Factors Influencing Adherence to ARVs among Patients Attending Comprehensive Care Clinic within Jomo Kenyatta University of Agriculture and Technology, Kiambu County, Kenya

Background: The efficacy of anti-retroviral Therapy (ART) depends on adherence to the prescribed regimen. However, lack of adherence leads to treatment failure and drug resistance among other negative outcomes.Objective: To determine factors influencing adherence to ARVS among patients attending the Comprehensive Care Clinic (CCC) within Jomo  Kenyatta University of Agriculture and Technology (JKUAT).Design: A descriptive cross sectional study.Setting: Comprehensive Care Clinic within JKUAT.Subjects: Three hundred HIV positive patients, undergoing ART treatment and follow up at the JKUAT clinic for a minimum duration of one month before the study, were recruited.Results: Of the 300 patients enrolled for the study (70% females and 30% males), 81%were adhering to ARV treatment. The factors that were significantly associated with adherence included; Support (encouragement and reminder to take drugs) (P=0.025); the number of meals respondents took in a day (P = 0.001); pill burden (P = 0.002) and forgetfulness (P = 0.001). However, there was no significant relationship between adherence and age, marital status, education, employment status or time taken to travel to the clinic.Conclusion: This study concluded that, the observed level of sub-optimal adherence to ART (19%) is of public health concern. These patients are vulnerable to treatment failure and development of resistant viral strains. Consequently the modifiable factors (Support, Number of meals taken, pill burden, and forgetfulness, should be addressed to change the current trea

Prevalence and Intensity of Single and Mixed Schistosoma mansoni and Schistosoma haematobium Infections in Primary School Children in Rachuonyo North District, Homabay County, Western Kenya

Objective: To determine the prevalence and intensity of single and mixed schistosomiasis infection among primary school children in Rachuonyo North District, Homabay County in western Kenya.Design: A descriptive cross sectional study.Setting: A parasitological survey involving six primary schools in  Rachuonyo North District, Homabay County.Subjects: Four hundred and seventy four(474) school children, seven to 15 years old. Each child provided a urine and stool sample for diagnosis of schistosome and soiltransmitted helminth infections. Urine samples were processed using the filtration technique and the sample examined by microscopy for Schistosoma haematobium ova. Stool samples were processed by the Kato-Katz technique and the sample examined by microscopy for ova of S. mansoni and soil-transmitted helminths.Results: Prevelance of S.haematobium was 37.6%, S.mansoni (12.2%), hookworm (14.6%), Ascaris lumbricoides (6.3%), Trichuris trichiura (5.3%) among the children in the participating schools. Overall, 78.6% of the children infected with S.haematobium had light infection (< 50eggs per 10 ml of urine) and the rest (21.4%) had heavy infection (.50 eggs per 10 ml of urine). On the hand, 75.9% of those with S.mansoni had lightinfection (one to 99 eggs per gram of stool (EPG), and the rest (24.1% ) had moderate infection intensities (100-399 (EPG).Conclusion: This is the first report in which both S.haematobium and S.mansoni are found together in the same geographic locality in high prevalence in the Lake Victoria region of western Kenya, with S. haematobium being the most predominant in some places. Rachuonyo North District becomes a new focus of mixed human schistosome infections in Kenya. The significant burden of schistosomiasis in this area highlightsthe need to include regular treatment for schistosomiasis in the national school based deworming programme especially now that the infection occurs in areas more than five kilometres away from the lake

Factors associated with late presentation of suspected tuberculosis cases to tuberculosis management facilities: The case in Dagoretti district, Nairobi, Kenya

Background: Tuberculosis is a highly contagious disease accounting for a high number of deaths in the developing countries; its control can beeffectively achieved if individuals with the disease receive adequate and timely treatment. The objective of this study was to determine the factorsassociated with late presentation of suspects to tuberculosis management facilities in Dagoretti district in Nairobi, Kenya.Methods: A cross sectional study was conducted on patients aged 18 years and above attending TB clinics in Dagoretti District, Nairobi Kenya. A total of 426 TB suspects were interviewed. The study covered 8 clinics in Dagoretti district. Analysis was done using SPSS version 16.0 and Epi info version 6, this included Chi Square for Bivariate analysis and Binary Logistic Regression for Multivariate Analysis.Results: Out of the 426 tuberculosis suspects, 248 (58.2%) suspects had delayed in seeking medical care. In Bivariate analysis male gender (P=0.039, O.R=1.51; 95% Confidence Interval; 1.00- 2.27), level of education (Primary class 5-8) (P=0.001, O.R= 2.06; 95% C.I 1.34-3.19) and place of first medical care (drug store) (P= 0.013, O.R=1.63; 95% C.I 1.09-2.46) were all significantly associated with late presentation. After multivariate logistic regression, gender (P=0,019, OR=1.6), level of education (p=0.029, OR=1.26) and place of first medical care (P= 0.01 OR=1.27), were found to be significantly associated with late presentation. Conclusion: This study shows that age, level of education and place of first medical care are the factors associated with late presentation of suspects to tuberculosis management facilities.Key words: Tuberculosis, late presentation, management, suspects, participants, respondents, Keny

Analysis of the genetic diversity of selected East African sweet potato (Ipomea batatas [L.] Lam.) accessions using microsatellite markers

Sweet potato (Ipomea batatas [L.] Lam.) is an economically important crop in East Africa chiefly grown by small holder farmers. Sharing of vines for planting is a very common occurrence among these farmers and eventually varieties are given local names, making it hard to trace the original pedigree. It is therefore important to characterise the sweet potato germplasm for purposes of breeding and germplasm conservation. In this study, 68 sweet potato accessions were evaluated for diversity using 12 microsatellite markers. The genetic relationship of the germplasm was evaluated using the Jaccard’s coefficient for dissimilarity analysis, unweighted pair group method with arithmetic means (UPGMA) tree and principal component analysis (PCoA) on DARwin software, while summary statistics was done using PowerMarker and Popgene softwares. The polymorphic information content of the markers ranged from 0.1046 for markers J67b and J67 to 0.3671 for marker J1809a, with a mean value of 0.2723. The total number of alleles amplified was 21. The major allele frequency ranged from 0.5882 for marker JB1809a to 0.9412 for markers J67b and J67c. Cluster analysis divided the accessions into four major clusters. Principle component analysis divided the accession into four groups which were different from those by cluster analysis. This study was able to identify several distinct accessions as well as a few possible duplicate accessions that overlapped on the cluster analysis.Key words: Sweet potato, cluster analysis, genetic diversity, principal component analysis, Simple SequenceRepeats

Immunological profiles in HIV positive patients following Haart initiation in Kigali, Rwanda

Background: Interleukin-10, IL-2 and IFN -γ are some of the crucial cytokines associated with HIV infection and pathogenesis. While IL-2 and IFN-γ play critical roles in host resistance to infection, IL-10 inhibits the synthesis IFN-γ, IL-2 at mRNA and protein level; exacerbating damage to immune system.Objective: To determine the levels of, changes in and correlation between CD4 count, viral load, IL-10, IL-2 and IFN-γ before HAART and at six months of HAART among HIV positive patients in Kigali; with a view to understand cytokine networks particularly in relation to HAART ; and to see whether they can be used as alternative markers of the disease progression.Design: Longitudinal study.Setting: Kagugu, Kimironko, Biryogo, Gitega Health Centres and Centre Medico-Social Cornum; all located in Kigali.Subjects: Thirty three (33) HAART initiation eligible HIV positive patients including 13 women and 20 men.Results: A drop in viral load (though only a small number of patients achieved an undetectable viraemia); a recovery of CD4+ cells, a decrease in IL-10 (though it remained high for many patients especially those with unchanged viraemia); and an increase in IL-2 and IFN-γ indicated a successful HAART . A negative correlation between CD4 count and viral load and between CD4 count and IL-10 (but r <-0.5) was observed. IL-10 correlated positively and strongly with viremia (r > 0.5 at both time points: p-values <0.05). There was no significant correlation between CD4 count, IL-2 and IFN-γ.Conclusion: Results demonstrated the down-regulatory effect of IL-10 on Th1 cytokines and that a shift from Th1 to Th2 cytokine is associated with HIV disease progression. A successful HAART results in CD4+ cells recovery, drop in viraemia and IL-10 with up-regulation of Th1 cytokines. Also, findings show potential usefulness of IL-10 as a marker of HIV disease progression

