Gervason Moriasi

Renal biomarkers change rapidly in early childhood, but pediatric reference intervals used in African laboratories are often extrapolated from non-African populations and discrete age partitions. This study derived continuous age-dependent centile curves and preliminary reference intervals for body mass index (BMI), serum creatinine, urea, and electrolytes in healthy Kenyan children aged 0 to 60 months. In this cross-sectional study, 176 children (90 males, 86 females) were systematically recruited at Kitui County Referral Hospital between June 2024 and February 2025. Children underwent clinical screening, World Health Organization–standard anthropometry, and morning fasting venous blood sampling. Creatinine and urea were measured using isotope-dilution mass spectrometry-traceable enzymatic assays, and electrolytes by direct ion-selective electrode. Centiles (2.5th, 50th, 97.5th) were estimated non-parametrically with 90% bootstrap confidence intervals, and continuous age trends modeled using generalized additive models for location, scale, and shape or quantile regression. BMI showed modest age-related variation, with median values rising from 15.8 kg/m ² (2.5th–97.5th: 11.4–20.2) at 0 to 11 months to 16.5 kg/m ² (10.1–23.0) at 48 to 60 months, with dispersion narrowing after age 2. Median creatinine rose steeply in infancy and more gradually thereafter, from 17.4 to 31.2 µmol/L. Urea increased gradually from a median of 2.59 to 3.63 mmol/L, with overlapping centile limits across adjacent strata. Electrolytes were tightly regulated and largely age-invariant: sodium ranged from 135 to 147 mmol/L (median ~141), potassium 3.6 to 5.7 mmol/L (median declining from 4.9 to 4.5), and chloride 100 to 111 mmol/L (median ~105–106). Sex-specific partitions were supported only in early life (BMI in infancy, creatinine in toddlers); correlations between anthropometric z -scores and biomarkers were weak (|ρ| < 0.15; P > .10). These continuous centile curves provide the first preliminary age-dependent reference estimates for renal biomarkers in Kenyan children under 5, showing rapid early renal maturation alongside stable electrolyte homeostasis. As this cross-sectional design cannot capture within-subject variation, larger multicenter and longitudinal studies are needed to confirm these trajectories, refine intervals, and develop age-dependent z -score calculators for clinical use.

Background: Diarrhoeal disease remains a major cause of morbidity and mortality among older adults, yet data on enteric bacterial pathogens and antimicrobial resistance in elderly populations in sub-Saharan Africa are limited. This study investigated the bacterial aetiology, antimicrobial resistance profiles, and associated risk factors among elderly patients presenting with diarrhoea at an urban Kenyan referral hospital. Methods: A hospital-based cross-sectional study was conducted among 271 patients aged ≥60 years presenting with acute diarrhoea at Mama Lucy Kibaki Hospital, Nairobi, between February and December 2025. Stool specimens were cultured using selective and differential media, and bacterial isolates were identified by standard biochemical methods. Clostridioides difficile was confirmed using glutamate dehydrogenase and toxin A/B immunoassays. Antimicrobial susceptibility testing was performed using Kirby–Bauer disk diffusion and Etest methods. Results: Enteric bacterial pathogens were isolated from 118 participants, yielding a positivity rate of 43.5%. Escherichia coli was the predominant isolate (28.8%), followed by Clostridioides difficile (15.3%), Campylobacter jejuni (10.2%), and Shigella flexneri (8.5%). High multidrug resistance rates were observed, with an overall MDR prevalence of 60.0% among non-C. difficile isolates. Salmonella typhi and Klebsiella pneumoniae demonstrated 100% MDR, while E. coli and C. jejuni exhibited MDR rates exceeding 70%. No significant associations were identified between infection status and water, sanitation, hygiene, or dietary factors (p>0.05). Conclusion: Elderly patients in urban Kenya carry a substantial burden of multidrug-resistant enteric bacterial infections. Strengthened antimicrobial stewardship, expanded diagnostic capacity, and integration of elderly populations into diarrhoeal disease surveillance programmes are urgently needed.

