Mycotoxin hazards in the Kenyan food and feed market - A retrospective study

Mycotoxins are toxic fungal metabolites naturally found in food and feed as contaminants. Animal feed and human food samples (n=1818) from three major Kenyan laboratories were categorized as compliant and non-compliant according to Kenya, America (USA) and Europe (EU) mycotoxin regulatory limits. Quantitative risk assessment of dietary aflatoxin intake in maize, wheat, peanut and dairy products in relation to human hepatocellular carcinoma was carried out employing deterministic approach. Non-compliant samples’ proportions were calculated, and logistic regression and chi-square test used to compare different commodities. Animal feed were least compliant, with 64% and 39% having total aflatoxin (AFT) levels above Kenya and USA standards, respectively. Peanuts were the most non-compliant food, with 61% and 47% samples failing Kenya and USA AFT standards respectively, while wheat was least compliant (84%) according to EU threshold for AFT. Half of baby food sampled had AFT level above Kenya and EU standards. High non-compliance rate with Kenya, USA and EU regulatory thresholds with respect to seven different mycotoxins (summarized as “mycotoxins”), and also AFT and aflatoxin M1 alone in edible materials is reported. Significant non-compliance is reported for compound animal feed, peanuts, wheat, baby food, feed ingredients, herbal healthy drink, maize and fodder feed in that order. High levels of aflatoxin residues in animal feed and human food was also observed. Lifetime human consumption of wheat and maize leads to high additional risk for primary liver cancer, human hepatocellular carcinoma (HCC) associated with dietary aflatoxin, wheat and its products causing the highest disease burden. Subsequent implications and limitations of current food safety standards are discussed. Humans and animals in Kenya appear to be chronically exposed to mycotoxin hazards: this calls for surveillance and risk management. There is urgent need for enhanced and consistent surveillance of the dietary mycotoxin hazards observed in this study employing representative sampling plans. Regulation and future research need to focus on reliable analysis techniques, collection of data on toxicological effects of mycotoxins and food consumption pattern, and regulatory limits accordingly set and compliance enforced to protect vulnerable groups such as paediatric, geriatric and sick members of the society to reduce cancer burden in Kenya

Mycotoxin hazards in the Kenyan food and feed market-a retrospective study

Mycotoxins are toxic fungal metabolites naturally found in food and feed as contaminants. Animal feed and human food samples (n=1818) from three major Kenyan laboratories were categorized as compliant and non-compliant according to Kenya, America (USA) and Europe (EU) mycotoxin regulatory limits. Quantitative risk assessment of dietary aflatoxin intake in maize, wheat, peanut and dairy products in relation to human hepatocellular carcinoma was carried out employing deterministic approach. Non-compliant samples’ proportions were calculated, and logistic regression and chi-square test used to compare different commodities. Animal feed were least compliant, with 64% and 39% having total aflatoxin (AFT) levels above Kenya and USA standards, respectively. Peanuts were the most non-compliant food, with 61% and 47% samples failing Kenya and USA AFT standards respectively, while wheat was least compliant (84%) according to EU threshold for AFT. Half of baby food sampled had AFT level above Kenya and EU standards. High non-compliance rate with Kenya, USA and EU regulatory thresholds with respect to seven different mycotoxins (summarized as “mycotoxins”), and also AFT and aflatoxin M1 alone in edible materials is reported. Significant non-compliance is reported for compound animal feed, peanuts, wheat, baby food, feed ingredients, herbal healthy drink, maize and fodder feed in that order. High levels of aflatoxin residues in animal feed and human food was also observed. Lifetime human consumption of wheat and maize leads to high additional risk for primary liver cancer, human hepatocellular carcinoma (HCC) associated with dietary aflatoxin, wheat and its products causing the highest disease burden. Subsequent implications and limitations of current food safety standards are discussed. Humans and animals in Kenya appear to be chronically exposed to mycotoxin hazards: this calls for surveillance and risk management. There is urgent need for enhanced and consistent surveillance of the dietary mycotoxin hazards observed in this study employing representative sampling plans. Regulation and future research need to focus on reliable analysis techniques, collection of data on toxicological effects of mycotoxins and food consumption pattern, and regulatory limits accordingly set and compliance enforced to protect vulnerable groups such as paediatric, geriatric and sick members of the society to reduce cancer burden in Keny

