Systematic epidemiological studies to identify and resolve health constraints to smallholder dairy production in coastal lowland Kenya

Since 1989, a step-wise series of farming systems surveys and epidemiological studies have been carried out in coastal Kenya to identify and resolve major disease constraints affecting smallholder dairy production. This paper describes the sequential studies and reports on the significance of, and intervention against, East Coast fever (ECF). The study was carried out in Kaloleni Division which has three agro-ecological zones (AEZ). In the point-prevalence study, exposure to ECF 20, measured by detection of antibodies to T. Parva schizonts in the indirect fluorescent antibody test, was influenced by AEZ and grazing system. In the wetter areas T. Parva antibody prevalence in free grazing cattle was higher than in drier area while in the wetter zero-grazed dairy cattle had a lower prevalence than those in the free-grazing system

Environment and farm factors associated with exposure to Theileria parva infection in cattle under traditional mixed farming system in Mbeere District, Kenya

The objective of this study was to investigate the relationship between seroprevalence to Theileria parva infection in cattle and potential environmental and farm-level effects in 80 farms under traditional crop–livestock system in Mbeere District, Kenya. A standardized questionnaire was used to collect the effects characteristics as related to T. parva infection epidemiology. Serum samples were collected from 440 cattle of all ages for detection of T. parva antibodies by the enzyme-linked immunosorbent assay technique. The association between the variables was assessed using a generalized estimation equation logistic regression model. The overall T. parva seroprevalence, accounting for correlation of responses, was 19.3% (95% confidence interval (CI) 14%, 25%). Two variables, “administrative division” and “presence of the vector tick on the farm”, were significantly associated with the T. parva seroresponse. Respectively, cattle from farms in Gachoka, Evurore, and Mwea divisions were (and their 95% CI) 1.3 (0.36, 4.8), 4.4 (1.2, 15.9), and 15.2 (4.9, 47.1) times more likely to be seropositive relative to those from Siakago Division (P=0.000). Cattle from farms in which the vector tick was present were 2.9 (1.2, 6.7) times more likely to be seropositive (P=0.011). Results of this study suggested that both environmental and farm factors may be associated with T. parva infection epidemiology in Mbeere District. Under such circumstances, characterization of environmental suitability for the vector tick and corresponding environment-specific farm management practices in the district is required both for improved understanding of the disease and in planning disease control programs

Estimating seroprevalence and variation to four tick-borne infections and determination of associated risk factors in cattle under traditional mixed farming system in Mbeere District, Kenya

A cross-sectional study of serum antibody responses of cattle to tick-borne disease (TBD) parasites (Theileria parva, Theileria mutans, Anaplasma marginale and Babesia bigemina) was conducted on traditional smallholder mixed farms in Mbeere District in Kenya. The objective was to estimate the infections’ seroprevalence and variation and identify associated risk factors. A total of 440 cattle in 80 farms, selected by stratified random sampling from the four divisions in the district, were surveyed. Information on animal and on each farm's management practices, particularly on tick control practices, was obtained by personal interview using a standardized questionnaire. Prevalences of serum antibodies were determined using the enzyme-linked immunosorbent assay (ELISA) technique. The relationship between TBDs seroprevalence and the risk factors was assessed by multivariable analysis using standard logistic regression models and mixed models using the farm as a random effect. Overall estimation of seroprevalences and their 95% confidence limits were: T. parva (19% [14%, 25%]), T. mutans (25% [20%, 29%]), A. marginale (58% [52%, 64%]) and B. bigemina (19% [15%, 23%]). Analysis in presence of extra-binomial variation under Analysis Of Variance (ANOVA) yielded relatively larger intra-farm correlation coefficient (ICC) (0.3) and variance-inflation factor (VIF) (2.35) values for T. parva than for the other parasites [range, 0.05–0.07 (for ICC) and 1.02–1.32 (for VIF)]. Both farm- and area-level variables had variably significant and large effects on all infections, but these were more pronounced on T. parva seroprevalence. Inclusion of farm random effect resulted in substantially higher estimate of farm variance component for T. parva infection (1.73) compared to other infections [range, 0.29–0.56], comparable ICC values with those under ANOVA analysis [range, 0.08–0.35] and a substantially better fit than the standard multivariable logistic regressions. The above results serve as possible indicators of existence of endemic instability for the studied TBD infections in the district. A probable differential ecological and climatic variability in vector suitability habitats, particularly for T. parva vector, was likely in Mbeere District and this was suggested to influence farm tick control management across the area. Implications of the design-based sampling and analyses on the above results are also discussed

Some preliminary observations on the susceptibility and resistance of different cattle breeds to <i>Theileria parva</i> infection

