Community Knowledge and Perceptions on National School-Based De-Worming Programme

Objectives: To determine the community level of knowledge, attitude and perception of soil transmitted helminthes and the national school-based de-worming programme in selected villages of Busia County in Kenya. Design: A cross-sectional survey. Setting: Busia and Bunyala districts in Busia County. Subjects: A total of 384 participants were studied. Main outcome measures: Socio-demographic characteristics, then knowledge, causes and effects of Soil Transmitted Infections on health and education, prevention strategies, knowledge of national school-based de-worming programming, implementing strategies of the programme, benefits of the programme, community satisfaction and health seeking behaviour. Results: Eating the uncooked food as a cause for soil transmitted infections constituted 27.16% (63) followed by 16.38% (38) not using latrines, 15.95% (37) eating left over foods, 12.93% (30) eating cold food, 10.78% (25) eating not well cooked pork, 9.48% (22) eating contaminated soil, and 7.33% (17) changing of diet. One head teacher interviewed stated that “One can be able to notice if his/her child has worm infection if the child eats without getting satisfied, eating all the time and yet his belly is big.”Community Health Extension Worker in the FGD stated that: “During floods seasons most of the areas in Budalangi become flooded and all latrines are filled with water and the excreta start overflowing. Most of the residents don’t have shoes especially the children and therefore they are prone to the worm infection.”99.57% of the parents were aware of the national school based de-worming programme of which (92%) learnt about the programme after their children were de-wormed in their various schools. Seventy five percent (174) were satisfied about the programme; 65.1% (151) and 10.3% indicated that the programme improves the children’s health and student’s school performance respectively. Conclusion: Most of the parents do not have adequate knowledge on worms, their causes and signs and symptoms of the intestinal worms. Low educational levels and poverty levels also contribute to the lack of awareness on intestinal worms and putting the prevention measures across the board. The study also found out that the community perception towards the de-worming programme was good because the de-worming programme improved the children’s health and performance in education

Experiences in Care Given During Child Birth at a Referral Hospital in Kenya

The fifth Millennium development Goal (MDG) calls for a reduction in the maternal mortality ratio (MMR) by 75% between 1990 and 2015, with a key indicator being the proportion of births attended to by skilled health personnel, (United Nations, 2007). In Kenya the MMR is 400 and has made insufficient progress towards improving maternal health, (UNICEF, WHO, World Bank, 2013). According to KDHS (2014), the proportion of skilled birth attendance is 46.5%, while in Kenya it is 62% against an MDG target of 90%. According to Zaers S., et al., (2008), prior experience in delivery care by skilled attendants affects their subsequent use of these services. In Africa little research has been carried out on the experiences of mothers in facility-based delivery care. This study was therefore set to describe the experiences of women during labour and delivery at a referral hospital in Kenya This was a cross sectional descriptive study that focused on experiences of delivery care by postnatal mothers at a referral hospital in Kenya. Systematic random sampling from a sampling frame of 327 was employed to recruit post-natal mothers who delivered in labour ward and four postnatal wards. A total of 109 participants were recruited into the study. Views and experiences of recently delivered women were elicited using a five-point Likert scale questionnaire focusing on four dimensions of participants’ intrapartum experience. Data was analyzed using ANOVA. Research results were presented in frequency distribution tables, graphs and charts. P-values were used to determine the statistical significance of the results obtained. Most participants (87.7%) agreed that they were treated with respect, accorded privacy and asked to consent, prior to the initiation of the procedures. A single aspect of communication, namely health provider explanation of health status with understandable terms was poorly rated (mean 1.8 to 2.2) as was the level of genuine interest in patient well-being (mean = 1.7 to 2.0) which was significant in the study. Most participant (n = 102(93.6%) said they would recommend delivery services at KNH to friends or family, although 6% of them said they would not recommend. Majority of the participants had a positive experience of quality in delivery care. This was evidenced by the fact that majority of then stated that they would come to deliver in the same institution again or recommend a relative or friend. Aspects of care such as health providers communicating to clients in understandable terms and showing genuine interest in patients wellbeing was rated poorly. Institutional factors such as inadequate space and shortage of staff were also noted to be significantly contributing to negative experience of delivery care in the study