Epidemiological profile and clinico-pathological features of pediatric gynecological cancers at Moi Teaching & Referral Hospital, Kenya

Background: The main pediatric (0–18 years) gynecologic cancers include stromal carcinomas (juvenile granulosa cell tumors and Sertoli-Leydig cell tumors), genital rhabdomyosarcomas and ovarian germ cell. Outcomes depend on time of diagnosis, stage, tumor type and treatment which can have long-term effects on the reproductive career of these patients. This study seeks to analyze the trends in clinical-pathologic presentation, treatment and outcomes in the cases seen at our facility. This is the first paper identifying these cancers published from sub-Saharan Africa. Method: Retrospective review of clinico-pathologic profiles and treatment outcomes of pediatric gynecologic oncology patients managed at MTRH between 2010 and 2020. Data was abstracted from gynecologic oncology database and medical charts. Results: Records of 40 patients were analyzed. Most, (92.5%, 37/40) of the patients were between 10 and 18 years. Ovarian germ cell tumors were the leading histological diagnosis in 72.5% (29/40) of the patients; with dysgerminomas being the commonest subtype seen in 12 of the 37 patients (32.4%). The patients received platinum-based chemotherapy in 70% of cases (28/40). There were 14 deaths among the 40 patients (35%) Conclusion: Surgery remains the main stay of treatment and fertility-sparing surgery with or without adjuvant platinum-based chemotherapy are the standard of care with excellent prognosis following early detection and treatment initiation. LMICs face several challenges in access to quality care and that affects survival of these patients. Due to its commonality, ovarian germ cell cancers warrant a high index of suspicion amongst primary care providers attending to adnexal masses in this age group

Impact of opioid substitution therapy on antiretroviral therapy outcomes:a systematic review and meta-analysis

BACKGROUND: Human immunodeficiency virus (HIV)-infected people who inject drugs (PWID) frequently encounter barriers accessing and remaining on antiretroviral therapy (ART). Some studies have suggested that opioid substitution therapy (OST) could facilitate PWID's engagement with HIV services. We conducted a systematic review and meta-analysis to evaluate the impact of concurrent OST use on ART-related outcomes among HIV-infected PWID. METHODS: We searched Medline, PsycInfo, Embase, Global Health, Cochrane, Web of Science, and Social Policy and Practice databases for studies between 1996 to November 2014 documenting the impact of OST, compared to no OST, on ART outcomes. Outcomes considered were coverage and recruitment onto ART, adherence, viral suppression, attrition from ART, and mortality. Meta-analyses were conducted using random-effects modeling, and heterogeneity assessed using Cochran Q test and I2 statistic. RESULTS: We identified 4685 articles, and 32 studies conducted in North America, Europe, Indonesia, and China were included. OST was associated with a 69% increase in recruitment onto ART (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.32-2.15), a 54% increase in ART coverage (odds ratio [OR], 1.54; 95% CI, 1.17-2.03), a 2-fold increase in adherence (OR, 2.14; 95% CI, 1.41-3.26), and a 23% decrease in the odds of attrition (OR, 0.77; 95% CI, .63-.95). OST was associated with a 45% increase in odds of viral suppression (OR, 1.45; 95% CI, 1.21-1.73), but there was limited evidence from 6 studies for OST decreasing mortality for PWID on ART (HR, 0.91; 95% CI, .65-1.25). CONCLUSIONS: These findings support the use of OST, and its integration with HIV services, to improve the HIV treatment and care continuum among HIV-infected PWID

Application of Novel Low-Fouling Membranes for Fish Processing Wastewater Treatment and Comparison to PES Commercial Membranes in a Lab Scale Membrane Bioreactor

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Feeding rates of malaria vectors from a prototype attractive sugar bait station in Western Province, Zambia: results of an entomological validation study

Background: Attractive targeted sugar bait (ATSB) stations are a promising new approach to malaria vector control that could compliment current tools by exploiting the natural sugar feeding behaviors of mosquitoes. Recent proof of concept work with a prototype ATSB® Sarabi Bait Station (Westham Co., Hod-Hasharon, Israel) has demonstrated high feeding rates and significant reductions in vector density, human biting rate, and overall entomological inoculation rate for Anopheles gambiae sensu lato (s.l.) in the tropical savannah of western Mali. The study reported here was conducted in the more temperate, rainier region of Western Province, Zambia and was designed to confirm the primary vector species in region and to estimate corresponding rates of feeding from prototype attractive sugar bait (ASB) Sarabi Bait Stations. Methods: The product evaluated was the Sarabi v1.1.1 ASB station, which did not include insecticide but did include 0.8% uranine as a dye allowing for the detection, using UV fluorescence light microscopy, of mosquitoes that have acquired a sugar meal from the ASB. A two-phase, crossover study design was conducted in 10 village-based clusters in Western Province, Zambia. One study arm initially received 2 ASB stations per eligible structure while the other initially received 3. Primary mosquito sampling occurred via indoor and outdoor CDC Miniature UV Light Trap collection from March 01 through April 09, 2021 (Phase 1) and from April 19 to May 28, 2021 (Phase 2). Results: The dominant vector in the study area is Anopheles funestus s.l., which was the most abundant species group collected (31% of all Anophelines; 45,038/144,5550), had the highest sporozoite rate (3.16%; 66 positives out of 2,090 tested), and accounted for 94.3% (66/70) of all sporozoite positive specimens. Of those An. funestus specimens further identified to species, 97.2% (2,090/2,150) were An. funestus sensu stricto (s.s.). Anopheles gambiae s.l. (96.8% of which were Anopheles arabiensis) is a likely secondary vector and Anopheles squamosus may play a minor role in transmission. Overall, 21.6% (9,218/42,587) of An. funestus specimens and 10.4% (201/1,940) of An. gambiae specimens collected were positive for uranine, translating into an estimated daily feeding rate of 8.9% [7.7–9.9%] for An. funestus (inter-cluster range of 5.5% to 12.7%) and 3.9% [3.3–4.7%] for An. gambiae (inter-cluster range of 1.0–5.2%). Feeding rates were no different among mosquitoes collected indoors or outdoors, or among mosquitoes from clusters with 2 or 3 ASBs per eligible structure. Similarly, there were no correlations observed between feeding rates and the average number of ASB stations per hectare or with weekly rainfall amounts. Conclusions: Anopheles funestus and An. gambiae vector populations in Western Province, Zambia readily fed from the prototype Sarabi v1.1.1 ASB sugar bait station. Observed feeding rates are in line with those thought to be required for ATSB stations to achieve reductions in malaria transmission when used in combination with conventional control methods (IRS or LLIN). These results supported the decision to implement a large-scale, epidemiological cluster randomized controlled trial of ATSB in Zambia, deploying 2 ATSB stations per eligible structure

Risk of Injection-Site Abscess among Infants Receiving a Preservative-Free, Two-Dose Vial Formulation of Pneumococcal Conjugate Vaccine in Kenya.

There is a theoretical risk of adverse events following immunization with a preservative-free, 2-dose vial formulation of 10-valent-pneumococcal conjugate vaccine (PCV10). We set out to measure this risk. Four population-based surveillance sites in Kenya (total annual birth cohort of 11,500 infants) were used to conduct a 2-year post-introduction vaccine safety study of PCV10. Injection-site abscesses occurring within 7 days following vaccine administration were clinically diagnosed in all study sites (passive facility-based surveillance) and, also, detected by caregiver-reported symptoms of swelling plus discharge in two sites (active household-based surveillance). Abscess risk was expressed as the number of abscesses per 100,000 injections and was compared for the second vs first vial dose of PCV10 and for PCV10 vs pentavalent vaccine (comparator). A total of 58,288 PCV10 injections were recorded, including 24,054 and 19,702 identified as first and second vial doses, respectively (14,532 unknown vial dose). The risk ratio for abscess following injection with the second (41 per 100,000) vs first (33 per 100,000) vial dose of PCV10 was 1.22 (95% confidence interval [CI] 0.37-4.06). The comparator vaccine was changed from a 2-dose to 10-dose presentation midway through the study. The matched odds ratios for abscess following PCV10 were 1.00 (95% CI 0.12-8.56) and 0.27 (95% CI 0.14-0.54) when compared to the 2-dose and 10-dose pentavalent vaccine presentations, respectively. In Kenya immunization with PCV10 was not associated with an increased risk of injection site abscess, providing confidence that the vaccine may be safely used in Africa. The relatively higher risk of abscess following the 10-dose presentation of pentavalent vaccine merits further study

