Prevalence of hepatitis A virus in patients attending a referral hospital in Bubanza Province, Northwest Burundi

Background: Viral hepatitis is a public health problem wide world. Hepatitis A, transmitted by fecal-oral route, is an infectious viral disease caused by hepatitis A virus and mainly due to poor sanitation. This study aimed to determine the prevalence of hepatitis A virus and associated factors in patients attending Mpanda referral hospital in Northwest Burundi.Methods: A cross-sectional study was done from November 2017 to January 2018 on 385 participants aged 2 years and above. Participants were recruited using a systematic random sampling technique. Data were collected using questionnaire from consented/assented participants. Five millilitres of venous blood was collected and analyzed. Anti-hepatitis A virus antibodies were screened using Enzyme Immuno Assay. Data were analyzed using Statistical Package for the Social Sciences version 16.0 software. A descriptive analysis was followed by bivariate analysis using a Chi-square test for comparison of various sub-groups with 5% statistical significance level. Odds ratio and 95% Confidence Intervals were calculated and presented.Results: The median age of the participants was 23 years and the range 72 years. The overall prevalence of Hepatitis A virus was 60.3%. There was a significant association between age [OR=7.22 (4.04-12.93), P <0.001], lack of clean water [OR=10.07 (5.63-18.01), P <0.001], traditional latrines [OR=1.86 (1.02-3.40), P=0.04] and Hepatitis A Virus seroprevalence.Conclusions: Present study shows high prevalence of HAV infection in patients attending Mpanda Referral Hospital. Younger age, lack of clean water and traditional latrines play roles in increasing prevalence of HAV infection in both rural and urban areas

Molecular Characterization of HIV-1 And Drug Resistance Among HIV-1 Infected Patients Attending Kayanza District Hospital, Burundi

This study was funded by the East Africa Public health Laboratory Network Project (EAPHLNP)/Burundi. Abstract Virological failure in management of HIV-1 infection has been reported to be between 11 to 24% after 12 months of treatment. Out of these, acquired or transmitted drug resistance mutations have been reported at 71% to 90% in Sub-Sahara Africa. In this cross-sectional study we aimed to determine virological failure and drug resistance mutations in HIV-1 infected patients on ART attending Kayanza district hospital, Burundi. Patients were recruited using a purposive sampling technique. After informed consent, 4mL of venous blood was collected from each patient. The blood was separated into plasma and cells for various laboratory assays. Plasma viral loads were quantified using the Abbott m2000rt system. Polymerase chain reaction using gene specific primers was done after extraction of nucleic acids from plasma with &gt;1000 copies/ mL, followed by sequencing of all amplified samples. Drug resistance was determined using the IAS and Stanford University database, with phylogenetic analyses done using the neighbor joining method.Two hundred patients were recruited; 13% of the respondents had virological failure associated with multiple sex partners (adjusted odds ratio (aOR, 0.154 , p =0.016) and irregularity in taking medications (aOR: 0.4 , p=0.014). Fifteen samples were successfully sequenced; 80% (12/15) were HIV-1 subtype C, 7% (1/15) subtype A, and 13% (2/15) were HIV-1 subtype A1. Of these, 87.5% had at least one mutation (NRTI or NNRTI), while 12.5 % did not carry any Drug Resistance Mutations. The most common drug resistance mutations were M183V, T215V M41L, E44D, L74I, L210W and K65R, K103N, Y188H. The prevalence of virological failure was established at 13%.Our findings showed possible gaps in the last 90% of the 90-90-90 WHO target by 2020. The results highlight the need for intense viral load and resistance testing for patients to improve overall treatment outcome. Some strategies are needed to improve adherence counselling and drug resistance mutation testing should be implemented to monitor HIV-1 patients on ART in Burundi. Keywords: HIV-1, antiretroviral therapy, Virological failure, DRMs, Burundi. DOI: 10.7176/JBAH/9-10-05 Publication date:May 31st 201

Prevalence and Genetic Characterization of Rotavirus Infections Among Children Under Five Years in Mutaho Health District, Gitega Province and Bujumbura Municipality, Burundi

