New therapies available: - KPA | Kenya Paediatric Association



BOOK OF ABSTRACTSADOLESCENT AND HEALTH BRIDGING THE GAP BETWEEN THE CAREGIVER AND ADOLESCENT ON SEXUAL REPRODUCTIVE HEALTHNguyen Q. Wanyoike W.University of Washington, Seattle. University of Nairobi, Nairobi. KEMRI, Kisii.Background: The adolescent age group comprises 24% of Kenya’s population. Adolescents are vulnerable to early and unintended pregnancy, unsafe abortion, female genital cutting/mutilation, child marriages, sexual violence, malnutrition and reproductive tract infections, including sexually transmitted infections (STIs) and HIV/AIDs. The median age at first sexual intercourse among men and women ages 20-49 is 17.4 and 18.0 years respectively and carries risks of sexually transmitted infections (including HIV/AIDS). Adolescents, ages of 10-19 years, represent about 9% of those living with HIV. The prevalence of HIV in adolescents between 15-19 years in urban and rural Kisii is 2.2% and 0.5% respectively.Early child bearing has risks of obstetric complications.Nyanza has one of the highest rates at 22%. Global organizations recommend comprehensive sexuality education (CSE), as the standard for adolescent Sexual Reproductive Health (SRH) education. CSE contributes towards reducing STIs, HIV and unintended pregnancy. Sexuality education that is delivered by trusted and trained adults is more effective in promoting healthy sexual behavior.Methods: A mixed methodology method was used. Data was collected through focus groups, questionnaires and key informant interviews. Knowledge gaps were identified and the caregivers educated. The qualitative data was analyzed identifying major themes from the focus groups. The quantitative data was analyzed using Excel. The caregivers’ pre- and post- intervention knowledge scores were calculated as percentages and compared. The statistical significance of the difference between the two test scores was calculated using the single tailed paired t-Test.Results: Discussing about sex is taboo in the Kisii community making it difficult for adolescents, parents and teachers to discuss. Key knowledge gaps identified included STIs, Cervical Cancer and Family Planning.Caregivers’ comprehensive knowledge on SRH significantly improved after the education (p <.01). Conclusions: Educating the caregivers on SRH improved knowledge in all aspects and were more willing to talk to their adolescents.ASTHMA & ALLERGY Does Phenotype Class matters in the Management of Asthma?Dr. Amukoye, CRO / KEMRIThe prevalence of asthma is controversial as researchers use different diagnostic tools in the surveys. The Global Asthma Report of 2014 () study undertaken between 2008 and 2010 estimates there are 334 million persons with asthma worldwide. In the International Study of Asthma and Allergies in Childhood (ISAAC)? ISAAC study in which KEMRI participated, the prevalence of asthma among the 14 years old population in Nairobi increased from 13% Phase one study to 17% in phase two, less than 10 years apart. Even though there are circumstances that this condition is overestimated, in most cases it is under diagnosed and undertreated leading to great suffering of the patients.The mainstay of management of asthma is steroid inhalers but even with proper use of this medication, there still is a percentage of patients who remain poorly controlled thus the need of add on’s or other remedies. The choice of what remedies to choose by and large has been a guess work. Recently many practitioners are now recommending classification of patient according to their phenotype to help guide on treatment. The classification can be based on triggers such as exercise induced bronchospasm, mono or multi triggers, allergic or non allergic asthma. Asthma phenotype classification may also be based on the duration of the disease, whether or not one has eosinophilia and lastly the obese asthma phenotype that is usually more difficult to treat. The new remedies are very expensive with potential severe side effects. With proper diagnosis, classification of phenotype and target treatment most asthmatics can be controlled and live a full life.Background: Despite optimum treatment for asthma up to 5 % of the patients remain uncontrolled. This is a literature review of the use of phenotype to more accurately assign treatment and help improve the control of the remaining 5%Methods: This is a review of the Asthma Phenotypes and remedies currently available for management. Literature search was done using the search term management of asthma phenotype 2015/2016 Results: A total of 58 papers for 2015 and 54 in 2016 were extracted. Using the title, we picked only those that had asthma and management in the title we then downloaded free full manuscript.Conclusions: Targeted treatment in management of asthma can reduce unnecessary side effect but does not lead to universal control KNOWLEDGE AND PERCEPTIONS ON CHILDHOOD ASTHMA AMONG PARENTS AND CARE-TAKERS OF CHILDREN WITH ASTHMA SEEN AT MOI TEACHING AND REFERRAL HOSPITALSimba, JM1, Marete, IK2, Waihenya, R1, Kombe, Y3, Mburugu, PM1, Mwangi, A2, & Ogaro, F4.1Jomo Kenyatta University of Agriculture & Technology, Juja; 2Moi University, Eldoret; 3Kenya Medical Research Institute, Nairobi; 4Moi Teaching and Referral Hospital, Eldoret.Background: In developing countries including Kenya, many children continue to visit hospitals with acute symptoms of asthma. For optimal self-management of asthma, patients and their parents/caretakers should be given asthma health education. Identifying knowledge gaps in asthma self-management and identifying existing myths is an important step in determining appropriate health education and demystifying the myths. The aim of this study was to identify the existing knowledge gaps and perceptions among the caregivers of asthmatic children.Methods: This was a cross sectional study. Parents and caretakers of asthmatic children aged 6-11 years seen at Moi Teaching and Referral Hospital during the study period were recruited. A questionnaire was used to collect data on knowledge and perceptions from the caregivers. Associations were assessed using Chi-square test. Analysis was done at 95% level of significance. Results: A total of 116 parent/caretaker were recruited of which 71.6% were mothers. Majority (75.9%) had attained tertiary level of education. Our cohort was largely urban (73.3%). Nearly 60% of the parents had asthma medications at home but only a third felt their children were asthmatic. Eight four (72.4%) had basic asthma knowledge. Syrups were preferred to inhalers by 70.7%, with 64.7% believing that inhalers were for the very sick. Preventer medications in asthma were felt to be necessary only by 36 (31%) of the caregivers. Acceptance of asthma as a diagnosis and presence of asthma drugs were significantly associated with better knowledge of asthma, p-values 0.015 and 0.009 respectively.Conclusions: While inhalers have been shown to work and are advocated for by national and international guidelines, most caregivers perceive syrups to be better, this is despite having good basic knowledge on asthma. This study provides evidence that there is need to address asthma perceptions among parents/caretakers in resource poor setting which is likely to improve control. CARDIOLOGYMYOCARDIAL INJURY, AS REVEALED BY CARDIAC TROPONIN T, IN CHILDREN ON CANCER CHEMOTHERAPY.Kimani E.W, Jowi C, Kariuki N, Wamalwa D.The University of Nairobi, Nairobi.Background: Use of chemotherapeutic agents has increased the survival of children with cancers. Their use is however limited by their toxicity profile, especially cardiac toxicities. It is thus essential to detect early cardiac toxicities of cancer chemotherapy so as to prevent occurrence of late cardiac toxicities including dilated cardiomyopathy. Cardiac troponins are the best known molecular markers of myocardial injury and have been shown to detect subclinical cardiac injury caused by chemotherapeutic agents much earlier than echocardiography (ECHO).Methods: The participants underwent Echocardiography before chemotherapy infusion. Patients with evidence of congenital heart disease or rheumatic heart disease were excluded. 24 hours after the chemotherapy infusion, the patients had an evaluation of the serum cardiac troponin T (cTnT) and a repeat ECHO. Patients were classified as having myocardial injury if the cTnT level was equal or greater than 0.014 ng/ml or if they had an Ejection fraction or a fractional shortening of <55% and <29% respectively on ECHO.Results: Of the 113 children who were enrolled, 100 children were included in the final analysis. Of these 32% had an elevated cTnT (CI 23.6%-43.6%) Vs. 8.5% (CI 4.9%-15.9%) who had abnormal ECHO parameters. Female patients were two times more likely to have an elevated cTnT (p=0.012).Exposure to an anthracycline was associated with an increased risk of an elevated cTnT (OR=1.877) and a cumulative anthracycline dose of >175 mg/m2 was associated with a 10 fold increased risk of an elevated cTnT. There was no significant association between elevated cTnT and abnormal ECHO parameters.Conclusion: Use of cancer chemotherapy is associated with biochemical evidence of myocardial injury even in the absence of echocardiographic features of myocardial injury.Hearts to Hearts: A Multi-professional advocacy for Rheumatic Heart Disease Prevention and Management in Uasin Gishu County.Nyariki Dilys KemuntoBackground: Rheumatic Heart disease (RHD), is a significant cause of cardiovascular disease in the world with the number of new cases in developing countries being on a constant increase. Each year, it is estimated that Kenya has approximately 200,000 new cases of rheumatic heart disease, making it among the world’s hardest-hit countries (World Heart Federation, 2007).RHD develops as a result of poorly managed Streptococcal infections that progresses to rheumatic fever and eventually RHD. The disease affects the young population, 5-25 year olds, majority of whom reside in poverty stricken areas with low social economic status. Quality health care and definitive management of the condition as is as such too costly or barely accessible to the affected. The inclusion of the RHD in World Health Agenda for May 2017 comes as an amplifier to the voices of advocacy in RHD. This project is therefore aimed at creating awareness, sensitization on the preventive measures and providing relevance guidance on access to quality health care of the affected.Objective: Our aim is to create awareness among the susceptible group on the existence of the disease, educating the predisposed community on preventive measures and creation of heart support groups that are geared towards :Creating a common community for the affected to share their individual experiences, ensuring accountability with regards to better understanding of the disease, identification of risk indicators and in ensuring adherence to treatment and providing a platform for advanced treatment opportunities to be availed to the patients.Methodology: The first phase of the project is expected to run between January and December 2017.It is a stepwise process that includes training of twenty members (students undertaking medicine, public health, medical psychology and law) of the Young Professional Chronic Disease Network (YPCDN) on the basics of the disease including prevention, diagnosis treatment and long term management including RHD in pregnancy. The volunteers will also be trained on presentation skills and the approach to primary school children. All sessions will be handled by professionals in the field. The team will then select 30 schools as a representation of each ward in the county and cover at least two schools a month with the knowledge being disseminated to the pupils and their teachers. A pre and post evaluation will be conducted during the visits and the feedback used during monitoring and evaluation at the end of the project.Current Progress: The volunteers have been selected and the majority of the trainings conducted. The school visits is expected to begin in the second week of March.CHILD DEVELOPMENTDEVELOPMENT EFFECTS ON CHILDREN WITH CLEFT LIP AND PALATESalome SitumaIntroduction:Help a child face tomorrow Is a non profit making organization which has widely done its reconstructive surgeries in Kenya (Wajir, Lodwar, Kakamega, Kisumu, Migori, Kwale County, Nyeri, Meru, Kisii, Kericho. Kapsabet, Bomet, Lungisa and Homabay. The organization is spearheaded by proffesor Meshack Onguti as the CEO. Outside the country it is also done in Bangladesh, Somali and RwandaDefinition: This is abnormal tissue or opening especially when result from failure of parts to fuse during embryonic developmentProblem Statement: Incidence of Cleft lip occurring as a single deformity is 1:3 in 1000, it could be Unilateral or Bilateral clefts in the palate can affect both hard and soft palate and this needs good lighting during initial examination. From the areas where surgeries have been done quite a number come with either cleft lip or palate or both especially in Wajir, Bomet, Narok, Migori etc. The most bigger population benefited from reconstructive surgery is 80% children 20% adult. Nutrition problems (underweight has been proved due to difficulties in feeding and the lowest weight recorded was 4kg for a 4year old baby. Children especially with Bileteral cleft lip palate have nutritional issues, expected weight is never achieved due to problems in feeding. Population have either reported of ear infections or chest infections which is due to aspiration of food. Methodology: Random sampling from all facilities that were randomly picked for reporting. Data collected from the number of reconstructive surgeries done through interviewing in each facility and identification of how many children were either nutritionally and developmental affected In Rwamagana Rwanda on 24-30 August, 2015 a total of 108Children -99Female-55Male -44Nutrition Effects:Of all 80% did not achieve their expected weigh of age, 20% who had cleft lips had relatively low weight. On 23rd March – 1st April, 2013 in Bosaso General HospitalIn Hargeisa Somali land 33 were repaired24% had developmental 28% Issues - impaired speech48%nutritional problem. Did not achieve expected weightMale = 69%Female = 31% In Migori 45 total nutritional issues – not expected weight 11/45 = 0.2%Developmental issues 5/45 = 01%On 3rd – 7th March, 2015 Kericho total nutrition problem was 8/33 and speech impalement was 2/33Bangladesh Mission:On 24th October, 2015 total surgeries was 76, 22% were childrenLips – 10Palate – 12Nutritional Effects palate – 77.2%Impaired speech 54.5%Conclusion: Cleft lip and palate has adverse effects both nutritionally and developmentally due to poor nutrition status and speech impaired undergoing trauma, stress, anxiety and depression. Early repair of cleft improves the nutrional status and development. Maternal nutrition may be one way contributing to incidence of cleftsRecommendation: Researchers they do research and find out what could be the probable causes of clefts. Research on whether after reconstructive surgery, does life become different, what of development especially speechAUTISM SPECTRUM DISORDER EARLY INTERVENTION USING NEW THERAPIES1Makali.P.S, Madu Madu M, Ngwiri.1Gertrude’s Children’s Hospital – Nairobi, Kenya.Background: Autism spectrum disorder (ASD) and autism are both a group of complex disorders of brain development. These disorders are characterized by difficulties in social interaction, verbal , nonverbal communication and repetitive behaviors. This review explored at comparing the old interventions and time of presentation/diagnosis for ASD comparing to new therapies which are started early.New therapies available: At Gertrude’s children hospital-child development centre, the neurodevelopment specialist assess all the children with developmental disorders and screen for other issues after which they are placed for specific management. For those requiring autism management were started on Combined therapies of Early Start Denver’s Model (ESDM),sensory integration and speech therapy or picture exchange communication therapy(PECS).Child Development Centre history: The Centre for Child Development was founded in August 2007 as part of Gertrude's Children's Hospital which is the only pediatric hospital in sub-Saharan region to cater for all children with developmental disorders. CDC is situated in the main campus at Muthaiga Nairobi at the basement.Intervention frequency: Children who were enrolled did three times in the hospital. Parents /caregivers of the children were also trained at the initial stage how to administer this therapies at home on daily basis.Intervention groupNumber improvedNumber not improvedTotalsTime of intervention1-3yrs1161712 months3years and above3121512 monthsTOTALS141832Outcome: Within one year of combined therapies , we have had 67% improvement in terms of social skills development, reduced hyperactivities, and development of verbal speech. 33% never improved and are continuing with these therapies at same frequencies.Conclusion: Combined therapies in the intervention of ASD produces good results when child presents early for intervention.Recommendations: Enhancement of processes directed at ensuring early diagnosis for ASD and intervention which increases the likelihood of a favorable outcome. Thus, regular screening of infants and toddlers for symptoms and signs of ASD is crucial as it allows for early identification of these patients.THE ROLE OF THE PEDIATRICIAN IN THE MANAGEMENT OF ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)NESBITT, N, GERTRUDE’S CHILDREN’S HOSPITAL, NAIROBIAwareness of Attention Deficit Hyperactivity Disorder (ADHD) is increasing amongst doctors, schools, media and the general public. This presentation aims to guide busy general paediatricians on when to suspect ADHD. Resources and diagnostic tools will be shared with paediatricians on how to start an “initial” assessment for ADHD. More detailed resources and training programs will be shared with those paediatricians interested in beginning to manage more children with ADHD in their practices. Recommendations on how to establish good working relationships with family, school and the community are shared. Resources that include easy to understand reading and video material will be shared. CHILD HEALTHA DESCRIPTIVE STUDY ON THE QUALITY OF CHILD CARE AT INFORMAL DAYCARES OF KARAGITA, NAIVASHASoma G.J, Ithondeka A., Ombiro O., Stewart J., Oliwa J.,Department of Pediatrics and Child Health; University of Nairobi, Naivasha Sub-County Hospital, University of Washington.Background: There has been a steady increase in the number of working mothers and subsequently the demand for childcare rmal, unregulated daycares are on the rise, especially in low-income country slums .Many daycares are congested, poorly ventilated, unsanitary and unsafe. Poor feeding practices, lack of stimulation and play are also reported.Karagita slum; a flower farm workers community in Naivasha, was identified as home to majority of children admitted at Naivasha Sub-county Hospital with diarrhea and malnutrition. We sought to map the location and characteristics of informal daycares in Karagita, to assess the quality of care and identify potential avenues to address child health issues. Methods: Thirty informal daycares were identified through community networks and snowballing within five days. Twenty one of 26 daycares visited were included in the study (Figure 1). Semi structured questionnaires were administered, quality of child care was assessed as per key household practices and informal daycares were mapped.Results: Problems highlighted were low rates of exclusive breastfeeding; poor complementary feeding ; poor sanitation ; inability to deal with a sick child; exposure to indoor smoke pollution; and poor child: caregiver ratios of 9:1.Care giver concerns included: lack of recognition; poor resources; lack of support; fear of closure and loss of livelihood; and challenges in caring for very young infants. Conclusion: Community IMCI interventions should target informal daycares for successful implementation of key household and community practices. Education, support for working mothers and improved access to water and sanitation are needed.Duration and determinants of exclusive breastfeeding among infants in Uasin Gishu and Nandi counties in Western Kenya: A Convergent Mixed Methods Design.NGETICH EK 1; NYANDIKO W 2, 3 VREEMAN R 3, 4; LIECHTY E 4.Moi Teaching &Referral Hospital(MTRH),Eldoret, Moi University School of Medicine, AMPATH, Eldoret, Indiana University School of MedicineIntroduction: Exclusive breastfeeding (first six months) in Kenya is only at 32 percent. Various studies have documented barriers to exclusive breastfeeding, but we carried out the mixed methods study to probe these reasons deeper. The objective was to assess duration of, barriers to, and promoters of exclusive breastfeeding among mothers to infants aged six to twelve months. Methods: This study was carried out (June to August 2015) at MTRH and Mosoriot Rural Health Centre. It involved a cross-sectional survey of 279 mothers using PI-developed, pretested, investigator-administered questionnaires.There were concurrent focus group discussions with 32 mothers. Quantitative data was analysed using STATA 13.0. Descriptive statistics were used for continuous data .Chi-square test and Fischer’s exact test were used to test for associations among categorical variables. The FGD dialogue was recorded, transcribed verbatim and the thematic content analyzed. Interpretation involved concurrent use of all the data. Research approval was given by the MTRH Institutional Research and Ethics Committee.Results: The mean duration of exclusive breastfeeding was 4.7 months. Only 28.3% of mothers interviewed exclusively breastfed for six months with lower numbers (6.1%) in Mosoriot compared to MTRH (27.6%).Barriers to exclusive breastfeeding included: Poor breastfeeding education (85%), Breastmilk not enough (36.9%), Mothers’ return to work (17%), Poor support at home (4.3%) and poor support at work (5.7%). Additional barriers (from the FGDs) included: maternal illness, and poor maternal nutrition. Promoters of exclusive breastfeeding included health education, spousal support, and community health workers outreach. Other promoters (FGDs) included positive maternal attitude towards exclusive breastfeeding, ability to express and store breastmilk, and more time with the baby. Conclusion: Rates of exclusive breastfeeding are still low in this population. Areas exist for possible intervention at community, hospital and policy level to ensure improved rates of exclusive breastfeeding.THE OUTCOME OF HEALTH INFORMATION TECHNOLOGY ON PATIENT CARE; CASE STUDY IN BUSIA COUNTRY TEACHING AND REFERAL HOSPITAL (BCTRH)Abade D O, Maseno University, School of MedicineIntroduction: First used for management and administrative purposes, electronic medical record (EMR) systems are now being increasingly employed to collect and synthesize medical information. The system offers support in medical decision making, promotes use of guidelines, increases coordination between different healthcare providers and is believed to improve the overall quality of care. There are still varied opinions on impact on cost and capacity of patient served. BCTRH the biggest hospital in Busia County, has Electronic health records (EHR), popularly known as SANITAS since its inception in 2015 in various departments. I initiated a study to access the outcome and the challenges faced. Objectives: Broad -To determine the outcome of HIT on patient care in BCTRH. Specific-To determine the advantages of HIT. To determine challenges and gaps of HIT system.Methodology: A cross-sectional survey was conducted using a self-administered questionnaire to evaluate use, quality and user satisfaction with EMR. Information was analyzed using SPSS software.Results: Out of 45 questionnaires distributed 33, 32 were analyzed. Overall, 24 (75%) of the personnel rated the current system as effective tool. Only 5 (15.6%) expressed difficulty with system, 19 (59.4%) have been trained on the system, 10 (31.3%) consider themselves computer semi-literate and 19 (59.4%) attested to the security of the system. On the cost, 7 (21.9%) feel the cost of medical care has been reduced.Conclusion: The medical records have come a long way from just being paper. EMRs have helped healthcare professionals focus on process, workflow, quality, completeness of records, timeliness, authenticity, point-of-care observation and documentation. Electronic medical records applications are complicated, yet EMR implementation positively affects workflow and practice efficiency in BCTRH. INITIATION OF THE CHILDHOOD ACUTE ILLNESS & NUTRITION (CHAIN) NETWORKSukhtankar, P; Tickell, KD; Tigoi, C; Olima C; Soreng, J; Mangale, DI; Bourdon, C; Denno, DM; Bandsma, R; Walson, J; Berkley, JA; on behalf of the CHAIN NetworkAffiliations: CHAIN Network, Nairobi, KEMRI Wellcome Trust Research Program, Kilifi; University of Washington, Seattle, USA; University of Oxford, UK.Background: Acutely-ill undernourished children have a greatly elevated risk of death despite implementation of current guidelines, both during hospitalization and following discharge from hospital. The CHAIN Network aims to better understand the mechanisms of their elevated risks in order to optimise the design of large-scale clinical trials to reduce mortality amongst this vulnerable group. Risk factors and target groups for intervention may vary between settings and between countries.Methods: This is a cohort study in Kenya (Migori, Mbagathi & Kilifi), Uganda (Kampala), Malawi (Blantyre), Bangladesh (Dhaka and Matlab) and Pakistan. Acutely-ill children admitted to hospital, stratified by mid-upper-arm circumference; and community participants not requiring hospitalisation are being enrolled. Acutely-ill children are treated according to national and WHO guidelines and followed-up until six-months after discharge. Exposures examined include biological (infection, immunity and metabolism), nutritional (intake and anthropometry) and social (maternal, household, economic, access to healthcare) factors. The main outcomes are mortality, re-admission to hospital and recovery of nutritional status. Sub-studies include qualitative of social science assessment, immune responses during recovery, antimicrobial resistance, enhanced tuberculosis screening and measurements of intestinal inflammation & permeability.Results: The CHAIN Network began recruiting in December 2016 and is expected to complete in 2019.Conclusions: Understanding the biomedical & social factors determining survival in vulnerable children will inform actionable interventions that, together with stakeholders, that can be developed and tested in clinical trials to inform policy.?IN SEARCH OF A DENOMINATOR: MAKING AUDITS MEANINGFULMyhre J, Ithondeka A, Ombiro O, Kinua E, Githura HNaivasha Sub-County Hospital (NSCH), Naivasha, KenyaBackground: The Kenyan Ministry of Health’s Basic Paediatric Protocols booklet includes policies on regular audits, for improving quality of care. Problem: Though inpatient neonatal mortality in Kenya has fallen from 30% to 17% over 20 years, neonatal deaths still comprise 60% of all under-5 childhood inpatient mortality. In a high-volume low-resource public hospital setting, reviewing only the number of deaths can lead to a sense of futility. We hypothesize that it is possible and beneficial to calculate a mortality ratio in a normal non-research clinical setting. Methods: We compared three methods of calculating a denominator for Newborn Unit (NBU) outcomes: (1) The Daily Bed Return (DBR) reports collated by the Medical Records department; (2) The number of billed files reported by the Finance department; and (3) The handwritten Nursing Register, counted manually from the pages at the end of the month. Results: Over a one-year period (Jan 2016 to Dec 2017) 1,662 infants were admitted to the NSCH NBU (138/month, range 44-212). The correlation coefficient between the DBR data and the Billing data was 0.89, between the DBR data and Nursing data was 0.99, and between Billing and Nursing was 0.92. The Nursing Register data also allowed quantification of gender, birthweight, mode of delivery, and Apgar scores. Using these denominators, inpatient neonatal mortality ratio averaged 10% (range 5%-14%), though the next challenge is to collect more complete death data.Conclusion: The high correlation coefficients indicate that any of the three data sources would provide an adequate denominator. Introducing mortality ratios could allow data to be compared between hospitals across the country, provides a basis for analyzing trends over time, and could prove beneficial to the motivation of providers by including survivors instead of only those who die. We suggest this be incorporated into the audit process across Kenya.References Kenya Basic Paediatric Protocols, 4th edition, February 2016, page 4.Aluvaala J, Nyamai R, Were F, et al. Assessment of Neonatal Care in Clinical Training Facilities in Kenya. Arch Dis Child 2015;100:42–47. Mwaniki MK, Gatakaa HW, Mturi FN, et al. An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years.?BMC Public Health. 2010;10:591. doi:10.1186/1471-2458-10-591.Aluvaala J, Okello D, Murithi G, et al. Delivery outcomes and patterns of morbidity and mortality for neonatal admissions in five Kenyan hospitals.?Journal of Tropical Pediatrics. 2015;61(4):255-259. doi:10.1093/tropej/fmv024.ROLE OF DEMOGRAPHIC AND HEALTH SURVEILLANCE SYSTEM IN FILLING THE GAPS IN CHILD HEALTH AND DEVELOPMENTOpondo W, Otieno W, Sifuna P, Tina L, Ogutu B,Ogwang S, Omollo KKEMRI/WRP Kombewa Health & Demographic Surveillance Systems, Kisumu, KenyaBackground: Building and maintaining an effective Health and Demographic Surveillance System (HDSS) remains vital to provide essential health information to set priorities, plan activities, allocate resources, implement prevention and developmental programmes, respond to outbreaks and evaluate control measures that affect child development. Routinely updated HDSS data helps identify gaps where applicable. The Kombewa HDSS has the crucial components of an effective HDSS including, the availability of routine updates, verbal autopsies and vital events reporting.Method: This paper employs decomposition method and analyses longitudinal data of 1259 children who were born in 2011 within the Kombewa HDSS and followed up during the bi-annual surveys conducted among approximately 145,011 individuals drawn from 34,718 households. The data collected showed the health and demographic dynamics in this population.Results: Of 1259 births reported in 2011, 77.5% were fully immunized, 19% were partially immunized while the immunization status of 3.5% was unknown. Immunization cards were available for 52.4%, were not available for 44.1% and were unknown for 3.6%. Use of insecticide-treated nets (ITNs) was 72.6%. At 5 years of age, 96.8% were still alive and 3.2% dead. Verbal autopsy was done for 70% of deaths with 50% attributed to infectious and parasitic diseases, 5% to nutrition and endocrine diseases, 5% to external causes and 10% being of unknown cause. Deaths occurred in hospital among 37.5%, 7.5% died enroute to a health facility, 25% at home and 30% at other locations. Among mothers, the highest level of education was primary at 74.4%, followed by secondary at 21.9%, college and university at 2.2% and 1.6% not attending school.Conclusion: The HDSS provided vital and timely data on the immunization coverage, ITN use, and common causes of death in children and the status of maternal education. A functioning HDSS therefore could be considered an effective tool for child health and development. COMPLIANCE WITH NATIONAL GUIDELINES ON DISPOSAL OF SOLID BIOMEDICAL WASTE: A CASE STUDY OF BUNGOMA COUNTY REFFERAL HOSPITAL, KENYA.Ngumi M. G, Maseno University, School of medicine, Kisumu.Background: Developing countries have extremely limited options for safe waste disposal. Kenya has been grappling with the problem of poor and ineffective management of Health Care Waste(HCW) from Health Care Facilities in the country. HCW poses a serious challenge in both public and private sector since no serious sustainable planning arrangements have so far been put in place.Methods: Qualitative data was collected using a prepared compliance checklist. This checklist was based majorly on the regulations by National Environment Management Authority (NEMA). The checklist was filled by site visit and interviewing key personnel (plant operator and sub-county public health officer).Results: Burn chamber. There was compliance except; A log of waste burned not kept, no firefighting equipment were installed in the plant site, there were no warning signs against eating or smoking on site.Deep burial. The landfill was overflowing and spilling to adjacent areas posing a great health hazard No fencing to keep off animals was present Recommended procedures for deep burial were not followed.Placenta pit construction. Compliant except; No ventilation pipe was in situ as per requirements No drainage channel was incorporated into the design of the placenta pits.Placenta pit use The use of the pit was compliant with regulations except that the cover slab was not cleaned and disinfected regularly as per recommendations and there were no markings to show date of closure.Conclusion: Bungoma county Referral Hospital was non-compliant in its disposal of solid biomedical waste. The hospital however excelled at the disposal of placentas with the worst performance in its use of a landfill to dispose biomedical waste.EXPLORING OPPORTUNITIES IN COGNITIVE COMPUTING FOR CHILD HEALTH: THE STONE-HMIS? EXPERIENCEGwer SA1, 2, Mueni D3, Oloo E3, Ombech EO3, Ndiritu MN3, 4Ubuntu-Afya Kiosk Programme, Afya Research Africa, Nairobi, KenyaDepartment of Medical Physiology, School of Medicine, Kenyatta University, Nairobi, KenyaInformatics and Epidemiology Department, Afya Research Africa, Nairobi, KenyaDepartment of Health Research, Kiambu County Government, Thika, KenyaBackground: Greater adoption of electronic systems to process paediatric patient data means more child health data is now being produced and stored in the digital space. If organized, the big data so generated provides opportunities to harness the power of artificial intelligence to provide greater insights in child health and disease. We share our experience in implementing our in-house modular STONE-HMIS? platform across our network of medical centres and utilizing cloud based artificial intelligence.Method: Since 2011, we have deployed a network of 27 community medical centres in rural and peri-urban areas of Kenya: Ubuntu-Afya Kiosks. To manage this network, we have implemented an in-house modular health management information system: STONE-HMIS?. STONE-HMIS? incorporates a community module, a registry module, a patient module that allows for both objective and free-text clerkship controlled with predictive text technology: guided by SNOMED and ICD-10 databases, a pharmacy, a lab module and an administrative module that also links with the DHIS2 database. To better manage the sites and the data, we