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Late diagnosis triggering more deaths in HIV-positive children – Study

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Latest study: Late diagnosis triggering more deaths in HIV-positive children

By ALLAN TAWAI

Latest study shows that more children infected with HIV are dying early in hospitals in spite of anti-retroviral therapy (ART) being available, blaming delayed diagnosis among this pool of patients for the problem.

The study which was conducted in four hospitals in Kenya – Kenyatta National Hospital and Mbagathi District Hospital in Nairobi and Jaramogi Oginga Odinga Teaching and Referral Hospital and Kisumu County Hospital in Nyanza between April 2013 and November 2015 indicates that HIV infection in most is only known when they are admitted to hospitals, an indication that there has been little or no focus for routine checks for status among children.

The findings published in the Lancet Health Journal last week reveal that ART has not helped increase chances of survival for hospitalized children.

“Many HIV-infected children in sub-Saharan Africa are frequently diagnosed during hospitalisation for an acute co-infection and experience high early mortality,” it stated.

It also stated that anti-retroviral therapy among hospitalised HIV-infected children might not speed up recovery and may in fact inhibit immune regeneration.

The research was done on 191 (76 percent) out of the 250 hospitalised HIV-infected children in the hospitals. They were aged between 0-12 years.

Of these, 181 children were randomly enrolled, 90 to urgent anti-retroviral therapy (done within 48 hours of enrolment) and 91 to post-stabilization ART (done 7-14 days after enrolment).

Overall, almost a quarter (21 percent) of children died in the first 3 months.

Eighteen (10 percent) of 181 children died in the first week. 12 (13 percent) of 90 children died in the urgent ART group and six (7 percent) of 91 children died in the post-stabilisation group.

Most of the deaths of the children occurred in the first month and dropped strikingly between one month and three months.

No deaths occurred between three months and six months after ART initiation.

“Overall it was observed that there was a high mortality rate in the first few weeks after ART initiation, with more than 80 percent of deaths occurring in the first month and all deaths occurring within three months,” said the study.

Results show that speeding up anti-retroviral therapy during hospitalisation does not have any survival benefit.

“Though rapid HIV diagnosis within one day of enrolment was practised at the four hospital sites, ART initiated within 48 hours did not reduce mortality when compared with ART initiated between 7 days and 14 days,” the research revealed.

A previous study in Kenya showed that 41 percent of hospitalised infants died before ART initiation at the average of 11 days after diagnosis, suggesting a narrow window for intervention in children.

Researchers in that study also found no survival benefit of initiating ART within seven days compared with 21 days in a hospitalised pediatric unit.

“Together, these studies suggest that waiting for more than 21 days might be too late while expediting to less than seven days might not provide survival benefit,” said the study.

The research also found out that delays by caregivers in providing ART treatment to the children were common and may have increased the risk of death.

More than a third of the children who had previously been hospitalised had not started ART either because of not having been tested for HIV, having been diagnosed but not referred for ART, or failing to link to ART services.

Pre-ART loss to follow-up rates of 15·2 per 100 people were also reported from a large treatment programme in western Kenya and 16 percent of children who did not follow-up died.

“Once children are discharged from the hospital, they often fail to return to clinic to start ART,” it read.

“This missed opportunity for earlier HIV diagnosis and treatment too often resulted in mortality,” added the report.

According to the World Health Organisation (WHO), about 1.6 million persons in Kenya are infected with HIV and only about one million are on ART.

Kenya has an estimated 71,034 new HIV infections among adults and about 6,613 new infections among children annually.

Approximately 120, 000 children in Kenya are living with HIV while only 78, 700 children (65 percent) are accessing anti-retroviral treatment.

In 2016, about 4, 800 children died due to HIV/AIDS.

The study proposes that the high mortality risk observed despite accelerated ART emphasizes the need for alternative strategies to improve survival in HIV-infected children who are presented late to care as well as interventions to test and treat children.

 

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Africa

American who survived 9/11 dies in Riverside attack

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An American who survived the 9/11 terror attack is among those who were killed in Tuesday’s terror attack at Nairobi’s 14 Riverside Drive.

