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PubMed2002

Clinical epidemiology of malaria in the highlands of western Kenya.

Malaria in the highlands of Kenya is traditionally regarded as unstable and limited by low temperature. Brief warm periods may facilitate malaria transmission and are therefore able to generate epidemic conditions in immunologically naive human populations living at high altitudes. The adult:child ratio (ACR) of malaria admissions is a simple tool we have used to assess the degree of functional immunity in the catchment population of a health facility. Examples of ACR are collected from inpatient admission data at facilities with a range of malaria endemicities in Kenya. Two decades of inpatient malaria admission data from three health facilities in a high-altitude area of western Kenya do not support the canonical view of unstable transmission. The malaria of the region is best described as seasonal and meso-endemic. We discuss the implications for malaria control options in the Kenyan highlands.

Adolescent↗

PubMed1982

Sensitivity of Plasmodium falciparum isolates to chloroquine in Kisumu and Malindi, Kenya.

The chloroquine sensitivity of Plasmodium falciparum isolates from infected persons living in Kisumu and Malindi, Kenya, was determined in vivo and vitro. There was no evidence of chloroquine resistance in 217 patients with P. faliparum infections who underwent standard W.H.O. 7-day in vivo tests. In 71 extended 35-day in vivo tests parasitemia recurred in 14 patients on days 21, 28, or 35. Parasites isolated from these 14 persons during the following period were tested in vitro. Eight tests were successful and showed the isolates to be chloroquine sensitive in vitro, suggesting that the recurrence of parasitemia resulted from reinfection rather than resistance. Macro in vitro tests were done on an additional 67 infected persons, 11 of whom also had sensitive 7-day in vivo tests. Chloroquine resistance was not demonstrated in vitro. In Malindi 100% of isolates were inhibited by a chloroquine concentration of less than or equal to 0.75 nmol/ml blood and 80% by less than or equal to 0.5 nmol as compared with 69% and 27.3% respectively of those from Kisumu. These data from individuals living in malarious areas of Kenya contrast with continuing reports of proven chloroquine-resistant P. falciparum malaria in non-immune visitors who acquired their infections in Kenya.

Adolescent↗

PubMed1991

Control of schistosome-transmitting snails in Kenya by the North American crayfish Procambarus clarkii.

Snail-transmitted trematode parasites such as schistosomes and liver flukes assume considerable medical and veterinary significance in tropical Africa. We have observed a strong negative association between the presence of medically important pulmonate snails and the crayfish Procambarus clarkii in freshwater habitats in Kenya. This crayfish, introduced into Kenya around 1970, readily consumes these snails in the laboratory. Field enclosure experiments indicate that crayfish exert a significant negative impact on the abundance of Biomphalaria pfeifferi, the intermediate host of the human blood fluke Schistosoma mansoni. It is likely that P. clarkii will continue to spread naturally in Kenya and that schistosome-transmitting snails will be excluded or reduced in numbers where crayfish are present. Procambarus clarkii may represent an alternative, biological means of snail control in East Africa.

Animals↗

PubMed1992

Biochemical characterization and zymodeme classification of Leishmania isolates from patients, vectors, and reservoir hosts in Kenya.

