Dr Anna Seale @ MRF's Meningitis and Septicaemia 2019

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Meningitis Research Foundation

Neonatal Sepsis in sub Saharan Africa

Health & Medicine

World War II Centre for Naval Analysis - warplanes
https://www.trevorbragdon.com/blog/when-data-gives-the-wrong-solution Syed, Matthew. 2015. Black BoxThinking. NewYork: Penguin Random House. pp 33-37Strengthen the planes where the bullets are causing most damage

Neonatal sepsis – the diagnosis
Seale et al Lancet Infectious Diseases 2014

Neonatal sepsis – morbidity
Seale et al Paediatric Research 2013

Neonatal sepsis – compartmental model estimates
Seale et al Paediatric Research 2013

Neonatal sepsis – population incidence based estimates
Fleischmann-Struzek et al Lancet Resp 20183·0 million cases of neonatal sepsis based on these data – none from sub-SaharanAfrica

Neonatal sepsis – the aetiology
Okomo U et al. Lancet Infect Dis 2019
• Staphylococcus aureus 25%
(21–29)
• Klebsiella spp 21% (16–27)
• Escherichia coli 10% (8–10)
• 151 studies
• (82 since 2008)
• 84534 neonates
• 26 countries
• Almost all in hospital

Neonatal sepsis – the example of Group B Streptococcus
Lawn et al CID 2017

Neonatal sepsis – what are we missing
Lawn et al CID 2017 Early-onset, high mortality, difficult to sample, difficult to detect in the lab

Neonatal sepsis – what does this mean?
Saha et al Lancet 2018
ANISA:
A robust, large, community
based investigation of
neonatal sepsis in South Asia
Even the most robust observational study will be limited by survivor bias

Neonatal sepsis – we need to look at alternatives
Blau D et alCID 2019 Study design – include those that don’t survive

Neonatal sepsis – we need to look at alternatives
Sobanjo-ter-Meulen,A.Vaccine 2019 Study design – an intervention to prevent the deaths

Thank you
All those whose work is included here.
All my colleagues and collaborators at LSHTM, KEMRI-WellcomeTrust
Research Programme, Haramaya University and Public Health England.
Particular thanks to
Joy Lawn
Anthony Scott
Jay Berkley

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Malaria associated anaemia represent a major public health problem. Thestudy considered Out-Patient children at Emergency Paediatric Unit, Federal Medical Centre, Yola aged 6 months-15 years from June to November 2015. Questionnaires were used to collect information relating to gender, age and parents/guardians sociodemographic characteristics. Microscopic examination of Thick and Thin blood films a technique was employed, Pack Cell Volumewas used to screen for anaemia. Of the 168 children sampled, the prevalence of malaria infection and malaria anaemia was 29.2% and 26.2% respectively and it was associated with P. falciparum. Malaria infection in relation to anaemia, children with mild anaemia (47.6%) had the highest infection rate. It was observed that malaria infection was higher among males (32.2%) than the females (25.6%), age group 5-9 years (34.2%) had the highest malaria infection and least was ≥15 years (20.0%) but these were statistically insignificant within gender and age of the children and malaria infection (p˃0.05). Higher malaria infection among children whose parents/guardians were unemployed (38.5%), attended primary education (52.6%) and reside in village setting (31.4%). Malaria anaemia in relation to children epidemiological data, males (31.6%), 5-9 years (31.6%) recorded with high prevalence rate while sociodemographic characteristics of parents/guardians, children whose parents/guardians were civil servant (18.9%), attended tertiary education (13.8%) and live in quarters (11.1%) had the least prevalence rate of malaria anaemia. Children gender, parents/guardians occupation and educational qualification were significantly associated with malaria anaemia (p˂0.05). Therefore, parents/guardians sociodemographic factors such as better occupation, higher educational qualification and well layout and refined area of residence reduces the prevalence of malaria infection and malaria anaemia in children. There is need to sensitized public on the importance of management of malaria and the possible effects of malaria anaemia on children in order to circumvent the menace.

