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PubMed1989

Epidemiology of rheumatic heart disease among primary school children in western Kenya.

A community survey was conducted to determine the prevalence of rheumatic heart disease in Kenyan children in all primary schools in 2 sublocations in Western Kenya. In total, 3631 children (97% school attendance) aged from 5 to 15 years were examined by one experienced physician and 2 cardiologists between September and December 1985. Six children were found to have evidence of rheumatic heart disease, giving a prevalence rate of 1.7/1000. As all cases occurred in the age group between 10 and 15 years, the rate was calculated for this group as 2.4/1000. None of these patients had previously been diagnosed as having rheumatic fever. There were 3 males and 3 females. Four patients had mitral regurgitation, one had aortic regurgitation and one had mitral stenosis. Three had electrocardiographic evidence of left atrial abnormality and one showed findings of left ventricular hypertrophy but two patients had normal tracings. Half were symptomatic with dyspnoea on exertion and two gave a history of fleeting polyarthritis. The socio-economic status (peasant), family size (mean = 6 siblings) and the number of children sleeping per room were the same in both the cases with rheumatic heart disease and their controls. The health workers achieved low scores (mean 26%) with regard to the clinical diagnosis, treatment and prevention of rheumatic fever at the level of primary health care. Rheumatic heart disease, nonetheless, was relatively insignificant in the overall picture of health care of school children in Western Kenya.

Adolescent↗
PubMed1984

Economic evaluation in primary health care: the case of Western Kenya community based health care project.

This paper describes the methodology and presents preliminary results of an economic appraisal of a community based health care project in Kenya. Community health workers, trained for 12 weeks and deployed in two locations in Kenya's Western Province, act as first contact providers of basic health care and promoters of selected health, sanitation and nutrition practices. A Cost Benefit Analysis has been undertaken using the Willingness to Pay approach to compare the costs of the project and its benefits. The benefits are in the form of more easily accessible basic health care and are measured as consumer surplus accruing to the community. Gain in consumer surplus is consequent on the fall of average user costs and rise in utilisation of the project established points of first contact with primary health care. The argument for the economic viability of the project is validated by the large Net Present Value and Benefit Cost Ratio obtained for the whole of the project area and for the two locations separately. Although the evaluation technique used faces the problem of valuation of community time, aggregation of health care services at all points of first contact and the partial nature of cost benefit analysis evaluations, the results are strongly in favour of decentralisation of primary health care on similar lines in the rest of the country.

Community Health Services↗
PubMed1986

Women's health in a marginal area of Kenya.

As eco-demographic pressure on the cultivable areas of tropical Africa increases, women, the main food producers in such areas, are experiencing serious threats to their physical health. Eco-demographic pressure may be defined as the effect of a rapidly-growing population, dependent largely on subsistence production, on the human carrying capacity of an ecological region. Continued subdivision of plots from father to sons, over grazing, and soil erosion lower agricultural productivity and create periodic food shortages, the main burdens falling most heavily upon the poorest people. Migration to cities in search of wage employment, or to lower-potential areas in search of land are common responses. Eco-demographic pressure in the high potential areas of Kenya has been responsible over many years for the migration of agriculturalists into marginal lands. The partial break-up of traditional modes of production and the difficulties of cultivating in a semi-arid environment greatly increase the demands on available labour, whilst levels of health are poor and health care delivery inadequate. It is suggested that women, in particular, are subject to a high degree of stress and evidence of such stress and accompanying ill-health is presented using data from a survey conducted in Kibwezi Division of Machakos District, Kenya. Higher-than-average economic dependence on women is shown in the demographic structure. Water collection patterns show that 70% of all trips are made by women over 15 years over a median distance of 3.5 km and that 87% of women collecting water carry loads without any mechanical assistance compared with 42% of men. Fertility levels remain high and anthropometry revealed that women in the survey were thinner and shorter than a comparable group from a more fertile part of the district. Using functional criteria, the data suggest a higher prevalence of chronic disablement amongst women, compared with men, and the disabilities mentioned tend to reflect the hard lifestyle and high fertility levels of women in Kibwezi.