A total of 407 Leishmania and other Leishmania-like isolates obtained from patients, other vertebrates, sand fly vectors, and other arthropods from Kenya and other countries were characterized and compared with several World Health Organization and other well-characterized reference strains of Leishmania, Trypanosoma, Crithidia, Herpetomonas, and Leptomonas by cellulose acetate electrophoresis (CAE), using 20 enzyme systems. Analysis of the isoenzyme banding patterns (IBP) of the isolates generated isoenzyme profiles that were resolved as zymodemes and tabulated. Isolates that produced similar isoenzyme profiles in all 20 enzyme systems were placed into a particular Leishmania isoenzyme taxon, with the zymodeme designated numerically as Zn. A total of 66 zymodemes were recorded for the 407 isolates studied. To obviate the need to draw all 66 representative IBP for each of the 20 enzyme systems, the 66 zymodemes (Z1-Z66) were again placed into similarity groups represented by pattern number or Pn. This resulted in 23-50 IBP (Pn) per enzyme system. The highest number of IBP scored was for malate dehydrogenase (MDH) (P1-50) and the lowest score was for glucose-6-phosphate isomerase (GPI) (P1-23). From these different isoenzyme profiles or zymodemes, IBP of 14 (MDH, GPI, nucleoside hydrolase, phosphoglucomutase, malic enzyme, isocitrate dehydrogenase, glucose-6-phosphate dehydrogenase, mannose-6-phosphate isomerase, 6-phosphogluconate dehydrogenase, glutamate oxaloacetate transferase/aspartate aminotransferase, glutathione reductase, superoxide dismutase, fumarase, and glyceraldehyde-3-phosphate dehydrogenase) of the 20 enzyme systems were selected for computer-calculated numerical taxonomy. Consistent individual isoenzyme bands with similar relative mobilities of the 14 enzyme systems were scored into groups (allelomorphs, allozymes, or electromorphs) and used in cluster analysis. For each pattern in every profile, the presence of a consistent band was entered as 1 and its absence as 0. A total of 419 allozyme characters (variables) were scored for the 14 enzyme systems. Lastly, all different zymodemes sharing a particular IBP (Pn) within an enzyme system were counted and the total number was shown as a zymodeme frequency (Zf). Final analysis of the CAE isoenzyme profiles and cluster-dendrograms resulted in the identification of several potentially new species and subspecies of Leishmania and other Leishmania-like isolates from patients, sand flies, and animal reservoir hosts collected from Kenya and other locations in Africa. Zymodeme analysis of the Kenyan visceral and cutaneous leishmaniasis isolates resulted in the identification of 11 subpopulations of the L. donovani species complex and six subpopulations of the L. tropica species complex endemic to different geographic areas of Kenya.

Animals↗

PubMed1998

First recorded outbreak of yellow fever in Kenya, 1992-1993. I. Epidemiologic investigations.

Outbreaks of yellow fever (YF) have never been recorded in Kenya. However, in September 1992, cases of hemorrhagic fever (HF) were reported in the Kerio Valley to the Kenya Ministry of Health. Early in 1993, the disease was confirmed as YF and a mass vaccination campaign was initiated. Cases of suspected YF were identified through medical record review and hospital-based disease surveillance by using a clinical case definition. Case-patients were confirmed serologically and virologically. We documented 55 persons with HF from three districts of the Rift Valley Province in the period of September 10, 1992 through March 11, 1993 (attack rate = 27.4/100,000 population). Twenty-six (47%) of the 55 persons had serologic evidence of recent YF infection, and three of these persons were also confirmed by YF virus isolation. No serum was available from the other 29 HF cases. In addition, YF virus was isolated from a person from the epidemic area who had a nonspecific febrile illness but did not meet the case definition. Five patients with confirmed cases of YF died, a case-fatality rate of 19%. Women with confirmed cases of YF were 10.9 times more likely to die than men (P = 0.010, by Fisher's exact test). Of the 26 patients with serologic or virologic evidence of YF, and for whom definite age was known, 21 (81%) were between 10 and 39 years of age, and 19 (73%) were males. All patients with confirmed YF infection lived in rural areas. There was only one instance of multiple cases within a single family, and this was associated with bush-clearing activity. This was the first documented outbreak of YF in Kenya, a classic example of a sylvatic transmission cycle. Surveillance in rural and urban areas outside the vaccination area should be intensified.

Adolescent↗

PubMed1998

A comparison of epidemiologic, histologic, and virologic studies on Hodgkin's disease in western Kenya and Nagasaki, Japan.

Rapid progress in molecular technologies has enabled the detection of several oncogenic viruses in various types of tumors. The pathogenesis of Hodgkin's disease is suggested to have a strong association with Epstein-Barr virus (EBV). However, Hodgkin's disease related to EBV shows a wide geographic variation in epidemiology. These variations among different populations suggest an interaction of environmental factors and a direct role of EBV infection. Therefore, we performed a comparative study on epidemiologic, histologic, and virologic features of Hodgkin's disease among those in the western part of Kenya and in Nagasaki, Japan. The age distribution of Hodgkin's disease showed a distinct peak in the 0-9-year-old age group in Kenya, and a higher and lower peak in the 60-69- and 30-39-year-old age groups, respectively, in Japan. The most common subtype of Hodgkin's disease in both countries was mixed cellularity, followed by nodular sclerosis, lymphocyte depletion, and lymphocyte predominance. Mixed cellularity showed a significantly high prevalence among Kenyan children nine years of age or younger. Using the in situ hybridization method, EBV-encoded RNA (EBER-1) was detected in 79% of the Kenyan cases and 59% of the Japanese cases, with the mixed cellularity subtype showing a strong correlation with EBER-1. There was 100% positivity in both countries in those less than nine years old. These results suggest that EBV plays a more direct role in the pathogenesis of Hodgkin's diseases in Kenya, especially in cases among young children and also in Japanese children. Environmental and/or genetic factors may have a role, in addition to EBV, in the pathogenesis of Hodgkin's disease, especially in Nagasaki, Japan.

Adolescent↗

PubMed1999

Transmission of epidemic Vibrio cholerae O1 in rural western Kenya associated with drinking water from Lake Victoria: an environmental reservoir for cholera?

Sub-Saharan Africa has the highest reported cholera incidence and mortality rates in the world. In 1997, a cholera epidemic occurred in western Kenya. Between June 1997 and March 1998, 14,275 cholera admissions to hospitals in Nyanza Province in western Kenya were reported. There were 547 deaths (case fatality rate = 4%). Of 31 Vibrio cholerae O1 isolates tested, all but one were sensitive to tetracycline. We performed a case-control study among 61 cholera patients and age-, sex-, and clinic-matched controls. Multivariate analysis showed that risk factors for cholera were drinking water from Lake Victoria or from a stream, sharing food with a person with watery diarrhea, and attending funeral feasts. Compared with other diarrheal pathogens, cholera was more common among persons living in a village bordering Lake Victoria. Cholera has become an important public health concern in western Kenya, and may become an endemic pathogen in the region.

Adolescent↗

PubMed2001

Histo and cyto-pathologic diagnoses at a rural hospital in Kenya.

BACKGROUND: Cancer has emerged as one of the common causes of morbidity and mortality in rural areas and as a major cause of premature deaths. OBJECTIVES: To provide histo-pathology and cyto-pathology data in a rural district hospital and highlight on the common malignancies seen in a rural setting in Kenya. DESIGN: Prospective study. SETTING: Histopathology Department, Machakos Provincial Hospital, Machakos district, Kenya. SUBJECTS: Two hundrend and sixty eight patients referred to Machakos laboratory for histopathology, fine needle aspirate or pap smear cyto-pathology were analysed. MAIN OUTCOME MEASURES: Staining with routine stains such Pap stain, Haeomatoxylin and Eosin was effective method of making a primary accurate and definitive histo-pathology and cyto-pathology diagnosis in a rural district hospital setting. RESULTS: Histo-pathology biopsies comprised 71.6% of the total slides seen. Pap smear cervical cytology comprised 13.8% while fine needle aspirate and post- mortem biopsies comprised 12.3%, 2.2% respectively. The commonest histo-pathology biopsies seen were breast comprising 24% of the total cases, followed by endometrium contributing 14.9%, then followed by skin 11.5%, lymph node 11.5%, cervical 11%, and gastrointestinal 6.3%. Most of pap smear cyto-pathology showed evidence of infection comprising 54% while fine needle aspirate infections and malignancy showed equal rate 24% of all cyto-pathology seen during this study. CONCLUSIONS: This is the first time histo-pathology and cyto-pathology data have been provided from a rural district hospital setting in Kenya. The malignant and pre-malignant pattern seen at Machakos General Hospital may be used to gain a broader picture of the common malignant conditions prevalent in any defined population in this country. This also serves as an important cancer epidemiological data in this region during the period of study.

Biopsy↗

PubMed2001

Maternal mortality in Kenya: the state of health facilities in a rural district.

BACKGROUND: This study was formulated from the premise that the known causes of maternal mortality, namely haemorrhage, sepsis, obstructed labour and abortion belie the more fundamental development problems that influence it, such as the state of local medical services, quality of care and the facilities' ability to respond to reproductive health emergencies. OBJECTIVE: To document some of the underlying problems and how they were found to influence maternal mortality in Kenya, with specific reference to a rural district. DESIGN: The researchers used the Prevention of Maternal Mortality Network (PMMN) methodology/study design to assess the current state of health facilities, their level of function, and factors influencing their utilisation. Both qualitative and quantitative methods of data collection tools were used. SETTING: Siaya District in the western region of Kenya. Data were collected from thirty facilities, which provide obstetric care in the district. PARTICIPANTS: Data were collected by nurse/midwives, nursing school tutors and social scientists with experience in qualitative research methods. Respondents included health service providers and managers at the 30 health facilities. Qualitative data were obtained through focus group discussions with health facility staff as well as community members. RESULTS: All the thirty facilities studied, were grossly wanting in terms of staffing, equipment, essential drugs and supplies. Both quality of care and record keeping were well below acceptable standards. CONCLUSIONS: The study findings are a sad but a fair reflection of our situation not only in Kenya but also in sub-Saharan Africa ten years after the declaration of the Safe Motherhood Initiative (SMI). The results indicate a predictable, widening gap in basic service provision that must be urgently bridged as a prerequisite to any serious and meaningful approaches to reducing maternal mortality in Africa.

Data Collection↗

PubMed2002

Advance provision of oral contraceptives to family planning clients in Kenya.

OBJECTIVE: In sub-Saharan Africa, many family planning programmes do not encourage advance provision of oral contraceptives to clients who must wait until menses to initiate pill use. Since some resistance to advance provision of pills is due to provider fears that the practice may be harmful, we conducted a study in Kenya in 1997 to compare pill-taking outcomes between 20 "advance provision" clients and 280 "standard" clients. DESIGN: Prospective observational study. SETTING: Six family planning clinics in Central and Western Kenya. SUBJECTS: Women presenting as new clients at MOH family planning clinics. INTERVENTIONS: Researchers used prospective tracking to compare indicators of pill-taking success between non-menstruating clients given pills to carry home for later use and menstruating clients who began pill use immediately. MAIN OUTCOME MEASURES: Pill-taking outcomes such as side effects, compliance, knowledge, satisfaction, and a continuation proxy. RESULTS: Among clients returning for re-supply, those receiving advance provision of pills did no worse than, and often had superior outcomes to, their counterparts who started taking pills immediately after the clinic visit. CONCLUSIONS: Advance provision of pills, already practiced worldwide, is safe and feasible. Explicit mention should be made of advance provision of pills in national family planning guidance documents and training curricula in Kenya and throughout sub-Saharan Africa.

Contraceptives, Oral, Combined↗

PubMed2004

Anorexia nervosa in Kenya.

