Factors associated with cholera in Kenya, 2008-2013

Introduction: Kenya experienced widespread cholera outbreaks in 1997-1999 and 2007-2010. The re-emergence of cholera in Kenya in 2015 indicates that cholera remains a public health threat. Understanding past outbreaks is important for preventing future outbreaks. This study investigated the relationship between cholera occurrence in Kenya and various environmental and demographic factors related to water, sanitation, socio-economic status, education, urbanization and availability of health facilities during the time period 2008-2013. Methods: the primary outcome analyzed was the number of cholera cases at the district level, obtained from the Kenya Ministry of Health's national cholera surveillance records. Values of independent variables were obtained from the 2009 Kenya Population and Housing Census and other national surveys. The data were analyzed using a zero-inflated negative binomial regression model. Results: multivariate analysis indicated that the risk of cholera was associated with open defecation, use of unimproved water sources, poverty headcount ratio and the number of health facilities per 100,000 population (p < 0.05). No statistically significant association was found between cholera occurrence and education, percentage of population living in urban areas or population density. Conclusion: the Sustainable Development Goals and Kenya's blueprint for development, Kenya Vision 2030, call for access to sanitation facilities and clean water for all by 2030. Kenya has made important economic strides in recent years but continues to be affected by diseases like cholera that are associated with low socio-economic status. Further expansion of access to sanitation facilities and clean water is necessary for preventing cholera in Kenya

Treatment of shigella infections: why sulfamethoxazole-trimethoprim, tetracyclines and ampicillin should no longer be used

Background: Bloody diarrhoea results in high morbidity and mortality especially in developing countries with shigellosis being the main cause of acute bloody diarrhoea. The use of appropriate antimicrobial agents in the treatment of acute diarrheal disease shortens the duration of illness and bacterial shedding leading to a reduction in morbidity and mortality. Treatment options for many infections are becoming limited due to globally emerging antibiotic resistance. Globally, resistance of shigella species to trimethoprim-sulfamethoxazole (TMP-SMX), tetracyclines and ampicillin has been reported with subsequent recommendations of not using these antimicrobial drugs for empirical therapy of acute bloody diarrhoea.Objective: To establish the antimicrobial susceptibility patterns and antimicrobial drug use for treatment of shigella species in patients with acute bloody diarrhoea.Design: A hospital based case control study.Setting: Six health facilities, three in Kilifi County and three in Nairobi County.Subject: A total of 284 stool specimens were collected from patients who fitted the standard cases definition for acute bloody diarrhoea.Results: Eighty (28.2%) bacterial isolates were recovered from 284 stool samples collected from cases presenting with acute bloody diarrhoea of which 67 (83.8%) were Shigella species, nine (11.3%) were Enteroinvassive Escherichia coli isolates, three (3.8%) were Salmonella Typhi and one (1.3%) were Yersinia enterocolitica. Shigella isolates had high resistance to sulfamethoxazole-trimethoprim (97%), tetracycline (83.6%) ampicillin (58.2%) and chloramphenicol (20.9%). The isolates showed low resistance to nalidixic (4.5%) and ciprofloxacin (3.0%) while there was no resistance to ceftriaxone. The most common multidrug resistance pattern detected in Shigella strains combined sulfamethoxazole-trimethoprim, amoxicillin/ampicillin and tetracyclines.Antibiotic prescriptions were given to 243(85.6%) of the patients presenting with acute bloody diarrhoea. Among these, 94 (38.7%) were given prescriptions for ciprofloxacin, 53 (21.8%) for sulfamethaxazole-trimethiprin and 36(14.8%) for Tetracyclines. Chloramphenicol, amoxicillin/ampicillin, nalidixic acid and ceftriaxone were prescribed to 10.7 %, 3.7%, 2.9% and 0.4% of the patients respectively. A total of 123 (51%) received antibiotics which were ranked to have high resistance (sulfamethoxazole-trimethoprim, tetracyclines ampicillin and chloramphenicol).Conclusion: The high rates of antimicrobial resistance among the commonly prescribed antimicrobials such as sulfamethoxazole-trimethoprim, tetracycline, ampicillin and chloramphenicol is of major concern. Despite recommendations discouraging the empirical use of sulfamethoxazole-trimethoprim, tetracycline, ampicillin and chloramphenicol for treatment of acute bloody diarrhoea, more than half of the patients with acute bloody diarrhoea were still treated with these antibiotics.There is need to train health care workers on the proper management of acute bloody diarrhoea and the importance of adhering to the clinical guidelines

Rift Valley fever virus seroprevalence among ruminants and humans in northeast Kenya

