Attitudes and practices of caregivers on adherence to antiretroviral (ARV) Drugs among HIV-Infected children attending comprehensive care clinic in Kenyatta National Hospital

Background: Ensuring high level of adherence to anti-retroviral medication (ARV) is a priority in treating people living with HIV and AIDS. Adherence in children cannot be fully studied if we do not recognize the involvement of primary caregivers who largely determine how well and often the ARV medication is taken.Objective: To determine attitude and practices of the primary caregivers on adherence of ARV in HIV+ve children.Methods: A cross-sectional study involving primary caregivers of HIV +ve children. Interviewer administered questionnaires were used to collect data from 126 primary caregivers. The data was complemented with key informant in-depth interviews with the health workers at the Comprehensive Care Centre (CCC) and two focus group discussions (FGD) of the primary caregivers.Setting: Kenyatta National Hospital comprehensive care centre for HIV/AIDS.Results: Adherence of 97.2 % to antiretroviral drugs was reported. The primary caregivers reported various methods they used to remind them when to give the medication e.g. clock alarms. 99.2% of the caregivers were aware of the ARV side effects. Out of the 126 caregivers interviewed, 96% of them recommended that caregivers of HIV+ve children should know their HIV Status.Conclusion: This study has revealed that practices and attitude of the caregivers of HIV +ve primary caregivers of HIV+ve children influence the ARV adherence levels. Primary care givers are susceptible to or do suffer stress and HIV/AIDs Comprehensive Care Centres should consider establishment of pychosocial support groups. More studies and follow up especially in the rural settings for comparison with urban areas are recommended.Keywords: antiretroviral treatment, children, primary caregivers, adherenceAfr J Health Sci. 2013; 26:330-33

Determinants of vaccination coverage among pastoralists in north eastern Kenya

Background: Vaccination is the most cost-effective, highest-impact health intervention to reduce the morbidity and mortality of Vaccine Preventable Diseases (VPDs). Despite success in Kenya implementing the Expanded Programme on Immunisation, VPDs remain prevalent in pastoralist communities. Pastoralism was defined as raising any livestock other than fowl; nomadism was defined by seasonal movement ofanimals for grazing.Objective: To examine the roles of geographic access and Knowledge, Attitudes, and Practices (KAPs) on vaccination coverage among settled and nomadic pastoralist households (HHs).Design: A cross-sectional study.Setting: Lagdera Sub-county, Garissa County, North Eastern, Kenya.Subject: Twelve mothers were selected for interview per cluster. We used a structured instrument to survey pastoralist mothers with children aged 0–59 months old.Results: A total of 476 eligible mothers were interviewed with 725 children; 241 mothers (50.6%) belonged to nomadic HHs while 235 (49.4%) belonged to settled HHs. Forty percent of nomadic mothers stated that vaccination was “very important” compared to 87.2% of mothers from settled HHs. Nearly 60% of mothers from nomadic HHs had never vaccinated all their children in comparison to 7.2% of mothers from settled pastoralist. The main reason for non-vaccination among mothers from nomadic HHs was “hospital or clinic was too far away” (78.6%).Analysis of the collected data revealed steep distance decay in the level of vaccine utilisation.Conclusion: Nomadic pastoralist exhibited very low vaccination coverage than their settled counterpart.This, in turn, calls for proper policy measures for addressing these inequities

Prevalence of cystic echinococcosis in livestock slaughtered in selected abattoirs of Laikipia West Sub-County, Kenya

Background: Cystic echinococcosis (CE) is a neglected, emerging and reemerging zoonotic disease caused by the larval stage of the dog tapeworm of the genus Echinococcus. It causes great public health and economic concerns wherever it occurs. CE is endemic in Kenya and most studies done in the country focused on two loci; Turkana and Maasai communities. The prevalence of CE has not been documented in Laikipia County which is located between two CE hot spot areas in Kenya.Objectives: To estimate the prevalence of CE in livestock slaughtered in abattoirs of Laikipia west Sub CountyDesign: A cross-sectional studySetting: Three selected abattoirs in Laikipia west Sub CountySubjects: All cattle, sheep and goats slaughtered in the selected abattoirs between October and December, 2015.Main outcome measures: Species, sex, CE status, and originResults: A total of 339 cattle, 1396 sheep and 478 goats were examined for presence of hydatid cysts in both the thoracic and abdominal cavities during postmortem meat inspection. Overall prevalence was 3.3% and individual species’ prevalence was 11.8%, 1.5% and 2.3% in cattle, sheep and goats respectively. Most (99.1 %) slaughter animals originated from the study area. Forty-three percent (31/72) of the CE positive animals had fertile cysts and 87.1% of them originated from the study area.Conclusion: The results show a significantly higher prevalence of CE in cattle with most slaughter animals and those with fertile cysts originating from the study area. Possible implications for public health and the livestock economy require immediate control measures