Objectives: Medication Therapy Management (MTM) remains poorly integrated into oncology care in many low-resource settings, including Kenya, where complex regimens and adverse medication events pose significant risks to patient safety. This study therefore aimed to assess the knowledge, attitudes, and practices (KAP) of cancer patients, family caregivers, and healthcare professionals regarding MTM, and to evaluate the current implementation status, perceived barriers, and opportunities for MTM integration in Kenyan cancer centres. Methods: A cross-sectional questionnaire study involving 450 participants, comprising patients (60.0%), family caregivers (24.9%), and healthcare professionals (15.1%) was conducted across four cancer care centres from February 2024 to January 2025. Patient eligibility, including confirmed malignancy, was verified by attending clinicians through medical record review. Key findings: Despite 91.8% of participants regarding MTM as beneficial, only 24.6% demonstrated understanding of the service. Active MTM availability was low, with 86.9% reporting services as unavailable and 67.2% of professionals estimating utilization below 20%. Major implementation barriers included inadequate funding (68.9%), staffing shortages (60.7%), and low awareness (55.7%). Conversely, 88.5% of participants believed MTM would improve adherence and reduce toxicities. Support for scale-up was robust, with high willingness to participate in education (93.4%) and strong advocacy for increased financing (62.3%) and awareness initiatives (55.7%). Conclusions: A significant disconnect exists between the high perceived value of MTM and its limited operationalization in Kenyan cancer care. Bridging this gap requires strategic investment in workforce capacity, sustainable financing, competency-based training, and digitally enabled delivery models to institutionalize medication safety.

Background: Bloodstream infections caused by Staphylococcus aureus ( S. aureus ) and its methicillin‐resistant S. aureus (MRSA) represent a major clinical challenge, contributing to prolonged illness, increased healthcare costs, and high mortality worldwide. In low‐resource settings, these infections are further aggravated by overcrowding, poor sanitation, and limited access to healthcare. Mukuru, the second‐largest informal settlement in Nairobi, Kenya, is characterized by such socioenvironmental conditions, which plausibly facilitate the transmission and persistence of antimicrobial‐resistant pathogens, including MRSA. Therefore, the aim of the study was to characterize the phenotypic and genotypic antibiotic resistance patterns of S. aureus isolated from outpatient blood samples collected in Mukuru Slum settlement. Methods: This cross‐sectional study analyzed blood samples collected from outpatients in Mukuru informal settlement. S. aureus isolates were identified using standard microbiological cultures and biochemical tests. Antimicrobial susceptibility testing (AST) was performed using the Kirby–Bauer disk diffusion method against a panel of 10 antibiotics. The molecular detection of antimicrobial resistance genes ( mecA , mecC , gyrA , gyrB , and tetM ) was conducted using polymerase chain reaction (PCR), agarose gel electrophoresis, and sequencing ( mecA ). Results: A total of 53 S. aureus isolates were recovered. Phenotypic resistance rates were sulfamethoxazole–trimethoprim (54.7%), ampicillin (50.9%), cefoxitin (37.7%), tetracycline (35.9%), ciprofloxacin (28.3%), gentamicin (28.3%), amoxicillin–clavulanic acid (28.3%), and erythromycin (18.9%). Multidrug resistance (MDR) was observed in 35.8% of the isolates. Genotypic analysis revealed that 82.4% of the cefoxitin‐resistant MRSA isolates harbored the mecA gene, while mecC was not detected. Among ciprofloxacin‐resistant isolates, 91.7% possessed the gyrA gene and 75.0% carried gyrB . The tetM gene was detected in 60.0% of tetracycline‐resistant isolates. Conclusion: The study reveals a high prevalence of MDR S. aureus and MRSA in the study population, driven by significant resistance to commonly prescribed antibiotics such as penicillin and trimethoprim–sulfamethoxazole. The strong concordance between phenotypic resistance and the presence of mecA , gyrA , and tetM genes underscores the genetic basis of resistance in this setting. These findings highlight the urgent need for enhanced antimicrobial stewardship and infection control measures in informal settlements.