BACKGROUND: Anorexia nervosa is a rare disorder in Africans, inspite of posing a serious public health hazard in the West. Whereas it is possible that African psychiatrists lack the skills to diagnose the disorder, other possible explanations for its apparent rarity must be sought in view of emerging evidence, which suggests a real lack of occurrence. OBJECTIVES: To establish the knowledge of practicing Kenyan psychiatrists about the signs, symptoms and management of anorexia nervosa and to establish the number of cases they had seen during all their years of practice of psychiatry. DESIGN: Telephone survey and data collection: case-finding approach. SETTING: Kenya, June 2001 METHODS: Forty seven psychiatrists registered to practice in Kenya as of June 2001 qualified for inclusion. The respondents were interviewed on the same day, to reduce the likelihood of cross checking between colleagues. RK called each one, (all knew her) explained the nature of the survey and obtained verbal consent to administer the brief (10 minutes) questionnaire, developed by the authors for the purpose. RESULTS: Twenty seven of all those eligible were reached on the day. All but one gave consent for the interview (55% response rate). The 20 who were not reached were similar to the respondents with regard to experience in psychiatry, (mean duration 11.4 versus 10.9 yrs) but differed in their place of residence, the majority of those not reached resided out of Nairobi (60% versus 26%). In a cumulative total of 320 years of practice, they had seen 16 cases of which seven were of African origin. The rest were Caucasian or of Asian origin. The psychiatrists demonstrated adequate skill in recognising anorexia nervosa. CONCLUSION: Kenyan psychiatrists can recognise cases of anorexia nervosa. The condition is rare in Kenya. The reasons for this remain unclear and traditional explanations for its cause as due to pressure for thinness may not be adequate for the Kenyan case.

Adult↗

PubMed2004

Influence of manufacturing practices on quality of pharmaceutical products manufactured in Kenya.

OBJECTIVE: To establish the quality of pharmaceutical products manufactured by the respective industries in Kenya and determine the effect of manufacturing practices on the quality of these products. DESIGN: Cross-sectional study. SETTING: Industries examined are in Nairobi, Kenya. Laboratory analysis was carried out using available facilities at Kenya Medical Research Institute and University of Nairobi, Faculty of Pharmacy. INTERVENTIONS: Structured Questionnaires were administered to examine how the code of good manufacturing practices has been used in the production of each pharmaceutical product by respective companies. Questionnaires designed to evaluate the distribution and carry out limited post-market surveillance study were administered to community pharmacy outlets. Drugs were sampled and analyzed for their quality according to the respective monographs. MAIN OUTCOME MEASURES: The questionnaires administered to the industry included the source of raw materials, quarantine procedure before and after manufacture, manufacturing procedure, quality audit, quality assurance procedure, equipment, and staff. That administered to the pharmacy outlet included availability, affordability and acceptability of locally manufactured pharmaceutical products. Quality analysis of products involved the establishment of the chemical content, dissolution profile, friability, uniformity of weight and identity. For antibiotic suspensions the stability after reconstitution was also determined. RESULTS: There were 15 respondents and two non-respondents from the industry and six out of nine respondents from the pharmacy outlets. The ratio of qualified staff to product range produced seemed to influence product quality. Industries producing several products with only limited number of pharmaceutical staff had more products failing to comply with pharmacopoeia specifications compared to those producing only few products. Nevertheless, all companies are well equipped with quality control equipment, in accordance with type of product manufactured. Private pharmacies stocked few of the locally manufactured products. The reason, they said, was due to low doctor and/or patient acceptance. Compliance with quality specifications as set out in respective monographs was overall 76%. CONCLUSION: Although the local pharmaceutical industries have adopted good manufacturing practices leading to many good quality products currently in commerce, these manufacturing practices are not comprehensive and measures need to be taken to continue improving them.

Cross-Sectional Studies↗

PubMed2004

Burkitt's lymphoma in Kenya: geographical, age, gender and ethnic distribution.

