The Performance of Rapid Diagnostic Test for Malaria Parasite Diagnosis Compared to Microscopic Test in Meru South Sub-County, Tharaka-Nithi County, Kenya

Despite intensive worldwide attempt to control malaria, it remains one of the most fatal and widespread protozoan infection of mankind. About 2.4 billon people inhabit malaria prone regions which is about forty percentage of the world population in over 90 countries of Sub-Saharan Africa are affected. Prompt accurate, diagnosis and treatment is important to avert suffering of patients and malaria infection is a serious global challenge in the affected countries. The rapid diagnosis test of malaria is a recent diagnostic technique whose performance has not been evaluated in Meru South Sub-County. The main purpose of this research study was to perform immunosurveillance and evaluate performance rapid diagnosis test for malaria parasites in Meru South Sub-County, Tharaka-Nithi County. The study design was hospital based cross-sectional study in the laboratory at Chuka Level Five Hospital. Three hundred and eighty four blood specimens were used from febrile patients with clinical manifestation of malaria infection. The blood specimens were used for thin, thick smear and rapid diagnosis test. The results were analyzed by t-test to compare the mean of the two methods. A P –value of 0.953 was obtained which is greater than 0.05, therefore we accept the null hypothesis that there is no difference in performance between the Rapid Diagnostic Test (RDT) and microscopic test. The results indicated that RDT had similar performance with microscopy for both positive and negative cases of malaria infection. In conclusion RDT is appropriate for malaria diagnosis since the incidence rate of malaria was found to be high and the predominant Plasmodium falciparum was high in the study area.  The researcher recommends the use of RDTs in mass screening for malaria infection, adopt or intensify protective measures during dry seasons and monitoring antimalaria drug resistance or tolerance in all counties in Kenya

Factors Underlying Stigmatization of Epilepsy: A Comparative Case Study of Suba and Meru Central Districts, Kenya

Epilepsy is the most common neurological disorder known to mankind. It is shrouded in mystery and associated with supernatural forces resulting in social stigma, systematic discrimination and psychological morbidity to the afflicted. The study was carried out in Suba and Meru central districts in Kenya. The Objective of this study is to determine the factors underlying stigmatization of People with Epilepsy (PWE) in Suba and Meru Central Districts and evaluate the social burden associated with epilepsy. A cross-sectional descriptive study involving the use of a 30-item structured questionnaire, Focus Groups Discussion and key informants. Two hundred and twenty-five (225) household heads, twelve focus group discussions and 30 key informants. A total of 225 households interviewed had male preponderance of 140 (62.2%) to 85 females (37.8%).  The level of education for Suba District respondents was higher as 54.3% had secondary and post secondary education compared to 35.2% for Meru Central  District. All respondents (100%) in both study cohorts were aware of epilepsy. Thirty four percent (34%) of Suba respondents had some knowledge about epilepsy compared to eleven percent (11%) in the Meru Central District cohort. Statistical relationship between negative attitude and fear of epilepsy overall was significant (c2 = 43.69354, df=1, p<0.05).There was no statistical significance in relationship between level of education and fear of epilepsy (c2 = 0.15773, df=2, p=0.092436). However there was statistical significance in relationship with knowledge on epilepsy and fear-for-epilepsy (c2 = 7.41663, df=1, p=0.00646). Occupation of respondents did not influence fear for epilepsy except among Meru Central District female respondents (c2 = 6.19763, df=2, p=0.04510).  as a conclusion we can say that in both communities epilepsy was considered a contagious and transferable disease and highly associated with witchcraft. Stigma and discrimination of PWE is amply evident. We recommend a comprehensive community sensitization programme to reverse the negative attitude, myths, beliefs and superstitions surrounding epilepsy.

Insecticidal decay effects of long-lasting insecticide nets and indoor residual spraying on Anopheles gambiae and Anopheles arabiensis in Western Kenya

BackgroundIndoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are the first-line tools for malaria prevention and control in Africa. Vector resistance to insecticides has been extensively studied, however the insecticidal effects of the nets and sprayed walls on pyrethroid resistant mosquitoes has not been studied thoroughly. We evaluated the bioefficacy of LLINs of different ages and lambda-cyhalothrin (ICON 10cs) on the sprayed mud walls for a period of time on malaria vector survivorship.MethodsWHO tube bioassay was performed using diagnostic doses of lambda-cyhalothrin (0.05%), permethrin (0.75%) and deltamethrin (0.05%). Cone bioassays were conducted on netting materials from 0 to 3 years old long-lasting insecticide-impregnated nets. Wall bioassays were performed monthly on mud slabs sprayed with lambdacyhalothrin over a period of seven months. All bioassays used An. gambiae mosquitoes collected from the field and the laboratory susceptible reference Kisumu strain. Concentration of the insecticides on the netting materials was examined using the gas chromatography method. Mosquitoes were identified to species level using PCR and genotyped for the kdr gene mutation frequencies.ResultsWHO bioassays results showed that populations from five sites were highly resistant to the pyrethroids (mortalities ranged from 52.5 to 75.3%), and two sites were moderately resistant to these insecticides (80.4 - 87.2%). Homozygote kdr mutations of L1014S ranged from 73 to 88% in An. gambiae s.s. dominant populations whereas L1014S mutation frequencies were relatively low (7-31%) in An. arabiensis dominant populations. There was a significant decrease (P < 0.05) in mosquito mortality with time after the spray with both lambda-cyhalothrin (75% mortality after six months) and with the age of LLINs (60% mortality after 24 month). Field collected mosquitoes were able to survive exposure to both IRS and LLINs even with newly sprayed walls (86.6-93.5% mortality) and new LLINs (77.5-85.0% mortality), Wild mosquitoes collected from the field had significantly lower mortality rates to LLINs (59.6-85.0%) than laboratory reared susceptible strain (100%). Insecticide concentration decreased significantly from 0.14 μg/ml in the new nets to 0.077 μg/ml in nets older than 18 months (P < 0.05).ConclusionThis study confirms that insecticide decay and developing levels of resistance have a negative contribution to reduced efficacy of ITN and IRS in western Kenya. These factors contribute to decreased efficacy of pyrethroid insectides in ongoing malaria control programs. In order to mitigate against the impact of insecticide resistance and decay it is important to follow the WHO policy to provide the residents with new LLINs every three years of use while maintaining a high level of LLINs coverage and usage. There is also need for urgent development and deployment of non-pyrethroid based vector control tools

Productivity of Malaria Vectors from Different Habitat Types in the Western Kenya Highlands

BACKGROUND: Mosquito Larval Source Management (LSM) could be a valuable additional tool for integrated malaria vector control especially in areas with focal transmission like the highlands of western Kenya if it were not for the need to target all potential habitats at frequent intervals. The ability to determine the productivity of malaria vectors from identified habitats might be used to target LSM only at productive ones. METHODS: Each aquatic habitat within three highland sites in western Kenya was classified as natural swamp, cultivated swamp, river fringe, puddle, open drain or burrow pit. Three habitats of each type were selected in each site in order to study the weekly productivity of adult malaria vectors from February to May 2009 using a sweep-net and their habitat characteristics recorded. RESULTS: All surveyed habitat types produced adult malaria vectors. Mean adult productivity of Anopheles gambiae sensu lato in puddles (1.8/m(2)) was 11-900 times higher than in the other habitat types. However, puddles were the most unstable habitats having water at 43% of all sampling occasions and accounted for 5% of all habitats mapped in the study areas whereas open drains accounted for 72%. Densities of anopheline late instars larvae significantly increased with the presence of a biofilm but decreased with increasing surface area or when water was flowing. Taking stability and frequency of the habitat into account, puddles were still the most productive habitat types for malaria vectors but closely followed by open drains. CONCLUSION: Even though productivity of An. gambiae s.l. was greatest in small and unstable habitats, estimation of their overall productivity in an area needs to consider the more stable habitats over time and their surface extension. Therefore, targeting only the highly productive habitats is unlikely to provide sufficient reduction in malaria vector densities

A contrast of physical, chemical and biological characteristics between habitats of high and low presence of anopheline larvae.

<p>CI = 95% Confidence Interval</p

Number of times habitats were sampled in all the 24 surveys

<p>Number of times habitats were sampled in all the 24 surveys</p

Dynamics of anopheline larvae (mean + upper 95%CI) in the habitats of high and low anopheline presence in each of the 24 surveys.

<p>Dynamics of anopheline larvae (mean + upper 95%CI) in the habitats of high and low anopheline presence in each of the 24 surveys.</p

Map showing anopheline breeding habitats whose physical, chemical and biological characteristics were repeatedly evaluated for 12 consecutive months at Musilongo (a), Emutete (b) and Kezege (c).

<p>Map showing anopheline breeding habitats whose physical, chemical and biological characteristics were repeatedly evaluated for 12 consecutive months at Musilongo (a), Emutete (b) and Kezege (c).</p