Is It Formal or Informal? Choice of Market Outlets for Unprocessed Tea in Nandi County, Kenya

The tea industry plays a key role in the agriculture sector and the economy at large with tea output contributing about 11% of the agriculture sector’s contribution to Gross Domestic Product. Like many other crops in Kenya, tea is produced both on small and large-scale basis. Smallholder farmers in Kenya make a significant contribution to the industry producing 61% of the total national production and with 66% of tea acreage. Formal market outlets are more profitable than informal ones. However, small tea agri enterprises in Nandi County prefer selling their unprocessed tea to informal market outlets. Empirical evidence on what motivates these agri-enterprises to sell most of their tea to these outlets is scanty. The main objective of this study was to compare the profitability of formal and informal market outlets for unprocessed tea in Nandi County. Multistage sampling procedure was employed and 384 respondents interviewed using semi-structured questionnaire. Data were analysed using gross margin analysis. Formal market outlets are more beneficial because of higher gross margin rate of 12.71% compared to informal market outlets having the gross margin rate of 1.08%.The findings are helpful in guiding smallholder tea farmers in information on the most profitable and efficient market outlets and informing policy makers on how to improve the efficiency of market outlets. DOI: 10.7176/JESD/11-22-10 Publication date: November 30th 202

Human Immunodeficiency Virus -1 and Hepatitis B Virus Co-Infections among Injecting Drug Users in Malindi, Kenya

Currently no published data addressing the burden of Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) co-infection among injecting drug users (IDUs) in Kenya exists. These two viruses share similar routes of transmission, with illicit drug use by injection being the major route of infection. Injecting drug use is a rapidly growing problem in coastal towns of Kenya and the problem is aggravated by sex tourism.This study aimed at determining the prevalence of HBV in HIV positive IDUs and correlating the findings with socio-demographic factors of the study population.A cross-sectional study was conducted using structured questionnaires and laboratory testing of blood samples. Surface antigens for HBV (HBsAg) and anti-HIV antibodies were screened using rapid kits followed by Enzyme Linked Immunosorbent assay tests on positive samples using Hepanostika and Vironostika test kits, for HIV and HBV, respectively. The CD4+ T-cell count was determined by flow cytometry.The prevalence of HIV/HBV co-infection was 14.3% (13/91) with a mean age of 33.2 (SD ± 8.1) years. The mean CD4+ cell count in the HIV/HBV co-infected individuals was significantly lower than HIV mono-infection. Needle sharing and duration of active injection of drugs were significantly associated with HIV/HBV co-infections.This study concludes a potentially high prevalence of HBV/ HIV co-infection in injecting drug users in Malindi, Kenya. With limited evidence on IDU prevalence and its consequences in sub-Saharan Africa, the results of this study highlight the need for a more refined policy on HIV treatment strategy among IDUs. There is a further need for triple testing for HIV, HBV and HCV among suspected IDUs and other associated risk groups like the commercial sex workers before commencement of treatment. Keywords: Injecting drug users, HIV-1, HBV, viral co-infection, Malindi, Keny

Assessment of Risk Predisposition to Human Papilloma Virus through Cervical Infections Screening of Women Attending an Outpatient Health Facility in Nairobi, Kenya

There is limited data on comparative disposition to cervical cancer among HPV infected women in Kenya. We aimed to determine the distribution of HPV infection, cervical abnormalities and infections commonly reported on cervical pap smears among both HIV positive and HIV negative women attending a reproductive health clinic at the largest national hospital in Kenya. A total of 187 women aged 18 to 50 years attending the reproductive clinic at Kenyatta National Referral Hospital in Nairobi were recruited into the study. All consenting subjects were screened for HIV by serology and their cervical smears taken and immediately fixed on slides for Papanicolaou (Pap) staining. A second endocervical swab was collected in the same sitting for HPV DNA extraction and PCR amplification of the HPV LI region.  Of the 187 women studied, 27 (14.4 %) were positive for HIV and 90 (48.1%) had one or more infection associated with bacterial vaginosis, candidiasis, cervicitis or inflammation of the cervix of unknown cause.  Eight (4.3%) women had abnormal cervix, 3/8 being of high grade squamous intraepithelial lesions (HSIL), 1/8 of low grade squamous intraepithelial lesions (LSIL), 1/8 had adenocarcinoma while the remaining 3 had atypical squamous cells of undetermined significance (ASC-US). The remaining 89/187 (47.6%) women had normal smears with no infection. Of the 89 women with normal smears, 82 (92.1%) were HIV negative.  A total of 66 (35.3%) women were positive for HPV L1 DNA by PCR and included 30 of the 89 women with normal cytology. Of the 27 HIV positive women, 14 (51.9%) were also positive for HPV LI DNA. 52 of the 160 (32.5%) HIV negative women were positive for HPV L1 DNA. We report more cases of cervical intraepithelial lesions among HIV positive than HIV negative women. Similarly, the other infections commonly found on Pap smear tests were higher among HIV negative than HIV positive women. HPV prevalence among these clinic-attending women was higher in those with normal cytology, indicating an increased underlying risk of cervical cancer in a setting where routine diagnostic screening is limited or non-existent. Keywords: cervical cancer, HIV, HPV, cervical cytolog

Detection and typing of Human Papillomavirus in urine from patients attending a sexually transmitted infections clinic in Nairobi County, Kenya

Human papillomavirus (HPV) is a common sexually transmitted infection (STI) that has been etiologically linked to cervical cancer. Different types of samples can be used for cervical screening, including Pap test or biopsy and Liquid Based Cytology, visual inspection using acetic acid or Lugol’s iodine, and HPV testing. These methods are invasive. The use of urine as an alternative specimen may be more widely accepted since it is non-invasive and the sample is readily available. The study aimed at detecting and genotyping HPV in urine from patients attending a sexually transmitted infections clinic in Nairobi County. It also aimed at assessing the factors associated with HPV infection. In this cross-sectional study, a structured ‘risk factor’ questionnaire was administered and HPV from urine specimen was genotyped using the L1 gene. Phylogenetic and molecular evolutionary analyses were conducted. Bivariate analysis and Pearson’s chi square (χ2) tests were used to determine the association between HPV infection and factors associated with HPV. A total of 222 adults (45 males and 177 females) aged 18-49 years were recruited. The prevalence of HPV among males and females was 22.2% (10/45) and 32.8% (58/177) respectively. The prevalence of high-risk types among males and females was 25% (1/4) and 27.5% (11/40) respectively. The high risk HPV genotypes detected among females were: HPV-16 (10%), -66 (7.5%), and -70 (7.5%) while low risk types were HPV 6 (27.5%), followed by -81 (25%), -83 (10%), -11 (7.5%), and -54 (2.5%) respectively. The prevalence of low risk types among males and females was 75% (3/4) and 72.5% (29/40) respectively. The prevalent low-risk HPV type detected in males was HPV type 6 (75%) while HPV-58 (25%) was the only high risk type in males. History of sexually transmitted infections was significantly associated with HPV infection among females (P=0.002). There was also significant association between marital status among males (p=0.046), how often one had used the contraceptives among females (p=0.038) and HPV genotypes at bivariate level. The results indicate high HPV prevalence, high risk and low risk HPVs could be detected in urine from the two populations. Therefore; molecular testing of HPV on urine samples is a method that utilizes a non-invasive technique that may increase screening coverage as it is easy to obtain. Key words: urine, Human papillomavirus, HPV genotypes, PCR, cervical cancer

Cervical Dysplasia, Infection, and Phylogeny of Human Papillomavirus in HIV-Infected and HIV-Uninfected Women at a Reproductive Health Clinic in Nairobi, Kenya

High risk human Papillomavirus (HPV) infections ultimately cause cervical cancer. Human Immunodeficiency Virus (HIV) infected women often present with multiple high-risk HPV infections and are thus at a higher risk of developing cervical cancer. However, information on the circulating high-risk HPV genotypes in Kenya in both HIV-infected and HIV-uninfected women is still scanty. This study is aimed at determining the phylogeny and the HPV genotypes in women with respect to their HIV status and at correlating this with cytology results. This study was carried out among women attending the Reproductive Health Clinic at Kenyatta National Hospital, a referral hospital in Nairobi, Kenya. A cross-sectional study recruited a total of 217 women aged 18 to 50 years. Paired blood and cervical samples were obtained from consenting participants. Blood was used for serological HIV screening while cervical smears were used for cytology followed by HPV DNA extraction, HPV DNA PCR amplification, and phylogenetic analysis. Out of 217 participants, 29 (13.4%) were HIV seropositive, while 68 (31.3%) were positive for HPV DNA. Eight (3.7%) of the participants had abnormal cervical cytology. High-risk HPV 16 was the most prevalent followed by HPV 81, 73, 35, and 52. One participant had cervical cancer, was HIV infected, and had multiple high-risk infections with HPV 26, 35, and 58. HPV 16, 6, and 81 had two variants each. HPV 16 in this study clustered with HPV from Iran and Africa. This study shows the circulation of other HPV 35, 52, 73, 81, 31, 51, 45, 58, and 26 in the Kenyan population that play important roles in cancer etiology but are not included in the HPV vaccine. Data from this study could inform vaccination strategies. Additionally, this data will be useful in future epidemiological studies of HPV in Nairobi as the introduction or development of new variants can be detected