data, critical interaction with public health data, and improvements in on-time reporting (OTR). METHODS: Between February and April 2017, FELTP conducted a mixed methods evaluation via online survey to examine outcomes achieved among all 215 graduates from 2014 and 2015. Data quality assessment (DQA) and data consistency assessment (DCA) scores, OTR percentages, and ratings of the training experience were the quantitative measures tracked from baseline and then at 6-month intervals up to 18 months postcompletion of the training. The qualitative component consisted of semistructured face-to-face interviews and observations. Quantitative data were analyzed using descriptive statistics and one-way analysis of variance (ANOVA). Qualitative data were transcribed and analyzed to identify key themes and dimensions. RESULTS: In total, 103 (47%) graduates responded to the survey. Quantitative analyses showed that the training significantly increased the mean DQA and OTR scores but there was a nonsignificant increase in mean DCA scores. Qualitative analyses found that 68% of respondents acquired new skills, 83% applied those skills to their day-to-day work, and 91% improved work methods. CONCLUSIONS: FETP-F improved overall data quality and OTR at the agency level but had minimal impact on data consistency between local, county, and national public health agencies. Participants reported that they acquired practical skills that improved data collation and analysis and OTR.

Point of care testing evaluation of lateral flow immunoassay for diagnosis of cryptococcus meningitis in HIV-positive patients at an urban hospital in Nairobi, Kenya, 2017.

OBJECTIVES: The objective of this study was to evaluate the performance of lateral flow immunoassay (LFA) against latex agglutination (LA), India ink and culture in point-of-care diagnosis of cryptococcus meningitis (CM). We conducted cross-sectional study among HIV-positive patients with suspected CM at Mbagathi Hospital, Nairobi, April-July 2017. RESULTS: Of 124 capillary blood and serum and 99 cerebrospinal fluid (CSF) samples, LFA and LA had a concurrence on serum of 94.4%, kappa (0.88), sensitivity (100%) and specificity (91%). LFA and LA on CSF, was 97.9%, kappa (0.96), sensitivity (100%) and specificity (96%). LFA and India ink was 96.9%, kappa (0.94), sensitivity (100%) and specificity (94.1%). On CSF culture, concurrence was 72.7%, kappa (0.43), sensitivity (100%) and specificity (64%) and of LFA on capillary blood, serum and CSF was 100% with kappa (1.00), sensitivity and specificity of 100%.

Cholera outbreak in Homa Bay County, Kenya, 2015.

Cholera is among the re-emerging diseases in Kenya. Beginning in December 2014, a persistent outbreak occurred involving 29 out of the 47 countries. Homa Bay County in Western Kenya was among the first counties to report cholera cases from January to April 2015. This case study is based on an outbreak investigation conducted by FELTP residents in Homa Bay County in February 2015. It simulates an outbreak investigation including laboratory confirmation, active case finding, descriptive epidemiology and implementation of control measures. This case study is designed for the training of basic level field epidemiology trainees or any other health care workers working in public health-related fields. It can be administered in 2-3 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating an outbreak in preparation for the actual real-life experience of such outbreaks.

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.