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PubMed1999

Stable antenatal HIV-1 seroprevalence with high population mobility and marked seroprevalence variation among sentinel sites within Nairobi, Kenya.

OBJECTIVES: To monitor and analyse trends in HIV-1 seroprevalence among antenatal women in Nairobi, Kenya. DESIGN: Six sequential surveys were carried out among antenatal clinic attenders at four Nairobi City Council health centres between November 1991 and April 1997. METHODS: A total of 6828 women attending for first antenatal clinic visit were administered a standard questionnaire to obtain demographic information and were screened for HIV-1. RESULTS: HIV-1 seroprevalence rose from 12.1% in the first survey to 16.2% in the third, completed in October 1993. No rise was observed in subsequent surveys, and seroprevalence among women under the age of 20 declined after the third survey. Significant differences in seroprevalence (P < 0.001) were observed in all survey rounds between women who reported that their province of origin was Nyanza (22.4% overall), compared with those from other provinces in western Kenya (14.1%), and the eastern group of provinces (8.9%). The rise in HIV-1 seroprevalence observed between 1991 and 1993 was almost entirely attributable to the rising seroprevalence among women from Nyanza. There were considerable differences in HIV-1 seroprevalence among the four health centres, partly accounted for by differences in the proportion of clinic attenders from different provinces of origin, which also changed significantly over time. CONCLUSIONS: HIV-1 seroprevalence has stabilized in antenatal women attending these health centres in Nairobi, and may be declining among women in the youngest age group. This may reflect stabilization of HIV-1 incidence, but further observation is required. The levels of infection among Nairobi residents reflect the evolution of the HIV epidemic in their provinces of origin, and changing client composition influences HIV-1 seroprevalence at different clinics. HIV sentinel surveillance should be carried out at multiple sites in large urban centres to monitor accurately the evolution of the HIV epidemic and the impact of control efforts in reducing transmission.

Adolescent↗
PubMed2001

Healthcare-seeking behavior and sexual behavior of patients with sexually transmitted diseases in Nairobi, Kenya.

BACKGROUND: Sexual and health-seeking behaviors are important components of sexually transmitted disease (STD) control. GOALS: To generate data for improved STD prevention and care, and to assess sexual behavior and relevant health-seeking behavior. STUDY DESIGN: A questionnaire to elicit social, demographic, healthcare-seeking, and sexual behavior information was administered to 471 patients attending the referral clinic for STDs in Nairobi, Kenya. RESULTS: A large proportion of the patients had sought treatment in public and private sectors before attending the clinic for STDs. Women waited longer than men to seek medical care. In addition, women more than men engaged in sex while symptomatic, mostly with their regular partner. Condoms were used rarely during illness. In their self-reports, 68% of the men admitted to having extramarital affairs, and 30% to paying for sex, yet they blamed their wives for their STDs. CONCLUSION: Health education messages in Kenya need adaptation to improve health-seeking behavior and safe sex practices.

Adult↗
PubMed2003

Distribution of human papillomavirus in a family planning population in nairobi, kenya.

BACKGROUND: In sub-Saharan Africa, cervical cancer is the leading cancer among women. The causative role of different human papillomavirus (HPV) types in cervical cancer is established, but the distribution of HPV types within this region is largely unknown. GOAL: The goal was to study the distribution of HPV among family planning clinic attendees in Nairobi, Kenya. STUDY DESIGN: This was a cross-sectional study of persons attending a family planning center in Nairobi, Kenya. RESULTS: HPV data of 429 women were analyzed; 7.0% had low-grade intraepithelial lesions, 6.8% had high-grade intraepithelial lesions, and 0.23% had invasive cancer. One hundred ninety samples (44.3%) were HPV-positive (28.4% were positive for multiple types). The most common HPV types were HPV 52 (17.9% of positive samples), HPV 16 (14.7%), HPV 35 (11.6%), and HPV 66 (9.0%). The risk of high-grade squamous intraepithelial lesions (HSIL) was 88.5 times higher (95% CI, 8.5-1.4 x 10 ) in HPV 16-positive women than in HPV-negative women. Relative risks were 54.3 (95% CI, 4.0-1.4 x 10 ) for HPV 35, 49.2 (95% CI, 3.6-9.5 x 10 ) for HPV 52, and 21.7 (95% CI, 0.0-1.9 x 10 ) for HPV 18. The prevalence of HSIL was not increased in association with HIV-positivity, yet HIV-1 was significantly associated with high-risk HPV types ( P< 0.00001). CONCLUSION: The pattern of HPV distribution in this population was different from that in other regions in the world, which has important consequences for HPV vaccine development.

