Papers by Emmanuel Onyango
Ecohydrology & Hydrobiology, 2013
Pages 234-235 3. The extent of nutrient removal by wastewater treatment plants along the Nyalenda... more Pages 234-235 3. The extent of nutrient removal by wastewater treatment plants along the Nyalenda Wigwa Stream and the River Kisat (Kenya)
Critical Care Explorations, 2021
Supplemental Digital Content is available in the text. OBJECTIVES: To compare the performance of ... more Supplemental Digital Content is available in the text. OBJECTIVES: To compare the performance of Sequential Organ Failure Assessment, systemic inflammatory response syndrome, Red Flag Sepsis, and National Institute of Clinical Excellence sepsis risk stratification tools in the identification of patients at greatest risk of mortality from sepsis in nonintensive care environments. DESIGN: Secondary analysis of three annual 24-hour point-prevalence study periods. SETTING: The general wards and emergency departments of 14 acute hospitals across Wales. Studies were conducted on the third Wednesday of October in 2017, 2018, and 2019. PATIENTS: We screened all patients presenting to the emergency department and on the general wards. MEASUREMENTS AND MAIN RESULTS: We recruited 1,271 patients, of which 724 (56.9%) had systemic inflammatory response syndrome greater than or equal to 2, 679 (53.4%) had Sequential Organ Failure Assessment greater than or equal to 2, and 977 (76.9%) had Red Flag Sepsis. When stratified according to National Institute of Clinical Excellence guidelines, 450 patients (35.4%) were in the “High risk” category in comparison with 665 (52.3%) in “Moderate to High risk” and 156 (12.3%) in “Low risk” category. In a planned sensitivity analysis, we found that none of the tools accurately predicted mortality at 90 days, and Sequential Organ Failure Assessment and National Institute of Clinical Excellence tools showed only moderate discriminatory power for mortality at 7 and 14 days. Furthermore, we could not find any significant correlation with any of the tools at any of the mortality time points. CONCLUSIONS: Our data suggest that the sepsis risk stratification tools currently utilized in emergency departments and on the general wards do not predict mortality adequately. This is illustrated by the disparity in mortality risk of the populations captured by each instrument, as well as the weak concordance between them. We propose that future studies on the development of sepsis identification tools should focus on identifying predicator values of both the short- and long-term outcomes of sepsis.
Scientific Reports, 2021
The ‘Sepsis Six’ bundle was promoted as a deliverable tool outside of the critical care settings,... more The ‘Sepsis Six’ bundle was promoted as a deliverable tool outside of the critical care settings, but there is very little data available on the progress and change of sepsis care outside the critical care environment in the UK. Our aim was to compare the yearly prevalence, outcome and the Sepsis Six bundle compliance in patients at risk of mortality from sepsis in non-intensive care environments. Patients with a National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled into four yearly 24-h point prevalence studies, carried out in fourteen hospitals across Wales from 2016 to 2019. We followed up patients to 30 days between 2016–2019 and to 90 days between 2017 and 2019. Out of the 26,947 patients screened 1651 fulfilled inclusion criteria and were recruited. The full ‘Sepsis Six’ care bundle was completed on 223 (14.0%) occasions, with no significant difference between the years. On 190 (11.5%) occasions none of the bundle elements were compl...
African Population Studies, 2011
This study examines the effect of mothers' migration status controlling for other proximate facto... more This study examines the effect of mothers' migration status controlling for other proximate factors (socio-economic, environmental and bio-demographic characteristics) on under two mortality in Kenya. Data used were drawn from 2003 Kenya Demographic Health Survey with focus on infants and children below two years in age. A total of 5949 infants and children born five years before the survey are used in the analysis. Cox proportional hazard model is used to assess the relative effect of the migration status (migrant or non-migrant) of the mother on survival rates controlling for other explanatory variables. The general results shows that children of migrant mothers especially those of urban-rural migrants face a higher mortality risk compared to those of non-migrant mothers. The results show that failure to account for migration may alter the estimation of urban-rural differentials in childhood mortality.
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Papers by Emmanuel Onyango