Jason Spindler’s mother Sarah Sandler told NBC News that her son “was trying to make positive change in the third world in emerging markets.”

Jason’s brother, Jonathan, also confirmed the family’s tragic loss via Facebook.

“It is with a heavy heart that I have to report that my brother, Jason Spindler passed away this morning during a terror attack in Nairobi, Kenya. Jason was a survivor of 9-11 and a fighter. I am sure he gave them hell!” Jonathan’s post read.

HAVING LUNCH

The US State department confirmed that an American citizen was killed in the Tuesday attack.

Spindler, who was the CEO and Global Managing Director of I-DEV International, was, according to colleagues, having lunch at the Dusit Hotel when the attack happened.

I-DEV is based at Metta, a space for entrepreneurs that is located at the 14 Riverside office complex in the Belgravia building’s sixth floor.

The Metta Africa Head of Community, memberships and operations Essie Mwikali said there were 45 people at the space when the attack happened and accounted for everyone and confirmed the death of Spindler.

Nailab CEO Sam Gichuru eulogized Spindler as “a strong supporter of the Kenyan Tech Ecosystem.”

By Agencies

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Why Java House will not open again on Westgate Mall: Founder speaks out on what happened during Westgate attack

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BY OLIVIA MUNGWANA

Java House founder has said the coffee house does not have plans of going back to Westgate Mall which was attacked by terrorists five years ago.

Recounting what happened, the coffee house’s chairman and founder Mr Kevin Ashley, said they will not open another Java Coffee House in the mall because he would not anybody’s children as much as his own, to go back to the mall.

“My view is that if I don’t want my own kids to go there, why would I want someone else’s kid to work there?” said Mr Ashley.

Recounting the terrorist attack, the Java founder said he was in California when terrorists stormed in the high end mall and he was scared for his children.

“My kids were in Nairobi. First I didn’t know where they were…they could have been in the mall. When I heard the news, I was on the phone with our yoghurt shop manager who was on the floor hiding. I could hear the gunshots,” he explains in an interview with GainExperience.

He told the manger to make sure she had nothing in her hands and to keep her uniform on.

“Don’t move because a security guard might walk in and shoot you, thinking you’re a terrorist. Stay calm, relax, keep your uniform”.

He then got on a plane and 36 hours later, he was in Nairobi.

When he arrived in Nairobi there were still things going on at the mall, rescue missions which took upto three days.

“They were still unsure about killing all the terrorists, I met with all the staff, no one was hurt.”

The chairman has also faulted the mall’s management for going on about the business without putting up a memorial plaque to remember the souls that were lost in the premises.

“People died there. There’s no plaque, no memorial, no park, there’s nothing there! We don’t need to go back in there with a profit motive and try to make a point. It’s karma…” he adds

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University expels female student for hugging male friend

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A university on Sunday said it had expelled a female student after she appeared in a video hugging a male colleague, accusing her of undermining the school’s reputation.

The video, which went viral earlier this month, showed a young man carrying a bouquet of flowers kneeling before a young woman and then hugging her in what appeared to be a marriage proposal.

The video was apparently not filmed at Al-Azhar University— a branch of Egypt’s highest Sunni Muslim authority — but at another establishment, Mansoura University in the country’s north.

Nevertheless the disciplinary council of the Al-Azhar University campus in Mansoura on Saturday “decided to expel the young girl definitively”, university spokesman Ahmed Zarie told AFP.

He said the video had caused a “public outcry” and that the university’s decision to expel her was because she had presented a “bad image” of Al-Azhar University, which strictly segregates the genders.

He said hugging between unmarried men and women violates “the values and principles of society”.

The woman, however, can appeal the expulsion decision, Zarie said.

The young man who appeared in the video could also face sanctions, a spokesman for Mansoura University said, adding that the school’s disciplinary council will meet on Monday to decide his “punishment”.

Egypt, a predominantly Muslim country, is a largely conservative society.

Last year, prosecutors detained a female singer for four days for “incitement to debauchery” after an online video clip which included sensual oriental dances and suggestive gestures went viral.

And in 2017 another female pop singer was sentenced to two years in prison on similar charges, also over a video deemed provocative. Her sentence was reduced to a year on appeal.​

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