CSF culture targets for meningitis

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CSF culture targets for meningitis
Wamae Maranga, M. English, A. Scott, S. Mudhune,
C. Mate, L. Omollo Kenya MOH bacterial meningitis
Surveillance workshop Sept. 21, 2006 KCCT Nairobi
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Presentation overview

• Available evidence on meningitis for Kenya
  Africa
• Current achievable CSF cultures for each
  Hospital
• Needed for Clinical services/Laboratory
  processing
• Blood cultures pneumonia and sepsis
• Role of health managers
• Conclusion

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Available evidence on meningitis in Kenya

• In Kenya
• Kilifi D. Hospital 1.3 - 2.0 (2002 2004)
• KNH in a study from 1979-81
• 46 of all meningitis lt 5yrs (33 lt 1 year 13
  1-5yrs with mortality of 15 8 )
• NME among young adults 15-30yrs was 32

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Available evidence on meningitis in Africa

• Confirmed bacterial Meningitis comprises about
  1.5-2.0 of all admissions from available Africa
  data
• Malawi 2.7 (1998 2006)
• Ghana (1 excluding lt2 month)
• Cameron, Gambia (3 including neonates)
• Mali,
• S. Africa

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Available evidence on meningitis in Africa

• Case fatality is high
• Kenya - Kilifi - 30 KNH lt1yrs - 15, 1-5yrs -
  8
• Burkina Faso - 25 (2006)
• Mali - 10 Hib meningitis
• Gambia -
• Malawi - 41

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KNH actual and possible performance
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Nakuru PGH actual possible performance
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Nyeri PGH actual possible performance
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MTRH actual and possible performance
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Embu PGH actual possible performance
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Kilifi D. Hospital actual and possible
performance
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Machakos G. H actual and possible performance
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Can the target be achieved?

• Yes, but only if certain things are put in place
• Promotion and support of GCP GLP
• Provide the necessary resources for above
• Supervision and motivation
• Monitoring and evaluation

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A hospital clinical laboratory
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Clinical and laboratory needs to achieving
targets

• Standard operating procedures
• Standard case definitions
• Standard laboratory processing
• Quality control
• Clinical and laboratory supplies
• Trained and motivated personnel
• Accurate data capture
• Local use of data by clinical and laboratory Dept.

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Your roles as health managers in achieving targets

• Managerial
• Support
• Supervision
• Audit
• Feedback
• As health care workers
• Best practices
• Peer review pressure
• Feedback
• audit

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Blood cultures

• Introduced in May 2005 in at KNH
• Kilifi D. Hospital been carrying blood cultures
  already
• KNH BC range between 40-100/month
• Target is 2000/year (170/month)
• One BC machine available for a performing site

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Why blood cultures?

• Will contributes in management of severely sick
  children targeted for BC.
• Well targeted blood cultures in children doubles
  the isolation rate of Hib and almost triples that
  of Streptococcus pneumoniae
• Pneumonia is common and with sepsis are major
  causes of death 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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Actual monthly blood cultures with target for KNH
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Hospital Sites challenges need to addressed

• Case detection, specimen collection and
  processing
• Support supervision and management
• sharing experiences/results between lab staff,
  clinicians and hospital management.
• Local use and analysis of laboratory information
• Supplies and data management

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Challenges

• Heavy work load in public hospital affects care
• Conforming and entrenchment of GLP in our
  laboratories
• Defined specimen collection system
• SOPs in place and used
• Good quality reagents and supplies
• Functional internal QA
• Participate in some form of External QA

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Strategy for achieving targets

• Partnership between MOH, WHO, netSPEAR and others
  in supporting bacterial diseases surveillance
• Supplies training from netSPEAR
• Dissemination and use of generated data from
  local to national level
• Formation of a MOH support/supervision team to
  review progress after 6 months
• Microbiology Labs targets once LP Increases to
  reasonable levels