Factors associated with the performance and cost-effectiveness of using lymphatic filariasis transmission assessment surveys for monitoring soil-transmitted helminths: a case study in Kenya.

Transmission assessment surveys (TAS) for lymphatic filariasis have been proposed as a platform to assess the impact of mass drug administration (MDA) on soil-transmitted helminths (STHs). This study used computer simulation and field data from pre- and post-MDA settings across Kenya to evaluate the performance and cost-effectiveness of the TAS design for STH assessment compared with alternative survey designs. Variations in the TAS design and different sample sizes and diagnostic methods were also evaluated. The district-level TAS design correctly classified more districts compared with standard STH designs in pre-MDA settings. Aggregating districts into larger evaluation units in a TAS design decreased performance, whereas age group sampled and sample size had minimal impact. The low diagnostic sensitivity of Kato-Katz and mini-FLOTAC methods was found to increase misclassification. We recommend using a district-level TAS among children 8-10 years of age to assess STH but suggest that key consideration is given to evaluation unit size

Hydro-Meteorology and Water Budget of the Mara River Basin Under Land Use Change Scenarios

Mara is a transboundary river located in Kenya and Tanzania and considered to be an important life line to the inhabitants of the Mara-Serengeti ecosystem. It is also a source of water for domestic water supply, irrigation, livestock and wildlife. The alarming increase of water demand as well as the decline in the river flow in recent years has been a major challenge for water resource managers and stakeholders. This has necessitated the knowledge of the available water resources in the basin at different times of the year. Historical rainfall, minimum and maximum stream flows were analyzed. Inter and intra-annual variability of trends in streamflow are discussed. Landsat imagery was utilized in order to analyze the land use land cover in the upper Mara River basin. The semi-distributed hydrological model, Soil and Water Assessment Tool (SWAT) was used to model the basin water balance and understand the hydrologic effect of the recent land use changes from forest-to-agriculture. The results of this study provided the potential hydrological impacts of three land use change scenarios in the upper Mara River basin. It also adds to the existing literature and knowledge base with a view of promoting better land use management practices in the basin

Hydro-Meteorology and Water Budget of the Mara River Basin Under Land Use Change Scenarios

Mara is a transboundary river located in Kenya and Tanzania and considered to be an important life line to the inhabitants of the Mara-Serengeti ecosystem. It is also a source of water for domestic water supply, irrigation, livestock and wildlife. The alarming increase of water demand as well as the decline in the river flow in recent years has been a major challenge for water resource managers and stakeholders. This has necessitated the knowledge of the available water resources in the basin at different times of the year. Historical rainfall, minimum and maximum stream flows were analyzed. Inter and intra-annual variability of trends in streamflow are discussed. Landsat imagery was utilized in order to analyze the land use land cover in the upper Mara River basin. The semi-distributed hydrological model, Soil and Water Assessment Tool (SWAT) was used to model the basin water balance and understand the hydrologic effect of the recent land use changes from forest-to-agriculture. The results of this study provided the potential hydrological impacts of three land use change scenarios in the upper Mara River basin. It also adds to the existing literature and knowledge base with a view of promoting better land use management practices in the basin

Land Use and Climate Change Impacts on the Hydrology of the Upper Mara River Basin, Kenya: Results of a Modeling Study to Support Better Resource Management

Some of the most valued natural and cultural landscapes on Earth lie in river basins that are poorly gauged and have incomplete historical climate and runoff records. The Mara River Basin of East Africa is such a basin. It hosts the internationally renowned Mara-Serengeti landscape as well as a rich mixture of indigenous cultures. The Mara River is the sole source of surface water to the landscape during the dry season and periods of drought. During recent years, the flow of the Mara River has become increasingly erratic, especially in the upper reaches, and resource managers are hampered by a lack of understanding of the relative influence of different sources of flow alteration. Uncertainties about the impacts of future climate change compound the challenges. We applied the Soil Water Assessment Tool (SWAT) to investigate the response of the headwater hydrology of the Mara River to scenarios of continued land use change and projected climate change. Under the data-scarce conditions of the basin, model performance was improved using satellite-based estimated rainfall data, which may also improve the usefulness of runoff models in other parts of East Africa. The results of the analysis indicate that any further conversion of forests to agriculture and grassland in the basin headwaters is likely to reduce dry season flows and increase peak flows, leading to greater water scarcity at critical times of the year and exacerbating erosion on hillslopes. Most climate change projections for the region call for modest and seasonally variable increases in precipitation (5–10 %) accompanied by increases in temperature (2.5–3.5 °C). Simulated runoff responses to climate change scenarios were non-linear and suggest the basin is highly vulnerable under low (−3 %) and high (+25 %) extremes of projected precipitation changes, but under median projections (+7 %) there is little impact on annual water yields or mean discharge. Modest increases in precipitation are partitioned largely to increased evapotranspiration. Overall, model results support the existing efforts of Mara water resource managers to protect headwater forests and indicate that additional emphasis should be placed on improving land management practices that enhance infiltration and aquifer recharge as part of a wider program of climate change adaptation

Land use and climate change impacts on the hydrology of the upper Mara River Basin, Kenya: results of a modeling study to support better resource management

