Reframing Non-Communicable Diseases and Injuries for Equity in the Era of Universal Health Coverage: Findings and Recommendations from the Kenya NCDI Poverty Commission.

Background: Kenya has implemented a robust response to non-communicable diseases and injuries (NCDIs); however, key gaps in health services for NCDIs still exist in the attainment of Universal Health Coverage (UHC). The Kenya Non-Communicable Diseases and Injury (NCDI) Poverty Commission was established to estimate the burden of NCDIs, determine the availability and coverage of health services, prioritize an expanded set of NCDI conditions, and propose cost-effective and equity-promoting interventions to avert the health and economic consequences of NCDIs in Kenya. Methods: Burden of NCDIs in Kenya was determined using desk review of published literature, estimates from the Global Burden of Disease Study, and secondary analysis of local health surveillance data. Secondary analysis of nationally representative surveys was conducted to estimate current availability and coverage of services by socioeconomic status. The Commission then conducted a structured priority setting process to determine priority NCDI conditions and health sector interventions based on published evidence. Findings: There is a large and diverse burden of NCDIs in Kenya, with the majority of disability-adjusted life-years occurring before age of 40. The poorest wealth quintiles experience a substantially higher deaths rate from NCDIs, lower coverage of diagnosis and treatment for NCDIs, and lower availability of NCDI-related health services. The Commission prioritized 14 NCDIs and selected 34 accompanying interventions for recommendation to achieve UHC. These interventions were estimated to cost $11.76 USD per capita annually, which represents 15% of current total health expenditure. This investment could potentially avert 9,322 premature deaths per year by 2030. Conclusions and Recommendations: An expanded set of priority NCDI conditions and health sector interventions are required in Kenya to achieve UHC, particularly for disadvantaged socioeconomic groups. We provided recommendations for integration of services within existing health services platforms and financing mechanisms and coordination of whole-of-government approaches for the prevention and treatment of NCDIs

Antibiotic quality and use practices amongst dairy farmers and drug retailers in central Kenyan highlands

Abstract Understanding antibiotic use in dairy systems is critical to guide antimicrobial stewardship programs. We investigated antibiotic use practices in small-holder dairy farms, antibiotic quality, and antimicrobial resistance (AMR) awareness among veterinary drug retailers in a mixed farming community in the central Kenyan highlands. Data were collected from 248 dairy farms and 72 veterinary drug stores between February 2020 and October 2021. A scale was developed to measure knowledge about AMR and antibiotic use using item response theory, and regression models were used to evaluate factors associated with antibiotic use and AMR knowledge. The active pharmaceutical ingredient (API) content of 27 antibiotic samples was determined using high-performance liquid chromatography (HPLC). The presence and levels of 11 antibiotic residues in 108 milk samples collected from the study farms were also investigated using liquid chromatography tandem mass spectrometry (LC–MS/MS). Almost all farms (98.8%, n = 244) reported using antibiotics at least once in the last year, mostly for therapeutic reasons (35.5%). The most used antibiotics were tetracycline (30.6%), penicillin (16.7%), and sulfonamide (9.4%), either individually or in combination, and predominantly in the injectable form. Larger farm size (OR = 1.02, p < 0.001) and history of vaccination use (OR = 1.17, p < 0.001) were significantly associated with a higher frequency of antibiotic use. Drug retailers who advised on animal treatments had a significantly higher mean knowledge scores than those who only sold drugs. We found that 44.4% (12/27) of the tested antibiotics did not meet the United States Pharmacopeial test specifications (percentage of label claim). We detected nine antibiotics in milk, including oxytetracycline, sulfamethoxazole, and trimethoprim. However, only three samples exceeded the maximum residue limits set by the Codex Alimentarius Commission. Our findings indicate that antibiotics of poor quality are accessible and used in small-holder dairy systems, which can be found in milk. These results will aid future investigations on how to promote sustainable antibiotic use practices in dairy systems

The misuse of antiretrovirals to boost pig and poultry productivity in Uganda and potential implications for public health