Adult↗
PubMed1995

Comparison of the declines in CD4 counts in HIV-1-seropositive female sex workers and women from the general population in Nairobi, Kenya.

Studies from Kenya have reported rapid clinical disease progression among HIV-infected professional sex workers. The reasons for this rapid decline are unknown. To better understand factors influencing the course of disease, HIV-1 disease progression was explored in terms of declines in CD4 counts. Two samples from Nairobi, Kenya, were studied, one from a cohort of female sex workers and another, as a comparison group, from mothers enrolled in an HIV-1 vertical-transmission study. A Markov model was used to analyze transitions between HIV-1 disease stages as defined by CD4 counts. It appears that sex workers experience a rapid decline in CD4 counts, consistent with earlier findings of rapid clinical disease progression among individuals in this group. The rate of decline in CD4 counts among the mothers appears to be lower. It is speculated that either intensive exposure to sexually transmitted pathogens or infection with several strains of HIV-1 may account for the rapid disease progression among female sex workers.

Adult↗
PubMed2007

Mycoplasma genitalium infection and persistence in a cohort of female sex workers in Nairobi, Kenya.

OBJECTIVE: The objective of this study was to assess the risk factors for and persistence of Mycoplasma genitalium (MG) in a highly exposed female population in Kenya. STUDY DESIGN: Two hundred fifty-eight sex workers in Nairobi, Kenya, 18 to 35 years of age, were enrolled. Every 2 months, cervical samples were collected for MG, Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (GC) testing by polymerase chain reaction. RESULTS: At enrollment, 16% were infected with MG. Seventy-seven subjects acquired 107 MG infections, giving an incidence of 22.7 per 100 women-years. Incident CT (adjusted hazard ratio [HR] = 2.4; 95% confidence interval [CI] = 1.5-4.0), GC (HR = 2.0; 95% CI = 1.2-3.5), and HIV infection (adjusted HR = 2.2; 95% CI = 1.3-3.7) were associated with an increased risk of MG. Seventeen percent, 9%, and 21% of MG infections persisted 3, 5, and >or=7 months, respectively. CONCLUSION: The high incidence of MG, greater than that for both CT (14.0%) and GC (8%), association with common sexually transmitted infection risk factors, and persistence in the female genital tract supports its role as a common sexually transmitted infection in Kenyan women.

Adolescent↗
PubMed2006

Outcomes of HIV-infected orphaned and non-orphaned children on antiretroviral therapy in western Kenya.

OBJECTIVES: Determine outcome differences between orphaned and non-orphaned children receiving antiretroviral therapy (ART). DESIGN: Retrospective review of prospectively recorded electronic data. SETTING: Nine HIV clinics in western Kenya. POPULATION: 279 children on ART enrolled between August 2002 and February 2005. MAIN MEASURES: Orphan status, CD4%, sex- and age-adjusted height (HAZ) and weight (WAZ) z scores, ART adherence, mortality. RESULTS: Median follow-up was 34 months. Cohort included 51% males and 54% orphans. At ART initiation (baseline), 71% of children had CDC clinical stage B or C disease. Median CD4% was 9% and increased dramatically the first 30 weeks of therapy, then leveled off. Parents and guardians reported perfect adherence at every visit for 75% of children. Adherence and orphan status were not significantly associated with CD4% response. Adjusted for baseline age, follow-up was significantly shorter among orphaned children (median 33 vs. 41 weeks, P = 0.096). One-year mortality was 7.1% for orphaned and 6.6% for non-orphaned children (P = 0.836). HAZ and WAZ were significantly below norm in both groups. With ART, HAZ remained stable, while WAZ tended to increase toward the norm, especially among non-orphans. Orphans showed identical weight gains as non-orphans the first 70 weeks after start of ART but experienced reductions afterwards. CONCLUSIONS: Good ART adherence is possible in western rural Kenya. ART for HIV-infected children produced substantial and sustainable CD4% improvement. Orphan status was not associated with worse short-term outcomes but may be a factor for long-term therapy response. ART alone may not be sufficient to reverse significant developmental lags in the HIV-positive pediatric population.

Adolescent↗
PubMed1995

Rabies and African wild dogs in Kenya.

Three packs of African wild dogs (Lycaon pictus) ranging to the north of the Masai Mara National Reserve in southwestern Kenya were monitored from 1988 to 1990. During a six week period (August 2-September 14, 1989), 21 of 23 members of one of these packs died. Histological examination of two brain samples revealed eosinophilic intracytoplasmic inclusions (Negri bodies), supporting a diagnosis of rabies viral encephalitis. An additional brain sample tested positive for rabies with a fluorescent antibody test. Nucleotide sequence of the rabies viral N and G genes from isolates of four African wild dogs (including an individual from Tanzania) indicated that infection was with a viral variant common among domestic dogs in Kenya and Tanzania. A hypothesis linking African wild dog rabies deaths to researcher handling is evaluated and considered implausible.

Animals↗
PubMed2006

Genetic diversity and phylogeography of cassava mosaic viruses in Kenya.

Cassava is a major factor in food security across sub-Saharan Africa. However, the crop is susceptible to losses due to biotic stresses, in particular to viruses of the genus Begomovirus (family Geminiviridae) that cause cassava mosaic disease (CMD). During the 1990s, an epidemic of CMD severely hindered cassava production across eastern and central Africa. A significant influence on the appearance of virus epidemics is virus diversity. Here, a survey of the genetic diversity of CMD-associated begomoviruses across the major cassava-growing areas of Kenya is described. Because an initial PCR-restriction fragment-length polymorphism analysis identified a much greater diversity of viruses than assumed previously, representative members of the population were characterized by sequence analysis. The full-length sequences of 109 components (68 DNA-A and 41 DNA-B) were determined, representing isolates of East African cassava mosaic virus and East African cassava mosaic Zanzibar virus, as well as a novel begomovirus species for which the name East African cassava mosaic Kenya virus is proposed. The DNA-B components were much less diverse than their corresponding DNA-A components, but nonetheless segregated into western and eastern (coastal) groups. All virus species and strains encountered showed distinct geographical distributions, highlighting the importance of preventing both the movement of viruses between these regions and the importation of the disease from adjacent countries and islands in the Indian Ocean that would undoubtedly encourage further diversification.

DNA Viruses↗
PubMed2001

Prevention of bacterial diarrhea by pasteurization of drinking water in Kenya.

Diarrheal disease is one of the major causes of morbidity and mortality in developing countries. Drinking water is a primary transmission route of infectious diarrheagenic bacteria in a rural area of Kenya (Microbiol. Immunol. 41: 773-778, 1997). We tried to prevent diarrhea at villages with approximately 1,500 households in Kenya by pasteurizing drinking water. A durable simple thermoindicator which changes color at 70 C was used as an indicator of pasteurization. The number of households in which drinking water was coliform bacteria-free increased from 10.7% to 43.1% after adoption of a pasteurization practice. Consequently, the incidence of severe diarrhea among people drinking pasteurized water was significantly lower than in people taking raw water (odds ratio=0.55, P=0.0016). The reduction ratio of the incidence after pasteurization was nearly equivalent with that after the adoption of a boiling method. Employment of women leaders as fieldworkers and demonstration of bacterial colony disappearance on agar plates by pasteurization also affected reduction of the diarrheal incidence.