Adolescent↗
PubMed1994

A community study of child spacing, fertility and contraception in West Pokot District, Kenya.

Kenya is well known for its high fertility rate and West Pokot District has the highest population growth rate in Kenya. This study was designed to examine the community's perceptions of fertility dynamics. It looks at traditional methods of family planning and the recent changes in child spacing, fertility and contraception and the attitudes behind them. This study also examines what the community (particularly women), want in the way of family planning services. The study used randomly selected groups throughout the district and employed a quasi-anthropological group discussion method.

Anthropology, Cultural↗
PubMed1996

Seroepidemiological survey of Taenia saginata cysticercosis in Kenya.

A sero-epidemiological study of Taenia saginata cysticercosis was carried out to determine the prevalence and distribution of the infection in three provinces of Kenya. Serum samples and meat inspection records were collected from cattle at slaughter at export and district abattoirs. Cattle origin and the presence of T. saginata cysticerci were noted as was the prevalence of other helminths such as Echinococcus granulosus and Fasciola gigantica. Serum samples were screened for circulating parasite antigen using a monoclonal antibody-based enzyme-linked immunosorbent assay (Ag-ELISA) and for ante-parasite antibody by indirect ELISA (Ab-ELISA). Eighty per cent of the sera were collected from cattle from the Rift Valley Province of Kenya. The prevalence of T. saginata cysticercosis and the other helminth infections varied between districts and was particularly high in Narok. Animal husbandry practices in arid areas such as Narok may be particularly conducive to transmission. The potential value of the Ag-ELISA for use in sero-epidemiological studies was verified by this study. It detected at least twice as many cases as T. saginata cysticercosis as meat inspection and, of the three methods investigated, was considered the most valuable.

Abattoirs↗
PubMed1988

Analysis of false positive HIV-1 serologic testing in Kenya.

Sera of 95 mothers and 129 children from Nairobi, Kenya, collected in 1976, and of 466 adults and 193 children of Embu District, Kenya, collected in 1984 and 1985, were analyzed for the presence of human immunodeficiency virus type 1 (HIV-1) antibodies. Although no HIV-1 seropositivity was demonstrated by western blot analysis in both study groups, 7% of Nairobi mothers and 10% of adult females from Embu District had false positive results by enzyme immunoassay (EIA) compared with less than 1% seroreactivity rates observed in adult males and children. False positive results were not due to simian T lymphotropic virus type III (STLV-IIIAGM)/human T lymphotropic virus type IV (HTLV-IV) seropositivity. Sixty-one percent of the HIV-1 EIA reactive sera could not be explained by cytotoxic activity to lymphocytes bearing the HLA-DR4 or HLA-DQw3 phenotype. We conclude that false positive HIV EIA tests are frequently encountered in East Africa. Seroprevalence rates in rural Africa must be interpreted with caution due to the decreased specificity of HIV EIAs.

Adult↗
PubMed1992

Cross-sectional survey of HIV infection among patients with tuberculosis in Nairobi, Kenya.

Evidence from many countries suggests an association of human immunodeficiency virus (HIV) infection and tuberculosis of major public health significance. In order to begin assessing the impact of HIV on tuberculosis in Kenya, we have determined the HIV-1 seroprevalence among tuberculosis patients and compared the clinical characteristics of tuberculosis in HIV-positive and HIV-negative patients in two cross-sectional studies at the Infectious Disease Hospital (IDH) and the Ngaira Avenue Chest Clinic (NACC), Nairobi, Kenya. The diagnosis in 92% of all patients with pulmonary tuberculosis was confirmed by culture. The remainder were diagnosed on histological, clinical or radiological grounds. HIV seroprevalence among tuberculosis patients at IDH was 26.5% (52/196) compared to 9.2% (18/195) at NACC (P less than 0.001). There was no association between numbers of streptomycin injections in the previous 5 years and HIV infection. Positive sputum smear rates in HIV-positive patients were slightly lower than in HIV-negative patients at both study sites (71% vs 83% at IDH and 73% vs 82% at NACC) but the difference was not significant. Only Mycobacterium tuberculosis was isolated. Miliary disease was not associated with HIV infection. Persistent diarrhoea, oral candidiasis, generalized itchy rash, herpes zoster and generalized lymphadenopathy were all associated with HIV infection, but 46% (95% CI:38-54%) of all HIV-positive patients had none of the clinical features listed in the WHO Clinical Criteria for the Diagnosis of AIDS, apart from fever, cough and weight loss. Stevens-Johnson Syndrome was reported in 7/52 (13%) patients with HIV infection, and in 4/144 (3%) patients without (RR 4.85, 95% CI: 1.45-15.88).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2004