Interaction Between Allelic Variations in Vitamin D Receptor and Retinoid X Receptor Genes on Metabolic Traits

Low vitamin D status has been shown to be a risk factor for several metabolic traits such as obesity, diabetes and cardiovascular disease. The biological actions of 1, 25-dihydroxyvitamin D, are mediated through the vitamin D receptor (VDR), which heterodimerizes with retinoid X receptor, gamma (RXRG). Hence, we examined the potential interactions between the tagging polymorphisms in the VDR (22 tag SNPs) and RXRG (23 tag SNPs) genes on metabolic outcomes such as body mass index, waist circumference, waist-hip ratio (WHR), high- and low-density lipoprotein (LDL) cholesterols, serum triglycerides, systolic and diastolic blood pressures and glycated haemoglobin in the 1958 British Birth Cohort (1958BC, up to n = 5,231). We used Multifactor- dimensionality reduction (MDR) program as a non-parametric test to examine for potential interactions between the VDR and RXRG gene polymorphisms in the 1958BC. We used the data from Northern Finland Birth Cohort 1966 (NFBC66, up to n = 5,316) and Twins UK (up to n = 3,943) to replicate our initial findings from 1958BC

Using a value chain framework for food safety assessment of broiler and indigenous chicken meat systems of Nairobi

Purpose: Research on livestock food systems in developing countries remains limited, yet this context needs to be understood to investigate the epidemiology of zoonoses. The aim of this study was to use a value chain framework to characterize the broiler and indigenous chicken meat systems of Nairobi and their food safety risks. Methods: Using such a framework for food safety characterisation at system level is novel and has significant potential in developing countries. Data collection involved 18 focus group discussions and 236 interviews with various poultry meat value chain stakeholders in Nairobi. Analysis included chain mapping and identification of governance and food safety challenges. Results: The study identified 10 chain profiles, characterising the broiler and indigenous chicken systems, and production-retailing continuum. Food safety risks identified were related to lack of biosecurity, cold chain and access to water, poor cleaning and hygiene practices, consumption of sick animals, significant environmental contamination of by-products, and lack of inspection at farm slaughter. Large companies dominated the governance of the broiler system through the control of day-old chick production. Overall government control was relatively weak leading to minimal official regulatory enforcement. Large companies and brokers were identified as dominant groups in market information dissemination and price setting. No dominant group was identified for indigenous chicken profiles, farming being at household level for local consumption, with quasi non-existent regulations. Lack of industry association was system-wide, creating a barrier for access to capital. Other system barriers included lack of space and expertise, leading to poor infrastructure and limited ability to implement effective hygienic measures. Conclusions and relevance: Optimal food safety and disease control strategies should consider the structure of the poultry meat system and stakeholder interactions to ensure effective programmes. This study provides a new perspective for epidemiologists and public health officers to address food safety risks in full understanding of the food system context

Effect of Haemophilus influenzae type b vaccination without a booster dose on invasive H influenzae type b disease, nasopharyngeal carriage, and population immunity in Kilifi, Kenya: a 15-year regional surveillance study

Background Haemophilus infl uenzae type b (Hib) conjugate vaccine, delivered as a three-dose series without a booster, was introduced into the childhood vaccination programme in Kenya in 2001. The duration of protection and need for a booster dose are unknown. We aimed to assess vaccine eff ectiveness, the impact of the vaccine on nasopharyngeal carriage, and population immunity after introduction of conjugate Hib vaccine in infancy without a booster dose in Kenya. Methods This study took place in the Kilifi Health and Demographic Surveillance System (KHDSS), an area of Kenya that has been monitored for vital events and migration every 4 months since 2000. We analysed sterile site cultures for H infl uenzae type b from children (aged ≤12 years) admitted to the Kilifi County Hospital (KCH) from Jan 1, 2000, through to Dec 31, 2014. We determined the prevalence of nasopharyngeal carriage by undertaking cross-sectional surveys in random samples of KHDSS residents (of all ages) once every year from 2009 to 2012, and measured Hib antibody concentrations in fi ve cross-sectional samples of children (aged ≤12 years) within the KHDSS (in 1998, 2000, 2004–05, 2007, and 2009). We calculated incidence rate ratios between the prevaccine era (2000–01) and the routineuse era (2004–14) and defi ned vaccine eff ectiveness as 1 minus the incidence rate ratio, expressed as a percentage. Findings 40 482 children younger than 13 years resident in KHDSS were admitted to KCH between 2000 and 2014, 38 206 (94%) of whom had their blood cultured. The incidence of invasive H infl uenzae type b disease in children younger than 5 years declined from 62·6 (95% CI 46·0–83·3) per 100 000 in 2000–01 to 4·5 (2·5–7·5) per 100 000 in 2004–14, giving a vaccine eff ectiveness of 93% (95% CI 87–96). In the fi nal 5 years of observation (2010–14), only one case of invasive H infl uenzae type b disease was detected in a child younger than 5 years. Nasopharyngeal H infl uenzae type b carriage was detected in one (0·2%) of 623 children younger than 5 years between 2009 and 2012. In the 2009 serosurvey, 92 (79%; 95% CI 70–86) of 117 children aged 4–35 months had long-term protective antibody concentrations. Interpretation In this region of Kenya, use of a three-dose primary series of Hib vaccine without a booster dose has resulted in a signifi cant and sustained reduction in invasive H infl uenzae type b disease. The prevalence of nasopharyngeal carriage is low and the profi le of Hib antibodies suggests that protection wanes only after the age at greatest risk of disease. Although continued surveillance is important to determine whether eff ective control persists, these fi ndings suggest that a booster dose is not currently required in Kenya

Interaction between allelic variations in vitamin D receptor and retinoid X receptor genes on metabolic traits

BACKGROUND: Low vitamin D status has been shown to be a risk factor for several metabolic traits such as obesity, diabetes and cardiovascular disease. The biological actions of 1, 25-dihydroxyvitamin D, are mediated through the vitamin D receptor (VDR), which heterodimerizes with retinoid X receptor, gamma (RXRG). Hence, we examined the potential interactions between the tagging polymorphisms in the VDR (22 tag SNPs) and RXRG (23 tag SNPs) genes on metabolic outcomes such as body mass index, waist circumference, waist-hip ratio (WHR), high- and low-density lipoprotein (LDL) cholesterols, serum triglycerides, systolic and diastolic blood pressures and glycated haemoglobin in the 1958 British Birth Cohort (1958BC, up to n = 5,231). We used Multifactor- dimensionality reduction (MDR) program as a non-parametric test to examine for potential interactions between the VDR and RXRG gene polymorphisms in the 1958BC. We used the data from Northern Finland Birth Cohort 1966 (NFBC66, up to n = 5,316) and Twins UK (up to n = 3,943) to replicate our initial findings from 1958BC. RESULTS: After Bonferroni correction, the joint-likelihood ratio test suggested interactions on serum triglycerides (4 SNP - SNP pairs), LDL cholesterol (2 SNP - SNP pairs) and WHR (1 SNP - SNP pair) in the 1958BC. MDR permutation model testing analysis showed one two-way and one three-way interaction to be statistically significant on serum triglycerides in the 1958BC. In meta-analysis of results from two replication cohorts (NFBC66 and Twins UK, total n = 8,183), none of the interactions remained after correction for multiple testing (Pinteraction >0.17). CONCLUSIONS: Our results did not provide strong evidence for interactions between allelic variations in VDR and RXRG genes on metabolic outcomes; however, further replication studies on large samples are needed to confirm our findings

Rates of acquisition of pneumococcal colonization and transmission probabilities, by serotype, among newborn infants in Kilifi District, Kenya.