Bacterial Infections↗
PubMed2004

Effect of point-of-use disinfection, flocculation and combined flocculation-disinfection on drinking water quality in western Kenya.

AIMS: Point-of-use drinking water disinfection with sodium hypochlorite has been shown to improve water quality and reduce diarrhoeal disease. However, the chlorine demand of highly turbid water may render sodium hypochlorite less effective. METHODS AND RESULTS: We evaluated a novel combined flocculant-disinfectant point-of-use water treatment product and compared its effect on drinking water quality with existing technologies in western Kenya. In water from 30 sources, combined flocculant-disinfectant reduced Escherichia coli concentrations to <1 CFU100 ml(-1) for 29 (97%) and reduced turbidity to <5 nephelometric turbidity units (NTU) for 26 (87%). By contrast, water from 30 sources treated with sodium hypochlorite reduced E. coli concentrations to <1 CFU 100 ml(-1) for 25 (83%) and turbidity to <5 NTU for 5 (17%). CONCLUSIONS: For source waters over a range of turbidities in western Kenya, combined flocculant-disinfectant product effectively reduces turbidity to <5 NTU and reduces E. coli concentrations to <1 CFU 100 ml(-1). SIGNIFICANCE AND IMPACT OF THE STUDY: The novel flocculant-disinfectant product may be acceptable to consumers and may be effective in reducing diarrhoeal disease in settings where source water is highly turbid.

Alum Compounds↗
PubMed1992

Identification of phlebotomine sandfly bloodmeals from Baringo District, Kenya, by direct enzyme-linked immunosorbent assay (ELISA).

Direct enzyme-linked immunosorbent assay (ELISA) was used to identify the sources of bloodmeals in phlebotomine sandflies from Baringo District, Rift Valley Province, Kenya. Some bloodmeals had been stored for over 4 years before being analysed. Among 356 sandflies identified, 62.9% were Phlebotomus martini, 14.8% Sergentomyia antennatus, 10% S.schwetzi, 6% S.clydei, 1.9% S.adleri, 1.6% P.duboscqi, 1.4% S.africanus and 0.8% S.bedfordi. Out of 224 P.martini bloodmeals, host source was identified for 69. The order of host preference for P.martini was: goat 28.5%, rabbit 22.7%, human 8.9% and others 8.9%. Evidence of mixed feeding was shown by four species comprising sixteen specimens, twelve of which were P.martini. The most effective methods for trapping bloodfed P. martini were sticky paper traps in termite hills, followed by light-traps. Of the 224 P.martini trapped, 58.9% were collected with traps in termite hills, and 22.7% with light traps. Roles of the three most popular hosts for P.martini should be investigated to ascertain whether they act as reservoirs in the transmission of Leishmania donovani causing visceral leishmaniasis in Kenya.

Animals↗
PubMed1993

Host feeding preference of Phlebotomus guggisbergi, a vector of Leishmania tropica in Kenya.

Recently the sandfly Phlebotomus guggisbergi was found to be a vector of Leishmania tropica causing cutaneous leishmaniasis in the Laikipia focus, Kenya, but extensive searches have shed no light on the identity of the rural reservoir host(s). In order to discover more about the biology of the vector, a host feeding preference study was conducted on wild sandflies in their natural cave environment over a 6-month period. Solid state Army miniature (SSAM) traps, without light bulb, were suspended over cages with potential hosts or an empty cage control. The animals tested included sheep, goat, dog, cat, hamster, rabbit, giant rat (Cricetomys gambianus), crested rat (Lophiomys imhausi) and rock hyrax (Procavia capensis), all of which (except hamsters) are normally found in the vicinity of the study site. Sandfly collections from traps baited with goat, sheep, cat, dog, rabbit, or wild rodent species were significantly higher than the control, whereas trap collections with hamster and rock hyrax were not significantly different from the control. Numbers of sandflies collected from the goat, sheep and cat were significantly greater than from the rabbit and rodents. The sex ratio also varied between collections: larger animals attracted a higher proportion of female P. guggisbergi than did the smaller animals (P > 0.05). Therefore greater emphasis should be placed on surveying larger animals to assess their status as reservoir hosts for L. tropica in Kenya.