Risk of Plasmodium falciparum infection during a malaria epidemic in highland Kenya, 1997.

Malaria epidemics in highland areas of East Africa have occurred with increasing frequency since the late 1980s, but the actual risk of Plasmodium falciparum infection in children and adults during these epidemics has not been well characterized. During a malaria epidemic in a highland area of Kenya, risk of infection was assessed in 50 adults (> or =18 years old) and 32 children (< or =8 years old) after treatment and parasitologic clearance with sulfadoxine-pyrimethamine treatment. Over a 10-week period, 36 of the 82 study participants (43.9%) became infected. The risk of infection was similar in children and adults (hazard ratio for children = 1.21, 95% CI: 0.63-2.33). These findings contrast with the age-related protection from infection reported in areas of stable, intense transmission, and demonstrate that during malaria epidemics, both children and adults in highland areas of Kenya are at high risk of infection.

Adolescent↗
PubMed2004

The development of Plasmodium falciparum in experimentally infected Anopheles gambiae (Diptera: Culicidae) under ambient microhabitat temperature in western Kenya.

The effect of microhabitat temperature variation on the early development of Plasmodium falciparum in experimentally infected Anopheles gambiae s.s. (Diptera: Culicidae) was studied. Batches of mosquitoes were fed artificially on gametocyteamic blood obtained from human volunteers and then held in five environmental conditions described as: (1) incubator maintained at constant temperature of 28 +/- 1 degrees C as control; (2) temperature unregulated laboratory environment; (3) screen house; (4) grass thatched mud house and (5) corrugated iron roofed mud house. Both the grass and iron roofed mud houses were real houses found in the village communities around the ICIPE Research Centre in Mbita Point, Suba District south-western Kenya. The temperature and relative humidity of these holding environments were recorded over the study period. Mosquitoes were dissected after 24 h and 7 days to enumerate ookinetes and oocysts stages, respectively in their midguts. The mean temperature observed in the temperature-unregulated laboratory (28 degrees C) was significantly higher than the temperature of the screen house (24 degrees C) while the mean temperature observed in the iron roof mud house (27 degrees C) was comparable with that in the grass-thatched mud house (27 degrees C) although the iron roof house experienced more variation (coefficient of variation, C.V., = 9.6%) and higher peaking temperatures than the grass-thatch house. The mean relative humidity for the laboratory and screen house were 23% and 32.5%, respectively, much lower than relative humidity in the incubator (73%). Relative humidity of the grass thatch hut (42%) and Iron roof hut (51%) were also lower than those of the incubator. The ookinete intensities for mosquitoes in the screen house (10.11 +/- 1.79 ookinetes/midgut) were not statistically different (P = 0.41) from those held in the laboratory (7.50 +/- 1.19 ookinetes/midgut) or in the incubator (9.89 +/- 1.47 ookinetes/midgut). The holding environments influenced the oocyst infection rates (P = 0.04) that increased from 8.4% in the screen house to 10.2% in the laboratory. The highest infection rate (12.5%) was observed in mosquitoes held in the incubator. However, the mean oocyst intensities in mosquitoes did not differ under these environments (P = 0.58). In the 'real village house' environments, the mean ookinete intensities were not statistically different between groups of mosquitoes compared to the incubator (P = 0.86). The oocyst infection rates observed in the highly fluctuating iron roof house were 9.4% as compared to 9.0% and 6.9% in the more stable and constant habitats of grass thatch house and incubator, respectively. Results show that the natural microhabitats did not influence the infections rates in mosquitoes (P = 0.62). These findings indicate that the variation in temperatures prevailing in western Kenya particularly inside the village houses do not impede the development of malaria parasites in A. gambiae mosquitoes.