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This research was done to determine factors that influence the occurrence of neonatal septicemia among babies admitted in Kampala international university teaching hospital. This study was guided by the following objectives: to assess the maternal related factors associated with occurrence of neonatal septicemia among babies admitted in Pediatric ward of Kampala international university teaching hospital; to determine neonatal related factors associated with occurrence of neonatal septicemia among babies admitted in Pediatric ward of Kampala international university teaching hospital and to determine the social-economic factors associated with occurrence of neonatal septicemia among babies admitted in Pediatric ward of Kampala international university teaching hospital. A cross sectional study design was used in this study; A sample of 134 respondents were studied which included neonates/caretakers and health workers; data was collected with the use of observation, interview guide and questionnaires; data analysis and interpretation were done using Statistical package for social sciences (SPSS) to generate descriptive statistics and Chi-square p-values that were used to draw conclusion of the study. The results from this research showed that; - the maternal factors that influenced the occurrence of neonatal septicemia among babies admitted in pediatric ward of Kampala international university teaching hospital were inadequate Antenatal Care (ANC) attendance, prolonged rupture of membrane, bathing neonates with herbal medicines and place of delivery whereby a significant number of mothers delivered from home. On the neonatal factors the researcher found out that birth weight had a significant influence on the occurrence of neonatal septicemia among babies admitted in pediatric ward of Kampala international university teaching hospital. Finally, the study identified the socio-economic factors responsible for the occurrence of neonatal septicemia among babies admitted in pediatric ward of Kampala international university teaching hospital as washing hands before handling the neonates, low level of monthly household income and low level of education among caretakers. Based on the findings of this study, the researcher recommends that the Government through the DHOs offices should embark on health education by educating the pregnant women on the dangers of giving birth from their homes and also being helped by unqualified midwives. Also, the government through district sensitization programs should encourage pregnant women to seek antenatal care at the health facilities where they can be health educated, comprehensively screened and treated of infections to prevent spread of infections to newborns. Keywords: Pediatric, Septicemia, Pregnant Women, Health Education, Antenatal care. ________________________________________

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Kathryn Maitland describes the challenges faced with oxygen therapy as an emergency intervention in critical illness in African children. Where Kathryn works, in East Africa, there is no access to intensive care. Caring for critically ill children is all done in the Emergency Department. 70% of the global burden of disease and deaths from pneumonia occurs in Southeast Asia and Sub-Saharan Africa. The WHO has published guidelines as to what classifies as pneumonia, severe pneumonia, and very severe pneumonia. These classifications rely on clinical signs. However, Kathryn in her research has discovered that these classifications are rarely correlated with the actual underlying disease process. Clinical signs are non-specific for the diagnosis of pneumonia. Oxygen is recommended for severe and very severe pneumonia. This has led to calls to prioritise oxygen delivery in African hospitals. However, it has not led to change from a health department or funding viewpoint. There are also oxygen delivery practicalities to consider. Often there is only one source of oxygen on a ward (if at all) with patients clustered around it. The production of Oxygen may only happen in a few places. Poor cylinder quality leads to leaks and therefore, low supply. Concentrators are useful however they need regular servicing. They also rely on power, and in a region that experiences regular power outages, this can be problematic. When the power goes off, there is no oxygen available. Kathryn asks – do all children actually need oxygen? There is still however a hidden burden of hypoxia. Outside of Africa, Kathryn discusses the current state of equipoise on oxygen therapy. Moreover, oxygen can be harmful if given inappropriately. This leads to concerns more broadly on the harms of oxygen therapy. Kathryn concludes her talk by looking to the future. She discusses ongoing research and the implications for future practice in resource poor settings, and indeed the world.

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Otitis media is the inflammation of the middle ear and has a worldwide distribution, particularly among children. A total of 68 patients between the ages 0-42 years who presented with sign and symptoms of otitis media at Bichi general hospital were enrolled for this study. Middle ear discharge were collected, processed and bacterial isolates identified using standard microbiological techniques. Disc susceptibility tests were performed on bacterial isolates. Results indicated that there was a high frequency of occurrence of bacteria incriminated in otitis media in the 0-5 and 6-11 year age groups in the two sexes. Male patients in the two age groups were more infected than the female counterparts. The sensitivity pattern obtained in this study show a progressive increase in the emergence of strains that are resistant to many chemotherapeutic agents. Drug resistance among bacterial isolates is a common phenomenon placing challenge to both medical practitioners and genetic scientists. A routine check on sensitivity patterns among these pathogens is vital so as to regulate the prescription measure to be employed.

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©IDOSR PUBLICATIONS International Digital Organization for Scientific Research ISSN: 2550-794X IDOSR JOURNAL OF SCIENTIFIC RESEARCH 8(2) 161-166, 2023. https://doi.org/10.59298/IDOSR/2023/10.2.6013 Neonatal Sepsis: Haematological Perspectives *Emmanuel Ifeanyi Obeagu1, Ndakize Benjamin Kigabo2, Getrude Uzoma Obeagu3, Okechukwu Paul-Chima Ugwu4 and Sophia Kazibwe5 1Department of Medical Laboratory Science, Kampala International University, Uganda. 2Department of Paediatrics and Child Care Health, Kampala International University, Uganda. 3School of Nursing Science, Kampala International University, Uganda. 4Department of Publications and Extension, Kampala International University, Uganda. 5Department of Public Management, Management Science, Human Resource Management, Kampala International University, Uganda. Email: emmanuelobeagu@yahoo.com ________________________________________ ABSTRACT Neonatal sepsis (NS) is a leading cause of neonatal morbidity and mortality and is considered a global public health challenge. The organisms and pathogens most commonly associated with neonatal sepsis vary by country. Pathogens range from Gram-positive and Gram-negative bacteria to viruses and fungi, with bacteria being the most commonly identified. Bacteria most commonly involved include Staphylococcus aureus, coagulase-negative staphylococci (CONS), Streptococcus pneumoniae, Streptococcus pyogenes, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonella typhi, and Group B Streptococcus increase, or urine culture is usually delayed for a day or two. A battery of tests, including C-reactive protein, total leukocyte count, absolute neutrophil count, platelet count, neutrophil cytoplasmic vacuolization, and polymorphic gastric aspiration cytology, was performed in neonates with a clinical diagnosis of NS. It's an excellent screening test. Keywords: Sepsis, neonates, haematological parameters, laboratory diagnosis, clinical findings

