Drug resistant tuberculosis in Kenya: trends, characteristics and treatment outcomes, 2008 – 2016

Background: Drug resistant (DR) tuberculosis (TB) remains a major public health concern. Failure to treat patients with TB adequately increases the risk of transmission of infection to the general population. Treatment of DR TB is characterized by lengthy treatment duration, use of toxic and less effective drugs and high likelihood of adverse treatment outcomes that include adverse drug reactions, high mortality and loss to follow up.Objective: To determine the trends, characteristics and treatment outcomes of patients >15 years notified with DR‐TB in Kenya from 2008 to 2016Design: Retrospective descriptive cross‐sectional studySetting: Tuberculosis treatment centers in KenyaSubjects: Persons above 15 years notified with DR TBResults: We reviewed records of 1903 DR‐TB patients who were notified between 2008 and 2016. The public sector made the highest contribution of the notified cases (80%). Most of the cases were male (62.3%). The HIV testing rate was 99.5%, with the TB/HIV co‐infection being 36%. Initiation of antiretroviral therapy among those who tested positive for HIV was 94.6%. Co‐trimoxazole preventive therapy uptake was 99.3%. Most patients had secondary DRTB (77.3%). Multi‐drug resistant TB accounted for 78.4% of the DR TB cases while mono drug resistance was observed in 26% of the cases. Treatment success was achieved in 79% of the cases. Mortality and treatment failure during the study period was 11% and 0.2% respectively.Conclusion: An upward trend in notified DR‐TB cases was observed during the period under review. The public sector gave the most contribution. Active surveillance on patients lost to follow up while on treatment and poor drug adherence will be of importance to reduce the potential of development of drug resistance

Outcomes of Kenyan children under five years of age, initiated on isoniazid preventive therapy following exposure to bacteriologically confirmed pulmonary tuberculosis, 2013-2016

Background: Isoniazid preventive therapy (IPT) is one of the key interventions in achieving the End TB Strategy of 90% reduction in Tuberculosis (TB) incidence by 2030 compared with 2015. One of the key pillars in achieving this is preventive treatment of persons at high risk of contracting TB. This group includes children less than five years exposed to bacteriologically confirmed TB. Despite Kenya national IPT roll out in 2015, there still exists limited information on its programmatic coverage, outcomes and missed opportunities for initiation of IPT.Objective: To determine the coverage, outcomes and missed opportunities for initiation of IPT among children under-five years in contact with bacteriologically confirmed pulmonary tuberculosis (PTB) in Kenya.Design: Cross sectional descriptive study.Setting: All the 47 counties in Kenya.Subjects: Children under-five years exposed to bacteriologically confirmed PTB initiated on IPT and notified between 2013 and 2016.Results: During the study period (2013-2016), a total of 6,507 children aged less than five years who were exposed to bacteriologically confirmed PTB were initiated on IPT. The number of children initiated on IPT increased from 721 in 2013 to 3306 in 2016.The number of counties notifying cases increased from 26 in 2013 to 47 in 2016. Treatment completion was 78%, 87% and 82% for 2013, 2014 and 2015 respectively. Of the 1390 children who had completed the 6 month-course of IPT during the study period, 9%had no TB, 7% were not accessed while84% had no documentation of outcomes by the end of the follow up period of 24 months. Missed opportunities for initiation of IPT reduced from 90% (7109) in 2013 to 60% (4872) in 2016.Conclusion: IPT coverage and completion rates have improved from 721 in 2013 to 3306 in 2016 and 78% in 2013 to 82% in 2015 respectively. Despite this, Kenya is yet to meet the targets set by the World Health Organization (WHO). Sustainable measures need to be put in place to achieve the WHO targets

Spatial and temporal distribution of notified tuberculosis cases in Nairobi County, Kenya, between 2012 and 2016

Background: Tuberculosis (TB) is an infectious disease of major public health concern globally. The disease has showed space‐time variations across settings. Spatial temporal assessment can be used to understand the distribution and variations of TB disease.Objective: To determine the spatial and temporal distribution of notified TB cases in Nairobi County, Kenya, between 2012 and 2016Design: A cross sectional studySetting: Nairobi County, KenyaSubjects: Tuberculosis cases notified in Tuberculosis Information for Basic Units from 2012 to 2016Results: A total of 70,505 cases of TB were notified in Nairobi County between 2012 and 2016, with male to female ratio of 3:2 and HIV coinfection rate of 38%.The temporal analysis showed a declining trend of the notified cases. The spatial clusters showed stability in most areas while others varied annually during the study period. The space‐time analysis also detected the four most likely clusters or hotspots. Cluster 1 which covered the informal settlements of Kibera, Kawangware and Kangemi with 4,011observed cases against 2,977expected notified TB cases(relative risk (RR) 1.37, p<0.001). Further, Cluster 2 covered Starehe and parts of Kamukunji, Mathare, Makadara, Kibra and Dagoretti North Constituencies (RR 1.93, p<0.001; observed and expected cases were 4,206 and 2,242, respectively.Conclusion: This study identified high TB case notifications, declining temporal trends and clustering of TB cases in Nairobi. Evidence of clustering of TB cases indicates the need for focused interventions in the hotspot areas. Strategies should be devised for continuous TB surveillance and evidence based decision making

Research agenda for preventing mosquito-transmitted diseases through improving the built environment in sub-Saharan Africa

Mosquito-transmitted diseases are a major threat to health in sub-Saharan Africa, but could be reduced through modifications to the built environment. Here we report findings from a major workshop held to identify the research gaps in this area, namely: (1) evidence of the health benefits to changes to the built environment, (2) understanding how mosquitoes enter buildings, (3) novel methods for reducing mosquito-house entry, (4) sustainable approaches for reducing mosquito habitats, (5) case studies of micro-financing for healthy homes and (6) methods for increasing scale-up. Multidisciplinary research is essential to build out mosquito-transmitted diseases, and not build them in

Implementation of Isoniazid Preventive Therapy Among HIV-Infected Children at Health Facilities in Nairobi County, Kenya: A Cross-Sectional Study

Background: HIV is the strongest risk factor for developing tuberculosis (TB) among people with latent or new Mycobacterium tuberculosis infection. Isoniazid preventive therapy (IPT) reduces the risk of active TB among people living with HIV by up to 62%. Despite evidence that IPT is safe and efficacious, its provision remains low globally. The current study aimed at documenting IPT uptake, adherence, and completion rates, as well as the correlates of IPT uptake among HIV-infected children in Kenya. The study also assessed the knowledge, attitude, and practices of health-care workers (HCWs) with regard to IPT.   Methods: A health facility-based cross-sectional study was conducted. Data were collected from caregivers of HIV-infected children as well as HCWs using an interviewer-administered questionnaire. Logistic regression was used to determine the factors associated with IPT uptake.   Results: The study enrolled 111 child-caregiver dyads. Most of the caregivers were female (n=75, 77.3%) and HIV-positive (n=82, 85.4%). The majority of children were male (n=65, 58.6%) and on ART (n=106, 95.5%). Overall, 59 children were on IPT (uptake of 53.2%, 95% confidence interval [CI], 43.9% to 62.4%). Out of the 25 children who had been on IPT for more than 6 months, 22 (88.0%) successfully completed the 6-month course of treatment. Further, 27 of the 34 children (78.4%) who were on IPT at the time of the study demonstrated satisfactory adherence to the therapy (no doses missed). The caregivers’ attributes that were associated with IPT uptake included having a secondary school education (adjusted odds ratio [aOR] 0.13; 95% CI, 0.03 to 0.67) and having been on IPT (aOR 27.50; 95% CI, 5.39 to 140.28). The characteristics of children that were significantly associated with IPT uptake were higher median baseline CD4 count (P=.007) and higher median current CD4 count (P=.024).   Conclusion: The study demonstrated suboptimal IPT uptake but favourable adherence and treatment completion rates. There was almost universal awareness of IPT within the study sample. Furthermore, the majority of the HCWs had a favourable attitude towards IPT. However, the attendant IPT practices were inadequate, with majority of HCWs reporting that they had never initiated IPT, prescribed IPT within the last 12 months, or renewed an isoniazid prescription

Factors Associated with Foodborne Pathogens among Food Handlers: A Case Study of Thika, Kiambu County, Kenya

Increasing risks of infections with foodborne pathogens may occur as a result of poor food handling practices. The present cross-sectional study employed a mixed-methods approach to determine the factors associated with foodborne pathogens among food handlers working in the food establishments in Thika, Kiambu County, Kenya. Random sampling was used to enroll respondents in the survey. A single stool specimen was collected from each study participant. Laboratory analysis of the specimen was done to test the selected foodborne pathogens. Overall, 44 out of the 285 food handlers who took part in the study had at least one food-transmitted pathogen, putting the prevalence of foodborne infections among the food handlers at 15.4% (95% confidence interval (CI) 11.7%–20.1%). The findings from multivariate logistic regression indicated the following protective factors for foodborne pathogens among the studied food handlers: being female (adjusted odds ratio (AOR) 0.098 (95% CI 0.0304–0.315, p<0.001)); having a valid medical examination certificate (AOR 0.141 (95% CI 0.141–1. 0.439, p=0.001)); not boiling or treating water before serving the water to customers was a risk factor for having infections with foodborne pathogens (AOR 3.043 (95% CI 1.2225–7.577, p=0.017)). The presence of foodborne pathogens among the food handlers in the study area potentially highlights the need to address the spread and transmission of foodborne infections in the study area. There is a need to institute appropriate control measures, including regular screening of food handlers for foodborne illnesses in addition to training them on safe food handling practices, hand hygiene practices, and regular monitoring of the food handling practices