Animals↗
PubMed2005

An electronic medical record system for ambulatory care of HIV-infected patients in Kenya.

Administering and monitoring therapy is crucial to the battle against HIV/AIDS in sub-Saharan Africa. Electronic medical records (EMRs) can aid in documenting care, monitoring drug adherence and response to therapy, and providing data for quality improvement and research. Faculty at Moi University in Kenya and Indiana and University in the USA opened adult and pediatric HIV clinics in a national referral hospital, a district hospital, and six rural health centers in western Kenya using a newly developed EMR to support comprehensive outpatient HIV/AIDS care. Demographic, clinical, and HIV risk data, diagnostic test results, and treatment information are recorded on paper encounter forms and hand-entered into a central database that prints summary flowsheets and reminders for appropriate testing and treatment. There are separate modules for monitoring the Antenatal Clinic and Pharmacy. The EMR was designed with input from clinicians who understand the local community and constraints of providing care in resource poor settings. To date, the EMR contains more than 30,000 visit records for more than 4000 patients, almost half taking antiretroviral drugs. We describe the development and structure of this EMR and plans for future development that include wireless connections, tablet computers, and migration to a Web-based platform.

Ambulatory Care↗
PubMed2006

Herbal usage and informant consensus in ethnoveterinary management of cattle diseases among the Kikuyus (Central Kenya).

For most smallholder farmers in Kenya conventional veterinary drugs have become very expensive and therefore unaffordable, causing them to seek low cost alternatives that are rarely documented in most ethnobiological studies. This study surveyed the utilisation of traditional herbal preparations in managing cattle ailments in Central Kenya with the aim of providing a comprehensive ethnobotanical profile and the most important plant species that may warrant scientific validation for efficacy and commercial utilisation. Using semi-structured questionnaires and detailed discussions with smallholder farmers, a total of 40 plant species in 26 families were found to be useful in traditional management of various cattle ailments in this region. Two plant families were particularly frequent in usage: Asteraceae and Lamiaceae, while the most utilised plant species were found to be Synadenium compactum N.E.Br. (Euphorbiaceae), Solanecio manii (Hook.f.) C. Jeffrey (Asteraceae) and Senna didymobotrya (Fresen.) Irwin and Barneby (Caesalpinaceae). Informant consensus was particularly high in managing anaplasmosis, East coast fever and ectoparasites. Such plant species become key target in efficacy tests and for development of commercial veterinary botanicals. The usage of some of the species is unfortunately unsustainable as some of the species are rare or endangered hence the need for conservation strategies to be undertaken.

Anaplasmosis↗
PubMed2005

Using gender analysis to build voluntary counselling and testing responses in Kenya.

The rapid expansion of voluntary counselling and testing (VCT) for HIV in sub-Saharan Africa has led to concerns over the quality and equity of the services. Kenya has seen an unprecedented scale-up of VCT, and valuable lessons have been learnt at national as well as at district and community levels. We combined quantitative and qualitative research methodology and showed how the results of gender analysis can be used to develop equity in VCT scale-up. A gender-disaggregated analysis of VCT client data was conducted for the first 8 months of 2003. These quantitative data revealed that despite an increased vulnerability to HIV, women are underrepresented in VCT sites in all settings in Kenya. Our data also showed that women were also less likely to use condoms or to take home condoms after a VCT visit than their male counterparts. Further exploration through in-depth qualitative work with women and men allowed a better understanding of the reasons behind gender differences in Kenyan VCT sites and helped to develop strategies to address gender inequity. We conclude that there is an ongoing need to mainstream gender in monitoring and evaluation strategies to ensure services meet the needs and priorities of all groups.