Rotavirus is the leading cause of severe diarrhea in children under five years worldwide. It is ranked as a priority for vaccine. In Burundi, vaccine against rotavirus was implemented in 2013. The impact of recent rotavirus vaccination on morbidities in Burundi is not well established. Moreover, no study has been carried out to document the genetic diversity of rotavirus strains circulating in Burundi. This cross-sectional health facility-based study aimed at determining the prevalence and molecular characteristics of rotavirus infections among children under five years of age in Mutaho Health District and the Municipality of Bujumbura, in Burundi. Stool specimens were collected from children presenting with acute diarrhea. These specimens were tested for rotavirus antigen using Diagnostar® rapid test kit.  Positive stool samples were confirmed at the Kenya Medical Research Institute (KEMRI) by ELISA. Positive confirmed samples underwent RT-PCR, G and P genotyping by multiplex semi-nested PCR using a cocktail of type specific primers or by sequencing. A total of 646 participants were enrolled in this study. The overall prevalence of rotavirus was 6.2% (40/646) with 4.0% (16/400) in Mutaho health district and 9.7% (24/246) in the Municipality of Bujumbura. Rotavirus detection rate tended to increase as the level of precipitation went down, showing a significant negative association between the two variables. (OR = 15.2; P = 0.0001). In addition, rotavirus detection rate was higher in Bujumbura Municipality than in Mutaho health district (OR = 2.6; P = 0.005). Two G genotypes were identified, G1 the predominating G genotype accounted for 53.8% (14/26) followed by G12 (46.2%, 12/26). The prevalence of the genotype G1 of Group A rotavirus was significantly higher in Bujumbura Municipality than in Mutaho health district while G12 predominated in Mutaho health district (OR = 7.33; P = 0.026). Rotavirus strains from pigs might have contributed to the high prevalence of human G12 rotavirus in that area. Three different P types were identified P[8] the most common, followed by P[6] and P[4]. The most common G/P combination genotype was G1P[8] which accounted for 45.5% of all rotavirus genotypes identified, followed by G12 P [8] (41.0%), G1P [6] (4.5%), G12 P [6] (4.5%) and G12 P [4] (4.5%). The emergence of G12 rotavirus strains which share neither G nor P genotypes with currently used rotavirus vaccines raises public health concerns as they have the potential to challenge their efficacy. Therefore, we recommend to initiate and maintain a continuous rotavirus strain surveillance in Burundi so as to monitor trends in the occurrence of these prevailing and potentially emerging new strains. Keywords: Rotavirus, diarrhea, genetic diversity, prevalence, Mutaho, Bujumbura, children DOI: 10.7176/JBAH/9-10-04 Publication date:May 31st 201

Factors Associated with Choice of Infant Feeding Practices among HIV-1 Positive Post-natal Clinic Attendees in Tharaka Nithi County

Background: Feeding practices for HIV-exposed infants plays a key role in determining the risk of morbidity and mortality. Infected mothers’ choice of infant feeding is influenced by many factors within the community hence challenging their decisions. We sought to determine factors associated with choice of HIV exposed infant feeding practices in the region. Methods: Two hundred and forty nine HIV infected mothers were systematically recruited.  Data on infant HIV status was obtained from facility records. Respondents were interviewed using a semi-structured questionnaire. Focus group discussions and key informant interviews were carried out to support primary data. Analysis was done using SPSS version 16.0. Logistic regression was used to determine association of factors that influenced choice of infant feeding practice. Results: Of the 249 respondents, 98% chose exclusively breastfeeding during prenatal counseling but majority did not sustain beyond 2 months, while replacement feeding was least practiced (2%) postnatal. Major factors that influenced feeding practices were mother’s education (OR 2.637; CI: 1.088-6.388), non-health care workers advise (OR 3.053; CI: 1.706-5.463), not belonging to support groups (OR 2.804; CI: 1.620-4.854) rejection of health care workers support (OR 3.386; CI: 1.937-5.919). Conclusion: Although exclusive breastfeeding was the preferred feeding choice among the respondents immediately after birth, it was not sustained beyond the second month of the infant’s life. Increased contact of HIV positive women with health care workers and professionals through promotion of trust in community health workers, attendance of ANC and delivery in hospital should be promoted.  Education efforts should also target non health care persons who influence feeding practices to reduce stigma among HIV positive mothers. Keywords:  Infant feeding practices; Stigm

High Parity and Low Education are Predictors of Late Antenatal Care initiation among Women in Maternal and Child Health Clinics in Kwale County, Kenya

Background: Timely initiation of antenatal care (ANC) clinic attendance during pregnancy helps identify and reduce risk factors in pregnancy.  The World Health Organization (WHO) recommends at least four ANC visits during pregnancy with the first being in the first trimester. In most developing countries including Kenya, the first visit occurs late in some mothers. Aim: This study describes ANC attendance by mothers at clinics in Kwale County. It was conducted with the aim of determining factors affecting ANC attendance in two dispensaries in Kwale County. Design: A cross-sectional study using quantitative research methods was adopted. Results: Two hundred and eighty pregnant women at a gestational age of 20 weeks and above were recruited and interviewed. All the mothers made at least one ANC visit with 19.6% starting in the first trimester. About a quarter of the mothers (24.0 %) came for the first time at nine months gestational age.  There was a significant relationship between late ANC initiation and low or no formal education (p = 0.001) as well as higher parity (p = 0.0001). Mothers with no formal education were four times more likely to initiate ANC clinics late  compared to those with secondary or tertiary education (OR = 4.687; CI 1.765 – 12.447). The likelihood of mothers whose husbands had no formal education initiating ANC later was almost three times more likely as compared to those who had secondary or tertiary education (OR = 2.775; CI 1.107 – 6.960).  Multiparous women were more likely to initiate ANC clinics earlier compared to grand multiparous women (OR = 0.513; CI 0.223 – 1.183). Conclusion: Timely initiation and appropriate ANC attendance was low in Kwale. Low education level and high parity had a significant negative association with timely ANC initiation. There is need for community mobilization and enlightening on the importance of timely ANC attendance for mothers to reap the full benefits of maternal and child health care. Keywords: Maternal, Antenatal, Child, Health, Parity, Multiparous, Grand multiparous.

Detection and typing of Human Papillomavirus in urine from patients attending a sexually transmitted infections clinic in Nairobi County, Kenya

Human papillomavirus (HPV) is a common sexually transmitted infection (STI) that has been etiologically linked to cervical cancer. Different types of samples can be used for cervical screening, including Pap test or biopsy and Liquid Based Cytology, visual inspection using acetic acid or Lugol’s iodine, and HPV testing. These methods are invasive. The use of urine as an alternative specimen may be more widely accepted since it is non-invasive and the sample is readily available. The study aimed at detecting and genotyping HPV in urine from patients attending a sexually transmitted infections clinic in Nairobi County. It also aimed at assessing the factors associated with HPV infection. In this cross-sectional study, a structured ‘risk factor’ questionnaire was administered and HPV from urine specimen was genotyped using the L1 gene. Phylogenetic and molecular evolutionary analyses were conducted. Bivariate analysis and Pearson’s chi square (χ2) tests were used to determine the association between HPV infection and factors associated with HPV. A total of 222 adults (45 males and 177 females) aged 18-49 years were recruited. The prevalence of HPV among males and females was 22.2% (10/45) and 32.8% (58/177) respectively. The prevalence of high-risk types among males and females was 25% (1/4) and 27.5% (11/40) respectively. The high risk HPV genotypes detected among females were: HPV-16 (10%), -66 (7.5%), and -70 (7.5%) while low risk types were HPV 6 (27.5%), followed by -81 (25%), -83 (10%), -11 (7.5%), and -54 (2.5%) respectively. The prevalence of low risk types among males and females was 75% (3/4) and 72.5% (29/40) respectively. The prevalent low-risk HPV type detected in males was HPV type 6 (75%) while HPV-58 (25%) was the only high risk type in males. History of sexually transmitted infections was significantly associated with HPV infection among females (P=0.002). There was also significant association between marital status among males (p=0.046), how often one had used the contraceptives among females (p=0.038) and HPV genotypes at bivariate level. The results indicate high HPV prevalence, high risk and low risk HPVs could be detected in urine from the two populations. Therefore; molecular testing of HPV on urine samples is a method that utilizes a non-invasive technique that may increase screening coverage as it is easy to obtain. Key words: urine, Human papillomavirus, HPV genotypes, PCR, cervical cancer