Rift Valley fever (RVF) is a zoonotic vector-borne disease present in much of Africa, and the Arabic peninsula. During outbreaks, the case fatality is high in young ruminants and there may be abortion storms, human disease is usually mild but some may suffer fatal hemorrhagic fever. Outbreaks in East Africa occur after periods of heavy prolonged rains, such as during El Niño southern oscillations, which lead to a sudden increase in the number of vectors hatched. Between outbreaks, there are indications that the virus is still circulating in some ecologies. Kenya has suffered repeated serious outbreaks of RVF, with high morbidity in humans and animals, and also severe economic consequences. In the northern of Kenya, a hot spot for RVF outbreaks, there are continuous expansions of irrigation schemes, which enable the societies to be less susceptible to droughts. However, there are concerns that the increased irrigation would provide more vector breeding grounds, and thus cause people living close to be more exposed to vector-borne diseases. In this study, 1117 serum samples were collected from humans in the age 5-90 years old, in the irrigated area, a riverine area, and the close-by district where people are fully depending on pastoralism. Samples were tested with a competitive ELISA detecting both IgM and IgG antibodies. Overall seroprevalence was 21.9%, and univarible analyses could find no difference between the three areas, but men were found to be significantly more seropositive than women (26.2 and 18.8% respectively, p=0.004). Ruminants (sheep, goats, and cattle) were also sampled within the irrigation. A total of 1997 animals were sampled, and tested with the same ELISA as the human samples. Overall seroprevalence was 25.6%, with no difference between the seroprevalences in goats, sheep and cattle. Juveniles had lower seroprevalence rates than adults, 12.3% compared to 30.2% (p<0.001). Since the last outbreak occurred in 2006-2007, juveniles could not have been infected during that outbreak. In conclusion, the study confirms that RVF can be circulating in ruminants between epidemics in irrigation schemes. However, the human sampling did not show any evidence that living in irrigation schemes would make people more exposed, although the exposure detected here is cumulative and longitudinal surveys may be more suitable to detect differences in infection rates

Integrating scientific and farmers' perception towards evaluation of rain-fed agricultural technologies for sorghum and cowpea productivity in Central Kenya

Integration of a minimal addition of organic and inorganic inputs on valued traditional crops with adequate rainfall under normal farming practices in semi arid lands is an option that may improve food security in the Central highlands of Kenya. Agricultural production is affected by the high variability of rainfall onset, distribution, and frequent droughts which usually occur during the growing season, often resulting in depressed yields and persistent crop failures. This study assessed a farmers’ participatory evaluation on selected water harvesting and integrated soil fertility management technologies for sorghum and cowpea productivity. Their evaluations were consistent and accurate

Adaptive strategies and local innovations of smallholder farmers in selected agri-food systems of central Kenya

Food production in Kenya is closely related to smallholder agricultural production. Paradoxically, many smallholders suffer extended periods of food crises. This underscores the importance of understanding the multiple pathways smallholders use to deal with food insecurity. Participatory action research, using both qualitative and quantitative methods was undertaken to identify adaptation strategies and innovations used to address food insecurity vulnerabilities. A sample of 360 households was drawn randomly from 18 farmers\u2019 groups living under acute food and livelihood crisis (Mbeere South district); experiencing borderline food insecurity (Kirinyaga West District) and those with low resilience (Nyandarua North District) all in Kenya. Results showed that smallholders in these areas use and perpetuate diverse adaptive strategies and innovations for coping with vulnerability, for risk avoidance and for livelihoods insurance enhancement. These strategies and innovations ought to be recognised by research, development and policy actors and should inform interventions intended to strengthen smallholder agri-food systems in Kenya.La production vivri\ue8re au Kenya est \ue9troitement li\ue9e \ue0 la production de petits exploitants agricoles. Paradoxalement, laplupart de ces exploitants souffrent de longues p\ue9riodes de crises alimentaires. Ceci souligne l\u2019importance de la compr\ue9hension de multiples voies et moyens qu\u2019ils utilisent pour faire face \ue0 l\u2019ins\ue9curit\ue9 alimentaire. Une action de recherche participative par des m\ue9thodes qualitatives et quantitatives \ue9tait enterprise pour identifier les strat\ue9gies d\u2019adaptation et innovations utilis\ue9es afin d\u2019adresser les probl\ue8mes li\ue9s \ue0 l\u2019ins\ue9curit\ue9 alimentaire. Un \ue9chantillon de 360 m\ue9nages \ue9tait al\ue9atoirement tir\ue9 de 18 groupes de fermiers vivant sous une crise alimentaire aigue (Mbeere South district); ceux vivant en situation proche de l\u2019ins\ue9curit\ue9 alimentaire (Kirinyaga West District) ainsi que ceux \ue0 faible flexibilit\ue9 \ue0 la situation de famine(Nyandarua North District) au Kenya. Les r\ue9sultats ont montr\ue9 que les petits exploitants des r\ue9gions pr\ue9cit\ue9es utilisent et perp\ue9tuent diverses strat\ue9gies d\u2019adaptation et innovations pour faire face \ue0 la vuln\ue9rabilit\ue9 pour \ue9viter le risque et promouvoir l\u2019assurance quant au gagne-pain quotidien. Ces strat\ue9gies et innovations devraient \ueatre reconnues par la recherche, ainsi que des des acteurs politiques et de d\ue9veloppement et s\u2019en inspirer pour initier des interventions visant \ue0 consolider des syst\ue8mes agro-alimentaires de petits exploitants au Kenya