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PubMed2004

Cyanobacterial blooms and the presence of cyanotoxins in small high altitude tropical headwater reservoirs in Kenya.

The phytoplankton community in three small (0.065-0.249 km2) reservoirs in the stepped plateau landscape in the Kinangop area above the Rift Valley floor in Kenya were studied between 1998 and 2000. Approximately 70 species of phytoplankton were identified. The community was dominated by chlorophytes, cyanobacteria and chrysophytes. Diatoms were rare. The phytoplankton assemblage was frequently dominated by cyanobacteria in the dry season. The phytoplankton assemblage transformed to a mixture of cyanobacteria, chlorophytes and chrysophytes at the onset of the long rains, and mixture of cyanobacteria and chlorophytes after the long rains. Thereafter the phytoplankton assemblage consisted mainly of a mix of cyanobacteria and chrysophytes until the onset of the short rains when cyanobacterial dominance re-emerged. The most common phytoplankton species included Microcystis spp., Botryococcus braunii, Ceratium hirundinella, Anabaena spp. and Euglena viridis. The dry season cyanobacterial blooms produced cyanotoxins that included microcystin and endotoxins. The concentrations were well above the recommended safe limits for drinking water. The patterns of cyanotoxin production showed that the growth of the toxin-producing cyanobacteria was regulated by water temperature, pH and nutrients. The appearance of cyanotoxins in the small reservoirs is a serious public health issue in rural Kenya because such reservoirs are key sources of water for humans, livestock and wildlife.

Altitude↗
PubMed2004

Perinatal mortality in the Special Care Nursery of Moi Teaching and Referral Hospital, Eldoret, Kenya.

OBJECTIVES: To determine the mortality rate and causes of death of all infants admitted to the Special Care Nursery (SCN) of a tertiary referral hospital in rural Kenya. DESIGN: Prospective and Cross-sectional study SETTING: Special Care Nursery, Moi Teaching and Referral Hospital, Eldoret, Kenya. SUBJECTS: All infants admitted to the Special Care Nursing (SCN). MAIN OUTCOME MEASURES: Survival status at seven postnatal days; major causes of mortality and morbidity. RESULTS: Three hundred and thirty five babies were studied between February and September 1999. Out of these 167 (49.9%) were male. There were 50 (15%) preterm and 124 (37.3%) low birth weight babies. There were 198 (76.2%) appropriate for gestational age (AGA), 46 (17.7%) small for gestational age and 16 (6.2%) large for gestational age babies. The seven day mortality rate of infants admitted to the Special Care Nursery was 66 (19.7%). Birth asphyxia and respiratory distress accounted for most deaths. Infants who were admitted primarily because the mother remained under general anesthesia generally did well. Logistic factors, including inadequate training for neonatal resuscitation in ward cadre of staff, unavailability of trained paediatricians and obstetricians, and inadequate operating theatre supplies were all found to delay treatment and likely to increase mortality. CONCLUSION: Morbidity and mortality of infants born at the MTRH remain high. The most common cause of mortality remains birth asphyxia. Some causative factors, such as lack of resources or personnel, are logistic and could be rectified. Antenatal care had a significant positive impact on both morbidity and mortality.

Cause of Death↗
PubMed2004

Socio-demographic characteristics and clinical features among patients attending a private paediatric dental clinic in Nairobi, Kenya.

OBJECTIVES: To evaluate the socio-demographic characteristics, chief complaints and clinical presentation of children attending a private dental clinic in Nairobi, Kenya. DESIGN: A retrospective survey of dental clinic records. SETTING: A private dental clinic in Nairobi, Kenya. SUBJECTS: All patients aged 0-18 years who were first-time attenders at the dental clinic during a three year period. RESULTS: The records of 800 patients were examined, comprising 395 males and 405 female children. The average age was 7.2 years (95%CI, 6.9-7.4). Referral to the clinic for treatment was mostly by self (81.4%). Most patients (57.9%) were self-sponsored for their dental treatment. Majority of the patients attending (86.8%) did not clinically have any underlying medical conditions. The major complaints for most patients were dental decay (27.4%) and dental pain (21.6%). Very few children (7.6%) attended for dental check-up. Five hundred and forty nine (68.6%) of the children suffered from dental decay while 294 (36.8%) suffered from gingivitis. The average number of teeth decayed was 4.02, SD +/- 2.4 (95% CI 3.8-4.2). Most carious lesions occurred in the younger children. There was a significant increase in the occurrence of decay over the three year period of the study. Significantly higher levels of gingivitis was observed in the prepubertal and pubertal age group. Attendance for traumatic injuries was relatively low with only 46 (5.8%) children reporting traumatic injuries to their dentitions. Most traumatic injuries involved the anterior teeth as a result of falls. Treatment given at the first visit was mainly restorative (28.6%) followed by dental extractions (25.4%). CONCLUSION: The average are of patients attending the clinic was 7.2 years. Interdisciplinary referral was low since most patients were self-referred and self sponsored for treatment. Dental caries was prevalent, necessitating a high demand for restorative treatment. Although gingivitis was less prevalent, it was significant among children in the prepubertal years.