Lessons Learned in Conducting Mass Drug Administration for Schistosomiasis Control and Measuring Coverage in an Operational Research Setting

The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was created to conduct research that could inform programmatic decision-making related to schistosomiasis. SCORE included several large cluster randomized field studies involving mass drug administration (MDA) with praziquantel. The largest of these were studies of gaining or sustaining control of schistosomiasis, which were conducted in five African countries. To enhance relevance for routine practice, the MDA in these studies was coordinated by or closely aligned with national neglected tropical disease (NTD) control programs. The study protocol set minimum targets of at least 90% for coverage among children enrolled in schools and 75% for all school-age children. Over the 4 years of intervention, an estimated 3.5 million treatments were administered to study communities. By year 4, the median village coverage was at or above targets in all studies except that in Mozambique. However, there was often a wide variation behind these summary statistics, and all studies had several villages with very low or high coverage. In studies where coverage was estimated by comparing the number of people treated with the number eligible for treatment, denominator estimation was often problematic. The SCORE experiences in conducting these studies provide lessons for future efforts that attempt to implement strong research designs in real-world contexts. They also have potential applicability to country MDA campaigns against schistosomiasis and other NTDs, most of which are conducted with less logistical and financial support than was available for the SCORE study efforts

Effect of perceived default risk and accounting information quality on the decision to grant credit to SMEs

ABSTRACT: The present study analyses the influence that perceived default risk and accounting information quality have on the process of credit granting to SMEs. Empirical evidence was obtained from a survey of 471 bank loan officers in Spain, in which they were asked to answer questions relating to audited and not-audited firms. Through a Structural Equations Modeling (SEM) approach, the results confirm that the likelihood that the loan officers are more willing to provide access to credit to SMEs, and to do so in more favourable conditions, is negatively influenced by perceived default risk and positively influenced by the general perception about accounting information quality. Besides, we find that information quality is an antecedent of perceived risk, so that the latter becomes the central element of the research model. Additionally, the perceptions of the decision-makers regarding all the analysed variables are better for the audited SMEs than for the unaudited ones

Epidemiology and interactions of Human Immunodeficiency Virus - 1 and Schistosoma mansoni in sub-Saharan Africa.

Human Immunodeficiency Virus-1/AIDS and Schistosoma mansoni are widespread in sub-Saharan Africa and co-infection occurs commonly. Since the early 1990s, it has been suggested that the two infections may interact and potentiate the effects of each other within co-infected human hosts. Indeed, S. mansoni infection has been suggested to be a risk factor for HIV transmission and progression in Africa. If so, it would follow that mass deworming could have beneficial effects on HIV-1 transmission dynamics. The epidemiology of HIV in African countries is changing, shifting from urban to rural areas where the prevalence of Schistosoma mansoni is high and public health services are deficient. On the other side, the consequent pathogenesis of HIV-1/S. mansoni co-infection remains unknown. Here we give an account of the epidemiology of HIV-1 and S. mansoni, discuss co-infection and possible biological causal relationships between the two infections, and the potential impact of praziquantel treatment on HIV-1 viral loads, CD4+ counts and CD4+/CD8+ ratio. Our review of the available literature indicates that there is evidence to support the hypothesis that S. mansoni infections can influence the replication of the HIV-1, cell-to-cell transmission, as well as increase HIV progression as measured by reduced CD4+ T lymphocytes counts. If so, then deworming of HIV positive individuals living in endemic areas may impact on HIV-1 viral loads and CD4+ T lymphocyte counts.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

IL-10 Blocks the Development of Resistance to Re-Infection with Schistosoma mansoni