OBJECTIVE: To show the geographical (Provincial), age, gender and ethnic distribution of Burkitt's lymphoma in patients in Kenya. DESIGN: A retrospective review of patients' records for the years 1988-1992 and a prospective evaluation of patients with BL between 1993 and 1997. These were descriptive and hospitals based studies. SETTING: Kenyatta National Hospital; Kenya's main referral and teaching hospital and seven provincial hospitals. MAIN OUTCOME MEASURES: For each tissue proven Burkitt's lymphoma case the following were required; province of birth and residence, tribe, age, sex, chief complains, physical examination findings, investigation results and tissues result confirming the diagnosis of BL. STATISTICAL METHOD: Mainly proportions were used to compare variables, however Pearson's liner correlation was used to assess the time trends. RESULTS: This study registered 1005 patients; 961 (95.6%) children and 44 (4.4%) adults. 0-14 years the age standardized incidence rate (ASR) of 0.83. Variations documented in the provinces' BL ASR range; 1.8 Coast to 0.23 Rift Valley and increasing yearly trend for both children and adults. The major tribes in Kenya consisted; Luo 29.5%. Luhya (24.1%) and Coastal (16.5%). No patient of Asian or European or Arab extraction was recorded in the study. The age distribution showed no case below two years, a rapid rise from three year 3 (5.6%), and peak at 6 (19.5%) for children and at 17 years (13.6%) years for the adult. Age group 5-9 years had the highest ASR. The male to female (M:F) ratios were; 1.5:1 and 1:1 in children and adults respectively, provincial ratios range; 2.6:1 in Nairobi to 1.2:1 in Nyanza, the tribes range; 3.5:1 in Somali to 1:1 in other tribes between 2 and 14 years old when also males were more than females. Peak time of presentation of symptoms was 4 weeks. Tumour sites were in children; jaw 51.6%, abdomen (25%), combined jaw and abdomen 13.8% and others 9.6% and adults; jaw (4.5%), abdomen (43.2%), combined jaw and abdomen (25%) and other sites (27.3%) 67.6% males and 42.4% female adults had HIV infection and disseminated BL disease. CONCLUSION: The study demonstrates that Burkitt's lymphoma is a childhood disease. The disease distribution is consistent with intermediate risk Burkitt's lymphoma level. Furthermore the distribution varied by province, tribe, age and gender. The variations could be due to environmental factors.

Abdominal Neoplasms↗

PubMed2004

Aspects of epidemiological and clinical features of patients with central nervous system Burkitt's lymphoma in Kenya.

BACKGROUND: Establishing characteristics of Central nervous System (CNS) Burkitt's lymphoma (BL) is essential as CNS disease is associated with poor treatment outcome. OBJECTIVE: To document the characteristics of those cases of Burkitt's who had CNS disease at the time of presentation. DESIGN: Prospective study of the clinical details of paediatric patients admitted and treated for Burkitt's lymphoma from January 1986 to December 1997. SETTING: Kenyatta National Hospital and seven provincial hospitals in Kenya. MAIN OUTCOME MEASURES: For every histologically proven Burkitt's case, the following were documented; Age, sex, geographical area (province in Kenya), complaints, physical findings, Cerebral Spinal Fluid (CSF) cytology results, Human Immunodeficiencies Virus screening test result and anatomical sites of the disease at the time of starting therapy. RESULTS: A total of 1005 BL cases were studied and 961(95.6%) were aged between two and 15.4 years median age of six years consisting of males 587(61%) and females 374 (39%) while 44 (4.4%) cases between 16 and 57 years consisting of males 23 (52%) and females 21 (43%). The main complaints; headache, swelling mainly facial, abdominal distension and proptosis. Peak duration at presentation 4 and 8 weeks, range 1 to 26 weeks. Clinical evaluation demonstrated CNS in 5.6%, presenting as headache, blurring of vision and difficulties in walking. Physical examination noted para-paresis, ophthalmoplegia and cranial nerve palsies, while CSF demonstrated BL cells in 158 (18.4%). Overall CNS BL was found in 161 (16.8%), children and 39% adults. All were systemic and no primary CNS BL detected. Peak age was 11 to 15 years for children. Their provinces Eastern; 24.5%, Central 21.3%, and Rift Valley 23.4%, ethnic origins, Meru 29.5%, Kikuyu 23.9% and Kamba 23.7%. The sites of tumour for CNS cases were abdominal, combined sites, and skeletal while least in maxilla and jaw. Seventy one per cent of adults had both CSF BL and HIV infection. CONCLUSION: CNS-BL children cases were older, reduced M:F ratio; had skeletal/abdominal presentation and were from the Central province, Kikuyu tribe and a positive CSF cytology for malignant cells found in almost all cases with CNS disease at presentation. No primary CNS BL detected. Geographically, cases were from mainly the highlands of Kenya. High CNS disease in adults coincided with HIV positive serostatus.

