RICKETS IN RURAL KENYAN PRESCHOOL CHILDREN: CASE REPORT.

Clinical rickets has not been reported previously in Embu district, Kenya. Baseline clinical assessments performed for a nutrition intervention study in preschool children (n=324) identified 28 cases of rickets (8.6% of study sample). Clinical characteristics included: delays of sitting, walking, and teething; bone and chest deformities; widened wrists and ankles; and bowed lower extremities. Risk factors identified were short duration of breastfeeding with feeding of cereal-based supplements with little or no milk, low calcium intake, limited sunlight exposure. Vitamin D and calcium deficiencies likely contributed to these cases. Treatment with Vitamin D3 and milk resulted in clinical improvement.

The contribution of very low birth weight deaths to infant mortality.

BACKGROUND: Infant mortality remains high in many developing countries in which the contribution of deaths among infants born very low birth weight (VLBW) may be considerable. This contribution has however not been quantified in most such countries. This paper explores a model that can be used in this respect. OBJECTIVE: To determine the contribution of very low birth weight infants towards the overall infants deaths in Kenya. DESIGN: Prospective cohort study. SETTING: Kenyatta National Hospital, Pumwani Maternity Hospital and Kilifi District Hospital. SUBJECTS: Very low birth weight infants followed up for a period of one year. RESULTS: The neonatal, post-neonatal and infant mortalities for the cohort were 442, 139 and 581/1000 respectively. These were thirteen, three and seven times higher than the national averages respectively. Of the national birth cohort of 1,300,000 during that year, it was estimated that between 15,600 (1.2%) and 24,700 (1.9%) were born VLBW. Given this VLBW infant burden and extrapolating the infant mortality observed in this study to the general population, between 9,064 (8.9%) and 14,351(14.2%) of the 101,400 (78/1000) infants who die during infancy in the country are born VLBW. CONCLUSION: The cohort reports very high infant mortality for VLBW infants when compared to the general population. Despite constituting less than 2% of the birth cohort, these infants contribute between 8.9% and 14.2% of all infant deaths.

Comparison of blood smear microscopy to a rapid diagnostic test for in-vitro testing for P. falciparum malaria in Kenyan school children.

OBJECTIVE: To compare the diagnostic performance of microscopy using Giemsa-stained thick and thin blood smears to a rapid malaria dipstick test (RDT) in detecting P. falciparum malaria in Kenyan school children. DESIGN: Randomised, controlled feeding intervention trial from 1998-2001. SETTING: Rural Embu district, Kenya. The area is considered endemic for malaria, with four rainy seasons per year. Chloroquine resistance was estimated in 80% of patients. Children had a spleen rate of 45%. SUBJECTS: A sample of 515 rural Kenyan primary school children, aged 7-11 years, who were enrolled in a feeding intervention trial from 1998-2001. MAIN OUTCOME MEASURES: Percent positive and negative P. falciparum malaria status, sensitivity, specificity and positive and negative predictive values of RDT. RESULTS: For both years, the RDT yielded positive results of 30% in children compared to microscopy (17%). With microscopy as the "gold standard", RDT yielded a sensitivity of 81.3% in 1998 and 79.3% in 2000. Specificity was 81.6% in 1998 and 78.3% in 2000. Positive predictive value was 47.3% in 1998 and 42.6% in 2000, and negative predictive value was 95.6% in 1998 and 94.9% in 2000. CONCLUSION: Rapid diagnostic testing is a valuable tool for diagnosis and can shorten the interval for starting treatment, particularly where microscopy may not be feasible due to resource and distance limitations.

Two year neurological outcomes of Very Low Birth Weight infants.

BACKGROUND: High risk newborns such as the Very Low Birth Weight (VLBW) require long term follow up to ascertain their subsequent survival and quality of life (based on neurological intactness). Though such data is now standard in the developed world, little is known in published literature about the situation in resource constrained countries. OBJECTIVE: To describe the neurological outcomes of VLBW infants evaluated at two years of age. DESIGN: Longitudinal descriptive survey. SETTING: Kenyatta National Hospital's Newborn Unit during the year 2002. SUBJECTS: One hundred and twenty infants born weighing 1000 grams and 1500 grams followed up until the age of 24 months. RESULTS: Of the 120 infants evaluated, 14 (11.7%; 95% CI 6.2-17.1) had cerebral palsy, 11 (9.2%; 95% CI 4.8-16.9) were delayed on cognitive assessment while 32 (26.7%; 95% CI 9.3-38.1) were found to have functional disabilities. The factors associated with functional disability in the cohort included; neonatal illness (P = 0.005, 95% CI 1.26<2.43<4.69), exclusive use of breast milk in the first month (P = 0.02, 95% CI 1.10<2.04<3.78), neonatal weight gain less than 15 grams/kg/day (P = 0.014, 95% CI 1.13<2.24<4.42), history of re-hospitalisation (P<0.001, 95% CI 1.72<3.33<6.34) and weight less than the third percentile at two years (P = 0.019, 95%1.09<2.22<4.53). CONCLUSIONS: Neurological dysfunction was more frequent in this cohort than presently reported from other centres. The cross-tabulations indicate that history of neonatal illness, choice of early nutrition, slower growth and post discharge morbidity were associated with subsequent neurological dysfunction. The factors associated with developmental delay in this cohort should be explored further in order to determine the manipulations required in the newborn period for improvement of neurological outcomes among these high risk infants.