Adolescent↗
PubMed2004

Alcohol abuse among patients with and without HIV infection attending public clinics in western Kenya.

OBJECTIVE: To evaluate the prevalence of hazardous drinking among persons with and without HIV/AIDS attending both urban/hospital-based and rural clinics in western Kenya. DESIGN: Cross sectional survey. SETTING: The Moi Teaching and Referral Hospital and the Mosoriot rural health care Centre. SUBJECTS: Two hundred and ninety nine adults with and without HIV/AIDS at a teaching and referral hospital and rural health centre. MAIN OUTCOME MEASURES: Results of the World Health Organization's Alcohol Use Disorders Identification Test (AUDIT) where a score of > 8 is indicative of hazardous alcohol consumption. Independent correlates of hazardous drinking were identified using logistic regression analysis including adjustment for common covariables. RESULTS: Study participants were relatively young (38 +/- 9 years) with 55% being male and 54% completing the AUDIT in Kiswahili. Home-made alcohol was more commonly drunk by patients attending the rural health centre while commercial beer was more commonly drunk by patients attending the teaching and referral hospital clinics. Approximately half (54%) of participants reported hazardous drinking behaviour (AUDIT score=9.9 +/- 9.4). Hazardous drinking was most prevalent among men attending the rural health centre (83% hazardous drinkers, AUDIT score=16.0 +/- 9.1). In multivariable analyses adjusting for age, sex and site of care, men remained more than nine times (odds ratio=9.3, 95% C.I.=5.1-16.9) likely to report hazardous drinking behaviour compared to women. CONCLUSIONS: Hazardous drinking is common among patients with and without HIV/ AIDS in western Kenya and is dramatically more common among rural men than women. Effective interventions for HIV/AIDS in this setting must include a concetrated effort to reduce hazardous drinking.

Adult↗
PubMed2003

Maxillary incisor root forms in orthodontic patients in Nairobi, Kenya.

OBJECTIVE: To evaluate, radiographically, the root forms of maxillary incisors in a sample of patients seeking orthodontic treatment in Nairobi, Kenya. DESIGN: A retrospective study of maxillary incisor root forms based on periapical radiographs. SETTING: A private dental clinic in Nairobi, Kenya. MATERIALS AND METHODS: The study comprised 393 maxillary incisors in 100 consecutive subjects (51 boys, 49 girls) aged 9-24 years. Intra-oral periapical radiographs of the incisors were evaluated. An index was used to categorise the roots as follows: 0=normal, 1=short, 2=blunt, 3=apical bend, 4=pipette apex. RESULTS: Normal root form was recorded in 60%, short in 12.5%, blunt in 7%, apical bend in 13%, and pippete-apex in 7% of the roots. Sixty nine percent of the pippete-apex roots were in central incisors and 94% of the roots with apical bend were in lateral incisors. Seventy three percent of short roots were in females. CONCLUSION: Based on evidence from previous studies on risk of root resorption which indicates that pipette and blunt roots are the forms mostly involved in this phenomenon, the present data imply that about 14% of the roots may have been at risk of moderate to severe resorption during fixed orthodontic treatment.

Adolescent↗
PubMed1992

Introduction of afterloading low dose-rate brachytherapy for cervical cancer in Kenya.

