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Mwangi LW, Omuse G, Adam R, Ong’ete G, Matheka C, Mugaine P, Sayed S, Maina D. Post-vaccination SARS-CoV-2 IgG spike antibody responses among clinical and non-clinical healthcare workers at a tertiary facility in Kenya. PLoS One 2024; 19:e0299302. [PMID: 38573911 PMCID: PMC10994319 DOI: 10.1371/journal.pone.0299302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/07/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Following the coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, vaccination became the main strategy against disease severity and even death. Healthcare workers were considered high-risk for infection and, thus, were prioritised for vaccination. METHODS A follow-up to a SARS-CoV-2 seroprevalence study among clinical and non-clinical HCWs at the Aga Khan University Hospital, Nairobi, we assessed how vaccination influenced SARS-CoV-2 anti-spike IgG antibody responses and kinetics. Blood samples were drawn at two points spanning 6 to 18 months post-vaccination, and SARS-CoV-2 spike antibody levels were determined by enzyme-linked immunosorbent assay. RESULTS Almost all participants, 98% (961/981), received a second vaccine dose, and only 8.5% (83/981) received a third dose. SARS-CoV-2 spike IgG antibodies were detected in 100% (961/961) and 92.7% (707/762) of participants who received two vaccine doses, with the first and second post-vaccine test, respectively, and in 100% (83/83) and 91.4% (64/70) of those who received three vaccine doses at the first and second post-vaccine test, respectively. Seventy-six participants developed mild infections, not requiring hospitalisation even after receiving primary vaccination. Receiving three vaccine doses influenced the anti-spike S/Co at both the first (p<0.001) and second post-vaccination testing (p<0.001). Of those who tested SARS-CoV-2 positive, the anti-spike S/Co ratio was significantly higher than those who were seronegative at the first post-vaccine test (p = 0.001). Side effects were reported by almost half of those who received the first dose, 47.3% (464/981), 28.9% (278/961) and 25.3% (21/83) of those who received the second and third vaccine doses, respectively. DISCUSSION AND CONCLUSION Following the second dose of primary vaccination, all participants had detectable anti-spike antibodies. The observed mild breakthrough infections may have been due to emerging SARS-CoV-2 variants. Findings suggest that although protective antibodies are induced, vaccination protected against COVID-19 disease severity and not necessarily infection.
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Affiliation(s)
- Lucy W. Mwangi
- Research Division, Medical College East Africa, The Aga Khan University Hospital, Nairobi, Kenya
| | - Geoffrey Omuse
- Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - Rodney Adam
- Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Nairobi, Kenya
- Department of Internal Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - George Ong’ete
- Occupational Safety and Health, The Aga Khan University Hospital, Nairobi, Kenya
| | - Cyrus Matheka
- Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - Patrick Mugaine
- Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - Shahin Sayed
- Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Nairobi, Kenya
| | - Daniel Maina
- Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Nairobi, Kenya
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Mwangi LW, Macharia W, Wachira BW, Kimeu J, Mativa B, Atwoli L. Role of hospital leadership in pandemic preparedness: experience at a tertiary hospital in Kenya during the COVID-19 pandemic. BMJ Lead 2023:leader-2023-000833. [PMID: 37567757 DOI: 10.1136/leader-2023-000833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION Pandemic preparedness refers to being ready for, responding to and recovering from public health crises, and is integral for health security. Hospital leadership is a critical building block of an effective healthcare system, providing policy, accountability and stewardship in a health crisis. OBJECTIVES AND METHODS We aimed to describe the leadership and governance structures put in place at the Aga Khan University Hospital, Nairobi, a private not-for-profit tertiary healthcare facility, following the COVID-19 pandemic. We reviewed over 200 hospital documents archived in the COVID-19 repository including those received from the Kenya Ministry of Health, emails, memos, bulletins, meeting minutes, protocols, brochures and flyers. We evaluated and described pandemic preparedness at the hospital under four main themes: (a) leadership, governance and incident management structures; (b) coordination and partnerships; (c) communication strategies; and (d) framework to resolve ethical dilemmas. RESULTS The hospital expeditiously established three emergency governance structures, namely a task force, an operations team and an implementation team, to direct and implement evidence-based preparedness strategies. Leveraging on partners, the hospital ensured that risk analyses and decisions made: (1) were based on evidence and in line with the national and global guidelines, (2) were supported by community leaders and (3) expedite financing for urgent hospital activities. Communication strategies were put in place to ensure harmonised COVID-19 messaging to the hospital staff, patients, visitors and the public to minimise misinformation or disinformation. An ethical framework was also established to build trust and transparency among the hospital leadership, staff and patients. CONCLUSION The establishment of a hospital leadership structure is crucial for efficient and effective implementation of pandemic preparedness and response strategies which are evidence based, well resourced and ethical. The role of leadership discussed is applicable to healthcare facilities across low and middle-income countries to develop contextualised pandemic preparedness plans.
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Affiliation(s)
- Lucy W Mwangi
- Research Division, The Aga Khan University Medical College East Africa, Nairobi, Kenya
| | - William Macharia
- Research Division, The Aga Khan University Medical College East Africa, Nairobi, Kenya
- Paediatrics and Child Health, The Aga Khan University Medical College East Africa, Nairobi, Kenya
| | - Benjamin W Wachira
- Accident & Emergency Department, The Aga Khan University Hospital, Nairobi, Nairobi, Kenya
- Brain and Mind Institute, The Aga Khan University, Nairobi, Kenya
| | - Jemimah Kimeu
- Department of Nursing, The Aga Khan University Hospital, Nairobi, Nairobi, Kenya
| | - Boniface Mativa
- Quality and Patient Safety, The Aga Khan University Hospital, Nairobi, Nairobi, Kenya
- Family Medicine, The Aga Khan University Medical College East Africa, Nairobi, Kenya
| | - Lukoye Atwoli
- Brain and Mind Institute, The Aga Khan University, Nairobi, Kenya
- Department of Medicine, The Aga Khan University Medical College East Africa, Nairobi, Kenya
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Mwangi LW, Abuga JA, Cottrell E, Kariuki SM, Kinyanjui SM, Newton CRJC. Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review. Wellcome Open Res 2022; 6:61. [PMID: 35299711 PMCID: PMC8902259.2 DOI: 10.12688/wellcomeopenres.16593.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Neurological impairments (NI) and disability are common among older children in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical and rehabilitative care by children and adolescents with NI in LMICs. Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all studies reporting on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches. Results: Our literature searches identified 3,258 reports of which 20 were included in the final analysis. Fifteen studies (75.0%) originated from diverse settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=17, 85.0%), geographical and physical inaccessibility (N=14, 70.0%), inadequate healthcare resources (N=14, 70.0%), prohibitive culture and beliefs (N=12, 60.0%), and inadequate education/awareness (N=11, 55.0%). Factors reported in <50% of the studies included competing domestic roles (N=4, 20%) and a lack of confidentiality for personal information (N=2, 10.0%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level. Conclusions: Financial constraints, geographic and physical inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs. PROSPERO registration: CRD42020165296 (28/04/2020)
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Affiliation(s)
- Lucy W. Mwangi
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Jonathan A. Abuga
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Global Child Heath Group, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, AHTC, Tower C4, Paasheuvelweg 25 1105 BP Amsterdam, The Netherlands
| | - Emma Cottrell
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Symon M. Kariuki
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
| | - Samson M. Kinyanjui
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxford OX3 7BN, UK
| | - Charles RJC. Newton
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
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Lajoie J, Kowatsch MM, Mwangi LW, Boily-Larouche G, Oyugi J, Chen Y, Kimani M, Ho EA, Kimani J, Fowke KR. Low-Dose Acetylsalicylic Acid Reduces T Cell Immune Activation: Potential Implications for HIV Prevention. Front Immunol 2021; 12:778455. [PMID: 34868050 PMCID: PMC8637415 DOI: 10.3389/fimmu.2021.778455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/22/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Acetylsalicylic acid (ASA) is a well-known and safe anti-inflammatory. At low-dose, it is prescribed to prevent secondary cardiovascular events in those with pre-existing conditions and to prevent preeclampsia. Little is known about how low-dose ASA affects the immune response. In this study, we followed women to assess how ASA use modifies T cells immune phenotypes in the blood and at the genital tract. Methods HIV uninfected women from Kenya were enrolled in this study and followed for one month to assess baseline responses including systemic/mucosal baseline immune activation. Participants then received 81mg of ASA daily for 6 weeks to assess changes to T cell immune activation (systemic and mucosal) relative to baseline levels. Results The concentration of ASA measured in the blood was 58% higher than the level measured at the female genital tract. In the blood, the level of ASA was inversely correlated with the following: the proportion of Th17 expressing HLA-DR (p=0.04), the proportion of effector CD4+ T cells expressing CCR5 (p=0.03) and the proportion of CD8+Tc17 expressing CCR5 (p=0.04). At the genital tract, ASA use correlated with a decreased of activated CD4+T cells [CD4+CCR5+CD161+ (p=0.02) and CD4+CCR5+CD95+ (p=0.001)]. Conclusion This study shows that ASA use impacts the immune response in both the systemic and genital tract compartments. This could have major implications for the prevention of infectious diseases such as HIV, in which the virus targets activated T cells to establish an infection. This could inform guidelines on ASA use in women. Clinical Trial Registration ClinicalTrials.gov, identifier NCT02079077.
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Affiliation(s)
- Julie Lajoie
- Laboratory of Viral Immunology, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Monika M Kowatsch
- Laboratory of Viral Immunology, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Lucy W Mwangi
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Geneviève Boily-Larouche
- Laboratory of Viral Immunology, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Julius Oyugi
- Laboratory of Viral Immunology, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.,University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Yufei Chen
- College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada
| | - Makobu Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
| | - Emmanuel A Ho
- College of Pharmacy, University of Manitoba, Winnipeg, MB, Canada.,Laboratory for Drug Delivery and Biomaterials, School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Joshua Kimani
- Laboratory of Viral Immunology, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.,University of Nairobi Institute for Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.,Partners for Health and Development in Africa, Nairobi, Kenya
| | - Keith R Fowke
- Laboratory of Viral Immunology, Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.,Partners for Health and Development in Africa, Nairobi, Kenya.,Department of Community Health Science, University of Manitoba, Winnipeg, MB, Canada
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Mwangi LW, Abuga JA, Cottrell E, Kariuki SM, Kinyanjui SM, Newton CRJC. Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review. Wellcome Open Res 2021; 6:61. [PMID: 35299711 PMCID: PMC8902259 DOI: 10.12688/wellcomeopenres.16593.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Neurological impairments (NI) and disability are common among survivors of childhood mortality in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical care by children and adolescents with NI in LMICs. Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all reports on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches, and we report a synthesized analysis of the barriers identified in the primary studies. Results: Our literature searches identified 3,074 reports of which 16 were included in the final analysis. Fourteen studies (87.5%) originated from rural settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=15, 93.8%), geographical inaccessibility (N=11, 68.8%), inadequate healthcare resources (N=11, 68.8%), inadequate education/awareness (N=9, 56.3%), and prohibitive culture/beliefs (N=9, 56.3%). Factors reported in <50% of the studies related to the attitude of the patient, health worker, or society (N=7, 43.8%), poor doctor-patient communication (N=5, 31.3%), physical inaccessibility (N=3, 18.8%), and a lack of confidentiality for personal information (N=2, 12.5%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level. Conclusions: Financial constraints, geographic inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs. PROSPERO registration: CRD42020165296 (28/04/2020)
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Affiliation(s)
- Lucy W. Mwangi
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Jonathan A. Abuga
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Global Child Heath Group, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, AHTC, Tower C4, Paasheuvelweg 25 1105 BP Amsterdam, The Netherlands
| | - Emma Cottrell
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
| | - Symon M. Kariuki
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
| | - Samson M. Kinyanjui
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, Oxford OX3 7BN, UK
| | - Charles RJC. Newton
- Clinical Research (Neurosciences), Kemri-Wellcome Trust Research Programme, Kilifi, PO Box 230-80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, Oxford OX3 7JX, UK
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