Adolescent↗

PubMed2005

Clinical characteristics of Burkitt's lymphoma from three regions in Kenya.

OBJECTIVES: To describe the clinical characteristics of Burkitt's lymphoma (BL) from three regions in Kenya at different altitudes with a view towards understanding the contribution of local environmental factors. DESIGN: Prospective cross-sectional study. SETTING: Kenyatta National Hospital and seven provincial hospitals in Kenya. METHOD: Histologically proven cases of Burkitt's lymphoma in patients less than 16 years of age were clinically examined and investigated. MAIN OUTCOME MEASURES: For every case the following parameters were documented: chief complaint(s); physical examination, specifically pallor, jaundice, oedema, lymphadenopathy, presence of masses, splenomegaly and hepatomegaly. Reports of evaluation of chest radiograph, abdominal ultrasound/scan, bone marrow aspiration, cerebral spinal fluid cytology, liver and kidney function tests, urinalysis, stool occult blood and full blood count results. Stage of disease was assigned A, B, C or D. Cases of BL from three provinces of Kenya with diverse geographical features were analysed: Central, Coast, and Western. RESULTS: This study documented 471 BL cases distributed as follows: Central 61 (males 39 and 22 females), M:F ratio 1.8:1; Coast 169 (111 males and 58 females), M:F ratio 1.9:1; and Western 241 (140 males and 101 females), M:F ratio 1.4:1. The major presenting complaints were: abdominal swelling--Central 36%, Coast 4% and Western 26%; swelling on the face--Central 31%, Coast 81% and Western 64%; and proptosis--Central 3%, Coast 1% and Western 9%. The mean duration of these complaints in weeks were Central 6.9, Coast 6.08, and Western 5.05. The initial physical finding was a tumour mass in 39%, 72% and 54% of cases for Central, Coast and Western respectively. Tumour stage at diagnosis was: stage A--Central 21%, Coast 43% and Western 34%; stage B--Central 10%, Coast 5% and Western 10%; stage C--Central 41%, Coast 34% and Western 30%; and stage D--Central 28%, Coast 17% and Western 26%. For the age and sex matched cases the results show that commonly involved sites were: abdomen--Central 35%, Coast 9% and Western 14%; jaw (mandible)--Central 24%, Coast 22% and Western 31%; maxilla--Central 6%, Coast 24% and Western 11%; and lymph nodes--Central 10%, Coast 4% and Western 8%. The disease stage was A--Central 33%, Coast 44% and Western 36%; stage B--Central 11%, Coast 10% and Western 27%; stage C--Central 39%, Coast 34% and Western 27%; and stage D--Central 21%, Coast 13% and Western 37%. CONCLUSION: This study shows that clinical features of childhood BL vary with geographical region. The variations are documented in proportion of jaw, maxilla, abdominal and lymph nodal sites involvement. The differences observed are potentially due to the local environmental factors within these provinces. BL cases from Western province had features, intermediate between endemic and sporadic. Coastal province BL cases were similar to endemic BL, while BL cases from Central province resembled more or less sporadic BL subtypes. Strategies to explain and investigate the local environmental factors associated with the observed differences may certainly contribute towards improved understanding and clinical management of BL.

Abdominal Neoplasms↗

PubMed2006

Socio-economic effects of khat chewing in north eastern Kenya.

