Neonatal jaundice and developmental impairment among infants in Kilifi, Kenya

BACKGROUND

Neonatal jaundice (NNJ) is common in sub-Saharan Africa (SSA), and it is associated with sepsis. Despite the high incidence, little has been documented about developmental impairments associated with NNJ in SSA. In particular, it is not clear if sepsis is associated with greater impairment following NNJ.

METHODS

We followed up 169 participants aged 12 months (57 cases and 112 controls) within the Kilifi Health Demographic Surveillance System. The diagnosis of NNJ was based on clinical laboratory measurement of total serum bilirubin on admission, whereas the developmental outcomes were assessed using the Developmental Milestones Checklist and Kilifi Development Inventory.

RESULTS

There were significant differences between the cases and controls in all developmental domains. Cases scored lower in language functioning (mean [M] = 6.5, standard deviation [SD] = 4.3 vs. M = 8.9, SD = 4.6; p < .001); psychomotor functioning (Mdn = 23, interquartile range [IQR] = 17-34 vs. Mdn = 31.0, IQR = 22.0-44.0; Mann-Whitney U = 4,122, p = .002); and socio-emotional functioning ([Mdn = 30.0, IQR = 27.0-33.0 vs. Mdn = 34.0, IQR = 30.0-37.0], Mann-Whitney U = 4,289, p < .001). There was no evidence of association between sepsis and psychomotor (r_pb = -.2, p = .214), language (r_pb = -.1, p = .510), and socio-emotional functioning (r_pb = .0, p = .916). Significant and medium to large portions of the variance (34-64%) in the developmental outcomes among children who survived NNJ were associated with home birth, low maternal education, and feeding problems during the first days of life.

CONCLUSIONS

NNJ is associated with developmental impairments in the early childhood years; however, NNJ associated with sepsis does not lead to more severe impairment. Prenatal and postnatal care services are needed to reduce the negative impact of NNJ for children from low resourced settings.

Consistency of agricultural drought characterization over Upper Greater Horn of Africa (1982-2013): Topographical, gauge density, and model forcing influence

The negative impact of Upper Greater Horn of Africa's (UGHA) complex topography on drought characterization exacerbated by gauge density and model forcing parameters has not been investigated. In order to fill this gap, this study employs a combination of remotely sensed, in situ, and model products (1982-2013); precipitation (CHIRPS, GPCC, and CHIRP), soil moisture (ERA-Interim, MERRA-2, CPC, GLDAS, and FLDAS), vegetation condition index (VCI), and total water storage products (GRACE and MERRA-2) to (i) characterize drought, (ii) explore the inconsistencies in areas under drought due to topographical variations, gauge density, and model forcing parameters, and (iii), assess the effectiveness of various drought indicators over Ethiopia (a selected UGHA region with unique topographical variation). A 3-month time scale that sufficiently captures agricultural drought is employed to provide an indirect link to food security situation in this rain-dependent region. The spatio-temporal drought patterns across all the products are found to be dependent on topography of the region, at the same time, the inconsistencies in characterizing drought is found to be mainly driven by topographical variability (directly) and gauge density (inversely) for precipitation products while for soil moisture products, precipitation forcing parameters plays a major role. In addition, the inconsistencies are found to be higher under extreme and moderate droughts than severe droughts. The mean differences in the percentage of areas under drought and different drought intensities over the region are on average 15.87% and 6.16% (from precipitation products) and 12.65% and 5.20% (from soil moisture products), respectively. On the effectiveness of various indicators, for the duration under study, the following were found to be most suitable over Ethiopia; VCI, GPCC, ERA, CPC, and FLDAS. These results are critical in putting into perspective drought analysis outcomes from various products.

A randomized control trial of phototherapy and 20% albumin versus phototherapy and saline in Kilifi, Kenya

Objective

The study evaluated the efficacy of phototherapy and 20% albumin infusion to reduce total serum bilirubin (TSB) in neonates with severe hyperbilirubinemia. The primary outcome was a reduction of TSB at the end of treatment. The secondary outcomes were the need for exchange transfusion, inpatient mortality, neurological outcomes at discharge, and development outcomes at 12-months follow-up.