The exploration of natural sources for novel anticancer agents has garnered significant attention in recent years, driven by the need for effective and safe anticancer medications, considering the escalating global burden of cervical cancer. Vitex doniana Sweet (Verbenaceae), a plant with diverse traditional medicinal uses, especially in Africa, has shown promise in this regard due to its rich phytochemical composition. This study investigated the cytotoxic and antiproliferative effects of V. doniana extracts on normal mammalian (Vero-CCL-81) and cervical cancer (HeLa) cells, including cancer-associated gene expression profiles, according to standard procedures. Phytochemical analysis was performed using gas chromatography-mass spectrometry (GC–MS). The findings revealed significant (P < 0.0001) concentration-dependent increases in cytotoxicity and inhibition of cancer cell proliferation, by the aqueous, methanolic, ethyl acetate, and dichloromethane leaf extracts of V. doniana. Notably, differential cytotoxicity profiles were observed among different extracts. The median cytotoxic concentrations (CC50) of the studied extracts were: 1025.12 µg/ml (Aqueous leaf extract), 10.67 µg/ml (methanolic leaf extract), 964.81 µg/ml (ethyl acetate extract), and 1238.85 µg/ml (dichloromethane leaf extract. Furthermore, high selectivity indices of the ethyl acetate (26.55) and dichloromethane (103.67) leaf extracts of V. doniana against HeLa cells were observed, underscoring their potential as targeted chemotherapeutic agents against cervical cancer. Mechanistic insights into the observed effects revealed significant modulation of key genes involved in cancer progression, including the androgen receptor (AR), B-cell lymphoma-2 (BCL-2), caspase-3 (CASP3), cyclin-dependent kinase 1 (CDK1), and tumour protein 53 (TP53/P53). GC–MS analysis revealed 10 bioactive compounds in the dichloromethane leaf extract of V. doniana, with γ-sitosterol and stigmasta-3,5-dien-7-one being the most abundant. Besides, the ethyl acetate leaf extract showed presence of 27 phytochemicals, whereby pentatriacontane and tetratetracontane were more common while α-calacorene and spiro (2.5) octane 5,5-dimethyl-4-(3-oxobutyl)- were less abundant. These findings provide valuable insights into the potential and molecular mechanisms underlying the anti-cervical cancer effects of V. doniana extracts, their attributable phytocompounds, and highlight their putative value as sources of lead compounds for the development of novel anticancer drugs.

Private hospitals are critical to healthcare delivery in Kampala, Uganda, where antimicrobial stewardship (AMS) programmes have been introduced as part of the Global Action Plan (GAP) to mitigate the growing threat of antimicrobial resistance (AMR). However, there is limited empirical data on the extent of AMS implementation and the specific barriers these facilities face in adopting such programmes. We therefore evaluated the implementation status and identified key barriers to AMS uptake in private hospitals across Kampala, Uganda. A cross-sectional survey was conducted from 9th January 2024–25th July 2024 in 17 private hospitals, using a mixed-methods approach. Quantitative data were collected using the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) Checklist and analysed descriptively. Qualitative data were gathered through key informant interviews and evaluated using content analysis. The findings revealed significant gaps in AMS implementation. Of the 17 hospitals surveyed, 70.6% (12/17) had not prioritised AMS initiatives in their operations. Besides, 88.2% (15/17) had no budget allocated for AMS activities and 82.4% (14/17) reported insufficient staffing. Additionally, 76.5% (13/17) had not provided AMS-specific training. Furthermore, 64.7% (11/17) lacked regular AMS reports, meeting minutes, or resources for antimicrobial prescribing optimisation, while 41.2% (7/17) had no designated AMS team lead. Besides, qualitative analysis showed structural and institutional challenges, including weak leadership commitment and a lack of sustainable financial planning for AMS programmes. The implementation of AMS programmes in selected private hospitals in Kampala was scanty and constrained by structural, financial, and institutional barriers, including inadequate budget allocation, insufficient staffing, limited training, and the lack of prioritisation of AMS activities. Strengthening institutional support through leadership engagement, funding, and embedding AMS as a core component of hospital policy is essential. Additionally, a multi-stakeholder approach is crucial to driving sustainable AMS adoption, aligning with global AMR mitigation efforts, and ensuring optimal patient outcomes.