have linked the site local area networks to a cloud server which feeds to cloud-based artificial intelligence systems.Results: Since January 2017, we have processed more than 2000 individual paediatric patient data. We have had to grapple with the challenge of unique identification for which we are now deploying biometric technology. We have presented the data to Google based deep learning cognitive computing solution and are working to figure out how to best discern and present the output. So far, we have determined significant occurrence of non-communicable diseases in children. We have also noted trends in non-adherence to wellness clinics and discrepancies in previous data collected and reported to the DHIS2.Conclusion: There is need to scale up programs to collect and organize data and feedback to workers in child health. CRITICAL CAREANTIBIOTIC USE IN SEPTIC SHOCK AMONG CHILDREN ADMITTED AT THE KENYATTA NATIONAL HOSPITALHirani V. Kumar R. Musoke R. Wafula EDepartment of Paediatrics and child health- University of Nairobi. Kenyatta National hospitalBackground: Paediatric septic shock is a major cause of mortality globally. Early empiric antibiotics in the first hour of recognition reduces mortality. Locally there are no studies and guidelines on antibiotics in septic shock. This study will guide our ways of practice.Objective: The purpose was to audit the antibiotic use among children aged 0 days to 5 years admitted at Kenyatta National Hospital (KNH) in 72 hours of recognition of septic shock. Methods: This was a cross sectional study carried out over 2 months (October- November 2016) at KNH. Ethics approval was obtained from KNH/UON-ethics board. An audit on the antibiotic use was carried in 72 hours. The data was recorded in a questionnaire. Data was analysed using STATA.Results: Empiric antibiotics were initiated in all 50 children included with septic shock on admission. Blood cultures were done in 24%. In 76% blood cultures were not done either it was not ordered by clinician or no bottles available. Monotherapy (72%) was the commonest choise followed by dual therapy (16%). In the first hour 88% received antibiotics. In 22.6% and 5.26% antibiotics were escalated at 24 and 48 hours respectively. Choise of antibiotic and time of administration to mortality was not significant (p=0.08, p= 0.16). The mortality at 72 hours was 70%.Conclusions: All children received empiric antibiotics on admission and 88% in the first hour. Blood cultures were done in a quarter of children. Monotherapy was the commonest choise. Antibiotics were escalated with clinical deterioration at 24 and 48 hours. The choise and time of initial empiric antibiotic was not significantly associated with mortality.PREVALENCE AND MANAGEMENT OF SEPTIC SHOCK AMONG CHILDREN ADMITTED AT THE KENYATTA NATIONAL HOSPITALHirani V. Kumar R. Musoke R. Wafula E, Chipkophe I.Department of Paediatrics and child health- University of Nairobi.Kenyatta National hospitalBackground: Paediatric septic shock is a major cause of mortality globally. Early recognition and goal directed therapy recommended by Surviving Sepsis guidelines reduces mortality. Locally the prevalence and outcome is unknown. Audit will assist improve our gaps in knowledge and provide the basis of development of local septic shock guidelines. Study objective: The purpose was to determine the prevalence, to audit the management and determine the outcome in 72 hours of septic shock among children aged 0 days to 12 years admitted at the Kenyatta National Hospital (KNH). Methods: This was a cross sectional study carried out over 2 months (September – October 2016) among all children admitted at the KNH. 325 children were enrolled. Ethics approval was obtained from KNH/UON-ethics board. Data was collected using standard questionnaire and analysed using STATA.Results: The prevalence of septic shock was 15.38% and highest in infants (82.5%). Male: female ratio was 1:1.8. All children diagnosed with septic shock had cold shock. 56% cases had hypotension. Septic shock was recognized in only 56% children by the attending clinician on admission. Optimal care based on the surviving sepsis guidelines were received in 0%, 6.9% and 20% at 1st hour of admission, 24 and 48 hours respectively. Mortality was 70% in 72hours and 54% died in ≤ 24 hours. Unavailability of mechanical ventilation on admission (p=0.03) and hypotension was associated with high mortality (p = 0.009). Conclusion: The prevalence of septic shock was 15.38% with high mortality. Septic shock was recognized in 56% children by the attending clinician. Optimal care at the Intensive care units due to limited bed capacity and resource limitations remains a challenge in the optimal care of patients at KNH.HIGH FLOW NASAL CANNULA IMPLEMENTATION FOR CHILDREN WITH LOWER RESPIRATORY TRACT DISEASE IN RURAL KENYAOkeyo B; Cook N; Muma S; Steere M; Roberts J; Stanberry L; Howard C; von Saint Andre AAIC Kijabe Hospital, Kijabe; Seattle Children’s Research Institute; Seattle Children’s/University of Washington, SeattleBackground: Acute lower respiratory infections are the leading cause of mortality among less than 5-year-old children in sub-Saharan Africa. Non-invasive ventilation is ideal for providing respiratory support, especially when intubation is unavailable. High Flow Nasal Cannula (HFNC) is a simple, effective method of non-invasive positive pressure respiratory support, thus far not reported used in Kenya.Methods: HFNC (Fisher Paykel) was introduced to ICU and HDU nurses, clinical officers and pediatricians through lecture-based and hands-on training. A local nurse HFNC champion performed training and quality improvement (QI) safety checks for all HFNC patients. HFNC was offered to patients aged 2 months-14 years with bronchiolitis, pneumonia or asthma, requiring admission to HDU or ICU, and delivered via weight-based titration protocol. Clinical management of enrolled patients was otherwise per standard care. Results: HFNC was offered to 13 patients between January - November 2016. Patients improved on HFNC over the first 2 hours with reduction in respiratory rate by 5.8 breaths/min (p=0.02), heart rate by 13.2 beats/min (p=0.05). QI safety checks, including correct HFNC flow limit and 60 min post-HFNC patient-provider check were completed on all patients. Five patients required intubation (38%), four died (30%), 11 required ICU care. Poor outcomes (intubation, death) were not attributed to HFNC by the care team. Following initial implementation, HFNC has turned into a nurse driven intervention. Conclusions: When supported appropriately, HFNC can be safely implemented in resource-limited settings. HFNC should be considered as respiratory support option where invasive ventilation is not available, but cost-effectiveness and further outcome data are needed. HAEMATOLOGYGOOD PERFORMANCE OF SICKLE SCAN? AS A POINT OF CARE DEVICEFOR RAPID DIAGNOSIS OF SICKLE CELL DISEASEOnsongo, SIntroduction: Sickle cell disease (SCD) is a life-threatening haematological disorder, affecting approximately 400,000 new-borns annually worldwide with a significant majority occurring in sub-Saharan Africa. Most parts of Sub-Saharan Africa are resource poor and diagnosis of sickle cell disease is often very late leading to late initiation into care. The current technologies for testing are expensive, not readily available in most areas and turn-around time for results is fairly long. We evaluated a new, rapid point-of-care diagnostic device called SickleSCAN? for qualitative detection of abnormal hemoglobins in Aga Khan Hospital Kisumu (AKHK)Methodology: Twenty known samples with HbA (3 samples), HbS (10 samples) and HbAS (6 samples) were subjected to both capillary electrophoresis and this new rapid point of care device- Sickle SCANTM (Catalogue No. CX J020, Lot No. 77-150706). Results from both methods were tabulated and compared. The final results from both methods were compared for both sensitivity and specificity.Results: Sickle SCANTM Point of care device showed a sensitivity and specificity of 100% when compared to capillary electrophoresis in qualitative detection of hemoglobins A and S in patient samples requiring very tiny volume of samples (6?L) and results were available within 5 minutes of testing.Discussion: Introduction of point of care devices promises to revolutionize the diagnosis of hemoglobinopathies in resource poor settings. Sickle SCANTM showed high sensitivity (100%) and specificity (100%) for rapid diagnosis of sickle cell disease. A study by Kanter et al also showed a sensitivity of 98.4% and specificity of 98.6% for diagnosis of sickle cell disease. Availability of these devices in areas where sickle cell is endemic will allow early and accurate diagnosis of sickle cell disease leading to early entry into care.QUALITY OF LIFE AMONG CHILDREN WITH SICKLE CELL DISEASE AT JARAMOGI OGINGA ODINGA TEACHING AND REFERRAL HOSPITAL (JOOTRH).Aluoch C. P.1, Otuoma G. M. 1, Mungai S. M. 1, Ouko R. J1.Maseno University, School of Medicine – Maseno, Kenya.Background: Sickle cell disease (SCD) is a gene linked blood disorder prevalent in areas of the tropics and subtropics which were endemic for malaria; although due to migration, this genetic disorder is now widespread in other parts of the world. It has been associated with early childhood morbidity and mortality, as well as a negative impact on quality of life, growth and development.Methods: This was a cross-sectional study of children with SCD and their caregivers who presented to JOOTRH between August and October 2015. The study set out to investigate the: quality of life and nutritional status of sicklers, nature of complications of SCD, and SCD management. Data gathered from questionnaires was analysed using Statistical Package for Social Sciences (SPSS) version 23.Results: Children (n=40; M = 6.781 years, SD = 3.468 years) with SCD and their parents participated in this study. The Paediatric Quality of Life Inventory (PedsQL) mean (SD) scores were as follows: physical 50.99 (25.56), emotional 67.05 (27.99), social 59.55 (29.34) and school 61.14 (22.42). Overall, males had higher Health Related Quality of Life (HRQOL) scores compared to females. Using mid upper arm circumference (MUAC), 20.0% of the children under 5 years of age (n= 15) had severe acute malnutrition, 33.3% were at risk of acute malnutrition, while 46.7% were well nourished. The most common SCD related comorbidity was acute pain crises at 85% followed by haemolytic crises at 65%. All the children used folate and paludrine with adherence rates at 95% and 85% respectively. Only 47.5% of the children took hydroxyurea with adherence rate at 15%.Conclusions: SCD continues to have a negative impact on quality of life of children with SCD. It is recommended that they should receive psychosocial support, better nutrition and medical management to ensure they not only survive, but thrive.THE SPECTRUM OF PATHOLOGIES FOUND IN BONE MARROW AMONGST CHILDREN BELOW 18 YEAR AT KENYATTA NATIONAL HOSPITAL, KENYA.Author: Dr. Baichoo-Audit. M.Affiliation: Department of Paediatrics and Child Health, University of Nairobi, Kenya.Background: Bone marrow examination (BME) is key for both haematological and non–haematological bone marrow disorders. BME consist of bone marrow aspiration (BMA) and bone marrow trephine biopsy (BMTB).Objectives: The primary objective was to describe the spectrum of pathologies found in BME among children below 18 years old at Kenyatta National Hospital (KNH). The secondary objectives were to describe common clinical presentations and to correlate the spectrum of pathologies with sex and age.Method: This is a descriptive cross-sectional study among children below 18 years with a BME done during the study period of 3 months. Reports of BMA/BMTB, clinical data and haematological parameters were recorded.Results: A total of 87 patients’ files and BME reports were analysed. Ages of the patients ranged from 6 months to 18 years. Males were 51 (58.6%) and females were 36 (41.4%). The peak age for the BME was 1 to 3 years (39.6%). The main findings were neoplastic disorders (51.3%) followed by reactive marrow (27.5%) and iron deficiency anaemia (5%). Acute lymphoblastic leukaemia (ALL) (66.6%) was the most common among the malignancies followed by acute myeloblastic leukaemia (11.9%) and neuroblastoma (9.5%). The commonest clinical presentations were pallor (51.2%), fever (32.5%) and bleeding manifestations (20%). Conclusion: Reactive marrow was the commonest benign haematological finding while ALL was the most frequent haematological malignancy found in BME among children at KNH.NEWBORN SCREENING FOR SICKLE CELL DISEASE AT KISUMU COUNTY HOSPITAL, KENYAKuta E. S. M.1 , Njuguna F. M.1 , Tenge C.N.1 and Ganda B.O.K.21 Moi University, College of Health Sciences, 2 Moi Teaching and Referral HospitalBackground: Sickle cell disease(SCD) has been acknowledged by World Health Organization(WHO) as a major public health priority. Newborn screening(NBS) for SCD coupled with provision of comprehensive medical care is one of the secondary preventive measures recommended by WHO. SCD has its highest prevalence in malaria endemic regions mainly the Coast and Nyanza regions in Kenya. NBS has been associated with a significant reduction in childhood mortality. NBS for SCD has not been adopted in Kenya, there is paucity of data on the acceptance of NBS and prevalence of SCD among newborns in Kenya.Objectives: To assess the acceptability of NBS for SCD, assess factors that influence acceptability and estimate the birth prevalence of SCD and SCT at Kisumu County Hospital, Kenya.Methodology: This was a cross sectional study carried out at Kisumu county Hospital. New-borns and their parent/guardian who met the eligibility criteria were recruited at the hospital’s postnatal ward. An interviewer administered questionaire was used to collect data from the parent/guardian. A blood sample was collected from the new-born by a heel-prick for new-borns whose parent/guardian gave consent for the screening test. The samples were analysed by isoelectric focussing and the results relayed to the parent/guardian. Those whose results were positive for SCD or sickle cell trait(SCT), Hb electrophoresis was done for those who returned for results. Results; Data was collected data from 1785 respondents and 1809 newborns over eight months. The acceptability of NBS for SCD was 99.4%, majority of those who declined cited fear of the unknown as a reason. Among the factors influencing acceptability of newborn screening for SCD, knowledge that SCD was preventable was the only statistically significant factor on multivariate analysis (OR 5.23, CI 1.29 -21.22). Knowledge that SCD was inherited was also significant on bivariate analysis (OR 0.12 (CI 0.02 -0.54). The prevalence of SCD and SCT among newborns during the study period was 57 (3.2%) and (250)13.9% respectively. One had HbFAC. Conclusion: New born screening for SCD was a highly acceptable intervention. In view of the high prevalence of the trait and disease in the study population, we recommend routine newborn screening for SCD in the Nyanza and Western regions. BURDEN OF ANAEMIA AMONG CHILDREN AGED 6-59 MONTHS AT ALUPE SUB-COUNTY HOSPITAL BUSIA, KENYA IN 2015 – 2016Gudu.E.1, Kiilu C.2, Omballa V.31 Alupe Sub County-Hospital, 2Moi University 3KEMRI-Center for Global Health ResearchBackground: Anaemia is a major cause of morbidity and mortality among children aged 6-59years. World Health Organization (WHO) states that it is a problem of global health concern that affects persons both in developing and developed countries. Methods: The study was carried out at the Alupe sub-county Hospital, a level 4 hospital located in Busia County (Altitude 1,200m above sea level). It aimed to characterize the disease burden of anaemia in children aged 6-59 months attending the hospital. It was a thirteen month retrospective cross-sectional study between May 2015 and July 2016, with a sample size of 497 persons. Check Haemoglobin and Full haemogram laboratory records were reviewed. Anemia was classified based on severity and red blood cell indices. Level of severity of anaemia was based on WHO classification. The necessary haemoglobin (Hb) level adjustments for altitude were made as recommended by WHO. Data was analyzed using Microsoft Excel? 2013 and Openepi? software. Results: The study population comprised 50.3% (250/497) females and 49.7% (247/497) males. The mean haemoglobin level was 8.9g/dl (SD 2.5; 95% CI 8.7 – 9.1). Majority of the children had anaemia (79.9% (397/497); 95% CI 76.1 – 83.2). Males had higher chances of anaemia during the period (OR 1.30; 95% CI 0.83, 2.03; p 0.25). Moderate anaemia comprised 52% (207/397) of the children with anaemia followed by severe anaemia at 28% (111/397) while mild anaemia accounted for 20% (78/397). Microcytic, hypochromic anaemia accounted for 71% (75/106) while normocytic normochromic only accounted for 8% (8/106) of the cases.Conclusion: The level of public health significance of anaemia is severe among children. Microcytic hypochromic anemia is the leading type of anemia. Studies on underlying factors in this population are necessary to advice on appropriate interventional strategies.HIVOPTIMIZING LINKAGE TO CARE, INITIATION AND RETENTION ON TREATMENT OF ADOLESCENTS WITH NEWLY DIAGNOSED HIV INFECTION, IN HEALTH FACILITIES IN HOMA BAY COUNTY.Ruria, E.C1, Masaba, R1, Kose, J1, Woelk, G 2,4, Mwangi, E1, Matu, L1, Ng’eno, H1,Bikeri, B1, Rakhmanina, N 2, 3, 4.1Elizabeth Glazer Pediatrics AIDS Foundation, Nairobi, Kenya.2Elizabeth Glazer Pediatrics AIDS Foundation, Washington DC, USA. 3Children’s National Health System, 4The George Washington University, Washington, DCBackground: Poor linkage to care and treatment (LCT), high loss to follow-up (LTFU) between testing and enrolment in care, and delayed initiation of ART contribute to adolescent HIV morbidity/mortality. The critical time period following a new HIV diagnosis requires prompt adolescent/youth-friendly LCT. In 2016, with funding by ViiV, EGPAF initiated an innovative project to implement and evaluate a comprehensive LCT and early retention program for adolescents and youth (15-21 years) in a high HIV prevalence (25.7%) Homa Bay County, Kenya. Methods: The Red Carpet Program (RCP) was adapted from a successful USA-based LCT model. A Youth-designed VIP Express Card provides clients with peer navigated fast-track access to HIV services, peer counseling (PC) and psychosocial support (PSS). The program provides training/sensitization to healthcare facilities (HCFs) and to schools to increase counseling and support to newly diagnosed adolescents/youth. The program evaluation protocol collects baseline and prospective data on HIV testing, new diagnosis, timing and outcomes of LCT.Results: RCP training and sensitization was implemented in 50 HCFs and 25 boarding schools, respectively. Within 6 months of program roll-out, 559 AY (F= 481; 86%) were newly-diagnosed with HIV (15-19 years n=277; 20-21 years, n=282). The majority (n=544; 97.3%) were linked to care compared to 56.5% at the baseline (p< 0.001). All (100%; n=559) AY received PC, PSS and the majority (n=430; 79%) were initiated on treatment. Retention on treatment increased from 64% to 90% (↑ 26%) at 3 months(p<0.001), and from 52.7% to 98% (↑45.3%) at 6 months (p<0.001).Conclusions: RCP significantly improved LCT and retention on treatment up at 6 months among AY. The ongoing study is collecting patient level data on the virologic outcomes and additional variables to enhance further capacity building of this promising approach.EFFECTS OF DISCLOSURE ON RETENTION TO HIV CARE AND TREATMENT AMONG ADOLESCENTS AGED 10-19 YEARS IN NYERI COUNTY: A CASE STUDY OF NYERI COUNTY REFERRAL HOSPITAL -KENYA.J Ouma1, D Mamai 2, Dr. A. McLigeyo3, Dr. F Njogu4.1. Centre for Health Solutions – Kenya, 2. Nyeri County Referral HospitalBackground: Ensuring disclosure and retention among adolescents plays an imperative role in enhancing ART adherence. According to Botswana Combination Prevention Project, an on-going clinical trial designed to measure how well a package of HIV prevention measures reduces the rate of new infections. Researchers at the Harvard AIDS Initiative and their colleagues at the Botswana Harvard AIDS Institute Partnership alludes to a June 2016, paper in the Lancet HIV, showing that Botswana is close to reaching the ambitious UNAIDS 90-90-90 goals. In order for desired prevention goals to be effectively met, there is need for adequate investment in adherence and retention. Center for Health Solutions - Kenya (CHS) has contributed to 90% and above retention between 2014 and 2016 among adolescents. This study aims at establishing disclosure and retention rates among adolescents (10-19 years) at a CHS supported County Referral Hospital.Objective: To establish disclosure, retention and treatment adherence among adolescents living with HIV from Nyeri County Referral Hospital.Methods: The researcher conducted a desk review of clients’ charts and psychosocial support groups (PSSG) meeting minutes to extract data using a data abstraction tool. The core interventions included; caregiver supportive disclosure, enrollment to adolescent PSSG, and adolescent centered medication adherence counselling. All this embraced adolescent empowerment, leadership and information sharing. A sample of 134 adolescents aged between 10-19 years was included in the study. These were adolescent initiated on ART between January 2013 and December 2015 and had attended PSSGs at least four times. All mentally challenged adolescents were excluded from the study.Results: 92% retention was recorded among adolescents with full disclosure; while 82% was recorded among those with partial disclosure. Where disclosure was not done, retention was at 64%. REVALENCE, BARRIERS AND FACILITATORS OF AGE APPROPRIATE TRANSITION FROM PAEDIATRIC TO ADULT CARE AMONG HIV INFECTED ADOLESCENTS AT KENYATTA NATIONAL HOSPITALGrewal G.K, Obimbo E.M, Wamalwa D, Inwani IUniversity of Nairobi/Kenyatta National Hospital, NairobiBackground: Rates of HIV infection among adolescents in Kenya continues to rise and due to wide access to life saving anti-retroviral, there has been an improvement in survival rates, resulting in more individuals who must eventually transition from paediatric to adult care. This study determined the proportion and described barriers and facilitators to age appropriate transition of HIV infected adolescents from pediatric to adult HIV services presenting between the age of 15 to 24 years at the KNH.Methods: This was a mixed method study conducted at the CCC, KNH. 96 HIV infected adolescents between the ages of 15 -24years were recruited using consecutive sampling over a period of four months. A standard questionnaire was used to determine the disclosure and transition status. In depth interviews were conducted with a total of 38 HIV infected adolescents and 11 key informants using purposive sampling approach.Results: Sixty seven percent of HIV infected adolescents had transitioned into adult care by the age of 19yrs. Most participants described feeling unprepared for transition and described anxiety and specific worries during the transition process. We identified four main barriers to transition to adult care: fear of letting go of the bond that the adolescents and health care providers had formed over the years, stigma and discrimination, difference in care between pediatrics and adult clinics and poor preparedness on transition. Three main facilitators were identified: being independent and having sense of responsibility, early preparation to transition and a strong social support system.Conclusion: Two thirds of adolescents had transitioned to adult care however significant barriers remain including stigma. The major facilitator for successful transitioning was adolescents who were exceptionally mature for their age and took ownership over their care.NUTRITIONAL PERSPECTIVES OF EXCLUSIVE BREASTFEEDING IN THE CONTEXT OF MATERNAL HIV INFECTION IN BUSIA COUNTY OF WESTERN KENYAAuthors: Nabakwe E.C 1, Egesah, O.2, Ettyang, G.A 3, Ann, M.4, Akong’a J.J 3.1 Department of Child Health and Paediatrics, School of Medicine, Moi University, Eldoret, Kenya, 2 Department of Anthropology and Human Ecology, School of Arts and Social Sciences Moi University, Eldoret, Kenya, 3Department of Nutrition, School of Public Health, Moi University, Eldoret, Kenya4 Department of behavioral Sciences, School of Medicine, Moi University, Eldoret, KenyaBackground: Contrary to the African society norm, WHO recommends exclusive breastfeeding (EBF) for 6 months with antiretroviral drugs (ARVs) for the mother-infant dyads. HIV-infected mothers might be in dilemma whether or not to EBF. Method: A cross-sectional mixed methods study described household food security and determined maternal and infant nutritional status in relation to EBF during the first 6 months in the context of maternal HIV infection. Socio-demographic, cultural beliefs, infant feeding practices data was collected. Maternal and infant anthropometry and hemogram were measured. Health workers were observed on skills of infant feeding counselling and nutritional assessment. Results: Ninety four percent of the mothers EBF; main support was food. Cowpeas was believed to reduce while busaa (local impure alcoholic drink) and exercise increased breast milk; fat mothers produced enough breast milk. Nutritional status of subjects who EBF or not, anemic and non-anaemic was similar. Nutritional status of infants of underweight, normal, and overweight mothers was significantly different (p = 0.007). Subjects were not examined for anemia; 75% of infants and 29% of mothers were anemic. Maternal and infant hemoglobin based on maternal ARV treatment was significantly different (p = 0.036, 0.009 respectively). Conclusion and recommendation: Anemia is a public health problem among HIV-exposed EBF infants. Hemogram of EBF infants and mothers on ARVs should be monitored. EBF HIV-infected mothers and infants need nutritional supplementation. ANTIBODY RESPONSES TO HEPATITIS B SURFACE ANTIGEN FOLLOWING ADMINISTRATION OF RTS,S/ASO1ETO HIV- INFECTED AFRICAN INFANTS AND CHILDRENSing’oei.Va Otieno.La, Oneko.Mb,Otieno.Wa, Abuodha.Jb,?Odero.Cg, Mendoza Yc, Andagalu Ba, Awino Nb, Ivinson.Kd,?Otsyula.Nf,? Oziemkowska.Mb, Otieno.Aa,? Otieno.Kb,?Cowden.Ja , Kariuki.Sb , Oyieko.Ja, Slutsker.Le, Lievens.Mc, Ogutu.Ba, Hamel.Mb*Introduction: The RTS, S/AS01E vaccine has been evaluated for efficacy, safety and immunogenicity in infants and children. It consists of sequences of the circumsporozoite (CS) protein and hepatitis B surface antigen (HBsAg), making it also a hepatitis B vaccine.Methods: A Phase III trial was conducted at two centers in Kenya from July 2010 to May 2013.Two hundred infants and children aged 6 weeks to 17 months whohad HIV stage 1 or 2 , were randomized in a ratio of 1:1 to receive either theRTS,S/AS01E or rabies control vaccine each administered in 3 doses 1 month apart.They received Hepatitis B vaccine prior to or during the study at 6, 10 and 14 weeks of age. Anti-HBs titers were measured prior to vaccination, 1 month post Dose 3 and 12 months post Dose 3 and the percentage of subjects with seroprotective levels of anti-HBs (10 mIU/ml and100 mIU/ml) determined.Results: Based on a threshold of 10mlU/ml,at baseline 57.1% (95%CI: 45.4-68.4) of individuals on the RTS,S/AS01E arm and 54.8% (95%CI: 42.7-66.5)of individuals on the rabies vaccine arm had seroprotective titers with anti-HBs Geometric Mean Titers (GMTs)of 24.1 mIU/ml (RTS,S/AS01E arm) and 19.2 mIU/ml( rabies arm). One month post-dose 3, 100% (95%CI: 95.1-100) of subjects in theRTS,S/AS01E arm and 52.3% (95%CI: 39.5-64.9) in the rabies arm were seroprotected with anti-HBs GMTs of 13,637.6 mIU/ml ( RTS,S/AS01E arm) and 19.9 mIU/ml (rabies arm). Twelve months post-dose 3, 100% (95%CI: 94.9-100) of subjects in the RTS,S/AS01E arm and 39.1% (95%CI: 27.1-52.1) in the rabies arm were seroprotected with anti-HBs GMTs of 2,294.8 mIU/ml(RTS,S/AS01 arm) and 11.8 mIU/ml (rabies arm).Conclusion: The RTS,S/ASO1E vaccine generated a strong immune response to HBsAg.Therefore,it could have the additional benefit of providing protection against Hepatitis B to children who have not been fully protected through routine vaccination.ANALYSIS OF THE INFLUENCE OF HIV ON THE IN-PATIENT MORTALITY OF SEVERELY MALNOURISHED CHILDREN IN OBAMA CHILDREN’S HOSPITAL (OCH) WITHIN JARAMOGI OGINGA ODINGA TEACHING & REFERRAL HOSPITAL(JOOTRH), KISUMURobert Kiobo – C.O. (Paeds), Christine Makori – C.O (Paeds) & Jane Olum – Paediatric NurseBackground: HIV disease progression is faster in children with severe acute malnutrition (SAM). HIV and SAM are immunosuppressive diseases so when they co-exist, they influence child mortality. Hospital based data on paediatric mortality patterns is a good reflection of the actual causes of deaths and the interventions initiated to mitigate their medical conditions upon arrival in the hospital and thereafter. Therefore data obtained from such review is actually beneficial in re-evaluating existing services with a view of improving the facilities and paediatric services offered leading to mortality reduction in the paediatric age bracket.Objective: To find out the correlation between HIV and mortality in children with Severe Acute Malnutrition admitted at JOOTRH Malnutrition Room.Method: Data of all children admitted in JOOTRH Malnutrition Room from 1st January 2016 to 31st December, 2016 were retrieved and relevant information was extracted.Results: There were a total of 96 admissions in the malnutrition room. Thirty four (34) died accounting for a mortality rate of 35.4% of which a sum of twenty (20) patients (20.8%) died due to HIV infections co-morbidities while on care. Eleven (11) patients (11.4%) died within 24 hours of admission, out of these; four (4) patients were confirmed to be HIV positive: Two of them were on care, while 2 were not at the time of their death. The remaining seven (7) were HIV negative. Fourteen (14) patients (14.5%) died due to other paediatric medical conditions not related to HIV infections like, hypoglycemia, hypothermia, shock, gastroenteritis, pneumonia and malaria in that order. All patients were managed as per the GoK Basic Paediatric Protocols.Conclusion: Twenty (20) out of thirty four (34) deaths were attributed to HIV infection while fourteen (14) deaths were due to other medical conditions not related to HIV infection.Recommendations: HIV infection plays a major role in the deaths of children with SAM at JOOTRH.INFECTIOUS DISEASESANTIBIOTIC PRESCRIBING PATTERNS AMONG PAEDIATRIC INPATIENTS AT NYERI COUNTY REFERRAL HOSPITAL, JUNE TO OCTOBER 2015Gakii Mercy3, Muchemi Onesmus2, Waqo Boru11.Kenya Field Epidemiology and Lab Training Program (FELTP), 2. Nyeri County Department of Health, 3. University of NairobiBackground: Irrational antibiotic prescribing is a major public health problem especially in resource-limited countries. Kenya has guidelines that govern paediatric practice and these have been shown to affect the antibiotic prescribing patterns. Drug prescribing is a pivotal step in antibiotic utilization. Our objective was to describe antibiotic prescribing patterns among paediatric inpatients at Nyeri County Referral Hospital between June and October 2015.Methods: This was a retrospective descriptive study carried out between 12th October and 4th December at Nyeri County Referral Hospital. Data were extracted from an existing database and analyzed using SPSS.Results: A total of 794 paediatric patients were admitted to the paediatric ward between June and November 2015. The median age of the patients on antibiotics was 18 months with a range of 30 months. Majority of the patients were male (61%) with 464 (58.3%) of them having been prescribed at least one antibiotic. Six hundred and six courses of antibiotics were prescribed to the 464 patients and 190 (40.5%) patients were prescribed more than one antibiotic. Popularly prescribed antibiotics were amoxicillin (36.8%, n= 223); penicillin (15.5%, n=94) and ceftriaxone (12.9%, n= 78). Among the patients prescribed antibiotics, 62 (13.4%) had a primary diagnosis of pneumonia. The parenteral route was prescribed in 272 (44.8%) of the prescriptions. Mean duration of hospitalization was 4.56 (±3.726) days among those prescribed antibiotics and 4.39 (±3.728) days among those not on antibiotic therapy. Thirty three clinicians admitted the patients. Twelve (37.5%) were medical officer interns and 20 (62.5%) were clinical officer interns. Of the 190 patients prescribed more than one antibiotic, 163 (85.8%) were admitted by medical officer interns, 25 (13.2%) by clinical officer interns.Conclusion: Antibacterial agents were the most commonly prescribed drugs with Penicillin being the most popular drug choice.COST-EFFECTIVENESS OF BIOMARKER ASSITED ANTIBIOTIC THERAPYBecze, Zsolt MDCounty Hospital Siófok, Department of ENT, Siófok, HungaryBackground: The use of procalcitonin (PCT) as a surrogate biomarker is an approach to more tailored management of systemic infections and guidance of antibiotic therapy. PCT can help us in finding the etiology and diagnosis of febrile conditions both in Emergency Rooms (ERs) and Intensive Care Units (ICUs). The highest value of PCT to be able to change the therapeutic decision, shorten the antibiotic duration and exposure, reduce the costs related to an antibiotic therapy on a direct (reduction of the antibiotic cost) and indirect (reduction of length of stay in hospital/ICU and appearance of multi-drug resistant pathogens) ways. PCT can be used to reduce antibiotic duration in different settings and infections with similar medical outcomes, and latest studies show that due to the meticulous check of the patients, the mortality also can be lower in case PCT is a routine part of the antibiotic stewardship. In these terms, its use has been best documented in respiratory tract infections (RTIs) and sepsis. The kinetics of the marker is coding the prognostic value in bacterial infections and sepsis as decreasing kinetics is associated with good, while increasing or stagnating PCT levels are associated with poor clinical outcome. PCT guidance has a differential effect on initial prescription and/or cease of antibiotic therapy depending on the severity of infection and/or the clinical setting. Important to note that one hour delay with the appropriate antibiotic (ATB) administration results in roughly 8 % increase in the mortality of septic patients. Shortening antibiotic exposure has been shown to significantly reduce the risk of antibiotic-related side effects in individual patients and reduce the incidence of multidrug resistance on a population level beside the economic benefits. Other biomarkers like interleukin 6 (IL6) and C-reactive protein (CRP) are also widely used in the management of severe bacterial infections. A comparison made between different biomarkers could be a useful tool in the choice of the right one to be used in the clinical routine. However, future intervention trials are needed to broaden the knowledge of PCT guidance in non-European countries, PCT can be a very versatile tool in the hands of physicians to detect severe bacterial infections early and manage the antibiotic treatment wisely.Results and Conclusion: The author also will demonstrate own experiences regarding daily routine use of PCT in intensive care settings and show examples how to reduce the antibiotic administration on a safe and rational way. These case presentations will cover bacterial, viral and fungal infections as well. PCT behaves differently in these infections and the ability to interpret of the values is important to make the relevant clinical decision.ANTIBIOTIC RESISTANCE PATTERNS AMONG COMMENSAL E. COLI IN CHILDREN UNDER 5 YEARS DISCHARGED FROM TWO REFERRAL HOSPITALS IN NYANZA.Singa Bi, Pavlinac Pii, Liru Miii, Bogonko Giv, Rwigi Di, Brander Rii, Tickell Kii, Belanger Sii, Amondi Mi, McGrath Ci,ii, Kariuki Si, Walson Jii.Affiliations: Kenya Medical Research Institute, University of Washington, Homa-Bay Teaching and Referral Hospital, Kisii Teaching and Referral HospitalBackground: Antibiotic resistance (ABR) is a global public health issue of significant concern in the developing world, where treatment options are limited due to cost and availability. Few studies in Kenya have compared ABR patterns across diverse locations that vary in their patterns of antibiotic use and HIV prevalence. Methods: We compared ABR patterns in commensal Escherichia coli (E. coli) isolates from children <5 years of age participating in an ongoing clinical trial of azithromycin to prevent post-discharge mortality at Kisii and Homa Bay Referral Hospitals. Children were eligible to be enrolled in the study at discharge if they were admitted to the hospital for a diagnosis other than trauma and not prescribed macrolide antibiotics at hospital discharge. Enrolled children were randomized to receive a 5-day course of azithromycin or placebo. At enrolment, stool culture was performed and a subset of E. coli isolates underwent Antimicrobial Susceptibility Testing (AST) using disc diffusion method.Results: As of January 31, 2017, 132 children were enrolled; 60 children were enrolled at Kisii and 72 at Homa Bay hospitals. E.coli was isolated from 129 children (98%) of the children enrolled at hospital discharge, a random subset of 43 (33%) children were tested for ABR. In Kisii, resistance to ampicillin (100%), cotrimoxazole (92%), chloramphenicol (53%) and ceftriaxone (39%) was common. Similarly in Homa Bay, the prevalence of resistance [ampicillin (92%), cotrimoxazole (94.%), chloramphenicol (35%) and ceftriaxone (12%)] was high. The prevalence of extended-spectrum beta-lactamase (ESBL) producing strains was 12% in Kisii and 39% in Homa Bay (p-value=0.085) Conclusion: Rates of ABR in E. coli isolates were high in both sites, with a trend towards higher ESBL prevalence in Homa Bay compared to Kisii. These findings are concerning, as ABR genes in commensal E. coli may be transferred to other bacterial pathogens. ROLE OF PROCALCITONIN IN THE MANAGEMENT OF ANTIBIOTIC THERAPYLakatos B, Becze ZsAffiliation: Saint Laszlo Hospital National Center for Infectious Diseases, Department of Infectious Diseases, Budapest, HungaryBackground: Procalcitonin (PCT), a protein of 116 amino-acids was discovered as a precursor prohormone of calcitonin. Circulating levels of PCT in healthy subjects are below detection limit, however serum concentrations of PCT are elevated in systemic inflammation, specifically if it is caused by bacterial infection. It has been suggested that in initiating and terminating antibiotic use PCT might have a beneficial role. Methods: Systematic review of literature.Results: PCT guidance for antibiotic discontinuation reduces antibiotic usage in adult patients in intensive care units without increasing mortality. PCT guidance for initiating and discontinuing antibiotic therapy significantly reduces antibiotic prescription rates and duration of use in patients with acute respiratory tract infections. Data to support a role for PCT guidance in the pediatric population is increasing in the literature.Conclusion: Evidence shows that using PCT, which reflects the likelihood of bacterial infection, to guide antibiotic therapy might lead to a more rationale antibiotic treatment strategy.MALARIAMALARIA VACCINE DEVELOPMENT, HOPES FOR ROLL OUT AND WAY FORWARD!Otieno W1,2, Otieno L1, Sing'oei V1, Kariuki S3, Njuguna P4, Odero C5.Affiliations: KEMRI-WRP1, Maseno University School of Medicine2, KEMRI-CDC3, KEMRI-CGR-Kilifi4.PATH5 Background: Between 2009 and 2014, three Kenyan Research sites were among the 11 African sites who conducted the RTS,S/AS01, a pre-erythrocytic stage vaccine trial in 7 African countries. The RTS,S/AS01 malaria vaccine showed protection against Plasmodium falciparum malaria, an acceptable safety profile, and immunogenicity in infants and children. Methods: This was a double-blind, randomized, controlled trial done in 11 centers in 7 African countries with a wide range of malaria transmission intensities ranging from 0.03-4.27 clinical episodes per infant during first 12 months of follow-up. In total we recruited 15,459 children enrolled in two age categories: 5–17 months (8,922) and infants aged 6–12 weeks (6,537). Results: The Phase III efficacy and safety trial concluded in January 2014. RTS,S/AS01 prevented a substantial number of cases of clinical malaria over a three- to four-year period in children and in young infants when administered with or without a booster dose, especially in areas with higher malaria transmission. Efficacy against severe malaria over the entire study period until study end was only observed in the older group of children who received a booster dose of RTS,S/AS01. Finally, vaccination with RTS,S/AS01 in children reduced overall hospital admissions, admissions due to malaria, severe anaemia, and the need for blood transfusion, with these protective effects being more marked in children who received a booster dose Conclusions: A positive scientific opinion from EMA on the quality, safety, and efficacy of RTS,S has paved the way for WHO recommendation, WHO prequalification and Marketing Authorisation applications to National Regulatory Authorities (NRAs) in sub-Saharan Africa. During this presentation, we would also like to talk about the epidemiological study to establish baseline rates of potential future adverse events and talk about the health economic value of malaria vaccination. Lastly we would discuss where we are as a country with the preparation for the introduction of the malaria vaccine.PRELIMINARY SAFETY AND TOLERABILITY DATA FROM AN AGE DE-ESCALATION/ DOSE ESCALATION TRIAL OF RADIATION ATTENUATED PLASMODIUM FALCIPARUM SPOROZOITE (PFSPZ) VACCINE ADMINISTERED BY DIRECT VENOUS INOCULATION (DVI) TO HEALTHY CHILDREN AND INFANTS 5 MONTHS THROUGH 9 YEARS OF AGE LIVING IN AN AREA OF HIGH MALARIA TRANSMISSION IN THE KEMRI AND CDC COLLABORATION HEALTH AND DEMOGRAPHIC SURVEILLANCE SYSTEM, WESTERN KENYAOneko M1, Cherop YR1, Otieno K1, Sang T1, Samuels AM2, Kariuki S1, Gutman J2, Abarbanell G3, Richie TL4, Seder R5, Hoffman SL4, Hamel MJ2, Steinhardt L2Affiliation: 1 Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya, 2 Centers for Disease Control and Prevention, Atlanta, GA, USA, 3Children’s Healthcare of Atlanta, Atlanta, GA, USA, 4 Sanaria,Rockville, MD, USA, 5 National Institutes of Health, Bethesda, MD, USABackground: Malaria remains a leading cause of morbidity and mortality among children in Africa. A highly effective vaccine is needed to prevent the disease. PfSPZ Vaccine is a promising pre-erythrocytic vaccine candidate composed of radiation-attenuated whole sporozoites administered by direct venous inoculation (DVI). Methods: We conducted an age de-escalating, dose escalating, randomized, double-blind, placebo-controlled trial to assess the safety, tolerability, and immunogenicity of one or two doses of PfSPZ Vaccine in children residing near Siaya County Referral Hospital. From July to November, 2016, we enrolled children in three age groups (5–9 years, 13–59 months, 5–12 months), and vaccinated with doses of 1.35/2.7/4.5/9.0/18.0 x 105 PfSPZ. Each age-dose group consisted of 12 children, 8 vaccine/4 placebo. Two vaccinations, eight weeks apart, were given to those receiving the two highest doses. Safety and tolerability were evaluated through daily home visits for 5 days post vaccination and clinic visits on days 8 and 29. Results: We performed 233 vaccinations on 165 participants, including 9 partial vaccinations in children <5. Data remain blinded to arm. There were no Grade 3 related adverse events (AEs), laboratory abnormalities, or significant electrocardiogram changes post vaccination. We recorded possibly to definitely related solicited local and systemic AEs (Grade 1/2) during 7 days post vaccination and possibly related unsolicited AEs (Grade 1) during 28 days in 14.3%, 7.1%, and 5% of participants, respectively; all resolved. All day 8 post-vaccination possibly-related Grade 1/2 laboratory abnormalities resolved. Three serious AEs were related to malaria; all resolved. In children <5, DVI was challenging initially, but improved with experience. Conclusion: DVI with PfSPZ Vaccine was tolerable, safe, and feasible in children and infants. These data provide the foundation for an ongoing phase 2 trial of PfSPZ Vaccine to assess safety, immunogenicity, and efficacy in 5–12-month-olds in Siaya. Clinical sensitivity to artemisinin based combination therapy in Kisumu County.Andagalu, B.M.; Onyango, I.A.; Akala, H.M.; Juma, D.W.; Chebon, L.J.; Cheruiyot, A.C; Ogutu, B.R..Kenya Medical Research Institute/The Walter Reed Project, Kisumu, KenyaBackground: Artemisinin-based combination therapies (ACT) were first recommended by the World Health Organization as first-line treatments for falciparum malaria in 2006 due to failures of older antimalarials. Less than a year later, debate about artemisinin resistance development along the Cambodian-Thai border started. Recently, slowly clearing infections (parasite clearance half-life >5 hours), strongly associated with single point mutations in the “propeller” region of the P. falciparum kelch protein gene on chromosome 13 (kelch13), have been detected throughout mainland Southeast Asia from southern Vietnam to central Myanmar. Africa is currently spared, but historically malaria drug resistance has originated from S.E. Asia and then spread to Africa. The emergence of drug resistance to ACTs in Kisumu would be disastrous, given that malaria transmission in Kisumu remains quite high despite self-reported insecticide-treated net use approaching 80% in children under 5. Methods: 2 two-arm randomized open-label trials were conducted at the Kisumu West District Hospital. Patients residing within the study area and presenting with uncomplicated malaria were recruited. The study treatments were artemether lumefantrine, dihydroartemisinin piperaquine and artesunate mefloquine. Therapeutic response was measured by determining parasite clearance rates. Results: The median parasite clearance slope half life was less than 5 hrs for all subjects. 100% of the subjects achieved adequate clinical and parasitological response at day 42 (PCR corrected). The mutations observed in the K13 region of the malaria parasites seemed not to affect h therapeutic response. None of the mutations reported in Southeast Asia was observed.Conclusions: ACT is still efficacious when used to treat uncomplicated malaria. Further studies on the genetic signature for ACT resistance in Africa are needed.UNDERSTANDING THE COMMUNITY’S KNOWLEDGE, ATTITUDES AND PRACTICES (KAP) IN PREVENTION AND MANAGEMENT OF MALARIA IN MATONGO, KISII COUNTY.Gaitho D, Carazo C, Nduati R, Naulikha J, Batra M, Walson J, Pak-Gorstein SUniversity of Nairobi – Department of Paediatrics, University of Washington, Seattle Children’s Hospital, KEMRI, Kisii Teaching and Referral hospitalBackground: In Kenya over 26,000 deaths due to malaria occurred in 2010. Most malaria related deaths in children under five occur within 48 hours. Malaria control requires an integrated approach with prevention (primarily vector control) using insecticide-treated nets (ITNs) and indoor residual spraying (IRS), and prompt treatment with effective antimalarial agents. According to the DHIS, in Kisii County malaria accounted for 32.7% of all visits among children under five from 2011-2015. Methods: We utilized quantitative and qualitative methods to address our objectives. Data sources included database review, focus-group discussions with Community health volunteers (CHV’s) n=16, Traditional herbalists n=21 and healthcare workers (HCW’s) n=17. Structured questionnaires were administered to the CHV’s, HCW’s and households n=20. Key informant interviews were held with the County director of health and county in charge of Public health, Community strategy and vector control.Results: From the 20 households interviewed, 85% of the respondents were mothers, 10% siblings and 5% fathers. The average number of people per household was 5.8. Children under 5 years were in 75% of households. Regarding malaria knowledge, only 45% of respondents could name at least three methods of malaria prevention. All households had ITN’s with 85% reporting their children sleeping under an ITN during the day and 60% sought treatment from health facilities when malaria was suspected. However 55% report never draining stagnant water or covering tanks. The monthly rate of clinical malaria among children under five brought to Matongo Health Centre ranged from 21.8% to 48.6%. The positivity rate for malaria steadily increased from 17% in 2011 to 75% in 2015. Among Matongo Sub-unit only 3/16 CHV’s are trained in Community case management (CCM), only two received rapid diagnostic tests and none are practicing CCM. All policy-makers interviewed thought malaria was a problem, 89% of whom said Kisii wasn’t well equipped to deal with the problem due to inadequate logistics and lack of CHV training.Conclusion: Malaria remains a challenge in Kisii County contributing significant burden of disease in children less than five.REGIONAL BURDEN OF MALARIA IN PATIENTS PRESENTING WITH FEBRILE ILLNESS IN KENYAJohn WaitumbiWalter Reed Project, Kenya Medical Research Institute, Kisumu, KenyaThe prevalence of malaria infection and distribution patterns of Plasmodium parasites vary across the country. This can be attributed to varying climatic conditions primarily temperature and rainfall that impact both the rates of sporogonic and mosquito life cycles. This study evaluated the burden of malaria in patients who presented with acute febrile illness at 11 hospitals/clinics in Kenya. A total of 2,522 blood samples was collected and qPCR used for parasite speciation and densities determination. Plasmodium parasites were found in 32% (800/2522) of the AFI patients, with the following regional distribution: 38% (397/1038) for hospitals in the Lake Victoria basin, 38% (262/687) for those in Garissa, 28% (29/103) for patients attending Malindi District Hospital and 16% (112/694) for the Kisii District Hospital. In all the surveillance hospitals, about 50% of parasitemias were below the limit of detection by microscopy or RDTs. This number was highest (89%) at the Coast. Unlike in the other surveillance sites, in the Lake Victoria basin, more that 30% of the parasitemias were above pyrogenic threshold (>250,000 parasites/?L). Of the 800 samples with malaria parasites, only 74% (594/800) could be speciated: 73% (434/594) as monoinfections of P. falciparum, 7% (42/594) P. ovale and 2% (10/594) P. malariae. The remaining 18% (108/594) were mixed infections. All the four species of Plasmodium were identified at all surveillance sites except P. malariae which was not observed in the coastal region. In conclusion, this study identified a huge proportion of individuals with parasitemias below detection limit of microscopy or RDT. In the Lake Victoria basin, over 30% of the parasitemias were above pyrogenic threshold that is associated with increased risk of morbidity and mortality. Further studies are needed to establish why 26% (206/800) of Plasmodium positive samples could not be speciated.MALNUTRITIONCHILDREN WITH MODERATE ACUTE MALNUTRITION REMAIN AT RISK OF RELAPSE DURING THE TREATMENT PERIOD.Olack B1, Inzani M2, Egondi T3, McGrath C4, Kivuva D1, Ouma L1, Melby P4, Otieno P1Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya.Kenya Medical Research Institute, Centre for Virus Research Nairobi, Kenya.Drugs for Neglected Diseases Initiative (Africa) Nairobi, Kenya.University of Texas Medical Branch, Galveston, Texas, USA.Background: Nutritional therapy using supplemental feeds for an average of 12 weeks is thought to be effective and sufficient in managing moderate acute malnutrition (MAM) and preventing deterioration to severe acute malnutrition (SAM).However, whether the current designated period for treatment is sufficient to maintain recovery is not well known. In this pilot study we describe recovery rates and relapse rates among children aged 6-59 months with MAM managed using standard of care. Methods: A prospective study was conducted in which children with MAM were recruited if mid-upper arm circumference (MUAC) was ≥ 11.5cm to ≤12.5cm and no bilateral pitting oedema. The children were provided with supplementary feeding of corn soy blend for 12 weeks and followed upto 11 months for nutritional assessments. Results: Among the 60 children enrolled in the study 9 (15%) were declared lost to follow-up. In this report we use two consecutive MUAC measurements ≥12.5 cm to define recovery. After 12 weeks 35 out of 51 (68.1%) children recovered fully though 8(22.9%) relapsed at least once during the treatment period.There were 3 cases of relapse at month 5 and one child deteriorated to SAM. At 11 months 39 out of 40 (98%) of children who remained in follow-up had recovered .Paired t test indicate that there was a significant increase in MUAC from 12.2 cm to 13.6 cm (p<0.000) over the follow up period.The median time to recovery was 8 (4-12) weeks.Conclusion: Recovery rate for children with MAM at the stipulated treatment time of 12 weeks was below the recommended SPHERE standards of >75% for recovery. The reasons behind the suboptimal recovery rate need further investigation, but it is clear that intensive and longer follow-up is required to monitor complete recovery in children with MAM.There is an urgent need for evidence-based policy recommendations on duration of follow-up. COMPARING TREATMENT OUTCOMES OF STANDARD INPATIENT AND OUTPATIENT MANAGEMENT OF SEVERE MALNUTRITION: A SYSTEMATIC LITERATURE REVIEW.Miranda A.OMaseno University School of Medicine, KisumuBackground: Worldwide approximately 19 million children under five are affected by severe acute malnutrition. This children have a 10- fold risk of death compared to normal nourished children. Community based or out-patient treatment of severe acute malnutrition has been recommended in recent years, however WHO recommended clinical guidelines of at least one month of in the inpatient care of severe malnutrition is still being used. This study aimed to assess the treatment outcomes of both in-patient and out-patient management of severe acute malnutrition.Materials and Methods: Relevant electronic available papers including thesis and dissertations were during identified by a comprehensive search within national institutional data repositories, international databases including PUBMED, Google scholar. The study included retrospective and prospective observational studies that reported treatment outcomes of inpatient and outpatient management of severe acute malnutrition. The outcomes to be reported included mortality rate, recovery/improvement, default, average weight, height and MUAC change. Results: The study included 24 eligible articles. 15 and 9 papers reporting outcomes for in-patient and out-patient respectively. For inpatient the mortality rate ranged 3.6% to 46%. Only 33% of the studies reported an acceptable case fatality ratio of <10%. With up to 40% reporting >20% case fatality ratio. The recovery rate ranged from 33.6% to 88.4%, 50% of the studies reporting acceptable standards (> 75%).For outpatient the mortality rate ranged from 0% to 4.1%. the recovery rate ranging from 58% to 81%.Conclusion: The study showed that a treatment outcomes of outpatient management are better compared to inpatient. This is comparable to previous PARISON OF SEVERE ACUTE MALNUTRITION (SAM) MANAGEMENT ACROSS 3 KENYAN HOSPITALS PARTICIPATING IN THE CHAIN NETWORKMangale, DI; Tickell, KD; Thitiri, J; Timbwa, M; Ng’ang’a, JW; Sukhtankar, P; D; Berkley, JA; Walson, JL; Denno, DMUniversity of Washington, Seattle, Washington; KEMRI Wellcome Trust Research Program, Kilifi, Kenya; Migori County Hospital; Mbagathi District Hospital; Kilifi County Hospital; Childhood Acute Illness and Nutrition (CHAIN) Network.Background: The Kenya National Basic Paediatric Protocol provides severe acute malnutrition (SAM) management guidelines. In preparation for Childhood Acute Illness and Nutrition (CHAIN) Network clinical studies, we assessed SAM management practices and factors influencing guideline adherence at Mbagathi District, Kilifi and Migori County Hospitals.Methods: Through direct observation, hospital reports and semi-structured interviews with clinical and administrative staff we assessed human resources, laboratory capacity, equipment and medicines necessary for managing SAM. Additionally, 30 inpatient notes (Kilifi (10), Mbagathi (17), Migori (3)), of children aged 2-23 months diagnosed with SAM were reviewed to understand clinical practice.Results: Sites had 28-32/32 essential equipment items and 21-24/24 essential medicines and nutritional therapeutics; however, stock-outs of F75, F100 and ReSoMal (replaced by in-house formulation) were reported. Stretched human resources affected care across the sites, which had 2.3-6.0 nurses and 2.3-5.5 doctors per 1000 admissions, but different cadres supplemented patient care, including nutrition students, clinical officers and lay health workers. Relactation, breastfeeding and psychosocial support were very limited or unavailable. Hospital policies did recommend screening paediatric inpatients for SAM and HIV; however, stock-outs of HIV test kits limited full implementation at one site. Discharge and follow-up care was hampered by therapeutic food stock-outs and loss-to-follow-up. In the notes reviewed, refeeding was largely compliant with guidelines--e.g., the median feeding rate was 129 mls/kg/day (interquartile range 103 –133) compared to recommended 130 mls/kg/day. Ninety-two percent were prescribed first line antibiotics for SAM (ampicillin or penicillin and gentamicin); 8% were prescribed ceftriaxone for suspected meningitis. Conclusion: SAM management at these Kenyan hospitals was broadly consistent with national standards. However, strengthening therapeutic food supply chain management, improving relactation and breastfeeding support and investing in emotional and cognitive stimulation would improve care. Future studies should identify barriers to discharge and follow-up care. DAILY CO-TRIMOXAZOLE PROPHYLAXIS AMONGST CHILDREN WITH COMPLICATED SEVERE ACUTE MALNUTRITION - A RANDOMISED CONTROLLED TRIALBerkley J, Ngari M, Thitiri J, Mwalekwa L, Timbwa M, Hamid F, Ali R, Shangala J, Mturi N, Jones K, Alphan H, Mutai B, Bandika V, Hemed T, Awoundo K, Morpeth S, Kariuki S , Fegan F.Affiliations: KEMRI Wellcome Trust Research Program, Kilifi, KEMRI Centre for Microbiology Research, Nairobi; University of Oxford, UK.Background: Children with complicated severe acute malnutrition (SAM) have increased risk of mortality in hospital and after discharge. Amongst HIV-infected children, mortality is prevented by daily co-trimoxazole prophylaxis. Antibiotics can also improve growth. We aimed to evaluate daily co-trimoxazole prophylaxis amongst children with complicated SAM.Methods: We randomly assigned HIV-uninfected children with SAM aged 2 to 59 months admitted to 2 urban and 2 rural hospitals to receive 6 months of daily oral co-trimoxazole prophylaxis or matching placebo. Children were given recommended medical care and feeding, and followed up for 12 months. The primary endpoint was mortality. Secondary endpoints included non-fatal illness, toxicity and growth. Findings: 1,778 children were enrolled: median age 11 months, 300 (16.9%) had oedematous malnutrition and 1,221 (68.7%) were stunted. During 1,527 child-years of observation, 122/887 (13.8%) children in the co-trimoxazole group died as compared with 135/891 (15.2%) in the placebo group (hazard ratio, 0.90; 95% CI, 0.71 to 1.16). For secondary outcomes, hospital readmission, outpatient treatment, suspected toxicity and growth did not differ between groups. Skin or soft tissue infection, urinary tract infection and malaria were less frequent, and diarrhoea more frequent in the group assigned to co-trimoxazole.Conclusions: Daily co-trimoxazole prophylaxis did not reduce mortality or improve growth amongst HIV-uninfected children with SAM, although, as expected, it did reduce some infections.MICRO RESEARCH sSURVEY OF PARENTS` AND GUARDIANS` KNOWLEDGE AND PRACTICE ON UNDER NUTRITION OF CHILDREN AGED 6 MONTHS TO 5YEARS AT MAMA LUCY DISTRICT HOSPITAL, NAIROBI KENYA.Ojee Edna 1, Oduor Bernard 2, Perez Obonyo3, Safina Dhadho 4, Kagasi Eunita1, Penninah Mugo5, Elizabeth Cummings.6Aim: The survey assessed parents` and guardians` Knowledge and practice on under nutrition and established the nutritional status of the children using anthropometric measurements which were compared against WHO standard charts. Our aim was to determine whether there was an association between their knowledge and practise and nutritional status of their children.Methodology: The present work was a cross-sectional quantitative and qualitative survey conducted in 2015. Quantitative data collection was done using questionnaires with open and closed ended questions assessing parents`/guardian knowledge on malnutrition; children’s anthropometric measurements were taken and recorded and Z scores checked against WHO standard charts. A knowledge scale was developed and the relationship of parents`/guardians` knowledge score and nutritional status of the children was assessed. Qualitative data was collected during focused group discussions that were tape recorded and notes taken and analysed using grounded theory.Results: The prevalence of malnutrition based on WHZ was 3.5%, 9.1% were stunted while 3.8% were under weight. Prevalence of malnutrition was high among boys 4.5% compared to girls 2.7%. Overall prevalence of stunting based on HAZ was 9.5%: boys 12.1 % and among girls 2.2%. Overall prevalence of underweight as determined by WHZ measurements was 3.9% ;5.6% among boys and 2.2% among girls. The parent/guardian mean knowledge score on child malnutrition was below average and there was no association between parents`/guardian`s knowledge on malnutrition and child growth indices WHZ, HAZ and WAZ. However, there was a weak positive association between HAZ and parent/guardian family income and a weak negative association between the family income and child nutrition outcome WAZ. Logistic regression showed no significant association between malnutrition and total knowledge score or malnutrition and total practice score. Children of mothers with a college/university level education have lower odds of being malnourished than children with mothers with a primary school education or less (OR= 0.20, CI 0.05-0.81, p=0.024). The association persists after controlling for the child's age, gender, the family's neighborhood of residence and annual income and maternal nutrition knowledge and nutrition practices (OR=0.15, CI= 0.03-0.65, p=0.012).Conclusion: Gaps in parent`s/guardians` knowledge on malnutrition were identified.Recommendations: Increasing parent/guardian knowledge on malnutrition through nutrition/health education programs will contribute significantly to improving children’s nutritional status in Kenya and reducing morbidity and mortality.ACTIVE CASE FINDING FOR TUBERCULOSIS AMONG MALNOURISHED CHILDREN BELOW FIVE YEARS OLD: MERU TEACHING AND REFERRAL HOSPITAL EXPERIENCEChepchieng DB1 Munyua MM2 Ngatia R21: Centre for Health Solutions TB ARC2: Meru County Teaching and Referral Hospital – MeruBackground: Kenya is among the 22 Tuberculosis (TB) high burden countries in the world and is among the top five from sub Saharan Africa. 75% of childhood cases occur annually in these 22 high-burden countries that together account for 80% of the world’s estimated incident cases. The risk of progression from TB infection to disease and development of disseminated TB is increased in the very young (0-5 years), immune-compromised and malnourished children. Despite this reality, active case finding for TB is not routinely conducted in nutrition clinics. Methodology: Stakeholder sensitization was done to hospital managers as well as Maternal and Child Health Clinic (MCH) staffs. Standard national TB screening tool was customized to capture the weight, and Mid Upper Arm Circumference (MUAC). Malnourished children below five years of age were referred to the clinical officer who administered the TB screening tool. Data from the screening tools were then summarized in Excel spreadsheets and analysis done. Demographic and clinical characteristics of the children presumed to have Tuberculosis were analyzed. Results: Of the 98 children presumed to have TB, 52 (53%) were female. 90 (92%) had cough, 76 (78%) with fever, 60 (61%) had contact to a person with Tuberculosis, 52 (53%) had failure to thrive and 46 (47%) had signs of respiratory distress on physical examination. Chest X-ray was done for 32 (33%). A total of 51(52%) children were diagnosed with TB based on the national simplified algorithm for childhood TB diagnosis. None of the children had sputum sample collected for bacteriological tests Conclusion/ recommendations: Active case finding for TB among children below five years with malnutrition is feasible Involvement of all stakeholders in the health facility is important Investment in capacity building of health workers to obtain a sputum sample for bacteriological investigations is importantCASE REPORT OF A TWO YEAR OLD BOY WITH MALNUTRITION AND CHRONIC SUPPURATIVE OTITIS MEDIABaraza,J.C (MBChB)1,Obungu,N.A(Mentor-MBChB)21 Dr Janet Chao Baraza, MBChB(Moi), Medical Officer Intern at Tenwek Mission Hospital, Bomet County2 Dr Norah Atieno Obungu MBChB (UoN) Medical Officer-Paediatrics, Tenwek Mission Hospital, Bomet CountyThis case report seeks to highlight a two year old boy who presented to the Paediatric ward in Tenwek Hospital with Chronic Suppurative Otitis Media(CSOM) since he was three months old and had persistent cough, fever and vomiting despite appropriate investigations and treatment. He later developed severe acute malnutrition that was unresponsive to standard management protocols for malnutrition. He eventually underwent a Gastric tube placement surgery for feeding as an adjunct to failed medical therapy for the malnutrition but died post-operatively. The underlying CSOM in his case might have been the reason for the inappropriate response to management of malnutrition. This combination of CSOM and Malnutrition contributed to the overall poor outcome of the young boy.NEONATOLOGYGESTATIONAL AGE ASSESSMENT AND PRETERM BIRTHOtieno P1, Kirumbi L1, Wanyoro A2, Mugo N1, Miller L,3 Odero L1, Keating R3, Butrick E3, Walker D3Affiliation: 1 Kenyan Medical Research Institute, 2 Kenyatta University 3 University of California, San FranciscoBackground: Prematurity is the leading cause of neonatal death, but is not well documented. As part of a new project on prematurity, we wanted to understand the baseline prevalence through a review of existing national sources, so we set out to examine whether GA is readily available and evaluate its accuracy compared to birthweight using international preterm growth standards.Methods: We compiled data from project sites which are Sub County and the County Health Facilities in Migori County. During baseline facility assessments we reviewed registers for completeness and compared birthweight to GA using international growth standards. In a separate effort we reviewed 259 cases by comparing GA in the register and medical charts. Finally, we collected register data from facilities between June-Dec 2016.Results: At the time of facility assessments we found that 94% of maternity register entries included GA. When we compared the GA and birthweights, we found that only 51% of these entries had a birthweight that fell between the 10th and 90th percentile of weight for GA by international standards 46% of all entries had a birthweight above the 90th percentile. Comparisons between registers and medical records found variability of up to 16 weeks. Conclusions: While tools exist to capture gestational age, there are well-documented challenges to determination of gestational age and these data suggest that there is a need to strengthen the data if they are to be useful. The finding that 46% of all cases had a birthweight above the 90th percentile likely indicates that GA was underestimated.KNOWLEDGE, ATTITUDES, AND PRACTICES REGARDING PREMATURE BIRTH IN KISII COUNTYOnkunya B1, Higgins J2, Naulikha J3, Nduati R1, Walson J2, Batra M2, and Pak-Gorstein S2Affiliations: 1Dept Paediatrics, University of Nairobi, Kenya, 2Dept Pediatrics, University of Washington, USA, 3Kenya Medical Research Institute (KEMRI)Background: The UN Sustainable Development Goal 3.2 targets ending "preventable deaths of newborns and children under the age of 5 years by 2030, with all countries aiming to reduce neonatal mortality to less than 12 per 1,000 live births". Objective: To understand the knowledge, attitudes, and practices regarding prematurity in Kisii county.Methodology: An exploratory study with 87 participants conducted in South Kitutu Chache sub-county in March-April 2016, using both qualitative and quantitative approaches, i.e. free listing, focus group discussions, key informant interviews, community S.W.O.T analysis and questionnaires respectively. Results: Free listing (n=23): Causes of premature birth were listed as abortion from unwanted pregnancy, physical exertion, stress and domestic violence. Health facility findings (n=39): Those interviewed included policymakers, health care managers and health care workers. Motorbike riding and failed abortions were identified as perceived causes of preterm birth. Risks faced by premature newborns included infections, neglect, infanticide and child-trafficking. Mothers risked social stigma and psychological depression. Community findings (n=25): Community health volunteers and traditional healers were interviewed. Perceived causes of preterm birth included failed abortion, overworking and infections. Preterm birth was believed to be preventable by early treatment of infections, family planning to prevent unwanted pregnancy and health education. Preterm infants risked hypothermia, malnutrition and neglect. Mothers faced risk of isolation, stigma and poverty. Traditionally preterm infants were cared for in isolation, not washed and kept warm by the fireplace.Conclusion: Prevention of preterm birth and premature infant survival requires action along the entire continuum of care from pre-pregnancy through delivery and post-natal period.PREVALENCE, CLINICAL MANAGEMENT AND OUTCOME OF NEONATAL DEHYDRATION ACROSS 13 HOSPITALS IN KENYA.Rotich B1,2, Mbevi G2, Chepkirui M2, Lagat A2, Wafula J2, Thomas J2, Irimu G2,3, Ayieko P2, Akech S2, English M2,4, on behalf of Clinical Information Network Authors.1School of Public Health, University of Nairobi, Kenya. brotich, 2Kenya Medical Research Institute/Wellcome Trust Research Programme,3Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya. 4Nuffield Department of Medicine, Oxford University, Oxford, UK.Background: Dehydration is thought to be common in neonates admitted to hospitals, but its prevalence is unclear. It’s thought to result from conditions that impair breastfeeding such as illnesses (asphyxia, sepsis), congenital anomalies and prematurity or that increase fluid losses. There is no standard guidance on criteria for diagnosis and management of neonatal dehydration and practice is thought to vary across different settings. This study aims to document the prevalence of neonatal dehydration in children across hospitals in Kenya in order to understand the burden of the problem. It investigates the management practices adopted in the absence of national guidelines and outcome in neonates with dehydration. Data is from neonates admitted to hospitals participating in the clinical information network (CIN). Methods: Medical records of children meeting the case definition of dehydration were randomly selected from each hospital. Treatments used, clinical criteria for diagnosis and outcomes were recorded. Prevalence was determined by inverse probability weighting.Results: We reviewed 846 records of neonates admitted to 13 CIN hospitals between December 2015 and November 2016. Median age was 6 days, 415(49%) were female, 26% had difficulty in feeding on admission and the median length of hospital stay was 5 days. The major observed illnesses were neonatal sepsis 485(57%), pneumonia 37(4.4%), jaundice 194(23%), respiratory distress syndrome 37(4.4%) and birth asphyxia 51 (6%) while the proportion who died were 44(6%). Currently, data analysis is ongoing and we will present on: Prevalence of neonates with clinical signs and laboratory investigations used to diagnose dehydration among neonates, fluid therapy used, treatment outcomes and risk factors for adverse outcomes in neonatal dehydration.Conclusion: Findings from this audit will quantify the burden of neonatal dehydration in Kenyan hospitals, establish need for guidance for neonatal dehydration, and recommend local solutions to mitigate high rates of admission due to dehydration. IMPROVEMENT IN NEONATAL MORTALITY AFTER NOVEL SIMULATION BASED TRAINING ON EMERGENCY OBSTETRIC AND NEONATAL CARE IN KISII KENYAKibore MW, Gachuno O, Osano BO, Njiri F, Wamalwa , Walker DUniversity of Washington, Department of Global Health, WA, USA, University of Nairobi, Nairobi, Kenya, University of California San Francisco, California, USABackground: One third of neonatal deaths in Kenya are due to birth asphyxia, a condition that can largely be prevented by enhancing the capacity of health facilities to provide routine and emergency obstetric and neonatal care (EmONC). In high-resource countries, simulation training has had the greatest success in changing practice and behavior in EmONC, however most simulation models are expensive, complicated and not conducive for low resource settings. We evaluated the impact of a low-tech highly realistic, simulation and team based training EmONC program for limited- resource settings (PRONTO) on perinatal morbidity and mortality in Kenya.Methods: We conducted a matched pair cluster randomized trial of PRONTO training from 2013 to 2016 in 16 rural health facilities in Western Kenya. All facilities received a Ministry of Health mandated training in EmoNC and intervention facilities received additional PRONTO training carried out in two modules 3 months apart. Neonatal resuscitation skills were reinforced in intervention facilities periodically during site visits. Data on maternal and neonatal morbidity and mortality were collected using an adapted WHO near miss tool at baseline and up to 16 months post-intervention. Mothers discharged before 24 hours had elapsed after delivery were followed up by community health volunteers to determine the status of the newborn.Results: A total of 90 health providers were trained in PRONTO from 8 intervention facilities and the regional referral hospital. We collected obstetric and perinatal data from 13,326 birth encounters over a period of 24 months. Overall, intervention facilities contributed 54.1% of all deliveries. There were a total of 171 neonatal deaths during the study period and 4 maternal deaths. Neonatal mortality in the pre-intervention period was comparable between the two arms (P =0.151) but was significantly lower in the intervention arm in the post-training period with 13 deaths/1000 live births reported in intervention facilities vs 19.7 deaths/1000 live births in control facilities (P=0.015).Conclusion: PRONTO training significantly reduced the neonatal mortality rate in the intervention facilities in comparison to control facilities. A longer follow up period after training may be required to determine if the training has lasting impact on neonatal mortality.BIRTH WEIGHTS OF TERM NEWBORNS DELIVERED IN WESTERN KENYA, AT JARAMOGI ODINGA TEACHING AND REFERRAL HOSPITAL, KISUMU, KENYA.Odhiambo J. O, Miranda A. O, Wanyonyi G. A, Ngayai G. M, Wanjohi A. M. W, Supervisor, Dr. Omoto J. Background: Birth weight is an important indicator of infant health, both in utero and post-nataly. Infants who are at both extremes of birth weights distribution have been shown to suffer from many complications. The Western Kenyan region faces a number of challenges that may significantly affect the outcome of pregnancy and thus birth weight. These are: malaria endemicity, high HIV prevalence and low socio-economic conditions.Objectives: To determine birth-weight distribution of term newborns delivered at JOOTRH from 1st January 2014 to 31st December 2014.Methodology: This was a retrospective study. The study involved the review of 2000 birth records in the specified period with a gestation of 37 to 42 completed weeks from JOOTRH registries.Results: From the sample, 52% of the newborns delivered were males while 48% were females. The average birth weight of the newborns was 3247.70g. The WHO reference for the 10th percentile corresponding to low birth weight is 2500g. The study showed the 10th percentile to be 2600g. From the study’s distribution 152 term newborns fell below the 10th percentile. The WHO reference for the 90th percentile is 4500g corresponding to the high extreme of birth weight. The distribution showed the 90th percentile at 3806g.In the study, 187 term newborns fell above the 90th percentile. Conclusion: The results from the study were comparable with the WHO reference. The study also shows a regional reduction in low birth weight incidence in comparison with the national average. Indicating a possible improvement in maternal health measures.EFFECT OF SYSTEM CHANGES ON NEONATAL OUTCOMES IN MATERNITY AND NEWBORN UNIT NAIVASHA SUBCOUNTY HOSPITALIthondeka A., 1 Ombiro O., 1 Githure H., 1 Fassl B., 2Naivasha Subcounty Hospital, University of UtahBackground: Neonatal mortality rate in Kenya remains a challenge with the majority of deaths occurring in the first month of life.1 Despite marked improvement in the infant and under-five mortality rates, only a minimal drop has been recorded with neonatal mortality rate. We sought to determine the effectiveness of a multifaceted quality improvement intervention (QI) on neonatal mortality in the newborn unit (NBU) at Naivasha Subcounty Hospital over three years.Methods: We formed a multidisciplinary QI team consisting of nurses, clinicians, hospital and county health administrators and completed a benchmarking visit to a larger tertiary facility. NBU and maternity staff completed standardized training courses in Helping Babies Breathe, and Emergency Obstetric Care. The hospital created high risk rooms for sick mothers and babies, a triage room for new admissions. We provided prophylactic antibiotics to mothers and babies at high risk of infection. We conducted a monthly internal audit of NBU patient outcomes between October 2013 and July 2016. The baseline/QI intervention period was Oct 2013 to July 2015 and Aug 2015 to July 31 2016 the post-intervention maintenance period. Results: A total of 3968 children were admitted to the NBU, 2209 and 1759 during pre- and post-intervention periods respectively. The mean monthly patient count in the NBU increased from 100 (range: 40-143) to 146 (range: 94-180) per month between time periods. Monthly mean all-cause neonatal mortality rates in the NBU decreased from 13% to 7% between periods Conclusion: Improvement in neonatal outcomes is achievable when consistent efforts to improve the care processes are made. Involvement of stakeholders has been key factor in achieving these successes. CLINICAL PROFILE AND AUDIT OF CLINICAL CARE OF PRETERM INFANTS WITH RESPIRATORY DISTRESS SYNDROME AT THE KENYATTA NATIONAL HOSPITAL.Ng’ang’a P. N.Department of Paediatrics and Child Health, University of Nairobi.Background: Respiratory Distress Syndrome (RDS) is the most common cause of respiratory distress in premature infants. It is a condition of pulmonary insufficiency that is characterised by features of respiratory distress at birth or shortly after birth. There are guidelines on care and management of preterm infants with RDS that have been shown to reduce morbidity and mortality.Study objectives: The purpose of this study was to describe the clinical profile of the preterm infants with RDS admitted at Kenyatta national hospital (KNH) and perform an audit on the management given within the first 48 hours.Methods: This was a descriptive retrospective study carried out among preterm infants admitted at the new born unit with RDS between August and December 2016. An audit of the records was done at admission, at 24 and 48 hours to assess the intervention measures given as recommended in the guidelines on the management of RDS. Results: Of the 207 preterm neonates enrolled in the study, 67% were born in KNH and 33% from a referral facility. Males constituted 51% and females 49% with a mean birthweight of 1693grams. The median gestational age was 32 weeks with 58.8% of the participants having been born via spontaneous vertex delivery and 42.2% via caesarean section. The audit revealed that 23% of the preterms received continuous positive airway pressure (CPAP) and 12.8% received surfactant administration. Intravenous fluids were prescribed and administered in 97.1% and antibiotics in 89.9%, the most frequently prescribed being crystalline penicillin and gentamycin (72.5%).Conclusion: There is room for improvement in uptake of the guidelines and implementation of the same in our setting.NEWBORN AND INFANT HEARING SCREENING LOSS FOR EARLY DETECTION OF PERMANENT HEARING LOSS IN NAIROBI KENYASerah S1,Tucci 2,MurilaF1,Macharia M1,Ayugi J1College of health Sciences University of Nairobi1, Duke University Medical Center, North Carolina, U.S.A2Background: Early detection of hearing loss followed by appropriate early intervention is associated with optimal speech and language outcomes.Newborn and infant hearing programmes are yet to be instituted in the health care system of Kenya. .The objective of this study was to determine the prevalence of permanent hearing loss so as to assess the need for services.Methodology: A cross sectional study of all new born babies in the KNH maternity ward and the new born unit and babies below three months of age presenting at the Anderson health center for immunization. Those with congenital external ear malformations such as bilateral meatal atresia and microtia were excluded.Initial screening with distortion product evoked otoacoustic emissions( DPOAEs) whose performed. All those who failed this test were referred to the Audiology section of the Ear Nose and Throat clinic at Kenyatta National Hospital for diagnostic hearing evaluation with ABR within six weeks. Results: A total of 5087 infants were screened between August 2016 and 22nd December 2017.The age ranges was 800 to 4170 grammes with a mean of 3.182 (SD=647) and gestation of 24 to 44 weeks with a mean of 38.61 weeks (SD=2). Only 2 of these failed the confirmatory test making the prevalence of permanent hearing loss 0.04 %.Conclusion: The prevalence of permanent hearing loss in this study was low. UPTAKE OF DELIVERY SERVICES IN PUBLIC HEALTH FACILITIES IN KERICHO EAST SUB-COUNTY BEFORE AND AFTER THE IMPLEMENTATION OF THE FREE MATERNITY HEALTHCARE POLICYODHIAMBO J. OBackground: Approximately 800 women die every day globally due to complications associated with pregnancy and childbirth. (World Bank 2015). 99% of these deaths occur in the developing countries (World Bank 2015). Kenya is among the countries with high maternal mortality rates in Africa; estimated at 368/100, 000 live births (KDHS 2014). In order to reduce maternal deaths and to improve on the quality of delivery among women government of Kenya decided to have free maternity healthcare services. Despite the FMHP there were mothers who were being admitted at the Kericho County Referral Hospital due to complications associated with childbirth after having delivered at Home.Objectives: To describe the uptake of delivery services in the public health facilities in Kericho East Sub- county between 2012 and 2015.Methodology: This was a retrospective study. It was done in Kericho East sub-county. The study period was 25th July, 2016 to 2nd September, 2016. The study involved retrieval of the delivery records for the mothers who delivered in public health facilities in the sub-county between the years 2012 and 2015 from the District Health information software. Any deliveries conducted outside this period and those conducted in the private health facilities were excluded.Results: A 20% increase in number of deliveries was noted in 2013 compared to 2012. This was followed by a 2% decrease in 2014 compared to 2013. A further 15% increase in 2015. Public health facility based maternal mortality ratios ranged between 25 and 141 maternal deaths per 100, 000 live births. These were less than the actual sub-county maternal mortality ratios. All maternal mortalities took place at the Kericho County Referral Hospital which is the major health facility in the sub-county.Conclusion: There was no consistent increase in the uptake of delivery services within three years following the implementation of the Free Maternity Healthcare Policy.NUTRITIONINNOVATIVE APPROACH TO PAEDIATRIC NUTRITIONKARIUKI F.W, MBUTHIA J.K, Kids Health and Nutrition, Nairobi, Kenya.Background: Globally, an estimated 165 million children under-five years of age are stunted. More than 90% of them live in Africa and Asia. Besides this, more than 100 million children of the same age are also underweight while 43 million are overweight. These findings suggest that there is need to accelerate awareness among parents and care givers on optimum feeding practices for infants and young children. Adequate nutrition is crucial in early childhood in order to guarantee proper organ formation and function, healthy growth, strong immune system, and neurological and cognitive development. Nutrition has increasingly been recognized as a basic pillar for social and economic development. The reduction of infant and young child malnutrition is essential to the achievement of the Millennium Development Goals particularly those related to the eradication of extreme poverty and hunger and child survival. According to the 2014 Kenya Demographic Health Survey26% of Kenyan children are stunted, 4% are wasted and 11% are underweight. This has been as a result of years of poor practice and long held tradition feeding values.What Kids Health And Nutrition Is Doing To Address Child Nutrition: To bridge the gap in knowledge and practice in paediatric nutrition, Kids Health and Nutrition (KHN) was formed in 2014 with a vision to build a healthier future generation through empowering children, parents and the community, with the correct information on child nutrition to enable them solves nutritional problems in creative and scientific ways. This is done through workshops, trainings and exhibitions for parents, caregivers and children through bi-monthly classes.Methods: A typical session deals with a particular topic based on gaps identified through feedback from parents and care givers. When this is done, the paediatrician introduces the topic of the day and addresses the clinical/ medical aspects of the topic. This is then followed by an interactive session by a nutritionist to discuss the nutrition aspect of the topic. Through simple recipes derived from readily available ingredients, the chef demonstrates how to prepare simple but tasty and attractive meals for children with the participation of the on looking class made up of parents, children and caregivers.Conclusion: The importance of nutrition education in addressing malnutrition among children cannot be underestimated. Households where children have nutrition knowledge are likely to also have positive attitudes, practices and hence better nutritional status. Overall, innovative dissemination of nutrition education has to be strengthened to effectively address malnutrition.THE QUALITY OF DIETS OF CHILDREN 6-23 MONTHS IN URBAN INFORMAL SETTLEMENT IN KISUMU COUNTY.Susan Jobando1, Mary Obade2, Dickens Onyango2UNICEF Kisumu, Kisumu County Department of Health.Introduction: Economic insecurity closely linked with sub optimal nutrition is a major driver of poor development among young children especially in the first 1,000 days. UNICEF Kenya supported the county government of Kisumu to carry out a baseline survey on infant feeding practices in the urban informal settlement of Nyalenda and Obunga in December 2016. This paper shares partial findings from the survey focusing on quality of diets of children 6-23 months in the urban informal settlements.Methods: The survey was household based, a quantitative cross sectional study using the standard KAP tools developed by the Ministry of Health, Division of Nutrition. The proportion of children 6-23 months receiving quality diets as recommended by WHO/UNICEF of 4+ food groups was established based on a 24 hour recall. The target population was children 6-23 months, with 157 children sampled randomly. The data was analyzed using STATA.Results: While UNICEF/WHO recommends consumption of more than 4 food groups, only 43.31% (95%CI, 0.358 – 0.511) proportion of children adhered to this recommendation. The mean dietary diversity score was 3.44±1.7. Evaluation of consumption by food groups found that majority of the children, 87%, consumed food from group 1 (Grains, roots and Tubers), followed by Group 6 (Vitamin A rich fruits and vegetables) consumed by 76% of children. Group 7 (other fruits and vegetables) was consumed by 56% of children in this cohort. Group 3(dairy products) and Group 4(flesh foods) were least consumed at 16% and 22% respectively.Conclusions and Recommendations: More than half of the children were at risk of micronutrient deficiencies due to poor compliance to the WHO/UNICEF recommendation on complementary feeding. Children in informal urban settlements were consuming poor quality diets contrary to the national policy on infant feeding and were at risk of poor growth and development. The effectiveness of the national infant feeding policy in addressing complementary feeding equity should be prioritized by poverty reduction strategies. DETERMINANTS OF ADHERENCE TO IRON AND FOLATE SUPPLEMENTS BY PREGNANT WOMEN IN KENYAOwiti, L.A.1, Mwangi, A.M.1 and Abong’, G. O.11 Department of Food Science Nutrition and Technology, University of Nairobi, KenyaBackground: Iron/folate supplementation can effectively control and prevent anaemia and other fetal abnormalities in pregnancy. However, limited adherence is may be a major reason for the low effectiveness of iron/folate supplementation programs in Kenya. This research describes the factors influencing the adherence to iron/folate supplementation during pregnancy in Thika County Referral Hospital, Kenya. Anaemia in pregnancy is usually associated with a negative outcome resulting in fetal anaemia, low birth weight, preterm birth, low APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score, intrauterine growth restriction, and perinatal mortality. Reduction of iron deficiency anaemia in pregnancy is pegged on iron-folate supplementation. Method: A cross-sectional study design was used to study 200 pregnant women aged 15-49 years selected through systematic random sampling from the hospital. Questionnaires were used to collected data over a one month period using individual in-depth interviews at point of contact with the women. Results: Self-reported adherence rate was 24.5% (95% CI: 18.530.5). Important determinants of adherence include (p<0.05): gestational age, history of anaemia in pregnancy, having knowledge on anaemia and making more than 3 antenatal clinic visits. Conclusion: Adherence rate to iron/folate supplements was low among pregnant women and further analysis showed awareness on anaemia as a predictor to adherence. Hence, community based interventions, such as nutrition education and distribution of supplements, should be prioritized in the interventions to improve adherence in Kenya.THE IMPACT OF A MEDICAL AND NUTRITION OUTREACH PROGRAM FOR CHILDREN LOCATED IN HARD TO REACH AREAS IN LAIKIPIA COUNTY, KENYAOdundo GO1, Ongadi P1, Lubembe E, Asembo P and Chanzu NM1Affiliation: 1Gertrude’s Children’s Hospital, Nairobi, KenyaBackground: Laikipia County, in Kenya is often hard hit with drought and famine and thus one of the major causes of childhood morbidity and mortality in the region is malnutrition. There is a growing need to ensure the survival of these vulnerable children and their families by ensuring access of timely healthcare and nutrition support. Towards this, the Gertrude’s Children’s Hospital Foundation in collaboration with the Children’s Health and Development in Kenya (CHADIK) launched a medical and nutrition outreach program to offer targeted nutrition interventions to a population of 20,000 malnourished children located in hard to reach areas in Laikipia County, Kenya. Methods: The target population was children aged between 0-14 years. Door to door community outreach initiatives were conducted to identify malnourished children based on anthropometric measurements. The children were kept in the program for 3 intensive follow up months. The interventions provided were food support and supplements distribution, health education and awareness on maternal nutrition, infant and young child feeding. Results: A total number of 4,762 children have benefited from the program. Of these 916 were aged 0-6 months, 1,053 aged 7-23 months, 1,744 aged 24-59 months and 1,049 aged 5-9 years of age. 3,100 breastfeeding mothers have fully embraced exclusive breastfeeding and appropriate infant and young child feeding practices despite cultural beliefs and practice boundaries. The infant morbidity and mortality reported in Doldol, Rumuriti and Likii regions have further dropped by 14% and 5% respectively according to facility morbidity and mortality trends.Conclusion: There is need for additional efforts towards the development of targeted nutrition intervention programs in addition to well-established surveillance systems across the country. FAILURE TO THRIVE: IS FOOD ALLERGY A CULPRIT?Marete C.N.1, Kamenwa R.2Moi University, Eldoret1.Aga Khan University, Nairobi2.Background: Development of food allergy occurs in the first two years of life which are also very crucial for growth. Gut barrier immaturity is one of the risk factors along with male gender, genetics and history of atopy. Food allergy leads to undernutrition through increased losses resulting from vomiting and diarrhea as well as decreased intake due to nausea and the diet limitations imposed during the diagnostic and therapeutic process. Problems such as food aversion, food refusal and anxiety about eating also contribute to inadequate intake in children with food allergy. The most common known food allergens are also the foods that comprise a major portion of a child’s diet.Case Report: A 9-year-old boy presented with irritability, fever, vomiting and bloody diarrhea from one month of age. Subsequently, he was admitted almost monthly with a similar presentation and occasional constipation, refusal to feed and undigested food in stool. Poor weight gain was noted from six months of age. The patient was exclusively breastfed for four months while the mother was on elimination diet and he was noted to worsen when the weaning began. He could only tolerate pumpkins and rice. Our patient also had allergic rhinitis, asthma and eczema as well as allergy to several medications. The physical examination often revealed dehydration, pallor, fever and undernutrition. The skin prick test was positive for milk, egg, beef, corn, banana and beans while specific IgE was negative for a wide variety of common foods. The patient responded well to symptom management and targeted elimination diet. He is able to tolerate most foods and is on follow up.Conclusion: We shall highlight the difficulties in management of food allergy in the pediatric population.FIRST LINE ANTIMICROBIALS IN CHILDREN WITH COMPLICATED SEVERE ACUTE MALNUTRITION (FLACSAM)Ogwang C1, Kagwanja N1, Murunga S1, Waichungo J1, Jemutai J1, Mwaringa S1, Mwalekwa L1, Timbwa M1, Berkley JA1,2Affiliations: Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya1University of Oxford, Oxford, UK2Background: Children with complicated severe acute malnutrition (SAM) admitted to hospital in sub-Saharan Africa have a case fatality between 12% and more than 20%. Because children with SAM may not exhibit the usual signs of infection, WHO guidelines recommend routine antibiotics. However, this is based on “low quality evidence”. There are widespread reports of increasing antimicrobial resistance. However, no trials of inpatient antibiotics for children with SAM have been conducted that can inform policy.Methods: We plan to conduct a multicentre clinical trial that will assess the efficacy of two interventions, ceftriaxone (compared to penicillin + gentamicin) and metronidazole (compared to placebo), on mortality, toxicity, re-admission to hospital and nutritional recovery during 90 days among 2,000 sick, severely malnourished children in a 2x2 factorial design. The trial will be conducted at Kilifi County Hospital, Coast General Hospital, Mbagathi Hospital in Kenya and Mbale Regional Referral Hospital in Uganda. The trial will assess effects on antimicrobial resistance in invasive and carriage bacterial isolates, and undertake further pharmacokinetics work on ceftriaxone, metronidazole, penicillin and gentamicin. The relative costs of care for SAM for health facilities and for families, including antimicrobial usage, and their cost-effectiveness will also be assessed.Results: The trial is yet to start.Conclusion: Clear data on the efficacy, risks and costs of antimicrobials used to treat severely malnourished children will influence policy on case management and antimicrobial stewardship in this vulnerable population.THE INFLUENCE OF MATERNAL PRENATAL HEALTH EDUCATION ON INFANT NUTRITIONAL STATUS IN MBAGATHI DISTRICT HOSPITAL, NAIROBI.Dr.Kiria Koigi M, Medical Officer, Pumwani Maternity Hospital; Prof. Koigi Kamau R, UON (ObGyn); Dr. Kamau Koigi,UON/KNH ( ObGyn); Dr Nyambura Kariuki, UON (Paeds), Dr. Kinuthia J, KNH (ObGyn).Background: Prenatal Health Education is deemed to be a strategy that is expected to improve maternal, neonatal and child health (MNCH) outcomes. The effect of prenatal health education in relation to infant nutritional status is expected to be catapulted into infancy with resultant reduction in malnutrition during this life period.Objective: To determine whether maternal prenatal health education influences infant nutritional status.Design: Retrospective unmatched case control study.Subjects: Mothers of infants aged 6 to 12 months with malnutrition as cases and mothers of infants within the same age bracket without malnutrition as controls.Results: The medial age group was 25 years to 31 years of age for cases and controls(48.3% vs 45.0% for controls, p = 0.885). Education was at secondary level at 46.7% for both cases and controls. The previous number of deliveries were 1 to 3 in 86.7% in cases and 88.3% in controls ( p = 0.60). The mean antenatal care visits was 4 times for cases and 5 for controls with the mean gestation at first visit of 4 months in each instance. There were 58.3% of cases and 51% of controls who reported receiving health education with each visit (p = 0.72) with 53% of cases and 64% of controls receiving information on infant nutrition ( p = 2.2). Infant nutrition was discussed in 60% of cases and 70% of controls (p = 0.25, OR 0.64, CI 0.30 – 1.37) and breastfeeding was reported as discussed in 58.3% and 60% respectively ( p = 0.85, OR 0.93, CI 0.45 – 1.93). Carbohydrates were reported as having been discussed in 60.0% of cases compared to 51.7% of controls (p = 0.35, OR 1.4, CI 0.68 – 2.89) with fats having been least discussed at 18.3% vs 8.3% respectively ( p value = 0.11, OR 2.47, CI 0.80 – 7.61). There were 81.7% of cases and 87% of controls ( p = 0.82) who were taught on breast feeding on demand with as many as 20% of cases and 18.3% of controls not having been taught at all on frequency of breastfeeding. However, 91.7% and 86.7% were informed on exclusive breastfeeding (p = 0.38). In regards to the technique of breastfeeding, positioning of the baby was taught in 83.3% of cases and 80.0% of controls (p = 0.64, OR 1.23, CI 0.49 – 3.16) but the details of the techniques were poorly done with expressing of breast milk being seen in 1.7% of both cases and controls (p = 1.00, OR 1.00, CI 0.06 – 16.37). Prenatal information on weaning was given and compliance was high. There were 90% of cases and 93.3% of controls who reported prenatal education on immunization whereas 83.3% of cases and controls took their children for immunization at the age of 6 weeks.Conclusion and Recommendation: Health education in the current state of provision does not appear to confer benefit on reduction of infant malnutrition. This depicts a need for more structured, objective effect oriented approach to health education. Further studies are needed in this neglected and very important area. VACCINOLOGYFACTORS ASSOCIATED WITH ROTAVIRUS POSITIVE DIARRHEA IN THE POST-VACCINE PERIOD AS SEEN AT MOI TEACHING AND REFERRAL HOSPITAL, ELDORET:Kiilu C. K.1, Apondi E.2 and Marete I.1Moi University, College of Health Sciences, 2. Moi Teaching and Referral HospitalBackground: Diarrhea still carries an unacceptably high morbidity and mortality rate in Sub-Saharan Africa and Kenya. Rotavirus infection in the pre-vaccine era has been the leading cause of diarrhea in Kenya. There is limited data on the characteristics of rotavirus diarrhea after the inclusion of Rotarix? in the regular vaccination schedule in Kenya on July 2014.Methods: This was a cross-sectional study describing the factors associated with Rotavirus diarrhea at Moi Teaching and Referral Hospital, Pediatric Emergency Department, Eldoret. The participants aged two years and below with Acute Diarrheal Illness, were interviewed and a Certest? rotavirus stool antigen test carried out. The study was conducted between November 2015 and June 2016. Results: 311 participants with acute diarrhea were recruited, with 55.6% (173/311) being rotavirus positive. On univariate analysis, age appropriate completion of routine vaccination (p=0.030), two doses of rotavirus vaccination (p=0.005) and nutrition status (p=0.009) were associated with a positive rotavirus test. On logistic regression, mild wasting (OR 2.581; CI 95% 1.068-6.236;p=0.035) and moderate wasting (OR 3.424; CI 95% 1.221-9.604;p=0.019) were associated with rotavirus positive diarrhea. Receiving two rotavirus vaccines (OR 0.151; CI 95% 0.032-0.709;p=0.017) and age appropriate completion of routine vaccination (OR 0.478; CI 95% 0.256-0.892;p=0.003) was protective. The peak rotavirus prevalence was during the dry season.Receiving one rotavirus vaccine, severe malnutrition and socio-demographic characteristics e.g. age, the child’s primary caregiver, overcrowding weren’t statistically significant. Although majority of the children with rotavirus positive diarrhea had non-severe dehydration (63%, 109/173) this was also not significant (OR 1.066; CI 95% 0.6695-1.699;p=0.786). Fluid stool was significant but at wide CI (OR 1.941; CI 95% 0.999-3.77;p=0.05).Conclusion: Prevalence of Rotavirus diarrhea is still high among the under twos in our set up. Two rotavirus vaccines are needed for full protection. Advocacy and public health interventions should intensified to improve the vaccine coverage.VACCINE PRODUCTION IN AFRICA: A FEASIBLE BUSINESS MODEL FOR CAPACITY BUILDING AND SUSTAINABLE NEW VACCINE INTRODUCTIONMakenga G.National Institute for Medical Research (NIMR), Tanzania.Background: Africa has the highest incidence of mortality caused by infectious diseases, and remarkably does not have capacity to manufacture vaccines. Vaccination is the most important medical practice ever introduced, it has been essential to reduce mortality, improving life expectancy, and promoting economic growth. GAVI has significantly helped introduction of new vaccines in Africa but sustainability is questionable, with failure to introduce new vaccine post graduation due to increased vaccine procurement cost. Vaccines targeted mainly or exclusively for Africa (e.g. malaria or invasive non-typhoidal salmonella) could be candidates for local production in Africa whose population and economic growth offers prospective market.Methods: This was in part a review study based on literature and published information (including pertinent websites), Interviews and specific online survey was conducted to determine interest from different organizations, and countries in Africa for vaccine manufacturing capacity implementation. Experts were consulted for generation and qualification of the business model in high level planning scenarios for building and implementation of manufacturing capacity in Africa.Results: Most African countries are interested on local vaccine production but only with an external support for investment. Global vaccine stakeholders are willing to offer technical support in any interested country. However, investment on vaccine production in Africa is not their preference of due to deficiencies in political will and lack of an agreeable market.Conclusion: Opportunities for vaccine production establishment in Africa are widely available. A well-chosen simple technology and a strategic country can suit the start of vaccine production in Africa. This study come up with an affordable implementation plan of the business model containing recommendations for an investment plan based on a proposed vaccine facility type affordable to most African countries and investors. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download