Early growth of very low birth weight infants.

BACKGROUND: Early growth in very low birth weight (VLBW) infants has been found predictive of their later outcomes. This has led to increased interest in establishing measures to optimise such growth. In facilities without the resources required to undertake long-term audits for all the high risk infants they graduate, these growth parameters may also be used as selection criteria for those meriting such follow up reducing costs. OBJECTIVES: To describe early growth patterns among a cohort of VLBW infants and determine some of the factors associated with poor growth among them. DESIGN: Cross section survey. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: One hundred and seventy five neonatal survivors. RESULTS: Of the 175 infants recruited, the male/female ratio was 4:6, sixty four (36.6%) were intrauterine growth retarded while significant illnesses during the neonatal period were reported in 109 (62.3%). Forty seven percent of the infants had been fed on exclusive breast milk, 33% on mixed feeds while 20% received exclusive preterm formula. The mean neonatal weight gain for the whole cohort was 13.5 (3.9) g/kg/day, length of 0.34 (0.11) cm/week and head circumference of 0.32 (0.71) cm/week. By term only 33 (18.9%), 37 (21.1%) and 48 (28%) had reached the expected (the 3rd percentile) weight, length and head circumference respectively. Sixty percent of the infants gained weight at <15 g/kg/day while 70% and 78% grew in head circumference and length at < 0.5 cm/week respectively. At term weight, head and linear growth faultering were recorded in 81%, 72% and 79% respectively. The factors that were associated with better growth at this stage included feeding on preterm formula (P < 0.001) and absence of neonatal morbidity (P < 0.001). Infants who were appropriate for gestational age at birth also had better catch up growth at term compared to those born small for gestation (P < 0.001) but their neonatal growth itself was not significantly better. CONCLUSION: The mean neonatal growth in all anthropometric measures was less than expected and by the time of their expected delivery, less than 30% of these infants had reached the 3rd percentile of the expected measurement in all the three growth parameters. Choice of milk and neonatal morbidity influenced these growth patterns. RECOMMENDATIONS: Routine fortification of mother's milk or addition of preterm formula and reorganised care of sick newborns is recommended to improve early growth.

Child battering in Nairobi, Kenya.

A survey of battered children was carried out at Kenyatta National Hospital, Nairobi between 1st May 1989 and 30th April 1990. Twenty eight cases were identified and compared with twenty six controls, matched for age and sex. The battered children were likely to be aged between three and four years, with slight male predominance. The abusing parents tended to live in crowded environments, were younger in age, less educated and were less likely to be practising contraception. They were relatively new migrants to Nairobi and were socially isolated. The socio-economic and cultural issues are discussed.

Training programmes run by African Medical and Research Foundation (AMREF)

With its commitment AMREF as a developmental NGO assists Ministries of Health in particular and NGOs engaged in health programmes to be self-sufficient in trained manpower resources. From what we can see above each of AMREFs six technical departments plays a significant role in the endeavour to produce the needed personnel for the governments of the countries where AMREF is working

A study of the efficacy and safety of albendazole (Zentel) in the treatment of intestinal helmenthiasis in Kenyan children less than 2 years of age.

One hundred children comprising of 57 males and 43 females aged between 8 and 24 months entered the study. 46 children had single and 54 children had multiple helminth infections. All children received albendazole 200 mg (10 ml) suspension as a single dose. Albendazole proved very effective and safe in the treatment of single and multiple helminth infections in children under 2 years of age, achieving cure rates of 100% in both Ascaris lumbricoides and Necator americanus respectively, 83% in Trichuris trichiura and 66% in Hymenolepis nana. Treatment of polyparasitism appears to be of benefit in improving nutritional status using haemoglobin concentrations as an index.

Analysis of false positive HIV-1 serologic testing in Kenya.

Sera of 95 mothers and 129 children from Nairobi, Kenya, collected in 1976, and of 466 adults and 193 children of Embu District, Kenya, collected in 1984 and 1985, were analyzed for the presence of human immunodeficiency virus type 1 (HIV-1) antibodies. Although no HIV-1 seropositivity was demonstrated by western blot analysis in both study groups, 7% of Nairobi mothers and 10% of adult females from Embu District had false positive results by enzyme immunoassay (EIA) compared with less than 1% seroreactivity rates observed in adult males and children. False positive results were not due to simian T lymphotropic virus type III (STLV-IIIAGM)/human T lymphotropic virus type IV (HTLV-IV) seropositivity. Sixty-one percent of the HIV-1 EIA reactive sera could not be explained by cytotoxic activity to lymphocytes bearing the HLA-DR4 or HLA-DQw3 phenotype. We conclude that false positive HIV EIA tests are frequently encountered in East Africa. Seroprevalence rates in rural Africa must be interpreted with caution due to the decreased specificity of HIV EIAs.