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Incidence of Tuberculosis in HIV Sero-positive Patients at HIV Clinic at Kampala International University Teaching Hospital, Bushenyi District Okello, Andrew School of Allied Health Sciences Kampala International University-Western Campus ________________________________________ ABSTRACT This study on the prevalence of TB among HIV sero-positive was carried at the HIV CLINIC of Kampala International University Teaching Hospital (KIUTH), Ishaka Bushenyi district. A retrospective cross-sectional study design was used to conduct this research. The study targeted all patients attending KIUTH HIV/TB clinic. A standard structured and semi-structured questionnaires were designed and pre-tested for validity and reliability at Kampala International University Teaching Hospital HIV/Tuberculosis clinic before being used for data collection. Data collection started by recruitment of qualified research assistants, appropriate training and orientation of the interviewers before the survey for example when reading the questions. Quantitative methods of data analysis was used in which data was presented in form of bar charts, graphs and tables. The prevalence of TB among HIV sero-positive patients attending HIV clinic at KIUTH stands at 8.06 per 100 participants. The study found that generally, people are aware about the modes of transmission of TB but there is still need for more awareness. Many patients are still not certain whether TB is curable in HIV patients. As seen from the above study, most of the people are not yet aware whether HIV goes hand in hand with tuberculosis. The prevalence of TB in HIV sero-positive attending HIV clinic at KIUTH is high. Generally, TB is affecting patients of all ages and most patients are still not aware if TB in HIV is curable. Most patients have a perception that all TB patients have HIV. Health workers in HIV clinic of KIU-TH should teach patients the modes of transmission and prevention of TB. KIUTH also need to provide easy access to TB screening services to patients. There is need for financial support by the government to the unemployed patients and low-income earners in order to curb TB infections. Keywords: Tuberculosis, HIV, Sero-positive, Bushenyi District ________________________________________

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Urinary schistosomiasis in most cases is complicated with bacterial infections because the so called normal flora of the genito- urinary tract has a better chance of entering and invading the underlying internal tissues as a result of the constant tear and scar of the epithelium by the spiny schistosomal eggs. The study was carried ou ton seasonal variations in the occurrences of Schistosoma haematobium and bacterial urinary infections among school age children in 8 irrigation rural communities of four Local Government Areas of Kano State from March 2012 to February 2013, in order to determine the incidence of S. haematobium and its co-infection with bacterial pathogens among the pupils. Ethical clearance was sought from the State Universal Basic Education Board (SUBEB). Midstream urine samples were collected in sterile universal containers and transported to the laboratory in cold box for the laboratory procession. Urine sedimentation was carried out using centrifugation method, followed by microscopic examination the of S. haematobium. Urinalysis was carried out on each sample particularly to detect the presence of important makers of urinary schistosomiasis and urinary tract infections. Sample culture was carried out on Blood Agar and cystein lactose electrolyte deficiency (CLED) medium; Gram staining and biochemical analyses were carried out for characterization of the Bacterial pathogens. A total of 960 pupils were examined (480 in each of the dry and rainy seasons respectively), of which 306 (31.88%) were males and 112 (11.66%) were females; 165 (34.73%) male pupils and 57 (11.88%) females were found to be infected with S. haematobium during the dry season whereas 141 (14.69%) males and 55 (5.73%) females were found to be infected during the rainy season. The highest prevalence of 115 (23.96%) was found among the 11-13years age group in dry season while the lowest prevalence of 12 (2.50%) was found among the 14-16years age group the dry seasons. In rainy season, the 11- 13 years age group had the highest prevalence (107) (22.29%) and 14-16years age group had the lowest prevalence (17) (3.54%).With regard to urinary tract pathogens, (8) (0.83%) female pupils and 4 (0.42%) male pupils were found to be infected during dry season while in rainy season, 70 (7.29%) females and 42 (4.38%) male pupils were infected. Considering co-infection, the rainy season had highest prevalence (4.38%) while dry season was found to have least prevalence (0.2%); the overall co-occurrence being 8.13%.The study shows no significant relationship between S. haematobium and urinary tract pathogens and seasonal variation has no profound effect on the occurrence of S. haematobium but plays an important role in urinary tract infections.

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