A Mutation in Myo15 Leads to Usher-Like Symptoms in LEW/Ztm-ci2 Rats

The LEW/Ztm-ci2 rat is an animal model for syndromal deafness that arose from a spontaneous mutation. Homozygous animals show locomotor abnormalities like lateralized circling behavior. Additionally, an impaired vision can be observed in some animals through behavioral studies. Syndromal deafness as well as retinal degeneration are features of the Usher syndrome in humans. In the present study, the mutation was identified as a base substitution (T->C) in exon 56 of Myo15, leading to an amino acid exchange from leucine (Leu) to proline (Pro) within the carboxy-terminal MyTH4 domain in the proteins' tail region. Myo15 mRNA was expressed in the retina as demonstrated for the first time with the help of in-situ hybridization and PCR. To characterize the visual phenotype, rats were examined by scotopic and photopic electroretinography and, additionally, histological analyses of the retinas were conducted. The complete loss of sight was detected along with a severe degeneration of photoreceptor cells. Interestingly, the manifestation of the disease does not solely depend on the mutation, but also on environmental factors. Since the LEW/Ztm-ci2 rat features the entire range of symptoms of the human Usher syndrome we think that this strain is an appropriate model for this disease. Our findings display that mutations in binding domains of myosin XV do not only cause non-syndromic hearing loss but can also lead to syndromic disorders including retinal dysfunction

Joint management of shared resources as an alternative approach for addressing maritime boundary disputes : the Kenya-Somalia maritime boundary dispute

Socio-economic security has motivated African states to explore natural resources in areas of overlapping maritime claims. However, Africa’s maritime boundaries are characterized by unresolved disputes. Resolution of these disputes is time-consuming, expensive and can undermine the state’s ability to exploit natural resources. The Somalia and Kenya maritime dispute under litigation with the International Court of Justice demonstrates the continental commitment to peaceful resolution. Citing cases from across Africa, we discuss outright delimitation or Joint Management Zones (JMZs) as means to address disputes over shared resources, particularly transboundary fisheries, which have received little attention. Reframing the Kenya-Somalia maritime dispute resolution process as cooperation over fisheries management will have spill-over effects into greater diplomatic relations. Fish do not abide by maritime boundaries. As such, we posit that the peaceful resolution of maritime boundary disputes lies in Africa’s ability to consider settlements by way of JMZs to motivate sustainable use of natural resources.PostprintPeer reviewe

Impact of opioid substitution therapy on the HIV prevention benefit of antiretroviral therapy for people who inject drugs

Objective: A recent meta-analysis suggested that opioid substitution therapy (OST) increased uptake of anti-retroviral treatment (ART) and HIV viral suppression. We modelled whether OST could improve the HIV prevention benefit achieved by ART amongst people who inject drugs (PWID). Methods: We modelled how introducing OST could improve the coverage of ART across a PWID population for different baseline ART coverage levels. Using existing data on how yearly HIV-transmission risk is related to HIV plasma viral load, changes in the level of viral suppression across the population were used to project the relative reduction in yearly HIV-transmission risk achieved by ART, with or without OST, compared to if there was no ART - defined here as the prevention effectiveness of ART. Results: Due to OST use increasing the chance of being on ART and achieving viral suppression if on ART, the prevention effectiveness of ART for PWID on OST (compared to PWID not on OST) increases by 44%, 31% or 20% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively. Improvements in the population-level prevention effectiveness of ART are also achieved across all PWID, compared to if OST was not introduced. For instance, if OST is introduced at 40% coverage, the population-level prevention effectiveness of ART could increase by 27%, 20% or 13% for a low (20%), moderate (40%) or high (60%) baseline ART coverage, respectively. Conclusions: OST could markedly improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART