Health-seeking behaviour of human brucellosis cases in rural Tanzania

<p>Abstract</p> <p>Background</p> <p>Brucellosis is known to cause debilitating conditions if not promptly treated. In some rural areas of Tanzania however, practitioners give evidence of seeing brucellosis cases with symptoms of long duration. The purpose of this study was to establish health-seeking behaviour of human brucellosis cases in rural Tanzania and explore the most feasible ways to improve it.</p> <p>Methods</p> <p>This was designed as a longitudinal study. Socio-demographic, clinical and laboratory data were collected from patients who reported to selected hospitals in rural northern Tanzania between June 2002 and April 2003. All patients with conditions suspicious of brucellosis on the basis of preliminary clinical examination and history were enrolled into the study as brucellosis suspects. Blood samples were taken and tested for brucellosis using the Rose-Bengal Plate Test (RBPT) and other agglutination tests available at the health facilities and the competitive ELISA (c-ELISA) test at the Veterinary Laboratory Agencies (VLA) in the UK. All suspects who tested positive with the c-ELISA test were regarded as brucellosis cases. A follow-up of 49 cases was made to collect data on health-seeking behaviour of human brucellosis cases.</p> <p>Results</p> <p>The majority of cases 87.7% gave a history of going to hospital as the first point of care, 10.2% purchased drugs from a nearby drug shop before going to hospital and 2% went to a local traditional healer first. Brucellosis cases delayed going to hospital with a median delay time of 90 days, and with 20% of the cases presenting to hospitals more than a year after the onset of symptoms. Distance to the hospital, keeping animals and knowledge of brucellosis were significantly associated with patient delay to present to hospital.</p> <p>Conclusion</p> <p>More efforts need to be put on improving the accessibility of health facilities to the rural poor people who succumb to most of the diseases including zoonoses. Health education on brucellosis in Tanzania should also stress the importance of early presentation to hospitals for prompt treatment.</p

The Rose Bengal Test in Human Brucellosis: A Neglected Test for the Diagnosis of a Neglected Disease

Brucellosis is a highly contagious zoonosis affecting livestock and human beings. The human disease lacks pathognomonic symptoms and laboratory tests are essential for its diagnosis. However, most tests are difficult to implement in the areas and countries were brucellosis is endemic. Here, we compared the simple and cheap Rose Bengal Test (RBT) with serum agglutination, Coombs, competitive ELISA, Brucellacapt, lateral flow immunochromatography for IgM and IgG detection and immunoprecipitation with Brucella proteins. We tested 208 sera from patients with brucellosis proved by bacteriological isolation, 20 contacts with no brucellosis, and 1559 sera of persons with no recent contact or brucellosis symptoms. RBT was highly sensitive in acute and long evolution brucellosis cases and this related to its ability to detect IgM, IgG and IgA, to the absence of prozones, and to the agglutinating activity of blocking IgA at the pH of the test. RBT was also highly specific in the sera of persons with no contact with Brucella. No test in this study outperformed RBT, and none was fully satisfactory in distinguishing contacts from infected patients. When modified to test serum dilutions, a diagnostic titer >4 in RBT resulted in 87.4% sensitivity (infected patients) and 100% specificity (contacts). We discuss the limitations of serological tests in the diagnosis of human brucellosis, particularly in the more chronic forms, and conclude that simplicity and affordability of RBT make it close to the ideal test for small and understaffed hospitals and laboratories

Poor performance of the rapid test for human brucellosis in health facilities in Kenya

Human brucellosis is considered to be an important but typically under-diagnosed cause of febrile illness in many low and middle-income countries. In Kenya, and throughout East Africa, laboratory diagnosis for the disease is based primarily on the febrile antigen Brucella agglutination test (FBAT), yet few studies of the diagnostic accuracy of this test exist. Assessment of the performance of the FBAT is essential for its appropriate clinical use, as well as for evaluating surveillance data reported by public health systems. To assess FBAT performance, we collected sera from people with symptoms compatible with brucellosis attending two health facilities in Busia County, Kenya. Sera were tested using the FBAT and results compared with those from the Rose Bengal Test (RBT), an assay with well-known performance characteristics. Positives on either test were confirmed using the classical serum agglutination test (SAT)-Coombs test combination and a rapid IgM/IgG lateral flow immunochromatography assay (LFA). A questionnaire focussing on known risk factors for exposure to Brucella spp. was also conducted, and relationships with FBAT positivity examined using logistic regression. Out of 825 recruited individuals, 162 (19.6%) were classified as positive using the FBAT. In contrast, only eight (1.0%) were positive using the RBT. Of the 162 FBAT positives, one (0.62%) had an atypical agglutination in SAT and three (1.9%) showed low Coombs titres. Out of 148 FBAT positive individuals tested using the LFA, five (3.4%) were IgM positive and none were IgG positive. Poor or no correlation was observed between FBAT results and most established risk factors for Brucella infection. We observed substantial disagreement between the FBAT and a number of well-known serological tests, with the majority of reactive FBAT results appearing to be false positives. Poor FBAT specificity, combined with a lack of confirmatory testing, strongly suggests overdiagnosis of brucellosis is common in this low prevalence setting. This is expected to have important economic impacts on affected patients subjected to the long and likely unnecessary courses of multiple antibiotics required for treatment of the disease