Results

One hundred and eighteen neonates were randomly assigned to phototherapy and 20% albumin (n = 59) and phototherapy and saline (n = 69). The median age at admission was 5 (interquartile range (IQR) 3–6) days, and the median gestation was 36 (IQR 36–38) weeks. No significant differences were found in the change in TSB (Mann–Whitney U =609, p = 0.98) and rate of change in TSB per hour after treatment (Mann–Whitney U = 540, p = 0.39) between the two groups. There were no significant differences between the two groups in the proportion of participants who required exchange transfusion (χ² (2) = 0.36, p = 0.546); repeat phototherapy (χ² (2) = 2.37, p = 0.123); and those who died (χ² (2) = 0.92, p = 0.337). Trial registration The trial was registered in the International Standardized Randomized Controlled Trial Number (ISRCTN); trial registration number ISRCTN89732754.

Neonatal seizures in a rural Kenyan District Hospital: aetiology, incidence and outcome of hospitalization

BACKGROUND

Acute seizures are common among children admitted to hospitals in resource poor countries. However, there is little data on the burden, causes and outcome of neonatal seizures in sub-Saharan Africa. We determined the minimum incidence, aetiology and immediate outcome of seizures among neonates admitted to a rural district hospital in Kenya.

METHODS

From 1st January 2003 to 31st December 2007, we assessed for seizures all neonates (age 0-28 days) admitted to the Kilifi District Hospital, who were resident in a defined, regularly enumerated study area. The population denominator, the number of live births in the community on 1 July 2005 (the study midpoint) was modelled from the census data.

RESULTS

Seizures were reported in 142/1572 (9.0%) of neonatal admissions. The incidence was 39.5 [95% confidence interval (CI) 26.4-56.7] per 1000 live-births and incidence increased with birth weight. The main diagnoses in neonates with seizures were sepsis in 85 (60%), neonatal encephalopathy in 30 (21%) and meningitis in 21 (15%), but only neonatal encephalopathy and bacterial meningitis were independently associated with seizures. Neonates with seizures had a longer hospitalization [median period 7 days - interquartile range (IQR) 4 to10] -compared to 5 days [IQR 3 to 8] for those without seizures, P = 0.02). Overall, there was no difference in inpatient case fatality between neonates with and without seizures but, when this outcome was stratified by birth weight, it was significantly higher in neonates >or= 2.5 kg compared to low birth weight neonates [odds ratio 1.59 (95%CI 1.02 to 2.46), P = 0.037]. Up to 13% of the surviving newborn with seizures had neurological abnormalities at discharge.

CONCLUSION

There is a high incidence of neonatal seizures in this area of Kenya and the most important causes are neonatal encephalopathy and meningitis. The high incidence of neonatal seizures may be a reflection of the quality of the perinatal and postnatal care available to the neonates.

Maternal and early onset neonatal bacterial sepsis: burden and strategies for prevention in sub-Saharan Africa

Maternal and child health are high priorities for international development. Through a Review of published work, we show substantial gaps in current knowledge on incidence (cases per live births), aetiology, and risk factors for both maternal and early onset neonatal bacterial sepsis in sub-Saharan Africa. Although existing published data suggest that sepsis causes about 10% of all maternal deaths and 26% of neonatal deaths, these are likely to be considerable underestimates because of methodological limitations. Successful intervention strategies in resource-rich settings and early studies in sub-Saharan Africa suggest that the burden of maternal and early onset neonatal bacterial sepsis could be reduced through simple interventions, including antiseptic and antibiotic treatment. An effective way to expedite evidence to guide interventions and determine the incidence, aetiology, and risk factors for sepsis in sub-Saharan Africa would be through a multiarmed factorial intervention trial aimed at reducing both maternal and early onset neonatal bacterial sepsis in sub-Saharan Africa.