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PubMed1983

Evaluation of a visually read ELISA for serodiagnosis and sero-epidemiological studies of kala-azar in the Baringo District, Kenya.

ELISA for detecting leishmanial antibodies was established at Baringo District Hospital Kabarnet, Kenya, and successfully applied in clinical routine and sero-epidemiological surveys. To simplify the procedure and to make it more economical, ELISA was read as visual endpoint titre and blood was collected by the blotting paper method. 63 parasitologically confirmed kala-azar patients all showed a diagnostic IgG specific ELISA titre of 1:27,000 or more, which indicates a sensitivity of 100%. 11 of 14 persons found with this diagnostic titre during a house-to-house survey in a known focus of kala-azar could be confirmed parasitologically. Two more showed typical signs and symptoms of kala-azar and were successfully treated accordingly. Controls from unaffected areas were all negative. Low titres of 1:1000 and 1:3000 were observed in healthy individuals from foci of kala-azar, but could be easily distinguished from active cases. ELISA has been shown to be a convenient and reliable method for the serodiagnosis of East African kala-azar. The technique can be integrated into the routine work of a clinical laboratory at the level of a district hospital, without sophisticated equipment and with a minimum of funds. Blood of suspected kala-azar cases can be collected on blotting paper in dispensaries and health centres near known foci and sent to the laboratory.

Antibodies↗
PubMed1983

Antibodies against haemorrhagic fever viruses in Kenya populations.

Human sera from Lodwar (77 sera), Nzoia (841 sera), Masinga (251 sera), Laisamis (174 sera) and the Malindi/Kilifi area (556 sera) in Kenya were tested by indirect immunofluorescence for antibodies against Marburg, Ebola (Zaire and Sudan strains), Congo haemorrhagic fever, Rift Valley fever and Lassa viruses. Antibodies against Ebola virus, particularly the Zaire strain, were detected in all regions and were, over-all, more abundant than antibodies against the other antigens. Ebola and Marburg antibody prevalence rates were highest in the samples from Lodwar and Laisamis, both semi-desert areas. Antibodies against Rift Valley fever virus were also highest in the Lodwar sample followed by Malindi/Kilifi and Laisamis. Congo haemorrhagic fever virus antibodies were rare and no antibodies against Lassa virus were detected in the 1899 sera tested.

Antibodies, Viral↗
PubMed1985

Rapid enzymological identification of leishmanial isolates in Kenya.

Leishmanial isolates from Kenya were identified as being either Leishmania major, L. donovani or L. aethiopica by using cellulose acetate electrophoresis. Species determination is based on the electrophoretic pattern for glucose phosphate isomerase alone. This report describes the technique and presents data on its reliability as a rapid identification test for Leishmania isolates from the same geographical region.

Electrophoresis, Cellulose Acetate↗
PubMed1985

Characterization of Trypanozoon stocks from the South Nyanza sleeping sickness focus in Western Kenya.

220 Trypanosoma (Trypanozoon) brucei sp. stocks isolated between 1969 and 1983 from the Lambwe valley sleeping sickness focus in South Nyanza, Western Kenya, were characterized by isoenzyme electrophoresis using 12 enzymes. 12 different zymodemes of T. (T.) b. rhodesiense were isolated from patients during the 13-year period and identical stocks were also found in cattle, reedbuck (Redunca redunca) and tsetse (Glossina pallidipes). Cattle may have played an important role in maintaining and increasing peridomestic transmission of trypanosomes during the 1980 outbreak of sleeping sickness in the valley, even though they themselves suffered heavy mortality. Sleeping sickness in Lambwe valley is unlikely to have been introduced from elsewhere, since T. (T.) b. rhodesiense stocks isolated from the valley were different from those from neighbouring epidemic areas. Alternatively, the recent outbreak may have been caused by the increased transmission associated with an expanding tsetse population. The possibility that genetic exchange contributed to the biochemical diversity of the trypanosomes examined is discussed.

Animals↗
PubMed1985

Epidemiology of hydatid disease in Kenya: a study of the domestic intermediate hosts in Masailand.