Some of the most valued natural and cultural landscapes on Earth lie in river basins that are poorly gauged and have incomplete historical climate and runoff records. The Mara River Basin of East Africa is such a basin. It hosts the internationally renowned Mara-Serengeti landscape as well as a rich mixture of indigenous cultures. The Mara River is the sole source of surface water to the landscape during the dry season and periods of drought. During recent years, the flow of the Mara River has become increasingly erratic, especially in the upper reaches, and resource managers are hampered by a lack of understanding of the relative influence of different sources of flow alteration. Uncertainties about the impacts of future climate change compound the challenges. We applied the Soil Water Assessment Tool (SWAT) to investigate the response of the headwater hydrology of the Mara River to scenarios of continued land use change and projected climate change. Under the data-scarce conditions of the basin, model performance was improved using satellite-based estimated rainfall data, which may also improve the usefulness of runoff models in other parts of East Africa. The results of the analysis indicate that any further conversion of forests to agriculture and grassland in the basin headwaters is likely to reduce dry season flows and increase peak flows, leading to greater water scarcity at critical times of the year and exacerbating erosion on hillslopes. Most climate change projections for the region call for modest and seasonally variable increases in precipitation (5–10 %) accompanied by increases in temperature (2.5–3.5 °C). Simulated runoff responses to climate change scenarios were non-linear and suggest the basin is highly vulnerable under low (−3 %) and high (+25 %) extremes of projected precipitation changes, but under median projections (+7 %) there is little impact on annual water yields or mean discharge. Modest increases in precipitation are partitioned largely to increased evapotranspiration. Overall, model results support the existing efforts of Mara water resource managers to protect headwater forests and indicate that additional emphasis should be placed on improving land management practices that enhance infiltration and aquifer recharge as part of a wider program of climate change adaptation

Clinical and Imaging Characteristics of Smear Negative Pulmonary Tuberculosis Patients: A Comparative Study

Background. Prevalence surveys in Ethiopia indicate smear negative pulmonary tuberculosis (SNPTB) taking the major share of the overall TB burden. It has also been a diagnostic dilemma worldwide leading to diagnostic delays and difficulty in monitoring treatment outcomes. This study determines and compares the clinical and imaging findings in SNPTB and smear positive PTB (SPPTB). Methodology. A case-control study was conducted on 313 PTB (173 SNPTB) patients. Data and sputum samples were collected from consented patients. Smear microscopy, GeneXpert, and culture analyses were performed on sputum samples. Data were analyzed using Stata version 17; a P value < 0.05 was considered statistically significant. Results. Of the 173 SNPTB patients, 42% were culture positive with discordances between test results reported by health facilities and Armauer Hansen Research Institute laboratory using concentrated smear microscopy. A previous history of TB and fewer cavitary lesions were significantly associated with SNPTB. Conclusions. Though overall clinical presentations of SNPTB patients resemble those seen in SPPTB patients, a prior history of TB was strongly associated with SNPTB. Subject to further investigations, the relatively higher discrepancies seen in TB diagnoses reflect the posed diagnostic challenges in SNPTB patients, as a higher proportion of these patients are also seen in Ethiopia

Costs and cost-effectiveness of single and two-day surveys for detection of any STH species infection, based on school-based (SB) or community-based (CB) sampling and use of the Kato-Katz (KK) or Mini-FLOTAC (mF) method, among school children who were recently dewormed as part of a national deworming programme, western Kenya, 2013.

1<p>The number of positive cases in each scenario was determined by KK and mF results during one round of community sampling (nine days) and one round of school based sampling (four days).</p>2<p>Cost per positive case detected was calculated by dividing the total costs for each diagnostic and sampling scenario by the number of positive cases identified in that scenario.</p>3<p>Cost per case correctly classified was estimated by dividing the cost per child tested by the related diagnostic test accuracy as estimated in the latent class model.</p

Sensitivity analysis of the relationship between cost per positive case detected and prevalence of infection for alternative diagnostic and sampling methods, using community-based (CB) and school-based sampling (SB) with diagnosis based on Kato-Katz (KK) or Mini-FLOTAC (mF)¹ among school children who were recently dewormed as part of a national deworming programme, western Kenya, 2013.

<p>¹ For presentation and comparison purpose, the y-axis for each graph was standardized at $1000. The highest estimate for each scenario was as follows:$1517.48 (SB + KK), $3162.64 (SB + mF),$1929.88 (CB + KK), $1377.23 (CB + mF).</p

Sensitivity and specificity of Kato-Katz and Mini-FLOTAC diagnostic methods for soil-transmitted helminths over single and consecutive day sampling as estimated by latent class analysis.

<p>Sensitivity and specificity of Kato-Katz and Mini-FLOTAC diagnostic methods for soil-transmitted helminths over single and consecutive day sampling as estimated by latent class analysis.</p

Tornado diagrams of the percentage change in cost per child tested in relation to cost input parameter variation using school-based (SB) and community-based (CB) sampling with diagnosis based on Kato-Katz (KK) and Mini-FLOTAC (mF).

<p>Tornado diagrams of the percentage change in cost per child tested in relation to cost input parameter variation using school-based (SB) and community-based (CB) sampling with diagnosis based on Kato-Katz (KK) and Mini-FLOTAC (mF).</p