Applied Risk Scoring in Acute Pyelonephritis: Evidence, Implementation, and Future Directions | Chapter 5 | Newer Frontiers in Urology, Volume III

 

Acute pyelonephritis (APN) spans a broad severity spectrum from uncomplicated febrile illness to emphysematous pyelonephritis with shock, creating a persistent need for reliable, bedside risk stratification. This chapter synthesises evidence on physiologic, disease-specific, and imaging-based scoring tools. It shows how to assemble them into a practical, layered pathway that improves triage, timing of imaging, and source control decisions. We review general sepsis scores (SIRS, SOFA, qSOFA, NEWS2) for early physiological surveillance; APN-specific clinical models for bacteremia prediction at first contact; global severity tools (Pitt Bacteremia Score, Charlson Comorbidity Index) for comorbidity and mortality profiling; and radiologic frameworks led by the Huang–Tseng CT classification for emphysematous pyelonephritis. Particular attention is given to a modified NEWS2 (mNEWS2) tailored for EPN, which retains original variables but re-bands risk and identifies scores ≥15 as a decisive high-risk delimiter linked to ICU need, nephrectomy, and mortality. We appraise biomarkers that add dynamic signal pro-calcitonin for bacteremia likelihood, lactate for occult hypoperfusion, and presepsin as an emerging adjunct and show how trends over 24–72 hours refine escalation or de-escalation. The chapter translates these elements into an implementation pathway: screen with NEWS2 or qSOFA; obtain early pro-calcitonin and lactate; expedite ultrasound or CT when red flags exist (diabetes, obstruction, acute kidney injury); apply APN specific bacteremia models to support admission and empiric coverage; and, in confirmed EPN, pair CT class with mNEWS2 bands to set thresholds for ICU, drainage, and early nephrectomy if non-responding. Special populations, such as those with diabetes, elderly or frail patients, transplant recipients, and those with obstruction, are addressed with lower action thresholds. Finally, we outline emerging opportunities for precision risk prediction, including machine learning classifiers to refine early bacteremia detection, radiomics-enhanced CT to integrate imaging features with clinical data, and transparent validation standards, moving APN care from static scores to adaptive, multimodal, precision risk prediction. The result is a clinician-facing roadmap that accelerates antibiotics, imaging, and decompression, reducing preventable harm across care systems.

 

 

Author(s) Details

Punith Jain R
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Suryaram Aravind
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Vivek Meyyappan
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Hariharasudhan Sekar
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology and Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH5

Factors Influencing Increased Accessibility of Maternal Health and Nutrition Information on Reproductive Health Practices among Rural Females of the Reproductive Age in Western Kenya | Chapter 8 | Medical Science: Updates and Prospects Vol. 3

 

Maternal health and nutritional Information form the cradle of healthy genetic development and population health, safeguarding the right to life and the quality of future livelihoods. Thus, this health and nutrition information often enables most females of reproductive age 15 to 49 years, globally, regionally and locally in western Kenya, to access quality, affordable and reliable health education on maternal health care and nutrition, and to mediate a primordial prevention and reduce maternal disease burden rates. It also promotes health demography and human development, through prevention and protection missions of public health, via community health awareness and capacity building, empowering population health and promote a healthy population. This is achieved by enabling regular health education on maternal and child nutrition, for better primary prevention than cure among rural females of the reproductive age and the larger population health through synergistic community participation. It was these reasons that led to the study, which aimed to evaluate the factors influencing increased accessibility to maternal and nutritional health information and their effects on reproductive health practices among rural females of reproductive age (15–49 years) in Western Kenya. Specifically, the study focuses on determining the prevalence of population health in the accessibility to affordable maternal health and balanced diet nutrition practices, determining the level of community participation in the promotion on maternal child health nutritional health education/information for quality  primordial prevention and decrease of maternal child health and nutrition, and lastly assessing how social economic, social cultural and religious beliefs influence the increased accessibility of maternal child health and nutrition health information on maternal health nutrition practices among rural females of the reproductive age in Western Kenya. The study also aimed to achieve in global health goals number 3 and 17 of Vision 2030 and beyond, in global health. Over 80% of community households have limited access to efficient, affordable, reliable, and sustainable quality maternal child health and nutrition information to promote primordial prevention in the general basic health population, especially in Sub Saharan Africa (SSA), through capacity building of health service providers and community health workers (CHWs), as their main sources of accessibility of maternal child health information, in the large diversified society of demographic health population and development, to improve the health population of the population health and their health live hoods. The study exploited descriptive, cross-sectional, cohort and triangulation designs. Purposive clusters, census retrospective and prospective sampling techniques were used to explore the ante and postnatal mothers with children aged 0-24 months as the target population. The questionnaire used as tool of survey and key informant interview and focused group discussion (FGD) was used in interview guides. Data was managed by SPSS version 27 and analysed by cross-tabulation of descriptive and inferential statistics to provide a significant inference. Results showed that health service providers and community health workers were the main sources of providing quality health education/information 97 (46.2%) and 69 (32.9%) respectively, with significant support from the global health of RR (0. 463, 0.335). The prevalence of the increased accessibility of maternal health nutrition was health/education information 101 (48%). Community awareness on the uptake of balance dietary intake from both animal proteins and plant was 67%, and majority opined significant uptake of animal protein was determined by social cultural with P value of 0.025, 95 % CI, and social economic has an influence remain insignificant with OD 1.0 and RR (0.25, 0.345), due to existing synergistic public private partnership global health to decrease unmated needs in the inequality at maternal health and nutrition community households. Need to advocate for more global health in public-private partnership participation to mediate the unmet basic needs of maternal health, nutrition and need to partner with urban reproductive of reproductive in issues of maternal health and nutrition, mediate global maternal health and nutrition global health goals number 3 and 17 of Vision 2030 and beyond to sustain quality global livelihoods and population health development.

