Population-Based Incidence of Typhoid Fever in an Urban Informal Settlement and a Rural Area in Kenya: Implications for Typhoid Vaccine Use in Africa

Background: High rates of typhoid fever in children in urban settings in Asia have led to focus on childhood immunization in Asian cities, but not in Africa, where data, mostly from rural areas, have shown low disease incidence. We set out to compare incidence of typhoid fever in a densely populated urban slum and a rural community in Kenya, hypothesizing higher rates in the urban area, given crowding and suboptimal access to safe water, sanitation and hygiene. Methods: During 2007-9, we conducted population-based surveillance in Kibera, an urban informal settlement in Nairobi, and in Lwak, a rural area in western Kenya. Participants had free access to study clinics; field workers visited their homes biweekly to collect information about acute illnesses. In clinic, blood cultures were processed from patients with fever or pneumonia. Crude and adjusted incidence rates were calculated. Results: In the urban site, the overall crude incidence of Salmonella enterica serovar Typhi (S. Typhi) bacteremia was 247 cases per 100,000 person-years of observation (pyo) with highest rates in children 5–9 years old (596 per 100,000 pyo) and 2–4 years old (521 per 100,000 pyo). Crude overall incidence in Lwak was 29 cases per 100,000 pyo with low rates in children 2–4 and 5–9 years old (28 and 18 cases per 100,000 pyo, respectively). Adjusted incidence rates were highest in 2–4 year old urban children (2,243 per 100,000 pyo) which were.15-fold higher than rates in the rural site for the same age group

Does Water Hyacinth on East African Lakes Promote Cholera Outbreaks?

Cholera outbreaks continue to occur regularly in Africa. Cholera has been associated with proximity to lakes in East Africa, and Vibrio cholerae has been found experimentally to concentrate on the floating aquatic plant, water hyacinth, which is periodically widespread in East African lakes since the late 1980s. From 1994 to 2008, Nyanza Province, which is the Kenyan province bordering Lake Victoria, accounted for a larger proportion of cholera cases than expected by its population size (38.7% of cholera cases versus 15.3% of national population). Yearly water-hyacinth coverage on the Kenyan section of Lake Victoria was positively associated with the number of cholera cases reported in Nyanza Province (r = 0.83; P = 0.0010). Water hyacinth on freshwater lakes might play a role in initiating cholera outbreaks and causing sporadic disease in East Africa

Home-based record (HBR) ownership and use of HBR recording fields in selected Kenyan communities: Results from the Kenya Missed Opportunities for Vaccination Assessment

<div><p>Background</p><p>Home-based records (HBRs), which take many forms, serve as an important tool for frontline health workers by providing a standardized patient history vital to making informed decisions about the need for immunization services. There are increasing concerns around HBRs with recording areas that are functionally irrelevant because records are incomplete or not up-to-date. The aim of this report was to describe HBR ownership and report on the utilization of selected recording areas in HBRs across selected study communities in Kenya.</p><p>Methods</p><p>The Kenya Missed Opportunities for Vaccination Assessment utilized a mixed-methods approach that included exit interviews, using a standardized questionnaire, among a convenience sample of caregivers of children aged <24 months attending a health facility during November 2016 as well as interviews of health staff and facility administrators. In addition to the exit interview data, we analysed data obtained from a review of available HBRs from the children.</p><p>Results</p><p>A total of 677 children were identified with a valid date of birth and who were aged <24 months. A HBR was in hand and reviewed for three-quarters of the children. Nearly one-third (n = 41) of those without a HBR in hand at the visit noted that they did not know the importance of bringing the document with them. Roughly two-thirds (n = 443) of caregivers noted they were asked by clinic staff to see the HBR during the clinic visit. Across the 516 reviewed HBRs, recording areas were most commonly identified for the child’s demographic information (80% of HBRs) and vaccination history (82%) with information marked in >90% of records. Recording areas were less frequently available for child early eye / vision problems (61%), growth monitoring (74%) and vitamin A (76%); with information marked in 33%, 88% and 60% of records, respectively.</p><p>Conclusions</p><p>Critical to the reduction of missed opportunities for vaccination, the HBR’s importance must be emphasized and the document must be requested by health workers at every health encounter. Health workers must not only ensure that all children receive a HBR and counsel caregivers of its importance, but they must also ensure that all sections of the record are legibly completed to ensure continuity of care. Programmes are encouraged to periodically review and critically assess the HBR to determine whether the document’s design and content areas are optimal to end user needs.</p></div

Summary of background characteristics of study target children and their mothers: Kenya Missed Opportunities for Vaccination Assessment, 2016.

<p>Summary of background characteristics of study target children and their mothers: Kenya Missed Opportunities for Vaccination Assessment, 2016.</p

Availability of selected recording areas in the home-based record and marked information in those recording areas among 516 reviewed home-based records: Kenya Missed Opportunities for Vaccination Assessment, 2016.

<p>Availability of selected recording areas in the home-based record and marked information in those recording areas among 516 reviewed home-based records: Kenya Missed Opportunities for Vaccination Assessment, 2016.</p

Current HBR ownership prevalence among 677 children aged <24 months by selected background characteristics.

<p>Current HBR ownership prevalence among 677 children aged <24 months by selected background characteristics.</p

Number of Cases of Typhoid fever and Rainfall Accumulation per Month, Kibera.

<p>Number of Cases of Typhoid fever and Rainfall Accumulation per Month, Kibera.</p

Figure 2.

<p>a) Flow Chart showing Numbers of Enrollees from Lwak, Blood Cultures Processed and Pathogens Isolated, Including <i>S</i> Typhi, Isolated. b) Flow Chart showing Numbers of Enrollees from Kibera, Blood Cultures Processed and Pathogens Isolated, Including <i>S</i> Typhi, Isolated.</p

Symptoms from data collected from clinic visit for 116 patients with <i>S.</i> Typhi bacteremia from Kibera and Lwak (from whom clinical data were available) compared with other patients with blood cultures processed.

<p>*p<0.001 when compared all patients without <i>S.</i> Typhi isolated from blood culture.</p><p>**p<0.01 when compared all patients without <i>S.</i> Typhi isolated from blood culture.</p><p>***p<u><</u>0.05 when compared all patients without <i>S.</i> Typhi isolated from blood culture.</p>&<p>p <0.05 when compared with patients with bacteremia due to pathogens other than <i>S</i>. Typhi.</p