Animals↗
PubMed2004

The difference between effectiveness and efficacy of antimalarial drugs in Kenya.

OBJECTIVE: To demonstrate the difference between effectiveness and efficacy of antimalarial (AM) drugs in Kenya. METHODS: We undertook a series of linked surveys in four districts of Kenya between 2001 and 2002 on (i) community usage of nationally recommended first- and second-line AM drugs; (ii) commonly stocked AM products in the retail and wholesale sectors; and (iii) quality of the most commonly available first- and second-line AM products. These were combined with estimates of adherence and clinical efficacy to derive overall drug effectiveness. RESULTS: The overall modelled effectiveness for sulphadoxine-pyrimethamine (SP) was estimated to be 62% compared with 85% for reported SP clinical efficacy. For amodiaquine the modelled effectiveness was 48% compared with 99% reported efficacy during the same time period. CONCLUSIONS: The quality of AM products and patient adherence to dosage regimens are important determinants of drug effectiveness, and should be measured alongside clinical efficacy. Post-registration measures to regulate drug quality and improve patient adherence would contribute significantly to AM drug performance.

Antimalarials↗
PubMed2005

Creutzfeldt-Jakob disease in Kenya.

OBJECTIVE: To study the pattern of occurrence of Creutzfeldt-Jakob disease (CJD) in Kenya. Study design Prospective, cross-sectional, descriptive study of clinical, encephalographic and natural history of CJD, backed by histology in as many patients as possible. METHODS: Consecutive patients presenting with the criteria laid down by WHO expert committee for diagnosis of CJD were recruited between January 1990 and May 2004. We analysed the clinical features and electroencephalography of all participants and took brain biopsies from four patients. RESULTS: There were four definite, seven probable and two possible cases. The electroencephalographic and histological features were typical of sporadic CJD. CONCLUSION: Sporadic CJD occurs in Kenya and the clinical, encephalographic and histological features were no different to those described elsewhere. Although we did not see variant, hereditary and iatrogenic forms of CJD, neurologists should not exclude these in making diagnoses.

Aged↗
PubMed2006

The financial and clinical implications of adult malaria diagnosis using microscopy in Kenya.

OBJECTIVE: A recent observational study undertaken at 17 health facilities with microscopy in Kenya revealed that potential benefits of malaria microscopy are not realized because of irrational clinical practices and the low accuracy of routine microscopy. Using these data, we modelled financial and clinical implications of revised clinical practices and improved accuracy of malaria microscopy among adult outpatients under the artemether-lumefantrine (AL) treatment policy for uncomplicated malaria in Kenya. METHODS: The cost of AL, antibiotics and malaria microscopy and the expected number of malaria diagnosis errors were estimated per 1,000 adult outpatients presenting at a facility with microscopy under three scenarios: (1) current clinical practice and accuracy of microscopy (option A), (2) revised clinical practice with current accuracy of microscopy (option B) and (3) revised clinical practice with improved accuracy of microscopy (option C). Revised clinical practice was defined as performing a blood slide for all febrile adults and prescribing antimalarial treatment only for positive results. Improved accuracy of routine microscopy was defined as 90% sensitivity and specificity. In the sensitivity analysis, the implications of changes in the cost of drugs and malaria microscopy and changes in background malaria prevalence were examined for each option. RESULTS: The costs of AL, antibiotics and malaria microscopy decreased from 2,154 dollars under option A to 1,254 dollars under option B and 892 dollars under option C. Of the cost savings from option C, 72% was from changes in clinical practice, while 28% was from improvements in the accuracy of microscopy. Compared with 638 malaria overdiagnosis errors per 1,000 adults under option A, 375 and 548 fewer overdiagnosis errors were estimated, respectively, under options B and C. At the same time, the number of missed malaria diagnoses remained generally low under all options. Sensitivity analysis showed that both options B and C are robust to a wide range of assumptions on the costs of drugs, costs of blood slides and malaria prevalence. CONCLUSIONS: Even with the imperfect microscopy conditions at Kenyan facilities, implementation of revised clinical practice (option B) would substantially reduce the costs and errors from malaria overdiagnosis. Additional interventions to improve the accuracy of microscopy (option C) can achieve further benefits; however, improved microscopy in the absence of revised clinical practice is unlikely to generate significant cost savings. Revision of guidelines to state explicitly age-specific indications for the use and interpretation of malaria microscopy is urgently needed. Further prospective studies are required to evaluate the effectiveness and costs of interventions to improve clinical practice and the accuracy of malaria microscopy.

