Cascaded clinical mentoring improves health workers selfefficacy in provision of integrated HIV care in rural hospitals in Kenya

Objective: To evaluate cascaded clinical mentorship strategy on access and health-worker’s self-efficacy in delivery of integrated HIV services. Design: A cross sectional survey study design. Setting: Government health facilities in the Coastal region and City of Nairobi, Kenya. Participants: Nurses and clinical officers who were recipients of cascaded mentorship. Intervention: Training of volunteer health-workers on mentorship and the HIV care package by a team of master mentors followed by support to carry out mentorship among fellow health-workers. Outcome measure: Access to HIV services, and health-worker self-reported efficacy in delivering integrated HIV care services based on an anonymous standard self-administered tool that evaluated 9 domains of HIV care. Results: There was an exponential increase in mentorship services, 126 volunteer health-workers were trained, and they formed 22 multidisciplinary District teams who extended mentorship to 231 health facilities. In the 33 months a total of 5503 mentor visits and 7724 mentoring sessions were made. The evaluated 150 health workers self-reported significant improvement in all 9 domains of HIV care compared to baseline (p < 0.001). Health-workers were exposed to a mean of 6 mentor-ship sessions. On controlling for region and cadre of staff, number of mentor-ship sessions were significantly associated with increased competence in 7 of 9 fields (p< 0.01). Compared to volunteer mentors, mentorship and site visits by master mentors were five and twice more costly respectively. Conclusions: Cascaded HIV mentorship increased staff self-efficacy and access to HIV treatment services. The impact of this cascaded mentorship on patient outcomes should be evaluated

Socio-Economic and Health Consequences of Drugs and Substance Use in Gachie: : A Peri-Urban Town on the Outskirts of Nairobi

Drug and substance abuse is a major socioeconomic and health problem to the drug users, family and society and is reported to be on a steady global rise. In Kenya, drug abuse is a major societal problem especially in many cosmopolitan cities such as Nairobi and Mombasa and the surrounding immediate environs. The objective of this study was to evaluate the types of drugs, the socio-economic and health consequences of drug abuse among the inhabitants of Gachie Sub-Location, Kiambu County a town within the Nairobi suburbs. A snowballing sampling method was used to recruit a total of 246 study participants aged between 15-65years recruited into the study after consenting and meeting drug and substance use and dependence clinical evaluation according to UNCOPE criteria. Data on the type of drugs abused, socio-economic and health implications of drug use on both drug abusers and the community was captured using a structured questionnaire and the resulting data analysed using SPSS version 21. Over-the counter prescription drugs including, benzodiazepine, Cozepam (“ma-cc”), rohypnol (“ma-blue”), and benzhexol (“ma-white”) as well as the traditional heroine were the major abused drugs reported in the study. Approximately 85% of the sampled drug abusers were men abusing mainly the licit over- the counter prescription drugs and heroine as a result of their easy affordability and accessibility. Failed marriages, conflictual family and communal relationships, unemployment, life of destitution and poverty were the main socioeconomic consequences of drug abuse reported in the study, corroborating reports of some previous studies. Participants’s self-reported feeling of hyperactiveness and euphoria was the major health consequence repoted. This study thus indicates that drug use is slowly creeping into rural areas in the vicinity of major towns with prescription over the counter drugs taking a centre stage than the traditional hard drugs due to the associated low costs, availability and accessibility and can result in myriad socioeconomic consequences in the society. This data provides an insight of the spread of drugs from the traditional cities to the surrounding town environments as these areas provide a safe haven for drug peddlers and thus should be of great focus by drug law enforcers as they strategize and seek to curb drug abuse problem. Future similar studies involving larger area are recommended to acquire more dynamics of this proble

A longitudinal analysis of the vaginal microbiota and vaginal immune mediators in women from sub-Saharan Africa

In cross-sectional studies increased vaginal bacterial diversity has been associated with vaginal inflammation which can be detrimental for health. We describe longitudinal changes at 5 visits over 8 weeks in vaginal microbiota and immune mediators in African women. Women (N = 40) with a normal Nugent score at all visits had a stable lactobacilli dominated microbiota with prevailing Lactobacillus iners. Presence of prostate-specific antigen (proxy for recent sex) and being amenorrhoeic (due to progestin-injectable use), but not recent vaginal cleansing, were significantly associated with microbiota diversity and inflammation (controlled for menstrual cycle and other confounders). Women (N = 40) with incident bacterial vaginosis (Nugent 7-10) had significantly lower concentrations of lactobacilli and higher concentrations of Gardnerella vaginalis, Atopobium vaginae, and Prevotella bivia, at the incident visit and when concentrations of proinflammatory cytokines (IL-1β, IL-12p70) were increased and IP-10 and elafin were decreased. A higher 'composite-qPCR vaginal-health-score' was directly associated with decreased concentrations of proinflammatory cytokines (IL-1α, IL-8, IL-12(p70)) and increased IP-10. This longitudinal study confirms the inflammatory nature of vaginal dysbiosis and its association with recent vaginal sex and progestin-injectable use. A potential role for proinflammatory mediators and IP-10 in combination with the vaginal-health-score as predictive biomarkers for vaginal dysbiosis merits further investigation

Securing Africa’s health sovereignty : why investing in science and innovation matters

This paper aims at provoking broad-based dialogues and debates on ways and means of securing Africa’s health sovereignty. It argues that health sovereignty is about the realization of specific national constitutional and policy objectives on citizens’ access to and enjoyment of good health, resilient to COVID-19 and related disease pandemics. The paper also emphasizes the urgency of African countries fulfilling their commitments under global and regional declarations on health research. Investing in research, knowledge and innovation is critical to fight and win the war against COVID-19 and other diseases that undermine economic productivity and competitiveness of African countries. There is also a need for venture capitalists to demonstrate bankable ideas emanating from the science academies and funded by National Science Foundations. The base teachings at school level need to significantly invest in the “African philosophy” to create a shift in mind-set from the “grab and own without use mentality that is currently predominant on the continent. The paper recommends that executive, political and science leadership are needed to strengthen national health research and innovation systems through improved evidence-based policy implementation. With these thrusts working effectively together, rather than in silos, will afford the African continent to emerge victoriously in the combat against COVID-19 and other disease burdens

Induction of humoral immune response to multiple recombinant Rhipicephalus appendiculatus antigens and their effect on tick feeding success and pathogen transmission

BACKGROUND: Rhipicephalus appendiculatus is the primary vector of Theileria parva, the etiological agent of East Coast fever (ECF), a devastating disease of cattle in sub-Saharan Africa. We hypothesized that a vaccine targeting tick proteins that are involved in attachment and feeding might affect feeding success and possibly reduce tick-borne transmission of T. parva. Here we report the evaluation of a multivalent vaccine cocktail of tick antigens for their ability to reduce R. appendiculatus feeding success and possibly reduce tick-transmission of T. parva in a natural host-tick-parasite challenge model. METHODS: Cattle were inoculated with a multivalent antigen cocktail containing recombinant tick protective antigen subolesin as well as two additional R. appendiculatus saliva antigens: the cement protein TRP64, and three different histamine binding proteins. The cocktail also contained the T. parva sporozoite antigen p67C. The effect of vaccination on the feeding success of nymphal and adult R. appendiculatus ticks was evaluated together with the effect on transmission of T. parva using a tick challenge model. RESULTS: To our knowledge, this is the first evaluation of the anti-tick effects of these antigens in the natural host-tick-parasite combination. In spite of evidence of strong immune responses to all of the antigens in the cocktail, vaccination with this combination of tick and parasite antigens did not appear to effect tick feeding success or reduce transmission of T. parva. CONCLUSION: The results of this study highlight the importance of early evaluation of anti-tick vaccine candidates in biologically relevant challenge systems using the natural tick-host-parasite combination

Clinical evaluation of Corridor disease in Bos indicus (Boran) cattle naturally infected with buffalo-derived Theileria parva

Corridor disease (CD) is a fatal condition of cattle caused by buffalo-derived Theileria parva. Unlike the related condition, East Coast fever, which results from infection with cattle-derived T. parva, CD has not been extensively studied. We describe in detail the clinical and laboratory findings in cattle naturally infected with buffalo-derived T. parva. Forty-six cattle were exposed to buffalo-derived T. parva under field conditions at the Ol Pejeta Conservancy, Kenya, between 2013 and 2018. The first signs of disease observed in all animals were nasal discharge (mean day of onset was 9 days post-exposure), enlarged lymph nodes (10 days post-exposure), and pyrexia (13.7 days post-exposure). Coughing and labored breathing were observed in more than 50% of animals (14 days post-exposure). Less commonly observed signs, corneal edema (22%) and diarrhea (11%), were observed later in the disease progression (19 days post-exposure). All infections were considered clinically severe, and 42 animals succumbed to infection. The mean time to death across all studies was 18.4 days. The mean time from onset of clinical signs to death was 9 days and from pyrexia to death was 4.8 days, indicating a relatively short duration of clinical illness. There were significant relationships between days to death and the days to first temperature (chi2 = 4.00, p = 0.046), and days to peak temperature (chi2 = 25.81, p = 0.001), animals with earlier onset pyrexia died sooner. These clinical indicators may be useful for assessing the severity of disease in the future. All infections were confirmed by the presence of macroschizonts in lymph node biopsies (mean time to parasitosis was 11 days). Piroplasms were detected in the blood of two animals (4%) and 20 (43%) animals seroconverted. In this study, we demonstrate the successful approach to an experimental field study for CD in cattle. We also describe the clinical progression of CD in naturally infected cattle, including the onset and severity of clinical signs and pathology. Laboratory diagnoses based on examination of blood samples are unreliable, and alternatives may not be available to cattle keepers. The rapid development of CD requires recognition of the clinical signs, which may be useful for early diagnosis of the disease and effective intervention for affected animals

