High ethionamide resistance in Mycobacterium tuberculosis strains isolated in Kenya

Background: Increasing development of tuberculosis (TB) resistance to the currently available drugs including second-line anti-TB drugs that are being used for treatment of Multi-Drug Resistant TB (MDR-TB) patients has frustrated efforts to control TB worldwide. Ethionamide (Eth) is one of the drugs used in the regimen for treatment of these patients. Objective: To determine level of Ethionamide resistance among second-line anti-tuberculosis drugs in Mycobacterium tuberculosis (MTB) strains isolated in Kenya. Design: A retrospective lab-based study involving archived strains from previous studies carried out at the Centre for Respiratory Diseases Research (CRDR), Kenya Medical Research Institute (KEMRI) from 2002 to 2007. Setting: Centre for Respiratory Diseases Research (CRDR), Kenya Medical Research Institute (KEMRI). Methods: A total of 216 MTB strains with pre-determined first-line drug susceptibility testing (DST) results were used including 78 first-line resistant to individual and combined drugs, and 138 susceptible to streptomycin, rifampicin, isoniazid and ethambutol. The strains were subjected to DST to ethionamide among other second-line. Results: Thirty two [32/216 (14.8%)] strains showed resistance to second-line drugs. Resistance to Eth was the highest [18/32 (56.3%)] including co-resistance with isoniazid [8/18 (44.4%)]. Nine [9/18 (50%)] strains were fully resistant and 9 [9/18 (50%)] were intermediate resistant to Eth. Conclusion: Unexplainable high levels of Eth resistance is a cause for concern. This will impact negatively on the outcome of management of MDR-TB especially in Kenya where the use of this drug is almost mandatory. Close monitoring of Eth before initiating individual patient management may be necessary. Keywords: Ethionamide, Resistant, MDR-TB

Blockchain in Supply Chain Trading

© 2018 IEEE. The emergence of blockchain technology has created a frenzy and a mind shift for organizations and industries. Governments and international bodies are increasingly discussing the potential implications of blockchain\u27s distributed ledgers on business, governments and the economy. The intended purpose of the blockchain technology is to connect business network members in a decentralized way. The technology enables exchange and sharing of information without the involvement of intermediaries acting as arbitrators. Powered by its decentralized nature, the network will not have any single point of failure and will not rely on any single entity. Hence, blockchain eliminates the risks of centralization. This paper discusses a scenario of a blockchain technology in distributed ledgers to manage a well function and secure supply chain

Increasing Fiber and Protein Contents of Baked Products Using Local Produce

Consumers are increasingly opting for healthier food products, and two current trends are high fiber and high protein options. Using locally available produce or their manufacturing by-products may lower ingredient cost when making these products. Durian rind, which is generally thrown away, comprises 60% of a durian fruit and has about 27% crude fiber. Mung bean has about 23% protein and is relatively inexpensive. In this study, durian rind was cleaned, dried, ground, and added to muffins while mung beans were oven-roasted, ground, and added to crackers. Quality and acceptability of the products were evaluated. Among the ratios tested, the most preferred formulation for muffins had 10% durian rind powder, while that of crackers had 50% mung bean flour. Consumer acceptability of the products was tested using a 9-point hedonic scale. The control and fiber-fortified muffins had similar mean consumer acceptability scores of 8 (liked highly) for color, texture, taste, and overall acceptability. Crackers with mung bean flour had significantly higher mean scores than the control (7.5–8.0 vs. 6.8–7.4) for appearance, texture, flavor, and overall acceptability. The fiber-fortified muffin had 6.26% crude fiber while the mung bean crackers had 9.98% crude protein. The addition of durian rind powder and mung bean flour to baked products may adversely affect some quality parameters like texture, but there are ways to lessen these effects. The improvement in nutrition profile of the products shows the market potential of durian rind powder and mung bean flour

Reproducibility of Results and Performance of TB Diagnostics in East Africa Public Health Laboratories Networking Project - in Kenya

No Abstract

Enteropathogen antibody dynamics and force of infection among children in low-resource settings.