Adolescent↗
PubMed2005

Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya.

OBJECTIVE: To develop a standard procedure for male circumcision in a resource-poor medical setting and prospectively evaluate the outcome in a randomized, controlled trial with the incidence of human immunodeficiency virus (HIV) as the main outcome, as studies suggest that circumcision is associated with a lower incidence of HIV and other sexually transmitted infections in high-risk populations. SUBJECTS AND METHODS: Healthy, uncircumcised, HIV-seronegative men aged 18-24 years from Kisumu District, Kenya, were offered participation in a clinical trial using a standard circumcision procedure based on "usual" medical procedures in Western Kenya. The follow-up included visits at 3, 8 and 30 days after circumcision, with additional visits if necessary. Healing, satisfaction and resumption of activities were assessed at these visits and 3 months from randomization. RESULTS: Overall, 17 (3.5%) of the 479 circumcisions were associated with adverse events judged definitely, probably or possibly related to the procedure. The most common adverse events were wound infections (1.3%), bleeding (0.8%), and delayed wound healing or suture line disruption (0.8%). After 30 days, 99% of participants reported being very satisfied with the procedure; approximately 23% reported having had sex and 15% reported that their partners had expressed an opinion, all of whom were very satisfied with the outcome. About 96% of the men resumed normal general activities within the first week after the procedure. CONCLUSION: Safe and acceptable adult male circumcision services can be delivered in developing countries should male circumcision ultimately be advocated as a public-health measure.

Adolescent↗
PubMed1981

A study of subacute sclerosing panencephalitis in Kenya.

A retrospective study was made over a five-year period of 53 patients at the Kenyatta National Hospital, Kenya, who presented with subacute sclerosing panencephalitis. The clinical, EEG and serological findings are similar to those found in other studies. As identified by epidemiological studies elsewhere, the factors which are likely to have a bearing on the aetiology of the disease are prevalent throughout the Kenya, yet there is a strong rural distribution of cases in this study. No cases have been reported from the Masai tribe. These features are discussed with regard to the possible implications for the aetiology of the disease.

Adolescent↗
PubMedDate not supplied

An ethnographic study of cervical cancer among women in rural Kenya: is there a folk causal model?

This article assesses knowledge, attitudes, and practices regarding cervical cancer among rural women of Kenya. One hundred and sixty women (mean age 37.9 years) who sought various health care services at Tigoni subdistrict hospital, Limuru, Kenya, were interviewed using a semistructured questionnaire. In addition, three focus group discussions (25 participants) were held, five case narratives recorded, and a free list of cervical cancer risk factors obtained from a group of 41 women respondents. All women were aged between 20 and 50 years. About 40% knew cervical cancer, although many still lack factual information. A history of sexually transmitted diseases (61.5%), multiple sexual partners (51.2%), and contraceptive use (33%) were identified as risk factors. Other factors mentioned include smoking, abortion, and poor hygiene standards. High parity, early sexual debut, and pregnancy were not readily mentioned as risk factors. We propose a folk causal model to explain the link between these factors and cervical cancer. Lack of knowledge constrains utilization of screening services offered at the clinics. Consequently, respondents support educating women as a way to tackling issues on cervical cancer. It is recommended that an integrated reproductive health program that addresses comprehensively women's health concerns be put in place.

Adult↗