Elephant movement and local community attitudes towards the proposed corridor between Thegu forest and Sangare ranch

Rapid human population growth has drastically reduced elephant range byreducing habitats and blocking traditional migration routes over the last several decades. Attempts to reopen migration routes have been met with mixed, albeit strong, reactions. A wider study to analyse human-elephant interactions in the area also sought the attitudes of local people towards re-opening migration between Mt Kenya forests and the nearby Sangare ranch. The route commonly traversed by elephants was mapped using Global Positioning Systems (GPS) and Geographical Information Systems (GIS) techniques. Two elephant sightings, footprints, dung and residents’ accounts confirmed this as the only route currently used by elephants out of Mt Kenya forests. The footprints and dung were observed within a 4 -10 m wide strip along the entire 7 km stretch between Mt Kenya and Sangare. A questionnaire was administered to collect data on demography and impacts of elephants on adjacent farms, while the dung pile count  technique was used to estimate elephant distribution and densities. Results showed that 33% of the community resented elephants, which was strongly associated with alleged levels of damage to lives and property (X2= 0.797, df =4, P < 0.01). This caused unwillingness to provide passage through their land, with only 2.6% of the respondents indicating they would let elephants on their property. About 42% of those against the corridor attributed this to damages and losses caused by elephants whereas 10.5 % did not give reasons. A majority of the respondents were aware of importance of elephants in tourism, as agents of seeddispersal, sources of bush meat and ivory, and in revenue generation, but only a 3% admitted having gained in any way. The corridor seemed unviable under the prevailing land uses and negative public attitudes towards elephants.Key words: Human-wildlife conflict, habitat fragmentation, migratio

Diversity and immune boosting claims of some African indigenous leafy vegetables in western Kenya

A survey was carried out to document the diversity and immune boosting claims of African indigenous leafy vegetables (AILVs) in Western Kenya. Both qualitative and quantitative methods of data collection were used. The results showed that there is diversity of AILVs in the study area with nine popular and frequently consumed, but cassava leaves, stinging nettle and russian comfry are not popular. Seven of these are cultivated but two, stinging nettle (Urtica massaica) and vine spinach (Basella alba) grow wildly. The AILVs are cultivated at subsistence level on home gardens withminimal inputs and only excess of this is sold. The religion one belonged to was significant (p<0.05) in determining consumption or not of some of the vegetables. The vegetables are rain fed and the process of harvesting is by first uprooting during thinning followed by breaking the main stem and finally plucking off the leaves with maturity. Vegetable preparation in most households was mainly by women. The elderly women were keen in this process and spent more time in preparing the vegetables which were believed to be ‘nutritious’. There was no processing and preservation of the AILVs for use during the dry season. The communities rely on wild weeds during such seasons. The AILVs though consumed for good nutrition are also associated with various medicinal and immune boosting claims. Out of the nine, five are known for various health benefits, African  nightshade and spider plant for good nutrition by 31.8% and 25.1% of the respondents, respectively, slender leaf for healing power by 34%, cowpea leaves and slender leaf for anti-aging by 50% and 43.8%, respectively, and cowpea leaves (43.6%) and amaranthus (53%) for smooth skin and adding blood, respectively. Chi square analysis indicated that African nightshade, spider plant and amaranthus are statistically significant (p<0.05) incontributing to good nutrition, healthy functioning of the body and immune boosting. Further analysis showed that spider plant and amaranthus are significant (p<0.05) for immune boosting.Key words: indigenous vegetables, diversity, immune boostin

Fungal Infections among Diabetic Foot Ulcer- Patients Attending Diabetic Clinic in Kenyatta National Hospital, Kenya

Objective: To isolate and identify fungal pathogens associated with dermatophytoses in diabetic patients and identify the spectrum of yeasts colonising diabetic foot ulcers at Kenyatta National Hospital.Design: A cross sectional Laboratory based study.Setting: The Kenyatta National Hospital diabetic clinic.Subjects: Sixty one patients with diabetic foot ulcers from August to November 2009.Results: The five most occurring pathogens were Biopolaris hawaiiensis (5.5%), Trichophyton schoenleinii (3.7%), Aspergillus niger (3.0%), Trichophyton rubrum (3.0%), Fusarium oxysporum (3.0%). Other moulds accounted for less than 3.0%. One suspected case (0.6%) of Penicilium marneffei was isolated although it could not be ascertained due to its high containment requirement. Among the dermatophytes, the most occurring mould was Trichophyton schoenleinii (3.7%) while in non-dermatophyte was Biopolaris hawaiiensis (5.5%). Eight pathogenic yeasts were identified with C. parapsilosis (6.1 %) being the most common followed by C. famata (3.0%). Fungal infestation was highest in callus formation (78.6%).Conclusion: Fungal aetiological agents are significant cause of diabetic wound infection and may require antifungal intervention for successful management of diabetic foot ulcers

Admission Characteristics, Diagnoses And Outcomes Of HIV-Infected Patients Registered In An Ambulatory HIV-Care Programme In Western Kenya