BACKGROUND: The khat habit is a widespread phenomenon which has in the past two decades spread to parts of Western Europe and North America from Eastern Africa and the Arabian Peninsula. Although khat has been identified as one of the most commonly abused substances in Kenya, restrictions on cultivation, trade and usage have been non-existent since its legalisation in 1977. OBJECTIVE: To describe the socio-economic effects of khat chewing in Ijara District in the North Eastern Province of Kenya. DESIGN: Cross sectional study. SETTING: Ijara District, North Eastern Kenya. SUBJECTS: Fifty respondents were interviewed. RESULTS: Eighty eight percent of the respondents were khat chewers, and the majority (80%) had family members who engaged in the khat habit. There was a general lack of education on the negative effects of khat chewing. Due to reported mood changes and withdrawal symptoms when not chewing khat, many respondents used more than half of their domestic budgets on khat, but few (28%) perceived this as a waste of resources. Fifty four percent of khat chewers typically started the habit during the day, implying a waste of time for productive work. However, only 40% of the persons interviewed admitted that the drug affected work performance negatively. The khat habit was associated with strain on family relationships, anti-social behaviour and health effects such as insomnia. CONCLUSION: In spite of the negative socio-economic impact of khat in Ijara District, khat consumption remains a widespread habit.

Adolescent↗

PubMed2006

Prevalence of trachoma in six districts of Kenya.

OBJECTIVES: To estimate the prevalence of active trachoma (TF) in children aged one to nine years and potentially blinding trachoma (TT) in adults aged 15 years and older in six known trachoma-endemic districts in Kenya. DESIGN: Community based survey. SETTING: Six known trachoma endemic districts in Kenya (Samburu, Narok, West Pokot, Kajiado Baringo and Meru North). SUBJECTS: A total of 6,982 children aged one to nine years and 8,045 adults aged 15 years and older were randomly selected in a two stage random cluster sampling method: Twenty sub-locations (clusters) per district and three villages per sub-location were randomly selected. Eligible children and adults were enumerated and examined for signs of trachoma. RESULTS: Blinding trachoma was found to be a public health problem in all the surveyed districts. Active trachoma was a district wide public health problem in four districts (Samburu, Narok, West Pokot and Kajiado) and only in some of the sub-locations of the other two (Baringo and Meru North). CONCLUSIONS: There is need for district trachoma control programmes preferably using the WHO recommended SAFE strategy in all the surveyed districts. Extrapolation of these survey results to the entire country could not be justified. There is need to survey the remaining 12 suspected endemic districts in Kenya.

Adolescent↗

PubMed2006

Efficacy and safety of an artesunate/mefloquine combination, (artequin) in the treatment of uncomplicated P. falciparum malaria in Kenya.

BACKGROUND: Although artesunate and mefloquine have been used as monotherapies in the treatment of malaria in Kenya for a long time, there is insufficient data on the clinical outcome when used as combination therapy in this population. OBJECTIVE: To derive data on the efficacy and safety profile of artesunate-mefloquine combination in the treatment of uncomplicated Plasmodium falciparum malaria in Kenya. DESIGN: An open label single arm clinical trial. SETTING: Bungoma district Hospital. Study area was Bungoma District of Kenya, an endemic area of malaria. The study was conducted between January 2004 and April 2004. SUBJECTS: A total of 200 males and females with uncomplicated plasmodium falciparum malaria weighing 35kg and above were recruited in the study. RESULTS: In the evaluable patient population the day 28 cure rate was 98.4% while day 14 and 7 cure rates were 98.4% and 99.2% respectively. There was rapid relief of symptoms the median time of fever clearance was one day and the most common drug related adverse events were headache dizziness and asthenia. There was no significant derangement in the haematological, biochemical and ECG parameters in the patients on treatment. CONCLUSION: Artesunate-mefloquine combination given simultaneously was found to be highly effective and safe in the treatment of uncomplicated malaria.

Adult↗