Background and Aim: Since 2015, local newspapers reported that pig and poultry farmers in Uganda use antiretroviral drugs (ARVs) to promote growth in animals and control diseases. This study was conducted to assess farmers’ knowledge, attitude and perceptions about the use of antiretroviral drugs as boosters in pigs and poultry and the possibility of detecting the antiretroviral drugs in meat using available laboratory methods. Materials and Methods: In 2019, a cross-sectional study was conducted in ten districts in Uganda. In 20 focus group discussions with 100 pig and poultry farmers and 70 animal health service providers, we assessed the use of ARV in livestock enterprises. Subsequently, samples of chicken, pigs, and animal feeds were collected from volunteer participants, and screened for residues of saquinavir, lopinavir, nevirapine, and efavirenz using liquid chromatography-tandem mass spectrophotometer. Results: Participants in all ten districts were predominantly smallholder farmers supplying the local markets. All groups reported the use of ARVs in pigs and broiler birds but not in layer hens. In the absence of good quality feeds, the motivation for feeding ARVs was rapid animal weight gain, as well as the control of animal diseases, for which farmers have no alternative solutions. ARVs were obtained within the community for free, against cash, or in-kind payment. Residues of lopinavir were detected in four, and saquinavir in seven districts, and all three sample matrices. Conclusion: Our study findings confirm anecdotal news reports on ARV use in livestock. While our findings are not generalizable to the whole country, they call for a representative follow-up. As the drugs were detected in tissues destined for human consumption, the potential risk to human health warrants further investigation

Processing methods affect phytochemical contents in products prepared from orange‐fleshed sweetpotato leaves and roots

Phytochemicals enhance human health by acting antagonistically on incidences of cancer and other chronic diseases. They are considered indispensable in a variety of nutraceutical, pharmaceuticals, and medicinal and cosmetic applications. This study evaluated the effects of common processing methods on inherent phytochemical content in the roots and leaves of orange-fleshed sweetpotato (OFSP) varieties called Kabode and SPK031. Yellosp and Whitesp, which are local sweetpotato varieties, were also included as check for roots and leaves, respectively. The sweetpotato products prepared for phytochemical analysis were boiling roots and leaves, frying chips and crisps, baking bread (for roots only), and fermenting and dehydrating leaves. Phytochemicals that were assessed included vitamin C, total phenolics and flavonoids, tannins, phytates, and soluble oxalates. Results indicated that retention of vitamin C was highest in boiled roots (85%-95%), followed by fries (71%-94%) and crisps (44%-76%), whereas the least retention was in bread (4%-11%) and leaves (0%-27%). Total phenolics, flavonoids, and antioxidant activity in leaves significantly (p < .05) varied with the type of processing. Higher retention of these phytochemicals was observed in processed roots but was lowest in bread. Boiling retained more than 100% of all carotenoids, while fermenting and drying the leaves retained 58-62 and 22%-48%, respectively. Frying retained more than 100% of the beta-carotene in the roots, while boiling retained 96%-100%. All processing methods significantly (p < .05) reduced antinutrients in leaves and roots. Fermentation of leaves had higher reduction of oxalates, tannins, and phytates, while boiling had the least effect. It is concluded that traditional boiling enhances phytochemical retention in roots but degrades most of them in leaves

Assessment of fungal contamination in fish feed from the Lake Victoria Basin, Uganda

The emergence of commercial fish farming has stimulated the establishment of fish feed factories in Uganda. However, no information is available on the safety of the feed, mainly due to lack of mycotoxin testing facilities and weak regulatory systems. A study was carried out to examine fungal colonization and mycotoxin contamination in fish feed samples (n = 147) of different types collected from nine fish farms (n = 81) and seven fish feed factories (n = 66) in the Lake Victoria Basin (LVB). Fungi were isolated in potato dextrose agar, grouped into morphotypes and representative isolates from each morphotype were identified based on the internal transcribed spacer (ITS) region of ribosomal DNA sequences. Aflatoxin B1 (AFB1) and total fumonisin (combinations of B1, B2 and B3; hereinafter named fumonisin) levels in feed samples were determined by enzyme-linked immunosorbent assay (ELISA). A wide range of fungi, including toxigenic Aspergillus flavus and Fusarium verticillioides, were isolated from the fish feed samples. AFB1 was detected in 48% of the factory samples and in 63% of the farm samples, with toxin levels &lt;40 and &gt;400 &micro;g/kg, respectively. Similarly, 31% of the factory samples and 29% of the farm samples had fumonisin contamination ranging between 0.1 and 4.06 mg/kg. Pellets and powder had higher mycotoxin contamination compared to other commercially available fish feed types. This study shows AFB1 as a potential fish feed safety issue in the LVB and suggests a need for more research on mycotoxin residues in fish fillets

Genetic Profiling of Aspergillus Isolates with Varying Aflatoxin Production Potential from Different Maize-Growing Regions of Kenya