Objective: To determine admissions diagnosis and outcomes of HIV-infected patients attending AMPATH ambulatory HIV-care clinics. Design: Prospective cohort study. Setting: Academic Model for Prevention and Treatment of HIV/ AIDS (AMPATH) ambulatory HIV-care clinic in western Kenya. Results: Between January 2005 and December 2006, 495 HIV-infected patients enrolled in AMPATH were admitted. Median age at admission was 38 years (range: 19 - 74), 62% females, 375 (76%) initiated cART a median 56 days (range: 1- 1288) before admission. Majority (53%) had pre-admission CD4 counts 200 cells/ml. Common admissions diagnoses were: tuberculosis (27%); pneumonia (15%); meningitis (11%); diarrhoea (11%); malaria (6%); severe anaemia (4%); and toxoplasmosis (3%). Deaths occurred in 147 (30%) patients who enrolled at AMPATH a median 44 days (range: 1 - 711) before admission and died a median 41 days (range: 1 -713) after initiating cART. Tuberculosis (27%) and meningitis (14%) were the most common diagnoses in the deceased. Median admission duration was six days (range: 1 - 30) for deceased patients and eight days (range: I - 44) for survivors (P=0.0024). Deceased patients enrolled in AMPATH or initiated cART more recently, had lower CD4 counts and were more frequently lost to follow-up than survivors (

Risk factors for death in HIV-infected adult african patients recieving anti-retroviral therapy

Objective: To determine risk factors for death in HIV-infected African patients on anti-retroviral therapy (ART).Design: Retrospective Case-control study.Setting: The MOH-USAID-AMPATH Partnership ambulatory HIV-care clinics in western Kenya.Results: Between November 2001 and December 2005 demographic, clinical and laboratory data from 527 deceased and 1054 living patients receiving ART were compared to determine independent risk factors for death. Median age at ART initiation was 38 versus 36 years for the deceased and living patients respectively (p<0.0148). Mediantime from enrollment at AMPATH to initiation of ART was two weeks for both groups while median time on ART was eight weeks for the deceased and fourty two weeks for the living (p<0.0001). Patients with CD4 cell counts <100/mm3 were more likely to die than those with counts >100/mm3 (HR=1.553. 95% CI (1.156, 2.087), p<0.003). Patientsattending rural clinics had threefold higher risk of dying compared to patients attending clinic at a tertiary referral hospital (p<0.0001). Two years after initiating treatment fifty percent of non-adherent patients were alive compared to 75% of adherent patients. Male gender, WHO Stage and haemoglobin level <10 grams% were associated with time to death while age, marital status, educational level, employment status andweight were not.Conclusion: Profoundly immunosuppressed patients were more likely to die early in the course of treatment. Also, patients receiving care in rural clinics were at greater risk of dying than those receiving care in the tertiary referral hospital

Changing use of surgical antibiotic prophylaxis in Thika Hospital, Kenya: a quality improvement intervention with an interrupted time series design.

INTRODUCTION: In low-income countries, Surgical Site Infection (SSI) is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals. METHODS: We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design. RESULTS: From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks) and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks) in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these. CONCLUSION: Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution

Temporal Association of Acute Hepatitis A and Plasmodium falciparum Malaria in Children

BACKGROUND: In sub-Saharan Africa, Plasmodium falciparum and hepatitis A (HAV) infections are common, especially in children. Co-infections with these two pathogens may therefore occur, but it is unknown if temporal clustering exists. MATERIALS AND METHODS: We studied the pattern of co-infection of P. falciparum malaria and acute HAV in Kenyan children under the age of 5 years in a cohort of children presenting with uncomplicated P. falciparum malaria. HAV status was determined during a 3-month follow-up period. DISCUSSION: Among 222 cases of uncomplicated malaria, 10 patients were anti-HAV IgM positive. The incidence of HAV infections during P. falciparum malaria was 1.7 (95% CI 0.81-3.1) infections/person-year while the cumulative incidence of HAV over the 3-month follow-up period was 0.27 (95% CI 0.14-0.50) infections/person-year. Children with or without HAV co-infections had similar mean P. falciparum asexual parasite densities at presentation (31,000/µL vs. 34,000/µL, respectively), largely exceeding the pyrogenic threshold of 2,500 parasites/µL in this population and minimizing risk of over-diagnosis of malaria as an explanation. CONCLUSION: The observed temporal association between acute HAV and P. falciparum malaria suggests that co-infections of these two hepatotrophic human pathogens may result from changes in host susceptibility. Testing this hypothesis will require larger prospective studies

The use of insecticide treated nets by age: implications for universal coverage in Africa

BACKGROUND: The scaling of malaria control to achieve universal coverage requires a better understanding of the population sub-groups that are least protected and provide barriers to interrupted transmission. Here we examine the age pattern of use of insecticide treated nets (ITNs) in Africa in relation to biological vulnerabilities and the implications for future prospects for universal coverage. METHODS: Recent national household survey data for 18 malaria endemic countries in Africa were assembled to identify information on use of ITNs by age and sex. Age-structured medium variant projected population estimates for the mid-point year of the earliest and most recent national surveys were derived to compute the population by age protected by ITNs. RESULTS: All surveys were undertaken between 2005 and 2009, either as demographic health surveys (n = 12) or malaria indicator surveys (n = 6). Countries were categorized into three ITN use groups: or =20% and projected population estimates for the mid-point year of 2007 were computed. In general, the pattern of overall ITNs use with age was similar by country and across the three country groups with ITNs use initially high among children <5 years of age, sharply declining among the population aged 5-19 years, before rising again across the ages 20-44 years and finally decreasing gradually in older ages. For all groups of countries, the highest proportion of the population not protected by ITNs (38% - 42%) was among those aged 5-19 years. CONCLUSION: In malaria-endemic Africa, school-aged children are the least protected with ITNs but represent the greatest reservoir of infections. With increasing school enrollment rates, school-delivery of ITNs should be considered as an approach to reach universal ITNs coverage and improve the likelihood of impacting upon parasite transmission