Low anti tuberculosis drug resistance despite high rates of recurrent tuberculosis and HIV infection in western Kenya

Background: The high rates of recurrent tuberculosis and HIV in Kenya raised the assumption that anti -tuberculosis drug resistance may be an increasing problem. Objective: To determine whether HIV co infection and TB recurrence are associated with anti TB drug resistance. Methods: Cross sectional study in which sputa from 872 TB suspects underwent ZN smear microscopy and culture. Growth was identified using Hain molecular identification kits. Screening for HIV infection was done using Uni GoldTM rapid test and the positives confirmed with enzyme linked immunosorbent assay. Results: A total of 186 M. tuberculosis complex and 15 non tuberculous mycobacteria isolates were obtained. The tuberculosis recurrence and TB HIV co infection rates amounted to 44.8% and 41.8%, respectively. All the 186 M. tuberculosis isolates were susceptible to streptomycin and ethambutol. Only 12 (6.5%) of the isolates were mono drug resistant, nine to isoniazid and three to rifampicin. Only 3/27 isoniazid resistant isolates were from recurrent TB cases. Conclusion and recommendation: No MDR strains of M. tuberculosis were observed in the current study. However, the study suggests an association between HIV co-infection and anti TB mono drug resistance. High TB recurrence observed in the current study was not associated with anti TB drug resistance. What needs to be examined is the cause of this high TB recurrence rate in Western Kenya. Keywords: Recurrent TB; HIV co infection; antiTB drug resistance; prevalenc

Ziehl-Neelsen microscopy in the diagnosis of tuberculosis in settings of high human immunodeficiency virus prevalence

Objective: To determine the accuracy of Ziehl-Neelsen microscopy in the diagnosis of TB in setings of high HIV prevalence.Design: Cross-sectional descriptive study.Setting: Hospitals serving areas of high human immunodeficiency virus prevalence in western Kenya. The study was conducted between September 2007 and September 2009.Results: In total, 341/872 (39.1%) of the TB suspects were positive in ZN, 53.1% (181/341) of them culture positive. Only 3.8% (20/531) of the ZN smear negatives were culture positive. Of the 695 suspects evaluated for both Mycobacterium and HIV infection, 255 (36.7%) were ZN smear positive, 42.7% of them HIV positive. Out of the 440 ZN smear negatives, 37% were HIV positive. Similarly, 168 suspects were culture positive, 46.4% of them HIV positive. The HIV infection did not significantly reduce ZN smear positivity rate (P = 0.42) and culture sensitivity (P = 0.09). The ZN sensitivity and specificity were 88.1% and 79.7%, respectively. The predictive values were 58.0 (PPV), and 95.5% (NPV), respectively. However, the area under the ROC curve was 0.84, with 95% CI between 0.80-0.87 and P< 0.001). The ZN smear microscopy had a lesser ability to distinguish between TB and non-TB cases compared to culture.Conclusion: ZN microscopy causes a significant over-diagnosis of TB in settings of high HIV/AIDS prevalence. There is need for further studies on this subject taking into consideration the various confounding factors

Factors associated with risky sexual behavior among HIV negative partners in HIV discordant relationships in Nairobi, Kenya

Introduction: Whereas risky sexual behavior influences HIV acquisition, little information is available on risk taking practices among negative partners in HIV discordant relationships in our settings. This study sought to determine the associated factors among this population in Nairobi.Methods: This study was a cross-sectional descriptive study and 133 HIV negative partners participated in the study.Results: Out of the 133 participants, 66.9% were male and 33.1% were female. Overall, 44.4% of the study participants reported inconsistent condom use, 14.3% reported having another sexual partner and 30% reported ever engaging in sexual activities under the influence of alcohol. Monthly earnings (p- 0.02), alcohol use (p- 0.03) and the index partner being on anti-retroviral medication (p-0.02) were significantly associated with having another sexual partner. Focus group discussion findings showed that male gender, alcohol use and the duration of the relationship influenced the decision to use condoms while male gender influenced having another sexual partner.Conclusion: Risky sexual behavior practices still occur among the HIV negative partners in discordant relationships. More education and sensitization should be made on the risks associated with this behavior so as to reduce the risk of HIV infection from their infected partners.Afr J Health Sci. 2013; 26:324-33