Condoms↗
PubMed2004

PCR amplification of RoTat 1.2 VSG gene in Trypanosoma evansi isolates in Kenya.

A direct card agglutination test for Trypanosoma evansi, CATT/T. evansi based on the predominant variable antigen-type (pVAT) RoTat 1.2 was evaluated previously in the field in Isiolo District, Kenya. Sixteen out of 51 (31.4%) parasitologically positive camels were negative by the antibody detection test. In the present study, trypanosomes isolated from the camels were analysed in an attempt to determine the cause of the false negative results of CATT/T. evansi. A total of 20 field isolates comprised 16 stocks from camels that were negative by CATT/T. evansi, and 4 from CATT/T. evansi-positive camels. In addition, 15 known T. evansi and four T. brucei were used as reference. Purified DNA samples were tested using an established RoTat 1.2-based polymerase chain reaction (PCR) that yields a 488 bp product for the specific detection of T. evansi. Antibodies to RoTat 1.2 variant surface glycoprotein (VSG) were used in Western blotting to detect RoTat 1.2 VSG linear epitopes. Results of PCR and Western blot showed that the 16 stocks isolated from CATT/T. evansi-negative camels fell into three groups. In Group 1, both the RoTat 1.2 VSG gene and the VSG were absent in three stocks. In five trypanosome stocks in Group 2, the RoTat 1.2 VSG gene was detected, but Western blot was negative indicating absence of the expressed VSG. Five other stocks containing the RoTat 1.2 VSG gene were also in this group. The RoTat 1.2 VSG gene was detected and Western blot was positive in all four trypanosome stocks in Group 3. All four stocks from CATT/T. evansi-positive camels contained the RoTat 1.2 VSG gene and the expressed VSG. The reference T. evansi KETRI 2479 lacked the RoTat 1.2 VSG gene and there was no immune reactivity detected by Western blot. The rest of the reference T. evansi stocks examined contained the RoTat 1.2 VSG gene. All the four T. brucei samples examined were negative by PCR and Western blot. In conclusion, this study showed that the RoTat 1.2 VSG gene was absent from some T. evansi trypanosomes in Kenya.

Animals↗
PubMed2005

The incidence of calf morbidity and mortality due to vector-borne infections in smallholder dairy farms in Kwale District, Kenya.

An observational longitudinal study was carried out on 92 randomly selected smallholder farms in two coastal lowland zones of Kwale District in Kenya between December 1997 and November 1999. The objective was to estimate the incidence of the main vector-transmitted diseases in pre-weaned calves. From an initial 41 pure or cross-bred Bos taurus calves which were less than 2 months and whose birth and disease histories were known, study calves were recruited progressively and monitored until they were weaned at around 146 days. Overall, 130 calves in 67 farms were monitored and these contributed a total risk period of 30,062 days. Disease parameters were analysed and compared as true annual and age-specific incidence rates. The incidences of East Coast fever (ECF) (23.1%) and trypanosomosis (29.1%) were the highest among the vector-borne diseases. The corresponding mortality incidence rates of ECF and trypanosomosis were 10.9 and 3.6%, respectively. The annual incidence rates of anaplasmosis and babesiosis were 10.9 and 1.2%, respectively. There was no mortality arising specifically from anaplasmosis or babesiosis. Analysis of survival times to natural infection indicated that the field challenge resulting to cases of trypanosomosis was much higher compared to the risk of either ECF or anaplasmosis. It was concluded that these vector-borne diseases constrain production of replacement stock in this coastal lowlands region of Kenya.

Aging↗
PubMed2002

Strategic use of moxidectin or closantel in combination with levamisole in the control of nematodes of sheep in the highlands of central Kenya.

The strategic use of moxidectin or closantel in combination with levamisole (LEV) to control gastrointestinal nematodes of sheep in the highlands of central Kenya was examined. Thirty Corriedale female lambs aged between 6 and 8 months were assigned to three treatment groups of ten lambs each. The three groups of lambs were set stocked on separate paddocks for the entire study period of 12 months. Lambs in Group 1 were dewormed strategically with moxidectin at 0.2 mg/kg body weight and those in Group 2 with closantel at 10 mg/kg body weight together with LEV at 7.5 mg/kg body weight. These strategic treatments were given 3 weeks after the onset of both the short and long rains and at the end of the long rainy season. The third group of lambs remained untreated (control group). Nematode infections in the treated groups of lambs and larval infectivity for the pastures on which the lambs were grazing were well controlled compared with the untreated control group. This resulted in higher weight gains and packed cell volume (PCV) in the treated lambs compared with the untreated lambs. These parameters were comparable between the lambs treated with moxidectin and those treated with closantel plus LEV. The estimated monitory benefit per animal from the control of gastrointestinal nematodes using moxidectin or closantel in combination with LEV when compared with animals in the control group were US dollars 26 and 25, respectively. It was concluded that worm control strategies for sheep in the study area, which are based on anthelmintic treatments during the rainy seasons, are effective. Due to the extended period during which pastures remain infective in the high rainfall central highlands of Kenya, anthelmintics with sustained action such as moxidectin or closantel may be most effective. On farms where resistance to the commonly used benzimidazoles or LEV groups of anthelmintics has developed, moxidectin or closantel may be used in helminth control programs for sheep.

Animals↗
PubMed2003

Cattle owners' perceptions of African bovine trypanosomiasis and its control in Busia and Kwale Districts of Kenya.

A study using a structured questionnaire was conducted in Busia District, Western Kenya and Kwale District, Coastal Kenya to obtain qualitative and quantitative information from 256 cattle owners about their production systems, their perceptions of the diseases encountered in their cattle, the drugs used, and other measures adopted to control trypanosomiasis in cattle. The predominant production system was mixed crop-livestock with farmers owning 2-11 local cattle on holdings between 2 and 5 ha. Approximately 15% of disease episodes in cattle were perceived to be trypanosomiasis, although the farmers' ability to make diagnoses was limited in that over half of the diagnoses were inconsistent with the clinical signs described. Drugs were generally obtained from agro-veterinary shops, and the farmers themselves administered slightly more than half of these. One third of drug treatments given to sick cattle were trypanocides, but over half of these trypanocidal treatments were given to cattle believed to have diseases other than trypanosomiasis.

Agriculture↗
PubMed1998

Characterisation of Leishmania isolates from Laikipia District, Kenya.

Using cloned kDNA sequences from the reference strain of Leishmania tropica IC-067, we have screened leishmanial isolates from Laikipia District of Kenya and identified these isolates as L. tropica. One isolate, IC-331, from a rat (Rattus rattus) was typed as L. tropica. This is the first time that L. tropica has been isolated from a wild rodent in Kenya and thus the first indication that the disease caused by L. tropica might be a zoonosis. The leishmanial isolates, especially those of sandflies, display extensive heterogeneity, prompting a need for selecting local and/or regional reference strains to generate species-specific DNA probes for use in identifying field isolates.

Animals↗
PubMed2002

Evaluation of an emergency contraception introduction project in Kenya.

The Consortium for Emergency Contraception introduced Postinor-2, a progestin-only EC product, into Kenya as part of its work to expand access to EC in developing countries. Introduction activities included registering Postinor-2, training providers, and developing provider and client materials. We surveyed family planning clients and providers to assess the impact of these activities. Knowledge of EC among clients and providers improved between the baseline and evaluation surveys. More women and providers had heard of EC and more providers were distributing it. Support for access to EC in Kenya also improved. The results indicate, though, that further information is needed. Only one-fifth of women at the evaluation had heard of EC and almost half of the women expressed concerns about EC at baseline and evaluation. More research and experience using novel ways of informing women about EC in Africa is needed, and information needs to address women's concerns.

Ambulatory Care Facilities↗