 

 

Author(s) Details

Maurice Silali
Mount Kigali University, Rwanda.

 

Please see the book here :- https://doi.org/10.9734/bpi/msup/v3/5419

Role of Community Participation in Integrated Water Hygiene and Sanitation (WASH) Programs in Supply of Accessible Safe and Clean Water to Households in Trans Nzioa, Kenya | Chapter 8 | Current Progress in Arts and Social Studies Research Vol. 4

 

Globally and regionally in Sub-Saharan Africa, accessibility to safe and clean water remains a cradle component to mediate the high demands for water. One water point center with quality safe, and clean water supply to population health and others in one health concepts of health around us, at the community health level. However, over 37% of the developing world’s population has limited access to affordable clean water. 2.5 billion Population health, have limited access to improved affordable basic sanitation and hygiene infrastructures. Over 780 million population health still have increased uptake of unsafe drinking water, associated with increased low uptake or access to quality hygiene and sanitation practices, Thus, contrary to the 8th ELEMENTS of primary health care PHC resolutions, passed in the WHO conference at Alma Ata Declaration in 1978. Which is one of the pillars of global health. Trans Nzioa County like many Counties in Kenya faces considerable challenges to accessing, affordable clean, and safe water and sanitation infrastructures and non-infrastructures, as one of the key Millennium Development Goals (MDGs), Sustainable goals and universal coverage target objectives on Primary Prevention better than cure. The County has four Sub counties namely Bondeni, Suwerwa, Kaplamai, and Waitaluk, which are blended with inadequate access to affordable safe clean water and sanitation services, coupled with poor hygiene practices at the lower Community households, which, kill and sicken vulnerable cohorts in the wide burden of diseases, in society, specifically women, adolescence and under-fives children. Who majority spend 4–5 times per day, fetching water from unprotected springs, rivers, or boreholes and thus, are overwhelmed with various health risks of the burden of water-related communicable diseases. It was these reasons that led to the study Role of community participation in integrated Water Hygiene and Sanitation (WASH) programs in the Supply of Accessible Safe and Clean Water to Community Households in Trans Zioa County to enable the sustainability of structures, through synergistic partnership of the National Government of Kenya, County government of Transnzioa, in partnerships with kind Development partners mainly WHO, UNICEF, USAID and UN-Habitat, to form integrated water resource management programs, for supplying accessible and affordable safe and clean water to its community households, to prevent control water-related communicable diseases. Descriptive Cross-sectional and triangulation designs of mixed research methods were used in data collection. A sample size of 297 respondents participated. Purposive, census, and quota sampling techniques were adopted, using sampling frames of community households in each Division with limited access to safe and clean water services. Structured questionnaire tool was utilized in quantitative surveys, Key Informant Interviews (KII) guides, Focus Group Discussion, (FGD) guides were used, Qualitative interviews to discuss themes into saturations to achieve the values of findings, using triangulation design. Data was statistically managed by MS Excel and SPSS version 27. Analysis was by cross-tabulation of descriptive and inferential statistics, to measure central tendency, and dispersion respectively. Results showed secondary attained households are critical for efficient implementation of safe and clean water supply compared to primary attained households, male participation in water issues was minimal (41%). Accessibility to safe water from one source, by the majority of residents,’ remains low (30 %). Hand washing after visiting latrine is still low (43%). However, the majority of households (88%) utilized latrines. Global health participation in the integrated programs was 37% in the County. Need for more grants and well-wishers for Public Private Provision programs in water resource management, and also policies put in place, to increase male involvement in community participation in integrated accessibility of safe and clean water supply to community households, Water Sanitation and Hygiene WASH programs in Trans Nzioa County is timely required due to their limited involvement as noted in the study.

 

 

Author(s) Details

Maurice Barasa Silalia
Mount Kigali University, Rwanda.

 

Please see the book here:- https://doi.org/10.9734/bpi/cpassr/v4/1951