Anti-tuberculosis drug resistance in Nairobi, Kenya

Background: Drug resistant tuberculosis (TB) which is a state when Mycobaterium tuberculosis (MTB) organisms are resistant to antimicrobial agents at the levels attainable in blood and tissue pose a serious threat to TB control programs. Limited information exists on the exact prevalence of resistance to anti-tuberculosis drugs in populations with high rates of tuberculosis and HIV co-infection such as those in Nairobi, Kenya. Setting: A cross sectional study was conducted among new and previously treated consecutive sputum smear positive pulmonary tuberculosis (PTB) patients of 14 years and older at 16 diagnostic and treatment facilities in Nairobi, Kenya, between February and August 2010. Objective: To determine the magnitude of drug resistance to first line antituberculosis drugs among MTB isolates obtained from a study addressing the diagnosis and epidemiology of drug resistant tuberculosis in Nairobi, Kenya. Methods: Sputum samples from patients with bacteriologically confirmed PTB on microscopy were cultured on Lowenstein Jensen (LJ) media. Participants were offered diagnostic testing and counselling for HIV testing. Strains of MTB complex from Lowenstein Jensen (LJ) slopes were subjected to drug susceptibility testing (DST) to isoniazid (H), rifampicin (R), streptomycin (S), and ethambutol (E) using the proportional method on the Mycobacterium Growth Indicator Tube (MGIT) conventional method. Results: A total of 595 TB patients had their MTB strains DST done. Of the 568 (95.4%) patients who had valid results for analysis, 369 were new and 199 previously treated. About eighty five percent and seventy seven percent of the strains from new patients and previously treated patients were fully sensitive to all the drugs tested respectively. Any resistance to isoniazid, streptomycin, ethambutol and rifampicin was 10.3%, 4.3%, 5.1% and 0.81% respectively among new patients. Among previously treated patients any resistance to isoniazid, streptomycin, ethambutol and rifampicin was 18.1%, 10.5%, 7.03% and 9.04% respectively. The prevalence of MDR TB defined as resistant to at least both isoniazid and rifampicin was 0.54% and 8.54% among new and previously treated patients respectively. Conclusion: The study found high levels of drug resistant TB in Nairobi compared to other previous studies done in the country. MDR TB in Kenya is now a reality and the situation in Nairobi being the largest cosmopolitant city is worrying. The upword trend of MDR TB in Nairobi is course of concern. This calls for urgent concerted efforts to address the problem especially the strenghthening of the implementation of the comprehensive framework of the DOTS-Plus strategy for appropriate management of MDR-TB

Misdiagnosis and clinical significance of non-tuberculous mycobacteria in Western Kenya in the era of human immunodeficiency virus epidemic

Objectives: To determine and document the role of non-tuberculous mycobacteria (NTM) in TB-like disease morbidity and demonstrate the confusion they cause in the diagnosis of TB in western Kenya.Design: A cross-sectional study.Setting: One provincial and nine District hospitals in western Kenya.Subjects: Tuberculosis suspects.Interventions: Sputa from 872 tuberculosis suspects underwent microscopy and culture on solid and liquid media. The growth was identified using the Hain’s GenoType® Mycobacterium CM and GenoType® Mycobacterium AS kits. Consenting clients were screened for HIV infection using Trinity Biotech Uni-GoldTM test and positive cases were confirmed with the enzyme linked immunosorbent assay. A questionnaire was used to obtain demographic data.Main outcome measures: ZN smear positivity / negativity; Culture positivity or negativity; Mycobacterium species isolates (tuberculous or non-tuberculous); HIV status.                                                      Results: Sputa from 39.1% (341/872) of the participants were ZN smear positive, of these 53.1% (181/341) were culture positive. Only 3.8% (20/531) of the ZN smear negatives were culture positive. In total 41.4% (361/872) participants were infected with mycobacteria, of which 44.3% (160/361) were culture negative and 55.7% (201/361) were culture positive. The culture positives yielded 92.5% M. tuberculosis complexand 7.5% NTM. The overall prevalence of the NTM disease was 1.72% (15/872).                                                                            Conclusion: A low prevalence of NT M pulmonary disease in western Kenya is reported in this study, but some the NTM disease cases could have been misdiagnosed as TB cases