Inherited tolerance in cattle to the apicomplexan protozoan Theileria parva is associated with decreased proliferation of parasite-infected lymphocytes

Theileria parva is the causative agent of East Coast fever and Corridor disease, which are fatal, economically important diseases of cattle in eastern, central and southern Africa. Improved methods of control of the diseases are urgently required. The parasite transforms host lymphocytes, resulting in a rapid, clonal expansion of infected cells. Resistance to the disease has long been reported in cattle from T. parva-endemic areas. We reveal here that first- and second-generation descendants of a single Bos indicus bull survived severe challenge with T. parva, (overall survival rate 57.3% compared to 8.7% for unrelated animals) in a series of five field studies. Tolerant cattle displayed a delayed and less severe parasitosis and febrile response than unrelated animals. The in vitro proliferation of cells from surviving cattle was much reduced compared to those from animals that succumbed to infection. Additionally, some pro-inflammatory cytokines such as IL1β, IL6, TNFα or TGFβ which are usually strongly expressed in susceptible animals and are known to regulate cell growth or motility, remain low in tolerant animals. This correlates with the reduced proliferation and less severe clinical reactions observed in tolerant cattle. The results show for the first time that the inherited tolerance to T. parva is associated with decreased proliferation of infected lymphocytes. The results are discussed in terms of whether the reduced proliferation is the result of a perturbation of the transformation mechanism induced in infected cells or is due to an innate immune response present in the tolerant cattle

Tourism culture(s): The Hospitality Dimension

The focus of the paper is on tourism culture as it operates where commercial hospitality is on offer, especially at hotels and resorts in developing countries. It is suggested that three quite distinct perspectives can assist in helping us understand this aspect of tourism culture, which emerges where worker and tourist roles inevitably converge and interact. In themselves, such perspectives are not new, but they rarely seem to have been applied in the context of hotels and resorts. The first perspective, derived from the work of Homi Bhabha, conceives of tourism culture as hybrid in nature, operating in a ‘third space’ between tourist and ‘host,’ and directs attention to the uncertain and negotiated aspects of tourism culture. In the second, that of the socio-technical system, tourism culture is seen as an interface between, on the one hand, the formal operational rules and procedures designed to deliver an organisation’s mission and, on the other hand, the on-going and lived-in cultures brought into the ‘system’ by tourists and the hospitality providers. The third perspective, that of the total institution, derived from Goffman, focuses to the social and physical boundaries that separate the hotel or resort from the outside world and on the cultural practices that serve to further differentiate it and its population from the outside. It is suggested that use of these perspectives can further our understanding of the nature of tourism at different destinations and the ways hotels and similar institutions impact on both staff members and holidaymakers. As a consequence, they are theoretically, empirically relevant and politically important

Maternal anaemia and duration of zidovudine in antiretroviral regimens for preventing mother-to-child transmission: a randomized trial in three African countries

Background: Although substantiated by little evidence, concerns about zidovudine-related anaemia in pregnancy have influenced antiretroviral (ARV) regimen choice for preventing mother-to-child transmission of HIV-1, especially in settings where anaemia is common. Methods: Eligible HIV-infected pregnant women in Burkina Faso, Kenya and South Africa were followed from 28 weeks of pregnancy until 12–24 months after delivery (n = 1070). Women with a CD4 count of 200-500cells/mm3 and gestational age 28–36 weeks were randomly assigned to zidovudine-containing triple-ARV prophylaxis continued during breastfeeding up to 6-months, or to zidovudine during pregnancy plus single-dose nevirapine (sd-NVP) at labour. Additionally, two cohorts were established, women with CD4 counts: \u3c200 cells/mm3 initiated antiretroviral therapy, and \u3e500 cells/mm3 received zidovudine during pregnancy plus sd-NVP at labour. Mild (haemoglobin 8.0-10.9 g/dl) and severe anaemia (haemoglobin \u3c 8.0 g/dl) occurrence were assessed across study arms, using Kaplan-Meier and multivariable Cox proportional hazards models. Results: At enrolment (corresponded to a median 32 weeks gestation), median haemoglobin was 10.3 g/dl (IQR = 9.2-11.1). Severe anaemia occurred subsequently in 194 (18.1%) women, mostly in those with low baseline haemoglobin, lowest socio-economic category, advanced HIV disease, prolonged breastfeeding (≥6 months) and shorter ARV exposure. Severe an- aemia incidence was similar in the randomized arms (equivalence P-value = 0.32). After 1–2 months of ARV’s, severe anaemia was significantly reduced in all groups, though remained highest in the low CD4 cohort. Conclusions: Severe anaemia occurs at a similar rate in women receiving longer triple zidovudine-containing regimens or shorter prophylaxis. Pregnant women with pre-existing anaemia and advanced HIV disease require close monitoring