Hospital based surveillance on bacterial diseases in Kenya

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Hospital based surveillance on bacterial diseases
in Kenya
Wamae Maranga, M. English, A. Scott, S. Mudhune,
C. Mate, L. Omollo Kenya MOH bacterial meningitis
Surveillance workshop September 21, 2006 KCCT
Nairobi
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Presentation overview

• Introduction
• Surveillance of bacterial diseases in Kenya
• WHO/Paediatrics Bacterial meningitis
  surveillance
• netSPEAR introduction
• Initial and current meningitis surveillance
  situation and summary results
• Mention of blood cultures
• Challenges and way forward
• Conclusion

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Meningitis kills or severely disable

• Severe complications affect up to 25-30
• Hemiplegia
• Blindness
• Deafness
• Epilepsy
• Severe learning difficulties
• Severe behavioural disturbances
• Case fatality is high
• Kenya Kilifi - 30 KNH lt1yrs - 15, 1-5yrs -
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• Burkina Faso 25- 46 (2006)
• Mali - 10 Hib meningitis
• Malawi - 41

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Changing epidemiology of meningitis
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Changing epidemiology of meningitis
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Pneumonia the forgotten killer of children

• Kill over 2 M annually globally
• lt 20 of children with pneumonia get recommended
  treatment antibiotics
• Significant pneumonia death occur out of
  hospital
• Affect the most vulnerable
• Malnourished
• Not breastfed exclusively
• Deficiency like Vit. D, Zinc,
• HIV positive
• Poor living conditions e.g. crowded, in-door
  pollution, etc

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Bacterial meningitis Surveillance in Kenya

• WHO/MOH Paediatrics bacterial meningitis
  surveillance since 2001
• KNH was the only site
• To monitor Hib after introduction of the
  conjugate Hib Vaccine in Kenya
• netSPEAR from Aug. 2003 aim to increase
  surveillance activities in line with PBM
• Sites increased from 1 to 6

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Enhanced surveillance in the region (netSPEAR)
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At the onset of surveillance (Clinical)

• No standard cases definitions
• No case management practices /guidelines
• Incomplete routine documentation
• LP not routine for clinical meningitis
• Missed out a large number of clinical meningitis

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Clinical laboratories

• Few Laboratories could analyse CSF adequately
• Blood culture capacity limited/non-existent
• No existing SOPs for use for common laboratory
  procedures
• Lack of standardisation and QA
• Isolation of any organism from CSF was rare
• No SPN isolate in almost all labs for years

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A surveillance laboratory
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Support for meningitis surveillance

• SOPs (Clinical and Lab SOPs) following
  consultation with clinician and laboratory
  representatives
• Clinical and lab Supplies as needed
• Sensitisation on case identification /specimen
  collection processing based on the SOPs
• Data management tool training
• Species re-confirmation and serotyping services
  available
• Minimum IQA initiative for the labs

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Support for meningitis surveillance

• EQA with quarterly circulation
• Blood cultures machine and supplies for KNH.
• Some exposure to research laboratory to improves
  skills
• Sharing/peer review by having whole network
  meeting
• Feedback from netSPEAR to sites
• Other site specific needs

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Lumbar puncture Blood cultures posters
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Flowcharts for use in the laboratory
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Supporting IQA sites QA assessment
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Trend on CSF cultures by country
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All Kenya sites trend for CSF cultures (N6427)
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Trend for CSF cultures any, SPN Hin isolates
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Blood cultures results

• Introduced at KNH in May 2005
• Kilifi D. Hospital been carrying blood cultures
  from the start of netSPEAR

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Why blood cultures?

• Will contributes in management of severely sick
  children targeted for BC (Pneumonia sepsis).
• Well targeted blood cultures in children doubles
  the isolation rate of Hib and almost triples that
  of Streptococcus pneumoniae
• Pneumonia is common and major cause of death
  there is inadequate data on what the main causes
  are.
• As a major cause of pneumonia death pneumococcal
  disease sero-type data representing children with
  pneumonia is vital

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Blood cultures trend from Aug-03 to
Jun-06(N17029)
Most BC from Kilifi D. Hospital
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Kenya Isolate trend for blood cultures
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Monthly trends on blood cultures
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Conclusion

• A network for hospital based surveillance of
  bacterial diseases in Kenya exist and is being
  enhanced in six key public hospitals
• To provide vital surveillance data for MOH
• MOH owned surveillance activities can be enhanced
  through partnerships with WHO, Kemri, netSPEAR
  and others
• Main challenge is sustaining and continuous
  improvement of performance
• As significant causes of mortality and morbidity
  bacterial disease surveillance need to be at
  similar level with VPD, HIV, Malaria

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Acknowledgement

• KEMRI/ Wellcome Trust
• Pneumo-ADIP
• WHO AFRO, WHO ICP, WHO country offices
• MOH (KEPI, NPHL all Participating hospitals)
• GSK Biologicals for supporting network
  conference since 2005