The Amersham afterloading low dose-rate brachytherapy system for cervical cancer was introduced in Kenya in 1986. The long intrauterine and medium size vaginal applicators were the most frequently used. Complications were generally few except for vesicovaginal fistulae (4%), some of which may not have been entirely due to irradiation. The system was acceptable to both patients and staff. The prolonged treatment times of approximately 50 hours was however, a drawback, and grossly limited the number of patients treatable per week. Low dose-rate brachytherapy is safe and acceptable but is not recommended for units with heavy patient loads. Constraints to establishment of radiotherapy facilities in developing countries are discussed and recommendations for further improvement of services in Kenya highlighted.

Adult↗
PubMed2006

Effects of microclimatic changes caused by deforestation on the survivorship and reproductive fitness of Anopheles gambiae in western Kenya highlands.

Land use changes have been suggested as one of the causes for malaria epidemics in the African highlands. This study investigated the effects of deforestation-induced changes in indoor temperature on the survivorship and reproductive fitness of Anopheles gambiae in an epidemic prone area in the western Kenya highlands. We found that the mean indoor temperatures of houses located in the deforested area were 1.2 degrees C higher than in houses located in the forested area during the dry season and 0.7 degrees C higher during the rainy season. The mosquito mortality rate was highly age-dependent regardless of study site or season. Mosquitoes that were placed in houses in the deforested area showed a 64.8-79.5% higher fecundity than those in houses located in the forested area, but the median survival time was reduced by 5-7 days. Female mosquitoes in the deforested area showed a 38.5-40.6% increase in net reproductive rate and an 11.6-42.9% increase in intrinsic growth rate than those in the forested area. Significant increases in net reproductive rate and intrinsic growth rate for mosquitoes in the deforested area suggest that deforestation enhances mosquito reproductive fitness, increasing mosquito population growth potential in the western Kenya highlands. The vectorial capacity of An. gambiae under study was estimated at least 106% and 29% higher in the deforested area than in the forested area in dry and rainy seasons, respectively.

Animals↗
PubMed2006

Cryptosporidiosis: prevalence, genotype analysis, and symptoms associated with infections in children in Kenya.

Cryptosporidium parasites are leading causes of enteric disease, especially in children. A prospective survey on the prevalence of cryptosporidiosis in children less than five years of age was undertaken at six microbiology laboratories in Kenya on fecal samples submitted for routine parasite and ova investigations. Analysis of 4,899 samples over a two-year study period showed an overall prevalence of cryptosporidiosis of 4% that was highest between November to February. Investigations on the nature of enteric diseases prompting ova and cyst examination requests showed 66.4% had acute diarrhea, 9% had persistent diarrhea, and 21% had recurrent diarrhea. The main symptoms were abdominal pain (51.1%), vomiting (51.6%), and abdominal swelling (11%). The prevalence of cryptosporidiosis was highest among children 13-24 months of age (5.2%) and least among those 48-60 months of age (2%). No significant differences were observed by sex but vomiting was slightly higher in males than in females (65% males and 52% females; P = 0.07). Cryptosporidiosis was significantly associated with persistent diarrhea (P = 0.0001, odds ratio [OR] = 2.193, 95% confidence interval [CI] = 1.463-3.29), vomiting (P = 0.0273, OR = 1.401, 95% CI = 1.04-1.893), and abdominal swelling (P = 0.0311, OR = 1.56, 95% CI = 1.04-2.34). Genotype analysis based on polymerase chain reaction-restriction fragment length polymorphism of the 18S rRNA gene fragment showed that 87% (153 of 175) of the Cryptosporidium isolates were C. hominis, 9% (15 of 175) were C. parvum, and remaining 4% were C. canis, C. felis, C. meleagridis, and C. muris. The most common protozoa in coinfected patients were Entamoeba histolytica/E. dispar, E. coli, and Giardia intestinalis (6%, 5%, and 2%, respectively). Our results show that Cryptosporidium is among the most common protozoan parasites in children with enteric diseases and that anthroponotic species are the leading cause of human cryptosporidiosis in Kenya, which suggests that human-to-human transmission is the main mode of spread.

Abdominal Pain↗
PubMed2006

Phase 1 safety and immunogenicity trial of malaria vaccine RTS,S/AS02A in adults in a hyperendemic region of western Kenya.