Little is known about enteropathogen seroepidemiology among children in low-resource settings. We measured serological IgG responses to eight enteropathogens (Giardia intestinalis, Cryptosporidium parvum, Entamoeba histolytica, Salmonella enterica, enterotoxigenic Escherichia coli, Vibrio cholerae, Campylobacter jejuni, norovirus) in cohorts from Haiti, Kenya, and Tanzania. We studied antibody dynamics and force of infection across pathogens and cohorts. Enteropathogens shared common seroepidemiologic features that enabled between-pathogen comparisons of transmission. Overall, exposure was intense: for most pathogens the window of primary infection was <3 years old; for highest transmission pathogens primary infection occurred within the first year. Longitudinal profiles demonstrated significant IgG boosting and waning above seropositivity cutoffs, underscoring the value of longitudinal designs to estimate force of infection. Seroprevalence and force of infection were rank-preserving across pathogens, illustrating the measures provide similar information about transmission heterogeneity. Our findings suggest antibody response can be used to measure population-level transmission of diverse enteropathogens in serologic surveillance

Operational Research Project Management, Experiences, Challenges and Lessons Learnt

Introduction: Effective project management revolves around Strategic Management. Logistics seem simple and straight forward but, often the role  it plays in scientific undertakings is overlooked. It is usually assumed that research starts and ends in the laboratory. It is a fact that, for research activities to be successful, it requires exceptional planning to ensure that, resources are available as per the approved work-plan. This entails  determination of what, when, who, why and how it is to be done. Recent studies indicate that, logistics-related activities' impact on research  undertakings significantly. Objective: To document the project management experiences and lessons learnt in coordinating and implementation of East Africa Public Health Laboratories Networking Project –Operational Research (EAPHLNP-OR) activities in five East African countries, namely: Kenya, Rwanda, Burundi, Uganda and Tanzania. Methodology: The operational research component of the EAPHLNP, KEMRI established an OR Secretariat to coordinate the project activities in  Kenya and provide leadership to regional principal investigators. In consultation with the project Secretariat, the role of the administrator involved Work plan and budget preparation, planning, organizing, communicating, coordinating local and regional meetings, linking KEMRI research team with the study site (Hospital Administration) and Research Teams in the various counties. The site Teams obtained informed consent, recruited respondents, collected specimens, analyzed the specimens and shipped a portion of the same together with the results to KEMRI. Key Activities Of The Project: Managing financial aspects (budget and financial report preparations), logistical coordination, and procurement of training materials, organizing for meeting venues, taking minutes, travel arrangements and participation in scientific report writing. Control mechanism such as dairies, ledger books, work plan charts and schedules, managing and monitoring the progress of the project activities. Lesson Learnt & Challenges: Interpersonal skills were essential at all stages of the project. The critical stage was the forming, storming, and  norming stages. Here, group dynamics and conflicts took center stage. This threatened to stall the OR Project. Timely and constant communication with the study site coordinators, prioritization of scheduled project activities, was essential. Ensuring all parties are kept informed on the progress of the OR activities. The information in user-friendly format dairies and schedules provided the necessary feedback at administrative level, on project performance and at research findings. Key challenges included fluctuating funding, group dynamic conflicts and staff transfers. Discussion: EAPHLNP-OR was a Seven (7) years project undertaking, which for effective management involved understanding of the operating environment, strategic planning for short and long term goals, constant communication, review of priorities, documentation and practise of goodinterpersonal skills. Conclusion: Successful project management in OR required an administrator to coordinate the utilization of the available resources both capital and human. This is the second supplement in this issue only aspects on findings from TB and Enteric studies done in Kenya have been addressed.Three regional policy briefs on TB Enteric and malaria have been included

Investigating a Non-Mesh Mosquito Net Among Outdoor Sleeping Nomadic Communities in Kenya.

Rising reports of exophagic malaria vectors make even more pressing the need for alternatives to traditional, mesh, long-lasting insecticidal nets (LLINs) designed for indoor sleeping and often inadequate in the protection of outdoor-sleeping populations. This study tests and evaluates the retention, utilization, and durability of novel, non-mesh nets designed for outdoor use. Longitudinal, cross-sectional surveys were conducted, the physical condition of nets was assessed, and bio-efficacy and insecticide content were tested. At 22 months, retention was 98.0%; 97.1% of nets fell within the World Health Organization (WHO) category of being in "good" condition; none were in the "torn" category. At 18 months post-distribution, 100% of nets had at least WHO Pesticide Evaluation Scheme (WHOPES)-acceptable levels of insecticide, this proportion was 66.7% at 22 months. This novel mosquito net has the potential to provide a durable and context-specific tool to prevent malaria among traditionally hard-to-protect and highly vulnerable populations