Efficient monitoring of HIV-1 vertically infected children in Kenya on first-line antiretroviral therapy

Background: Worldwide access to antiretroviral therapy (ART) in low- and middle-income countries has significantly increased. Although this presents better treatment options for HIV-infected individuals, the challenge of monitoring ART in these settings still remains. Objective: To investigate efficient and cost-effective criteria for assessing ART failure among HIV-1-infected children on first-line ART in resource-limited settings. Study design: Retrospective analysis of 75 HIV-1 vertically infected Kenyan children with a follow-up period of 24 months after initiating ART. Plasma viral load, peripheral CD4+T-cell counts and HIV-1 drug-resistance mutations were monitored biannually. Results: Plasma viral load (VL) was suppressed to undetectable level or more than 1.5 log10 from baseline levels in 53 (70.7%) children within 24 months. VL in the remaining 22 (29.3%) children was not suppressed significantly. Of the 22 children, 21 were infected with HIV-1 strains that developed drug-resistance mutations; 9 within 12 months and 12 between 12 and 24 months. Among the 53 who were successfully treated, VL was suppressed in 33 within 12 months and in 20 between 12 and 24 months. There was no significant difference in VL at baseline and the change of CD4+T-cell counts after initiating ART between those treated successfully and the failure groups. Conclusion: After initiating ART, children may require longer times to achieve complete viral suppression. Plasma viral load testing 24 months after initiating ART could be used to differentiate ART failures among HIV-1 vertically infected children in resource-limited settings. Additionally, drug resistance testing, if affordable, would be helpful in identifying those failing therapy and in choosing second-line regimens. © 2011 Elsevier B.V. All rights reserved

HIV-1 subtype and viral tropism determination for evaluating antiretroviral therapy options: an analysis of archived Kenyan blood samples

<p>Abstract</p> <p>Background</p> <p>Infection with HIV-1 is characterized by genetic diversity such that specific viral subtypes are predominant in specific geographical areas. The genetic variation in HIV-1 <it>pol </it>and <it>env </it>genes is responsible for rapid development of resistance to current drugs. This variation has influenced disease progression among the infected and necessitated the search for alternative drugs with novel targets. Though successfully used in developed countries, these novel drugs are still limited in resource-poor countries. The aim of this study was to determine HIV-1 subtypes, recombination, dual infections and viral tropism of HIV-1 among Kenyan patients prior to widespread use of antiretroviral drugs.</p> <p>Methods</p> <p>Remnant blood samples from consenting sexually transmitted infection (STI) patients in Nairobi were collected between February and May 2001 and stored. Polymerase chain reaction and cloning of portions of HIV-1 <it>gag</it>, <it>pol </it>and <it>env </it>genes was carried out followed by automated DNA sequencing.</p> <p>Results</p> <p>Twenty HIV-1 positive samples (from 11 females and 9 males) were analyzed. The average age of males (32.5 years) and females (26.5 years) was significantly different (p value < 0.0001). Phylogenetic analysis revealed that 90% (18/20) were concordant HIV-1 subtypes: 12 were subtype A1; 2, A2; 3, D and 1, C. Two samples (10%) were discordant showing different subtypes in the three regions. Of 19 samples checked for co-receptor usage, 14 (73.7%) were chemokine co-receptor 5 (CCR5) variants while three (15.8%) were CXCR4 variants. Two had dual/mixed co-receptor use with X4 variants being minor population.</p> <p>Conclusion</p> <p>HIV-1 subtype A accounted for majority of the infections. Though perceived to be a high risk population, the prevalence of recombination in this sample was low with no dual infections detected. Genotypic co-receptor analysis showed that most patients harbored viruses that are predicted to use CCR5.</p