Diarrhoeal disease remains a major cause of morbidity and mortality among children under five, especially in low- and middle-income countries where poor water, sanitation, and hygiene (WASH) infrastructure exacerbates its impact. This cross-sectional study examined the prevalence, antimicrobial resistance (AMR) patterns, and risk factors for enteric bacterial infections in 216 children aged 0–60 months in Nairobi County, Kenya. Stool analysis yielded 204 bacterial isolates, predominantly Escherichia coli (36.3%), Shigella sonnei (11.8%), Enterobacter cloacae (9.8%), and Aeromonas hydrophila (8.8%). The highest prevalence occurred in children aged 48–60 months (23.5%), with females accounting for 59.3% of isolates. Antimicrobial susceptibility testing revealed high E. coli susceptibility to meropenem (100.0%), gentamicin (96.6%), and ciprofloxacin (96.6%), but substantial resistance to ampicillin (78.0%) and nitrofurantoin (30.5%). S. sonnei showed complete resistance to ampicillin and high resistance to nitrofurantoin (66.7%). Resistance to nitrofurantoin was also frequent in A. hydrophila (94.4%) and Enterobacter spp. Socio-demographic assessment indicated that most caregivers had tertiary education (50.9%) and low to moderate incomes; half had piped water access, and 44.4% used shared sanitation, yet poor household hygiene was observed in 51.9%. Clinically, diarrhoea was often accompanied by abdominal pain (93.5%), fever (55.6%), and dehydration (46.3%). Oral rehydration salts and zinc were commonly used, while 44% of children had taken antibiotics in the month prior to sampling. The findings reveal a high burden of bacterial diarrhoea and AMR in this setting, underscoring the urgent need for improved WASH infrastructure, antibiotic stewardship, and targeted public health interventions.

Antimicrobial resistance (AMR) poses a growing threat to global health, with wound infections serving as significant reservoirs for multidrug-resistant bacteria. Understanding the socio-demographic, clinical, and microbiological characteristics of wound infections is critical for effective intervention strategies in resource-limited settings. Thus, this study aimed to evaluate the diversity, bacterial profiles, and resistance patterns of wound infections at Kisii Teaching and Referral Hospital. To do this, a total of 118 bacterial isolates from wound swabs were collected from 149 patients who met the eligibility criteria, from May to November 2024. These samples were cultured and analysed using standard microbiological techniques and antibiotic susceptibility testing according to the Clinical and Laboratory Standards Institute guidelines. Resistance genes associated with Vancomycin resistance in Staphylococcus aureus and Staphylococcus xylosus were also investigated using polymerase chain reaction (PCR) with appropriate primers and agarose gel electrophoresis. The results revealed a predominance of male patients (n = 79; 53.02%), avulsions (n = 50; 34.00%), and wounds on lower limbs (n = 63; 42.29%). Escherichia coli (n = 33; 27.97%), Enterobacter gergoviae (n = 20; 16.95%), Staphylococcus aureus (n = 18; 15.25%), and Staphylococcus xylosus (n = 18; 15.25%) were the most frequently isolated pathogens. Alarmingly high resistance rates were observed against ACCESS antibiotics, including Cotrimoxazole-Trimethoprim (n = 114; 97%), Ampicillin (n = 109; 92%), and Streptomycin (n = 100; 85%). Resistance to Watch and Reserve antibiotics, including Vancomycin (n = 11; 29%) and Ceftriaxone (n = 27; 33%), was also documented, particularly among Gram-positive isolates such as Staphylococcus aureus and Gram-negative pathogens like Pseudomonas aeruginosa. Resistance genes (VanA, VanB, VanC) were detected in S. aureus and S. xylosus, underscoring the role of genetic mechanisms in resistance propagation. These findings highlight the critical need for targeted antimicrobial stewardship programmes and strengthened infection prevention measures in high-burden hospital settings, such as Kisii Teaching and Referral Hospital. This study underscores the importance of local resistance data in guiding empirical therapy and informs policies to mitigate AMR in resource-limited contexts. Moreover, enhanced surveillance and research into alternative therapies are crucial to safeguarding the efficacy of life-saving antibiotics and improving patient care outcomes.