Factors associated with adaptation and performance of trypanotolerant Orma boran bulls in Kajiado District, Kenya

l’ adaptation de 14 taureaux Orma Boran trypanotolerant distribués dans le district de Kajiado pour d'amélioration génétique du bétail a été évaluée. Les taureaux ont été suivis mensuellement de Novembre 2002 à Décembre 2004pour les changements de poids corporel, PCV, et la prévalence de la trypanosomiase, l'anaplasmose, babésiose et infections ECF. La morbidité, la durée de détention par l’éleveur et les taux de mortalité ont été mesurés facteurs d’adaptation des taureaux. Seulement 29% des taureaux ont achevé la période de détention de deux ans prévu au moment de leur distribution. Durée moyenne était de 20,8 mois avec la différence importante entre les zones de basse et haute densité de mouches tsé-tsé. La Moyenne de PCV était de 27% et a été significativement plus faible dans les taureaux infectés par trypanosomose. Prévalence des infections a été de 20,3% pour la trypanosomose, 9% pour ECF, 46% pour anaplasmose et 7% pour babésioses. Bien que, l'infection à la trypanosomose a eu le plus d'effet significatif sur la santé, la survie et la productivité des taureaux, un cas detrypanotolerance a été soupçonné chez un taureau chez qui il n'a jamais été détectée une infection a trypanosome suggérant que la race pourrait être utilisée efficacement dans les zones infestés de mouche tsé-tsé. Les défis rencontrés par l'adoption cette race bovine sont entre autres l’apathie des pastoralists, la grave sécheresse, la forte prévalence des infections et la mortalité.Adaptation of 14 trypanotolerant OB bulls disseminated to Kajiado District for livestock improvement was assessed. The bulls were monitored for body weight changes, PCV, and prevalence of trypanosomosis, anaplasmosis, babesiosis and ECF infections monthly from November 2002 to December 2004. Morbidity status, retention time and mortality rate were used as the measures of outcome indicating bulls’ adaptation. Data was analyzed using descriptive statistics, association tests and logistic regression. Only 29% of the bulls completed the anticipated 2 year retention period. Mean duration of stay was 20.8 months with significant difference between low and high tsetse density areas. Mean PCV was 27% and was significantly lower in trypanosomosis infected bulls. Prevalence of infections was trypanosomosis 20.3%, ECF 9%, anaplasmosis 46% and babesiosis 7%, which were associated with animal level, management and geographic factors. Although trypanosomosis infection had the most significant effect on bulls’ health, survival and productivity, perhaps a true case of trypanotolerance was demonstrated by one bull that wasnever detected with a trypanosome infection suggesting that the breed could be used for effective utilization of tsetse fly infested lands. Pastoralists’ apathy, severe drought, high prevalence of infections and mortality were challenges faced by adoption of trypanotolerance technology

Comparative returns from livestock and crops among the agro-pastoralists of Magadi division, Kajiado District, Kenya

Une étude transversale a été menée dans le district Kajiado en août 2003 afin d'estimer les revenus provenant du bétail et des cultures agricoles, et d'évaluer les facteurs importants associés à eux. Une sélection aléatoire et objective des éleveurs et leurs animaux a été utilisé afin de recueillir des données qui ont ensuite été analysées à l'aide de statistiques descriptives et les modèles linéaires généralisés auprès des ménages tous dirigés par des hommes. Ces éleveurs sont généralement considérés commeriches, avec une moyenne de 232 animaux de bétail et les marges de profit annuel total de 436 300 KShs, provenant a la fois des cultures et de l'élevage, démontrant la complémentarité et la diversification des moyens d'existence afin de réduire les risques dus aux catastrophes. Le Coût des intrants et de la valeur des revenus ont été significativement associés à des bénéfices réalisés à partir des productions agricoles ou l'élevage. Cette étude a révélé que l'élevage reste la principale source de revenuedans le district Kajiado rapport à la production des cultures. Une réduction des coûts de production en élevage et production agricoles accroîtrait les profits aussi bien chez les grands et les petits éleveurs ; de même la complémentarité des cultures et l'élevage pourraient permettre aux pasteurs d’exploiter les possibilités existantes dans leur environnement pour créer plus de richesse et d'atteindre la sécurité alimentaire.A cross-sectional study was conducted in Kajiado District in August 2003 to estimate incomes from livestock and crop agricultural enterprises, and assess important factors associated with them. Purposive and random selection of pastoralists and their animals was used in order to collect data which were then analyzed using descriptive statistics and Generalized Linear Models from the households (HHs) that were all headed by men.These pastoralists were considered generally wealthy with an average livestock holding of 232 heads of livestock and annual total profit margins of Kshs 436,300 from both livestock and crops, demonstrating their complementarity and livelihood diversification for risk aversion. Cost of inputs and value of income were significantly associated withprofit from either crop or livestock production enterprises. This study revealed that livestock production still remained the major source of livelihood in Kajiado District compared to crop production. While reducing cost of livestock and crop production could increase profit for the large and small scale pastoralists respectively, complementarity of crop and livestock production could be exploited by medium scale pastoralists to harness existing opportunities for significant wealth generation and achieve food security