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PubMed2002

HIV and cervical cancer in Kenya.

OBJECTIVES: To determine the effect of the HIV epidemic on invasive cervical cancer in Kenya. METHODS: Of the 3902 women who were diagnosed with reproductive tract malignancies at Kenyatta National Hospital (KNH) from 1989 to 1998, 85% had invasive cervical cancer. Age at presentation and severity of cervical cancer were studied for a 9-year period when national HIV prevalence went from 5% to 5-10%, to 10-15%. RESULTS: There was no significant change in either age at presentation or severity of cervical cancer. Of the 118 (5%) women who were tested for HIV, 36 (31%) were seropositive. These women were 5 years younger at presentation than HIV-negative women. CONCLUSIONS: A two- to three-fold increase in HIV prevalence in Kenya did not seem to have a proportional effect on the incidence of cervical cancer. Yet, HIV-positive women who presented with cervical cancer were significantly younger than HIV-negative women.

Adenocarcinoma↗
PubMedDate not supplied

Antibiotic susceptibility and genotypes of non-typhi Salmonella isolates from children in Kilifi on the Kenya coast.

A 4-year retrospective study was undertaken at the Kilifi District Hospital on the coast of Kenya to determine the antibiotic-susceptibility patterns and genotypes of non-typhi Salmonella (NTS) isolates from children. Overall, during the period 1994-97, positive cultures were obtained from 543 (14%) of 3885 blood samples, 364 (30%) of 1210 stool samples and 143 (11%) of 1283 cerebrospinal fluid (CSF) samples. NTS were isolated from 151 (27.8%), 72 (19.8%), and 11 (7.7%) of these positive cultures, respectively. The total 234 NTS isolates were serotyped: the most frequent were Salmonella enterica serotype Enteritidis (41%) and S. enterica serotype Typhimurium (38%). Antibiotic sensitivity testing was done using ampicillin (amp), chloramphenicol (chl), gentamicin (cn), co-trimoxazole (s-t), cefuroxime (cxm), ciprofloxacin (cip), cefotaxime (ctx), amoxicillin-clavulanic acid 20 micrograms-10 micrograms (amc), and tobramycin (tob). Of the 234 isolates, 43 were sensitive to all antibiotics tested and 133 were multiple drug resistant (MDR). The most common resistance type seen was amp, cn, cxm, s-t, ctx, amc, tob (36/234). Our results indicate a high proportion of MDR amongst the isolates from Kilifi. We conclude that 2 major serotypes of salmonella, i.e., S. enterica serotype Typhimurium and S. enterica serotype Enteritidis, of micro-epidemic nature that have been previously unrecognized in Kilifi are responsible for infection in Kilifi district on the coast of Kenya and that over half (56.8%) of total NTS isolates are MDR.

Child↗
PubMedDate not supplied

Malaria is an important cause of anaemia in primigravidae: evidence from a district hospital in coastal Kenya.

A study was undertaken in order to determine the prevalence and aetiology of anaemia in pregnancy in coastal Kenya, so as to establish locally important causes and enable the development of appropriate intervention strategies. 275 women attending the antenatal clinic at Kilifi district hospital, Kenya, were recruited in November 1993. The prevalence of anaemia (haemoglobin [Hb] < 11 g/dL) was 75.6%, and the prevalence of severe anaemia (Hb < 7g/dL) was 9.8% among all parities; 15.3% of 73 primigravidae were severely anaemic, compared with 7.9% of 202 multigravidae (P = 0.07). In primigravidae, malaria infection (Plasmodium falciparum) was strongly associated with moderate and severe anaemia (chi 2 test for trend, P = 0.003). Severe anaemia was more than twice as common in women with peripheral parasitaemia as in those who were aparasitaemic, and parasitaemia was associated with a 2.2g/dL decrease in mean haemoglobin level (P < 0.001). In multigravidae, iron deficiency and hookworm infection were the dominant risk factors for anaemia. Folate deficiency and human immunodeficiency virus infection were not strongly associated with anaemia. It is suggested that an intervention that can effectively reduce malaria infection in primigravidae could have a major impact on the health of these women and their infants.

Anemia↗
PubMedDate not supplied

Antifolate drug resistance and point mutations in Plasmodium falciparum in Kenya.

Due to increased chloroquine resistance, the antifolate/sulpha drug combinations are becoming increasingly important in the chemotherapy of falciparum malaria. However, point mutations in the dihydrofolate reductase gene lead to resistance to the antifolate drugs. We therefore investigated the prevalence of the 6 reported point mutations in this gene among field isolates of Plasmodium falciparum from Kenya, to determine if the mutations correlated with resistance to pyrimethamine and the biguanides cycloguanil and chlorcycloguanil. We used a mutation-specific polymerase chain reaction technique to test for these reported mutations in 21 Kenyan isolates and 4 reference lines. We also amplified and directly sequenced the dihydrofolate reductase coding sequence from these parasites to confirm the results and test for other possible mutations. Of the reported mutations, we found S108N, which is the central mutation of pyrimethamine resistance, and mutations N51I and C59R, which modulate the levels of resistance and may confer decreases in response to cycloguanil that are folate and p-aminobenzoic acid dependent. No isolate possessed the paired point mutations S108T and A16V, or I164L and S108N, which have been associated with cycloguanil resistance in previous studies. These results provided supportive evidence for the combined use of a cycloguanil-class drug (e.g., chlorproguanil) and a sulpha drug (e.g., dapsone) against P.falciparum malaria in Kenya.

Animals↗
PubMed2001

Indoor air pollution from biomass combustion and acute respiratory infections in Kenya: an exposure-response study.

BACKGROUND: Acute respiratory infections (ARI) are the leading cause of the global burden of disease and have been causally linked with exposure to pollutants from domestic biomass fuels in less-developed countries. We used longitudinal health data coupled with detailed monitoring of personal exposure from more than 2 years of field measurements in rural Kenya to estimate the exposure-response relation for particulates smaller than 10 mm in diameter (PM(10)) generated from biomass combustion. METHODS: 55 randomly-selected households (including 93 infants and children, 229 individuals between 5 and 49 years of age, and 23 aged 50 or older) in central Kenya were followed up for more than 2 years. Longitudinal data on ARI and acute lower respiratory infections (ALRI) were recorded at weekly clinical examinations. Exposure to PM(10) was monitored by measurement of PM(10) emission concentration and time-activity budgets. FINDINGS: With the best estimate of the exposure-response relation, we found that ARI and ALRI are increasing concave functions of average daily exposure to PM(10), with the rate of increase declining for exposures above about 1000-2000 mg/m(3). After we had included high-intensity exposure episodes, sex was no longer a significant predictor of ARI and ALRI. INTERPRETATION: The benefits of reduced exposure to PM(10) are larger for average exposure less than about 1000-2000 mg/m(3). Our findings have important consequences for international public-health policies, energy and combustion research, and technology transfer efforts that affect more than 2 billion people worldwide.

Acute Disease↗
PubMed2002

Oesophageal cancer: a common malignancy in young people of Bomet District, Kenya.

Oesophageal cancer is a common cancer with uneven geographical distribution. We reviewed all malignancies diagnosed at Tenwek Hospital (Bomet District, Kenya) between 1989 and 1998. Oesophageal cancer was the most common malignancy; 274 cases accounted for 19% of 1459 malignancies diagnosed, and for a steady rise in total cancer cases during this period. A striking feature of our study was the presence of a subset of very young patients. 26 (11%) patients were aged 30 years or less at diagnosis, and the youngest patient was 14 years old. This area of West Kenya seems to be a high-risk region for oesophageal cancer.

Adolescent↗
PubMed2004

Assessment of inpatient paediatric care in first referral level hospitals in 13 districts in Kenya.

BACKGROUND: The district hospital is considered essential for delivering basic, cost-effective health care to children in resource poor countries. We aimed to investigate the performance of these facilities in Kenya. METHODS: Government hospitals providing first referral level care were prospectively sampled from 13 Kenyan districts. Workload statistics and data documenting the management and care of admitted children were obtained by specially trained health workers. FINDINGS: Data from 14 hospitals were surveyed with routine statistics showing considerable variation in inpatient paediatric mortality (range 4-15%) and specific case fatality rates (eg, anaemia 3-46%). The value of these routine data is seriously undermined by missing data, apparent avoidance of a diagnosis of HIV/AIDS, and absence of standard definitions. Case management practices are often not in line with national or international guidelines. For malaria, signs defining severity such as the level of consciousness and degree of respiratory distress are often not documented (range per hospital 0-100% and 9-77%, respectively), loading doses of quinine are rarely given (3% of cases) and dose errors are not uncommon. Resource constraints such as a lack of nutritional supplements for malnourished children also restrict the provision of basic, effective care. INTERPRETATION: Even crude performance measures suggest there is a great need to improve care and data quality, and to identify and tackle key health system constraints at the first referral level in Kenya. Appropriate intervention might lead to more effective use of health workers' efforts in such hospitals.

Anemia↗
PubMed1984

Effectiveness of amodiaquine as treatment for chloroquine-resistant Plasmodium falciparum infections in Kenya.

Studies were conducted in Malindi, Kenya, to assess the response of Plasmodium falciparum to chloroquine and amodiaquine in vivo (by an extended 14-day test) and in vitro (with the Rieckmann micro test). In-vivo resistance was demonstrated in 19 of 69 (28%) infections treated with chloroquine, but in only 2 of 60 (3.3%) of those treated with amodiaquine (p less than 0.001). In-vitro resistance to chloroquine was demonstrated in 15 of 23 (65%) tests. In contrast, 22 of the same 23 isolates were sensitive to amodiaquine in vitro. Effective concentrations by probit analysis for 50% and 99% (EC50 and EC99) inhibition, respectively, were 180.7 and 4319.6 nmol/l for chloroquine and 12.2 and 147.0 nmol/l for amodiaquine. The results suggest that amodiaquine is effective for the treatment of chloroquine-resistant falciparum malaria in Kenya.

Adolescent↗
PubMed2000

Financial analysis of animal trypanosomiasis control using cypermethrin pour-on in Kenya.

The financial impact of use of cypermethrin pour-on (Ectopor(R)) in control of animal trypanosomiosis was determined in a trial undertaken by the Kenya Trypanosomiasis Research Institute (KETRI). This trial started in December 1990 and ended in February 1992. It was undertaken in two adjacent ranches in the coast province of Kenya. The trial site was in an area of high apparent density (AD) of tsetse flies, and at the start of the trial no cattle were kept in this area. Cypermethrin was applied fortnightly to the 1100 steers which were kept in pour-on ranch 'A' while another 100 steers were kept in control ranch 'B' to act as control sentinels. From the main pour-on group, 100 animals were identified as the pour-on sentinels and compared to the control sentinels which received no pour-on.Pour-on application led to a significant decrease in the tsetse AD in the pour-on ranch A to 90% of the initial AD in some areas. The animals treated with pour-on had a significantly higher mean packed-cell volume (PCV). The weekly prevalence of trypanosome infections in animals treated with pour-on was <4% with only one exception when it was <10%. In the control animals, the prevalence ranged between 10 and 50% (with a few exceptions when it was <10%). The incidence of tick-borne diseases was lower in the pour-on animals. The mean monthly weights of the pour-on animals was significantly higher, and at the end of the trial the pour-on animals had a mean weight gain of 136.70+/-16.7kg while the control animals had gained 97.16+/-22.6kg. The financial net return of using cypermethrin pour-on was positive and the financial rate of return of 122.6% indicated that use of the pour-on was highly beneficial despite the high cost of the product.

Administration, Topical↗
PubMed2001

Seroprevalences of vector-transmitted infections of small-holder dairy cattle in coastal Kenya.

A cross-sectional study was carried out from July to September 1989 in Kaloleni Division, Coast Province, Kenya to estimate the prevalence of vector-transmitted diseases in small-holder dairy cattle and to identify the risk factors associated with different management systems. One hundred and thirty of the 157 herds with dairy cattle in Kaloleni Division were surveyed. These were from three agro-ecological zones (coconut-cassava, cashew nut-cassava and livestock-millet), comprised two management systems (stall-feeding and herded grazing) and were herds with either dairy cattle only or with Zebu and dairy cattle. A formal questionnaire sought answers to questions on cattle health and management practices. A total of 734 dairy and 205 Zebu cattle in 78 dairy and 52 mixed (dairy and Zebu) herds were sampled and screened for haemoparasites (Trypanosoma, Anaplasma, Babesia, and Theileria infections). Sera were tested for antibodies to Theileria parva, using the schizonts-antigen indirect fluorescent-antibody (IFA) test and to antibodies for Babesia bigemina and antigens to Anaplasma marginale by enzyme-linked immunosorbent assay (ELISA). Packed-cell volume (PCV) also was measured. Tick-control measures were practised by all except three of the farmers. Despite this, overall seroprevalence to T. parva was >70%--suggesting either that control practices were not strictly implemented or they were ineffective. The seroprevalence of T. parva in adult cattle kept in stall-feeding systems in the coconut-cassava zone was significantly lower (57+/-8% (S.E.)) than in herded-grazing systems (79+/-3%) and there was no association between antibody prevalence and age of cattle in this zone. Antibody prevalences in cattle in the cashew nut-cassava and the drier livestock-millet zone increased with age. Cattle in herded-grazing systems had an overall lower seroprevalence of T. parva infection in the livestock-millet zone (45+/-6%) than in the other two zones. Analysis was confined to the coconut-cassava zone for B. bigemina and to the coconut-cassava and cashew nut-cassava zones for A. marginale. Mean prevalences of B. bigemina were 40.9+/-9 and 73+/-6% for dairy cattle under stall-feeding and herded-grazing systems, respectively, and increased with age. Antigen prevalences of A. marginale were over 80% in all age groups of cattle in the coconut-cassava and cashew nut-cassava zones. Overall trypanosome prevalence in cattle was <1%. Trypanocidal treatment was uncommon. The variations in antibody prevalence associated with risk factors such as feeding system, agro-ecological zone and age of animal suggest that management system influenced exposure to tick-borne infection (particularly, T. parva infections) in small-holder dairy cattle in coastal Kenya.

Agriculture↗
PubMed2001

A longitudinal study of disease incidence and case-fatality risks on small-holder dairy farms in coastal Kenya.

A longitudinal study was carried out in the coastal lowlands coconut-cassava agro-ecological zone of Kaloleni Division, Coast Province, Kenya between June 1990 and December 1991 to estimate disease incidence and cause-specific case-fatality risk in an average of 120 cattle in 26 small-holder dairy herds kept in two grazing-management systems. East Coast fever (ECF) was the predominant disease diagnosed; the mean monthly incidence rate was 2.5 and 6.9% in animals < or = 18 months of age under stall-fed and herded-grazing systems, respectively. In cattle > 18 months of age, the monthly incidence rate was < 1%. The 6-month ECF incidence rate was 20+/-8% (S.E.) in the stall-feeding system compared with 39+/-7% in the herded-grazing systems. There was a gradual increase in antibody prevalence with age to over 90% in cattle over 18 months of age in herded-grazing systems, whilst less than a third of cattle in the stall-feeding systems were sero-positive at any age. Overall accumulated mortality to 18 months of age was estimated to be 56%. Annual mortality in cattle > 18 months averaged 9%. Cattle managed in the herded-grazing system had a 60% higher mortality, although not significantly so, than those fed in stalls. Deaths due to ECF accounted for over two-thirds of the deaths. ECF was then the major disease constraint to small-holder dairy production in the coconut zone of coastal Kenya. Clinical cases occur the whole year round (especially in young stock)--despite apparent tick control, and in both herded-grazing and stall-feeding system.

Age Factors↗
PubMed2001

Identification of a target population for immunisation against East Coast fever in coastal Kenya.

Two experiments were carried out to identify the target population of cattle for immunisation against East Coast fever (ECF) using the infection-and-treatment method. Firstly, a sentinel-calf study was used to determine the age window for ECF immunisation by determining ages at clinical detection of infection with Theileria parva. Six groups of five naive cross-bred (Bos taurus/Bos indicus) male calves, introduced at intervals of 2 months at a mean age of 26 days, were exposed to natural tick challenge on a high ECF-risk, small-holder farm in the coastal lowland, coconut-cassava agro-ecological zone of coastal Kenya. Secondly, a challenge study evaluated the relationship between the presence of T. parva antibodies and immunity. Ten indigenous adult Zebu cattle and nine Zebu young stock purchased from farmers in the same zone, and eight cross-bred calves (survivors of the sentinel-calf study) were challenged with 10 times the immunising dose of T. parva Marikebuni stock. Twenty-four of these 27 cattle had high antibody titres before challenge. Two cross-bred calves, obtained from an ECF-free area and seronegative to T. parva schizont antigen, also were challenged and used as susceptible controls. Twenty-five (83%) of the 30 sentinel calves contracted ECF over an age range of 36-116 days (mean 72 days). The remaining five calves died of other causes within 2 months of arrival on the farm. Fourteen of the 25 calves survived the infection and developed antibodies to T. parva. Despite tick control, seven of these 14 calves had a second episode of ECF and two died. In total, 13 of the 25 calves that contracted ECF died. Only one of 19 indigenous Zebu animals developed clinical ECF when challenged with T. parva Marikebuni (mild clinical signs with spontaneous recovery). Of the eight cross-bred survivors from the first experiment, only one succumbed to ECF when challenged and it died. Both susceptible cross-bred calves developed severe clinical signs of ECF and one died. The experimental studies show that in the high ECF-risk areas of the coconut-cassava zone of coastal Kenya, immunisation against ECF in cross-bred (B. taurus/B. indicus) cattle should be targeted at an early age (preferably within 1-2 months of birth).

Agriculture↗
PubMed2003

The use of amplified fragment length polymorphism for molecular analysis of Beauveria bassiana isolates from Kenya and other countries, and their correlation with host and geographical origin.

Beauveria spp. (one Beauveria sp., two B. brongniartii, and 47 B. bassiana) isolated from insects and soil from Kenya and other 16 different countries, were obtained from the CABI Bioscience Genetic Resource Collection. DNA was extracted from the 50 isolates and their genetic variability was investigated using restriction analysis of the internal-transcribed-spacer ribosomal region restriction fragment length polymorphism (ITS-RFLP), ITS sequencing, and amplified fragment length polymorphism (AFLP). The B. bassiana isolates could not be distinguished by ITS-RFLP as all of them showed the same banding pattern. However, the AFLP technique provided more information on polymorphism between the isolates, allowing them to be clustered by relative similarity using band matching and unweighted pair group method with arithmetic mean analysis. Although no significant correlation between the isolates and host and geographical origins were observed, the technique revealed clonal populations of B. bassiana within Kenya.

Acrylic Resins↗
PubMed2002

Medicinal plants used by Luo mothers and children in Bondo district, Kenya.

In a follow-up to studies of school-children's medical knowledge among the rural Luo of western Kenya, seven mothers were asked for their knowledge of plant medicine, and the 91 plant remedies mentioned by them were collected, 74 of these remedies were identified as 69 different species (in 13 cases, the material did not allow identification of the species, in two cases, only the family could be identified, and in two, not even this was possible). The results of this survey and some comments on Luo illness concepts are presented below and briefly discussed in relation to the earlier work on school-children and to another survey of Luo plant medicine in the same district. The article concludes that the consensual core of Luo plant medicine is known by ordinary mothers and their children as well as by recognised healers. It is a shared resource, that is used by women, mainly in the care for their children, and it is not an expert domain of knowledge, as is often, in studies of herbal or 'traditional' medicine are studied. The medicinal plants, upon which many mothers as well as healers agree should be examined further pharmacologically in order to assess their efficacy against the common infectious and parasitic diseases found in this area of western Kenya.

Adolescent↗
PubMed1991

Leishmaniasis in a domestic goat in Kenya.

The pathological and electron-microscopic features of the first case of autochthonous leishmaniasis affecting a domestic goat in Kenya are described. They are similar to what have been described in man and other animals. Using a short amino-acid sequence common to all the species of leishmania as primers for kDNA synthesis, the intervening sequence of 120 bases was amplified in the goat's tissues by polymerase chain reaction (PCR). The leishmania kinetoplast DNA sequence was detected in all the different infected tissues of the goat examined. The sensitivity and specificity of this assay are discussed. The result of the assay used was consistent with the parasite being either L. major or L. aethiopica as the infecting agent. The isoenzyme studies were consistent with L. aethiopica as the strain responsible for this goat's infection. The control of leishmaniasis and its vector must take into account the potential role of animal reservoirs in the environment. Even though Kenya and other East African countries are endemic for kala-azar, the presence of kala-azar in goats is of considerable veterinary public health importance in Africa. Efforts must not be spared to identify and detect other possible animal reservoirs in the subregion. Using DNA amplification techniques, which are sensitive and specific, such as the one described in this paper, sera and other biological fluids and tissues from different animal species should be utilized for detecting additional reservoirs for leishmania parasites particularly in known endemic areas of the world.

Animals↗
PubMed2001

Perspectives of adolescent boys on the risks of unwanted pregnancy and sexually transmitted infections: Kenya.

Sexual debut for boys in Kenya occurs mostly by mid-adolescence. This study looks at the perspectives of adolescent boys aged 15-19 attending schools in rural, eastern Kenya on the dual risks of unwanted pregnancy, STDs and HIV, based on qualitative data from eight focus group discussions with 90 boys. Despite a high knowledge of sexual risks, fear of HIV and awareness of the protective value of condoms, the young men exhibit high risk behaviour. They feel the need to conform to social prescriptions of male prowess, early sexual experience, and having more than one partner, yet their feelings about this behaviour are ambiguous and contradictory. They consider getting girls pregnant and having had a treatable STD as marks of masculinity, blame girls for not protecting themselves (and girls' parents), and want to boast about their sexual conquests to their peers. Yet they feel embarrassed and reticent about discussing sexual issues with adults, and are unwilling to get condoms from places where anonymity is not assured as they know their sexual activity is not sanctioned. There is a clear need for educational programmes that confront male sexual norms, address issues of gender power relations, promote communication skills, informed choice and sexual responsibility among boys as well as girls, and provide a consistent supply of good quality condoms free or at affordable prices.

Adolescent↗
PubMed1999

Perianesthesia care in Kenya: issues in managing pain.

A complex interplay of logistic difficulties and socioeconomic factors have created a huge gap between what is known (and taught) and what is done (and practiced) about pain and its management in Kenya. This report explores this gap between theory and practice and other issues that influence the practical management of pain in Kenya.

Analgesics↗
PubMed2003

Performance of forecasting, warning and detection of malaria epidemics in the highlands of western Kenya.

On the 4th July 2002 a leading national newspaper in Kenya, the Daily Nation, ran the headline 'Minister sounds alert on malaria' in an article declaring the onset of epidemics in the highlands of western Kenya. There followed frequent media coverage with quotes from district leaders on the numbers of deaths, and editorials on the failure of the national malaria control strategy. The Ministry of Health made immediate and radical changes to national policy on treatment costs in the highlands by suspending cost-sharing. Development partners and non-governmental organisations also responded with a large increase in the distribution of commodities (approximately 500,000 US dollars) to support preventative strategies across the western highland region. What was conspicuous by its absence was any obvious effort to predict the epidemics in advance of press coverage.

Animals↗