We conducted a phase 1 trial of candidate malaria vaccine RTS,S/AS02A in western Kenya to determine its safety and immunogenicity in healthy adults in an area hyperendemic for malaria. Twenty adults were enrolled and received RTS,S/AS02A (50 microg of RTS,S in 0.5 mL of AS02A) by intramuscular injection on a 0-, 28-, and 178-day schedule. All 60 scheduled immunizations were given, and 18 of 20 volunteers completed the last study visit on day 210. The vaccine was safe and well-tolerated. There were no vaccine-related severe adverse events. The most common solicited adverse events associated with immunization were injection site pain and headache. The geometric mean concentration of antibodies to circumsporozoite protein was 1.9 microg/mL at baseline and it increased 2-4 weeks after each dose to 16, 17.8, and 36.6 microg/mL, respectively. These safety and immunogenicity data from adults in hyperendemic Kenya are comparable to data reported earlier from two trials in west African adults in hypo-endemic and meso-endemic areas of The Gambia. We conclude that in this small study, RTS,S/AS02A is safe and similarly immunogenic in malaria-exposed African adults of different ethnicity in different transmission settings.

Adolescent↗
PubMed1991

Prevalence of paediatric cardiac disease in rural Kenya.

A series of 31 patients referred for evaluation of paediatric cardiac disease in rural Kenya is reported. The prevalence of symptomatic rheumatic heart disease is unchanged from previous data in the literature which is well over a decade old. We can conclude that recent improvements in medical care in Kenya have not yet reached certain rural areas as far as rheumatic fever is concerned. In addition, a significant number of children presumed to have had no discernible heart disease at this evaluation, suggesting the need for critical re-evaluation of this population at intervals. Finally, cyanotic disease seems under-represented in the series, suggesting that infants with certain cyanotic lesions may have been selected out and hence not referred to us.

Child↗
PubMedDate not supplied

Adolescent sexuality and fertility in Kenya: a survey of knowledge, perceptions, and practices.

This article presents findings from a survey conducted in Kenya in 1985 of the reproductive health knowledge, attitudes, and practices among more than 3,000 unmarried Kenyan youth, students and nonstudents, between the ages of 12 and 19. The survey was designed to elicit information that would be useful in gauging the kinds of problems Kenyan adolescents face in order to design programs that meet their needs. The study shows that although a solid majority of adolescents appear to have received information on reproductive health, the quality of the information is generally low. Fewer than 8 percent could correctly identify the fertile period in a woman's menstrual cycle. A substantial proportion of the population surveyed, more than 50 percent, is sexually active, having initiated intercourse some time between 13 and 14 years of age, on average. In spite of a general disapproval of premarital sex (but approval of the use of contraceptives among the sexually active), most of the sexually active population--89 percent--have never used contraceptives. The many contradictions between attitudes and practices pose serious questions and demonstrate the need to reexamine the programs (and policies) that provide access to reproductive health services to adolescents in Kenya.

Abortion, Induced↗
PubMed1991

Child nutrition in the pre-harvest season in Kenya.

This study examines the food consumption and nutritional status of pre-school children during the period March-April, at the end of the dry season in the Kano Plain of Nyanza Province. The diet of pre-school children in this region of Kenya consists foremost of maize and milk. Food consumption was generally low with considerable deficits in energy intake and other nutrients among all age groups, although protein intake was generally at recommended levels. The heights of the children did not differ from the available national and regional figures, but the weights of the children were far below earlier figures which must be related to the prevailing lean seasons. The youngest group in the sample, aged 6-12 months, showed the largest deficit in weight status. This group appears to suffer most from the seasonal imbalance. Overall the findings indicate that the seasonal deficits in this part of Kenya are more severe than was assumed until now.

Agriculture↗
PubMed1991

Serological evidence of arboviral infections among humans of coastal Kenya.

A serosurvey was conducted during September 1987 for evidence of human arboviral infections in the Coast Province of Kenya. Sera were collected from 1624 outpatients at three hospitals and tested for antibody to eight arboviruses by the indirect immunofluorescent antibody technique. Antibody prevalence rates were: Rift Valley fever, 2.8%; Sindbis, 2.6%; dugbe, 2.1%; dengue-2, 1.0%; West Nile, 0.9%; chikungunya, 0.7% and Nairobi sheep disease, 0.3%. Evidence of Crimean-Congo haemorrhagic fever viral antibody was not detected. The data suggested low arbovirus activity since 1982, when an epidemic of dengue occurred in this region, and revealed the first evidence of dugbe viral infection among humans in Kenya.

Adolescent↗
PubMed1990

The management of cerebral malaria in a provincial general hospital in Kenya.

The practice of physicians at the Nakuru Provincial General Hospital (NPGH), Kenya, when dealing with cerebral malaria is reviewed over a 4-month period. The definition, management, and outcome of patients labelled to have cerebral malaria is presented and criticism of their practice offered in a manner applicable to other rural hospitals in Kenya.

Animals↗
PubMed1990

Legionella antibodies in human and animal populations in Kenya.

Using a microagglutination method, domestic and wild animal sera, together with human patient and healthy blood donor sera, have been analysed for titres against various Legionella species, comprising fourteen different serogroups. Generally, the level of moderately elevated titres, i.e. greater than or equal to 64, was low for all the aforementioned serum groups. Within the domesticated animals, cattle, pigs and dogs presented a much lower prevalence in Kenya than found elsewhere, whereas it was the other way round for goats. Human sera, either from patients or from healthy donors, did not react against L. pneumophila serogroups 1, 6, or 3, which in that sequence are the most common L. pneumophila serogroups in Europe, and in other geographic areas where legionellosis is common. High titres of greater than or equal to 256 against L. pneumophila serogroup 6 (two cattle) or against L. bozemanii strain Mi-15 (two cattle, one dog) indicate that although the epidemiological picture may be different from other parts of the world, Legionella infections exist in Kenya as well.

Agglutination Tests↗
PubMed1990

Anopheles gambiae complex egg-stage survival in dry soil from larval development sites in western Kenya.

The potential for Anopheles egg survival in dry soil from larval development sites was investigated in western Kenya. A total of 230 dry soil samples collected in 1987, 1988 and 1989 yielded 126 first-instar Anopheles gambiae s.l. larvae from 2 to 5 days after flooding with water. These larvae were from dried animal hoofprints along streams (57.9%), from dried edges of permanent and temporary pools (41.3%) and from dried stream beds (0.8%). Larval density was 1.2 larvae/kg of soil from positive microhabitats in 1987 and 2.4 larvae/kg in 1988. Thirteen larvae from the 1989 soil samples, reared to adults, were identified by DNA probes as Anopheles gambiae sensu strictu (n = 6) and Anopheles arabiensis (n = 7). Experimentally, eggs from field-collected females remained viable up to 12 days for An. gambiae s.l. and 10 days for An. funestus. In western Kenya, egg viability in dry soil may represent a significant, short-term survival mechanism for 2 species of the An. gambiae complex.

Animals↗
PubMed1989

Cryptosporidiosis and childhood diarrhoea in a rural community in Kenya.

Cryptosporidiosis has come to recent prominence as a cause of diarrhoea throughout the world in both adults and children, producing either an acute self-limiting diarrhoea or a protracted chronic diarrhoea which can be fatal in immunosuppressed patients. This study was therefore conducted to assess the prevalence of the infection among children less than five years of age in a rural community in Kiambu District, Kenya. 1420 diarrhoea specimens from children less than five years which were processed for bacteriology and parasitology were also examined for Cryptosporidium oocysts, using the modified Ziehl-Neelsen (ZN) acid-fast stain, 3.8% of all the diarrhoea samples were positive for oocysts. 320 non-diarrhoeic stools from children in the same age group were also examined and were all negative for Cryptosporidium oocysts. The results of this study would imply that infection with Cryptosporidium is associated with acute childhood diarrhoea in Kenya.

Child, Preschool↗
PubMedDate not supplied

Contraceptive use and fertility decline in Chogoria, Kenya.

This article describes the results pertaining to fertility and family planning from a 1985 survey conducted in the catchment area of Chogoria Hospital in central Kenya. Current contraceptive prevalence was found to be quite high, 43 percent as opposed to 17 percent for Kenya as a whole. The total fertility rate of 5.2 births per woman was 2.5 births lower than the national rate. Very few women reported wanting to have large numbers of children or thinking that fate or God should determine family size. Although these data cannot conclusively demonstrate that the family planning program operating in the area has been responsible for reduced fertility there, they do provide some support for this hypothesis.

Adolescent↗