Despite effective chemotherapy to treat schistosome infections, re-infection rates are extremely high. Resistance to reinfection can develop, however it typically takes several years following numerous rounds of treatment and re-infection, and often develops in only a small cohort of individuals. Using a well-established and highly permissive mouse model, we investigated whether immunoregulatory mechanisms influence the development of resistance. Following Praziquantel (PZQ) treatment of S. mansoni infected mice we observed a significant and mixed anti-worm response, characterized by Th1, Th2 and Th17 responses. Despite the elevated anti-worm response in PBMC's, liver, spleen and mesenteric lymph nodes, this did not confer any protection from a secondary challenge infection. Because a significant increase in IL-10-producing CD4+CD44+CD25+GITR+ lymphocytes was observed, we hypothesised that IL-10 was obstructing the development of resistance. Blockade of IL-10 combined with PZQ treatment afforded a greater than 50% reduction in parasite establishment during reinfection, compared to PZQ treatment alone, indicating that IL-10 obstructs the development of acquired resistance. Markedly enhanced Th1, Th2 and Th17 responses, worm-specific IgG1, IgG2b and IgE and circulating eosinophils characterized the protection. This study demonstrates that blocking IL-10 signalling during PZQ treatment can facilitate the development of protective immunity and provide a highly effective strategy to protect against reinfection with S. mansoni

The dominant Anopheles vectors of human malaria in Africa, Europe and the Middle East: occurrence data, distribution maps and bionomic précis

<p>Abstract</p> <p>Background</p> <p>This is the second in a series of three articles documenting the geographical distribution of 41 dominant vector species (DVS) of human malaria. The first paper addressed the DVS of the Americas and the third will consider those of the Asian Pacific Region. Here, the DVS of Africa, Europe and the Middle East are discussed. The continent of Africa experiences the bulk of the global malaria burden due in part to the presence of the <it>An. gambiae </it>complex. <it>Anopheles gambiae </it>is one of four DVS within the <it>An. gambiae </it>complex, the others being <it>An. arabiensis </it>and the coastal <it>An. merus </it>and <it>An. melas</it>. There are a further three, highly anthropophilic DVS in Africa, <it>An. funestus</it>, <it>An. moucheti </it>and <it>An. nili</it>. Conversely, across Europe and the Middle East, malaria transmission is low and frequently absent, despite the presence of six DVS. To help control malaria in Africa and the Middle East, or to identify the risk of its re-emergence in Europe, the contemporary distribution and bionomics of the relevant DVS are needed.</p> <p>Results</p> <p>A contemporary database of occurrence data, compiled from the formal literature and other relevant resources, resulted in the collation of information for seven DVS from 44 countries in Africa containing 4234 geo-referenced, independent sites. In Europe and the Middle East, six DVS were identified from 2784 geo-referenced sites across 49 countries. These occurrence data were combined with expert opinion ranges and a suite of environmental and climatic variables of relevance to anopheline ecology to produce predictive distribution maps using the Boosted Regression Tree (BRT) method.</p> <p>Conclusions</p> <p>The predicted geographic extent for the following DVS (or species/suspected species complex*) is provided for Africa: <it>Anopheles </it>(<it>Cellia</it>) <it>arabiensis</it>, <it>An. </it>(<it>Cel.</it>) <it>funestus*</it>, <it>An. </it>(<it>Cel.</it>) <it>gambiae</it>, <it>An. </it>(<it>Cel.</it>) <it>melas</it>, <it>An. </it>(<it>Cel.</it>) <it>merus</it>, <it>An. </it>(<it>Cel.</it>) <it>moucheti </it>and <it>An. </it>(<it>Cel.</it>) <it>nili*</it>, and in the European and Middle Eastern Region: <it>An. </it>(<it>Anopheles</it>) <it>atroparvus</it>, <it>An. </it>(<it>Ano.</it>) <it>labranchiae</it>, <it>An. </it>(<it>Ano.</it>) <it>messeae</it>, <it>An. </it>(<it>Ano.</it>) <it>sacharovi</it>, <it>An. </it>(<it>Cel.</it>) <it>sergentii </it>and <it>An. </it>(<it>Cel.</it>) <it>superpictus*</it>. These maps are presented alongside a bionomics summary for each species relevant to its control.</p