A high rate of recurrent tuberculosis in western Kenya independent of human immunodeficiency virus infection

Background: Previous studies have shown that recurrent TB develops in about 2-5% of the patients after curative treatment with short-course anti-TB chemotherapy. With the advent of HIV/AIDS, the rate TB recurrence is anticipated to rise. Objectives: To determine whether HIV infection and TB recurrence are associated with anti-TB drug resistance and the rates of ZN microscopy and culture positivity among the recurrent TB cases in western Kenya. Design and methods: A cross-sectional study was carried out between 2007 and 2009. Sputa from 872 tuberculosis suspects underwent mycobacteriologic evaluation using Ziehl Neelsen smear microscopy, LowensteinJensen and BACTEC MGIT 960 culturing, and Hain’s GenoType® Mycobacterium CM and GenoType® Mycobacterium AS molecular identification tests. Consenting participants were screened for HIV infection using Uni-Gold TM test and positives were confirmed with the enzyme linked immunosorbent assay. Results: In total, 361/872 (41%) of the suspects mycobacterial disease (346 TB, 4.2% non-tuberculous mycobacterial disease). HIV testing was accepted by 695 (79.7%) and 39.1% of these (272/695) were found positive. Recurrence of TB constituted 44.8% (155/346) of the TB cases, with 41.9% (65/155) of them co-infected with HIV. There was nosignificant difference in TB recurrence rates with HIV status [OR = 0.57; 95% CI: 0.29-1.13; P = 0.10]. Conclusions and recommendations: This study reports a much higher (44.8%) rate of recurrent TB, compared to that of National TB control Programme of 5% in 2008 and a combined retreatment rate of 14% in 2009. The HIV co-infection and TB recurrence were not associated with anti-TB drug resistance. The majority of TB recurrent cases were ZN smear negative (67.7%) and culture negative (80%). The high TB recurrence observed in this study calls for studies to determine the proportions of the disease attributable to endogenous re-activation (relapse) and exogenous re-infection. Keywords: Recurrent tuberculosis; HIV co-infectio

Prognostic factors influencing HIV-free survival among infants enrolled for HIV early infant diagnosis services in selected hospitals in Nairobi County, Kenya

YesDespite being a preventable disease, pediatric HIV infection continues to be a public health concern due to the morbidity and mortality associated with the disease. Vertical transmission of HIV occurs when a mother living with HIV passes the virus to her baby during pregnancy, childbirth, or breastfeeding. Globally, the vertical transmission rate of HIV is 9% with sub-Saharan Africa accounting for 90% of these infections. In Kenya, the national vertical transmission rates of HIV stood at 11.5% by the end of 2018, with a target to reduce vertical transmission rates to below 5% and 2% in breastfeeding and non-breastfeeding infants respectively, by the end of 2021. To determine the prognostic factors influencing HIV-free survival among infants enrolled for HIV early infant diagnosis (EID) services in selected hospitals in Nairobi County, Kenya. A prospective cohort study design was adopted. HIV exposed infants were recruited at six weeks to determine HIV-free survival over 12 months follow up. Simple random sampling was used to select 166 infants and data were collected from the mothers using semi-structured interviewer-administered questionnaires. Log-rank tests were used to test for associations at the bi-variable level while Cox-proportional regression was used to analyze data at the multi-variable level, with the aid of STATA 14 software. Ethical approval was obtained from Kenya Medical Research Institute, Scientific Ethics Review Unit. The overall infant HIV incidence rate over one-year follow-up was 9 cases per 100 person-years (95% CI: 5.465-16.290). The failure event was defined as an infant with a positive PCR test during the study period with total failures being 13 (9.41%) over 12 months. Prognostic factors associated with poor infant HIV-free survival were young maternal age (18-24 years) and mothers with a recent HIV diagnosis of ≤ 2 years since a positive HIV diagnosis (HR 5.97 CI: 1.20, 29.58) and (HR 6.97 CI: 1.96, 24.76), respectively. Maternal prognostic factors associated with poor infant HIV-free survival were young maternal age (18-24 years) and recent maternal HIV diagnosis of ≤ 2 years since positive HIV diagnosis. The study recommended the development of an intervention package with more rigorous adherence counseling and close monitoring for young mothers, and mothers with recent HIV diagnoses