Highly toxigenic strains of Aspergillus flavus have been reported to frequently contaminate maize, causing fatal aflatoxin poisoning in Kenya. To gain insights into the environmental and genetic factors that influence toxigenicity, fungi (n = 218) that were culturally identified as A. flavus were isolated from maize grains samples (n = 120) from three regions of Kenya. The fungi were further characterized to confirm their identities using a PCR-sequence analysis of the internal transcribed spacer (ITS) region of rDNA which also revealed all of them to be A. flavus. A subset of 72 isolates representing ITS sequence-based phylogeny cluster and the agroecological origin of maize samples was constituted for subsequent analysis. The analysis of partial calmodulin gene sequences showed that the subset consisted of A. flavus (87%) and Aspergillus minisclerotigenes (13%). No obvious association was detected between the presence of seven aflatoxin biosynthesis genes and fungal species or region. However, the presence of the aflD and aflS genes showed some association with aflatoxin production. The assessment of toxigenicity showed higher aflatoxin production potential in A. minisclerotigenes isolates. Given that A. minisclerotigenes were mainly observed in maize samples from Eastern Kenya, a known aflatoxin hotspot, we speculate that production of copious aflatoxin is an adaptative trait of this recently discovered species in the region

Multi-Environmental Evaluation of Protein Content and Yield Stability among Tropical Soybean Genotypes Using GGE Biplot Analysis

The yield and protein performance in a soybean genotype result from its interaction with the prevailing environmental conditions. This makes selecting the best genotypes under varied target production environments more complex. This study’s objectives were to determine protein content and protein stability of 30 elite soybean genotypes in major soybean-growing areas of Uganda, assess the yield performance and stability in soybeans and determine the relationship between the protein content and grain yield in soybeans. The genotypes were planted in a randomized complete block design of three replications for six seasons across eight locations in Uganda. Genotype and genotype-by-environment (GGE) biplot analyses classified the test locations into three mega-environments for soybean protein and grain yields. Genotype NII X GC 20.3 had the highest mean protein content of 43.0%, and BSPS 48A-9-2 and BSPS 48A-28 were superior for the mean grain yield (1207 kg ha−1). Bulindi was the most discriminating and representative test environment for soybean yield. A weak and negative correlation (r = −0.1**, d.f. = 29) was detected between the protein content (%) and yield (kg ha−1). The highest-yielding genotypes BSPS 48A-9-2, BSPS 48A-31, and Nam II × GC 44.2 are recommended for further evaluation under farmers’ production conditions for selection and release as new soybean varieties in Uganda

Multi-Environmental Evaluation of Protein Content and Yield Stability among Tropical Soybean Genotypes Using GGE Biplot Analysis

The yield and protein performance in a soybean genotype result from its interaction with the prevailing environmental conditions. This makes selecting the best genotypes under varied target production environments more complex. This study’s objectives were to determine protein content and protein stability of 30 elite soybean genotypes in major soybean-growing areas of Uganda, assess the yield performance and stability in soybeans and determine the relationship between the protein content and grain yield in soybeans. The genotypes were planted in a randomized complete block design of three replications for six seasons across eight locations in Uganda. Genotype and genotype-by-environment (GGE) biplot analyses classified the test locations into three mega-environments for soybean protein and grain yields. Genotype NII X GC 20.3 had the highest mean protein content of 43.0%, and BSPS 48A-9-2 and BSPS 48A-28 were superior for the mean grain yield (1207 kg ha−1). Bulindi was the most discriminating and representative test environment for soybean yield. A weak and negative correlation (r = −0.1**, d.f. = 29) was detected between the protein content (%) and yield (kg ha−1). The highest-yielding genotypes BSPS 48A-9-2, BSPS 48A-31, and Nam II × GC 44.2 are recommended for further evaluation under farmers’ production conditions for selection and release as new soybean varieties in Uganda

Association Mapping of Candidate Genes Associated with Iron and Zinc Content in Rice (<i>Oryza sativa</i> L.) Grains

Micronutrient deficiencies, particularly of iron (Fe) and zinc (Zn), in the diet contribute to health issues and hidden hunger. Enhancing the Fe and Zn content in globally staple food crops like rice is necessary to address food malnutrition. A Genome-Wide Association Study (GWAS) was conducted using 85 diverse rice accessions from the Democratic Republic of Congo (DRC) to identify genomic regions associated with grain Fe and Zn content. The Fe content ranged from 0.95 to 8.68 mg/100 g on a dry weight basis (dwb) while Zn content ranged from 0.87 to 3.8 mg/100 g (dwb). Using MLM and FarmCPU models, we found 10 significant SNPs out of which one SNP on chromosome 11 was associated with the variation in Fe content and one SNP on chromosome 4 was associated with the Zn content, and both were commonly detected by the two models. Candidate genes belonging to transcription regulator activities, including the bZIP family genes and MYB family genes, as well as transporter activities involved in Fe and Zn homeostasis were identified in the vicinity of the SNP markers and selected. The identified SNP markers hold promise for marker-assisted selection in rice breeding programs aimed at enhancing Fe and Zn content in rice. This study provides valuable insights into the genetic factors controlling Fe and Zn uptake and their transport and accumulation in rice, offering opportunities for developing biofortified rice varieties to combat malnutrition among rice consumers