BACKGROUND: Herd protection and serotype replacement disease following introduction of pneumococcal conjugate vaccine (PCV) are attributable to the vaccine's impact on colonization. Prior to vaccine introduction in Kenya, we did an epidemiological study to estimate the rate of pneumococcal acquisition, by serotype, in an uncolonized population. METHODS: Nasopharyngeal swab specimens were taken from newborns aged ≤ 7 days and weekly thereafter for 13 weeks. Parents, and siblings aged <10 years, were swabbed at monthly intervals. Swabs were transported in skim milk-tryptone-glucose-glycerin and cultured on gentamicin blood agar. Pneumococci were serotyped by the Quellung reaction. We used survival analysis and Cox regression analysis to examine serotype-specific acquisition rates and risk factors and calculated transmission probabilities from the pattern of acquisitions within the family. RESULTS: Of 1404 infants recruited, 887 were colonized by 3 months of age, with the earliest acquisition detected on the first day of life. The median time to acquisition was 38.5 days. The pneumococcal acquisition rate was 0.0189 acquisitions/day (95% confidence interval, .0177-.0202 acquisitions/day). Serotype-specific acquisition rates varied from 0.00002-0.0025 acquisitions/day among 49 different serotypes. Season, coryza, and exposure to cigarettes, cooking fumes, and other children in the home were each significant risk factors for acquisition. The transmission probability per 30-day duration of contact with a carrier was 0.23 (95% CI, .20-.26). CONCLUSIONS: Newborn infants in Kilifi have high rates of nasopharyngeal acquisition of pneumococci. Half of these acquisitions involve serotypes not included in any current vaccine. Several risk factors are modifiable through intervention. Newborns represent a consistent population of pneumococcus-naive individuals in which to estimate the impact of PCV on transmission

Population immunity to pneumococcal serotypes in Kilifi, Kenya, before and 6 years after the introduction of PCV10 with a catch-up campaign: an observational study of cross-sectional serosurveys

BACKGROUND: In Kilifi (Kenya), a pneumococcal conjugate vaccine (PCV10) was introduced in 2011 in infants (aged <1 year, 3 + 0 schedule) with a catch-up campaign in children aged 1-4 years. We aimed to measure the effect of PCV10 on population immunity. METHODS: In this observational study, repeated cross-sectional serosurveys were conducted in independent random samples of 500 children younger than 15 years every 2 years between 2009 and 2017. During these surveys, blood samples were collected by venesection. Concentrations of anti-capsular IgGs against vaccine serotypes (VTs) 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F, and against serotypes 6A and 19A, were assayed by ELISA. We plotted the geometric mean concentrations (GMCs) by birth year to visualise age-specific antibody profiles. In infants, IgG concentrations of 0·35 μg/mL or higher were considered protective. FINDINGS: Of 3673 volunteers approached, 2152 submitted samples for analysis across the five surveys. Vaccine introduction resulted in an increase in the proportion of young children with protective IgG concentrations, compared with before vaccine introduction (from 0-33% of infants with VT-specific levels over the correlate of protection in 2009, to 60-94% of infants in 2011). However, among those vaccinated in infancy, GMCs of all ten VTs had waned rapidly by the age of 1, but rose again later in childhood. GMCs among children aged 10-14 years were consistently high over time (eg, the range of GMCs across survey rounds were between 0·45 μg/mL and 1·00 μg/mL for VT 23F and between 2·00 μg/mL and 3·11 μg/mL for VT 19F). INTERPRETATION: PCV10 in a 3 + 0 schedule elicited protective IgG levels during infancy, when disease risk is high. The high antibody levels in children aged 10-14 years might indicate continued exposure to vaccine serotypes due to residual carriage or to memory responses to cross-reactive antigens. Despite rapid waning of IgG after vaccination, disease incidence among young children in this setting remains low, suggesting that lower thresholds of antibody, or other markers of immunity (eg, memory B cells), may be needed to assess population protection among children who have aged past infancy. FUNDING: Gavi, the Vaccine Alliance; Wellcome Trust