The results are given of a study on the epidemiological significance of cattle, sheep and goats in maintaining the life-cycle of Echinococcus granulosus in Masailand, Kenya. A total of 134 (8.9%) of 1499 cattle, 146 (8.1%) of 1798 sheep and 144 (7.1%) of 2020 goats slaughtered in abattoirs in Masailand were found to harbour hydatid cysts. The frequency distribution of the hydatid cysts in each intermediate host species was over-dispersed. Of 729 cattle cysts examined 71 (9.7%) were fertile (cyst contained protoscoleces) with an average viability of 71%, 507 (69.5%) were sterile and 151 (20.7%) were calcified. Out of 810 sheep and 451 goat cysts examined 571 (70.5%) and 213 (47.0%) were fertile with respective viabilities of 88% and 86% and 143 (17.7%) and 194 (43.0%) were sterile leaving 96 (11.6%) and 45 (10.0%) sheep and goat cysts which were calcified. The greater fertility of the sheep and, to a lesser extent, goat cysts coupled with the reported greater infectivity of sheep and goat than cattle material to dogs and the common Masai practice of slaughtering sheep and goats at home, indicates that, at present, sheep and goats are the most important intermediate hosts for the maintenance of the domestic life-cycle of E. granulosus in Masailand. The incidence of hydatidosis in donkeys and the relationship of the domestic cycle to the wildlife cycle operating in the same area is unknown and requires further study.

Animals↗
PubMed1986

Hydatid disease: research and control in Turkana, Kenya. 1. Epidemiological observations.

A brief account is given of the geographical features of the Turkana area and of the events which led to the discovery that this part of Kenya had the highest incidence of clinically recognized hydatid disease in man anywhere in the world. Observations were made on the distribution of the disease following an aerial survey designed to determine the distribution of the people. It was found that the highest incidence of 198 surgical cases per 100,000 people per annum was in the north-western area bordering on the Sudan, Ethiopia and Uganda and this area was selected for the pilot control programme. By the development and assessment of better serodiagnostic methods combined with the use of a mobile ultrasound machine it has been shown that the true prevalence of hydatid disease in Turkana is between 5 and 10%. Studies on the parasite and its transmission have revealed that the species in Turkana is Echinococcus granulosus and that dogs and jackals are the main definitive hosts. Although goats, sheep, cattle and camels are all infected with hydatid cysts, dogs and jackals are also thought to be infected by scavenging on human corpses. In contrast to Masailand where wild carnivores and wild herbivores are infected, there is no wild life cycle in Turkana. The unusually high prevalence in man is thought to be due to the close intimacy of the Turkana with their dogs and to customs relating to the handling of dog faeces.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Hydatid disease: research and control in Turkana, III. Albendazole in the treatment of inoperable hydatid disease in Kenya--a report on 12 cases.

The results of treatment of 12 cases of inoperable hydatid disease in Kenya using albendazole at a dose of 10 mg/kg body-weight for eight weeks are reported. In all the cases there was marked regression and collapse of the cysts but a further four weeks course of treatment at a higher dose of 15 mg/kg was given to two cases because they both still had a large number of demonstrable cysts on ultrasonography at eight weeks. No side effects of the drug were noted. Albendazole is likely to play an important role in the control programme in Turkana.

Adolescent↗
PubMed1986

Response of Plasmodium falciparum to dihydrofolate reductase inhibitors in Malindi, Kenya.

The response of Plasmodium falciparum isolates to dihydrofolate reductase inhibitors (DHFRI) was examined in Malindi, Kenya. All 20 infected children treated with pyrimethamine/sulphadoxine responded. In contrast, after treatment with pyrimethamine, parasitaemia in 9 of 14 infections failed to clear or recrudesced during the seven-day follow-up. In a 48-hour in vitro test, five of six isolates resistant to pyrimethamine in vivo had a minimal inhibitory concentration (MIC) to pyrimethamine greater than or equal to 300 nmoles/1 compared with less than or equal to 100 nmoles/1 for the four sensitive isolates; four isolates did not grow. MIC to M-B 35769, an experimental DHFRI structurally similar to pyrimethamine were the same (six isolates) or 10-fold lower (three isolates). In the laboratory four of five isolates adapted to in vitro culture had the same MICs as in the field while one isolate became less responsive to both drugs. Cycloguanil (the active metabolite of proguanil) was more active in vitro in the laboratory than pyrimethamine or M-B 35769.

Child↗
PubMed1986

Response of falciparum malaria in vivo to a standard regimen of chloroquine in Kisumu District, Western Kenya.

The sensitivity of Plasmodium falciparum to chloroquine was studied in 140 children in two locations in Western Kenya. The standard WHO in vivo field test was used and chloroquine phosphate 25 mg base/kg administered in divided doses over three days. In one area 13.2% of cases had recrudescent parasitaemias, while in the other area 8.2% of infections were resistant, with 3.5% having an RII pattern. The remaining isolates were sensitive to chloroquine. Further in vivo and in vitro tests in the region are needed to document the extent and level of resistance.

Blood↗
PubMed1986

A study of head lice among primary schoolchildren in Kenya.

Of 1270 schoolchildren (651 girls and 619 boys) from 33 urban and rural primary schools in different regions of Kenya who were examined for head lice, 17.1% were infested (8% with living lice or nits, 9.1% with dead nits). The over-all difference between infestation rates in urban and rural schools was not significant, but there was considerable variation in the five different regions selected. Infestation was not sex-related. Infestation rates tended to be higher in older children and in children with longer hair. Negroid children had lower infestation rates than non-Negroid children. The criterion seems to be hair type. Prevalence of infestation was higher in private schools because non-Negroid children predominate in these schools. There was no correlation between infestation and the sharing of a towel or comb, but infestation tended to be higher in those who wash less, in those who share their bed, and in those who sleep with room-mates. Levels of infestation were low, with most harbouring only one or two lice.

Adolescent↗
PubMed1988

Failure of erythromycin to improve chloroquine treatment of Plasmodium falciparum malaria in Kenya.

58 children aged 1 to 10 years who had pure Plasmodium falciparum infections acquired on the coast of Kenya were treated with chloroquine 25 mg/kg given over 3 d and erythromycin 10 mg/kg 4 times a day given for 7 d. After 4 weeks follow-up, 62% had recurrent infections and 11% failed to clear their parasitaemia (1 had an RIII pattern of resistance). Of 38 children treated with chloroquine 25 mg/kg alone, 55% had recurrences and 21% failed to clear (including 1 RIII). In vitro microtests classified 74% of isolates from initial infections and 91% of isolates from recurrent infections as resistant. Erythromycin does not improve chloroquine treatment in children with infections due to P. falciparum having low to moderate levels of chloroquine resistance.

Animals↗
PubMed1988

Chlorproguanil/dapsone for the treatment of non-severe Plasmodium falciparum malaria in Kenya: a pilot study.

Chlorocycloguanil, the active metabolite of chlorproguanil, was synergistic in vitro with dapsone against 2 culture-adapted Plasmodium falciparum isolates from Kenya; maximal synergy occurred at lower concentrations that it did with pyrimethamine and sulfadoxine. 48 children with asymptomatic P. falciparum infections were treated with chlorproguanil (at a target dose of 1.2 mg/kg) and dapsone (target dose of 1.2 or 2.4 mg/kg); all were free of parasitaemia by day 7. The following numbers had recurrences on days 14, 21, and 28, respectively: 1 of 48, 7 of 47, and 7 of 40. All 39 children treated with pyrimethamine (target dose 1.2 mg/kg) and sulfadoxine (target dose 24 mg/kg) were cleared of infection, while the following had recurrences on days 14, 21, and 28: 1 of 39, 2 of 38, and 2 of 36. The rate of decrease in parasitaemia was the same in the 2 groups, and there was no change in haematocrit or haemoglobin during the follow-up. The rate of recurrence in the children receiving chlorporguanil/dapsone was higher, probably because these drugs have a much shorter clearance time than pyrimethamine/sulfadoxine. Chlorproguanil/dapsone is an effective combination for treating P. falciparum malaria and deserves further study.

Animals↗
PubMed1988

Isolation of Leishmania donovani from Phlebotomus martini in Baringo district, Kenya.

An 18-month sandfly survey was conducted at 4 locations in Baringo District, Rift Valley Province, Kenya. 3 collection techniques were used: aspiration, sticky paper trap, and light trap in sites selected because of their proximity to homes of visceral leishmaniasis patients diagnosed and treated within 6 months before the survey. Over 2000 female Phlebotomus martini were collected of which 6 females were found to have flagellate protozoan infections. 3 of these infections were cultured successfully and cryopreserved. 2 isolates were identified as Leishmania donovani by cellulose acetate electrophoresis. The zymogram of the third isolate was different from all Old World Leishmania reference strains examined, and it is still unidentified. The finding of 2 P. martini naturally infected with L. donovani strongly supports the hypothesis that this species is a vector of visceral leishmaniasis in this area.

Animals↗
PubMedDate not supplied

Cortisol and Plasmodium falciparum infection in pregnant women in Kenya.

Women living under holoendemic conditions of malaria in Kenya exhibited an increased prevalence of clinical malaria during pregnancy. In addition parasite rate and density were higher in primigravidae compared to multigravidae. Higher serum cortisol concentrations were found in women with patent malaria during pregnancy and the levels were higher before, during and after the malaria episode. A causal relation between serum cortisol levels and suppression of malaria immunity during pregnancy is discussed.

Adolescent↗
PubMedDate not supplied

Chemotherapy-based control of schistosomiasis haematobia. 3. Snail studies monitoring the effect of chemotherapy on transmission in the Msambweni area, Kenya.

Regular snail sampling was performed at 40 sites, representing the principal snail habitats, during a 4 year chemotherapy programme targetted at school-children in the Msambweni area of the coastal plain of Kenya. Populations of Bulinus africanus group snails, primarily from pools, showed seasonal variations, dropping when sites dried out and rising when they were refilled by the rains. Transmission, judged by the recovery of snails shedding typical fucocercous cercariae, continued throughout the treatment period at very low levels (less than 1% of the snails collected were infected) with peaks in October/November and in January/February after seasonal rains. Spatially, most infected snails were recovered from 2 large pools near the sea, close to the school that responded least well to the initial chemotherapy programme. Later, infected snails were found sporadically in inland pools, rice fields and temporary streams near another school where there was evidence of substantial reinfection as the study progressed. The snail findings are consistent with a reduction but not elimination of transmission associated with the chemotherapy programme.

Animals↗
PubMedDate not supplied

Differences in the rate of hepatosplenomegaly due to Schistosoma mansoni infection between two areas in Machakos District, Kenya.

The relationship between intensity of Schistosoma mansoni infection and the degree of related morbidity was suspected to differ locally within the Machakos district of Kenya. To test this possibility, prevalences of hepatomegaly and splenomegaly among 1483 school children were compared between 2 areas, Kangundo and Kambu, within this district. These areas, which were similar in many geographical and economic respects and populated by the same tribe (Akamba), had comparable levels of S. mansoni infection and no S. haematobium infection. A relationship was observed between the prevalence of hepatomegaly and intensity of S. mansoni infection, which showed no consistent difference between the 2 areas. In contrast, a relationship between the prevalence of splenomegaly and intensity of S. mansoni infection was observed only in the Kambu schools, and not in the Kangundo schools where the overall prevalence of splenomegaly was much lower. It was possible that part of the splenomegaly observed in Kambu was due to malaria. However, the observation that malaria and schistosomiasis in 2 Kambu schools were not positively correlated allowed approximations to be made of the relative contributions of each to the prevalence of splenomegaly. It was concluded that, in a school close to the river that formed the main transmission site of S. mansoni, schistosomiasis-related hepatosplenomegaly was present in at least 17% of children. The reason for the high prevalence in Kambu of hepatosplenic schistosomiasis remains uncertain, but it could include a synergistic interaction of schistosome infection with malaria.

Adolescent↗
PubMedDate not supplied

The reservoir of Plasmodium falciparum malaria in a holoendemic area of western Kenya.

The reservoir of infectious Plasmodium falciparum gametocytes in a population living in an area of holoendemic malaria in western Kenya was estimated by directly feeding mosquitoes on volunteers. Resulting mosquito infections were assessed both by midgut examination for oocysts and by enzyme-linked immunosorbent assay for P. falciparum circumsporozoite antigen. Calculations based on the age structure of the population and the resulting rates of mosquito infections indicated that children under 10 years of age were responsible for 72% of mosquito infections, individuals between 10 and 21 years of age contributed 12%, and those over 21 years of age accounted for 16%. No infection resulted in mosquitoes fed on infants less than 1 year of age.

Age Factors↗
PubMedDate not supplied

The role of shops in the treatment and prevention of childhood malaria on the coast of Kenya.

A community survey of 388 mothers in a rural and peri-urban population surrounding a district hospital on the coast of Kenya revealed that the preferred choice of treatment for childhood febrile illnesses was with proprietary drugs bought over the counter at shops and kiosks (72% of interviews). 67% of the mothers who reported using shops claimed they would buy chloroquine-based drugs. Preventative measures such as mosquito nets were uncommon (6.2%), but the use of commercial pyrethrum mosquito coils was reported more frequently (46.4%). Separate investigations of treatment given to 394 children before presentation at hospital with severe and mild malaria was consistent with the reports in the community of high usage of shop-bought anti-malarials and anti-pyretics. The involvement of the private sector in peripheral health care delivery for malaria is discussed.

Adult↗