Theileria parva-naïve Friesian (Bos taurus), Boran (Bos indicus) and Maasai Zebu steers (B. indicus) were infected with a T. parva sporozoite stabilate dose which had previously been shown to induce an estimated 50 % mortality rate in Boran cattle. All the cattle developed patent infections with no significant differences in the length of the prepatent period to development of macroschizonts (P > 0.05) between the three groups. Clinical theileriosis occurred in all eight the Friesians (100 %), five out of nine Borans (55.6 %) and two out of five Zebus (40 %). Three of the Friesians (37.5 %), and two of the Borans (22.2 %) died of theileriosis. The different cattle types were equally susceptible to the infective dose used as indicated by the length of the prepatent periods, but there was a marked difference in their development of clinical theileriosis. The gradation in resistance to disease confirms the findings of earlier less critical studies and identifies these cattle breeds as suitable for investigations into the mechanisms of resistance to theileriosis

Epidemiology of East Coast fever (Theileria parva infection) in Kenya: Past, present and the future

In this article, we review the epidemiology of East Coast fever (ECF), a tick borne infection of cattle, in Kenya. The major factors associated with epidemiology of ECF include the agro-ecological zone (AEZ), livestock production system (LPS) and both animal breed and age. These factors appear to influence the epidemiology of ECF through structured gradients. We further show that the gradients are dynamically shaped by socio-demographic and environmental processes. For a vector-borne disease whose transmission depends on environmental characteristics that influence vector dynamics, a change in the environment implies a change in the epidemiology of the disease. The review recommends that future ECF epidemiological studies should account for these factors and the dynamic interactions between them. In Kenya, ECF control has previously relied predominantly on tick control using acaricides and chemotherapy while ECF immunization is steadily being disseminated. We highlight the contribution of ECF epidemiology and economics in the design of production system and/or geographical area-specific integrated control strategies based on both the dynamic epidemiological risk of the disease and economic impacts of control strategies. In all production systems (except marginal areas), economic analyses demonstrate that integrated control in which ECF immunization is always an important component, can play an important role in the overall control of the disease. Indeed, Kenya has recently approved ECF immunization in all production systems (except in marginal areas). If the infrastructure of the vaccine production and distribution can be heightened, large ECF endemic areas are expected to be endemically stable and the disease controlled. Finally, the review points the way for future research by identifying scenario analyses as a critical methodology on which to base future investigations on how both dynamic livestock management systems and patterns of land use influence the dynamics and complexity of ECF epidemiology and the implications for control

Population attributable fractions of farm vector tick (Rhipicephalus appendiculatus) presence on Theileria parva infection seroprevalence under endemic instability

The primary objective of this study was to assess the impact of Rhipicephalus appendiculatus tick presence (exposure variable) on Theileria parva infection seroprevalence (outcome variable) in a group of cattle belonging to a farm using population attributable fractions (PAF). The analyses were based on a representative sample of 80 traditional smallholder mixed farms. The farms were selected by first stratifying the population administratively and implementing a multistage random sampling in Mbeere district in Kenya. The PAFs were estimated using the stratified, Bruzzi, and sequential partitioned PAF approaches. A secondary objective was, thus, to evaluate the impact of the approaches on the PAF estimates. The stratified and Bruzzi approaches estimated proportion of T. parva infection cases directly attributable to the exposure after controlling for confounding by agro-ecological zone (AEZ). The sequential partitioned PAF approach estimated a PAF associated with exposure after adjusting for any effect that the AEZ may have had by influencing the prevalence of the exposure. All analyses were carried out at the farm level where a farm was classified as infested if the tick was found on cattle on a farm, and infected if at least one animal on a farm was positive for T. parva antibodies. Variance estimation for PAFs was implemented using ‘delete-a-group’ jackknife re-sampling method. The stratified PAF (26.7% [95% CI: 9.0%, 44.4%]) and Bruzzi PAF (26.4% [95% CI: 9.6%, 43.2%]) were consistent in estimating a relatively low impact of farm vector tick presence with a relatively high level of uncertainty. The partitioned PAF (15.5% [95% CI: 1.5%, 29.6%]) suggested that part of the impacts estimated using the stratified PAF and Bruzzi approaches was driven by AEZ effects. Overall, the results suggested that under endemic instability in Mbeere district, (1) presence of R. appendiculatus was not a good indicator of T. parva infection occurrence on a farm; (2) ecological variation could play a role in determining infection impacts. This study provides a preliminary basis for evaluating the potential value and utility of estimating PAFs for variables amenable to control in tick-borne diseases (TBDs) epidemiological studies

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran