A high rate of Human Immunodeficiency Virus infection among suspected Tuberculosis cases in Western Kenya

Background: Kenya is a high HIV/AIDS prevalence country and the epidemic has been declared a national disaster, and is at top of the government’s agenda. Objective: To determine the prevalence of HIV infection among suspected tuberculosis (TB) cases seeking healthcare at chest and paediatric clinics in Western Kenya. Methods: This cross-sectional study was done between 2007 and 2009. A total of 695 suspected TB cases (388 males and 312 females) were screened for HIV infection using Trinity Biotech Uni-Gold TM test and positives confirmed with the enzyme linked immunosorbent assay. A questionnaire was used to collect demographic data of the participants. Results: In total, 272 (39.1%) of the suspects were HIV infected 50.7% females and 48.3% males. Females were significantly affected than males [OR = 0.69; 95% CI: 0.51-0.94; P = 0.02]. The majority (39.3%) of the HIV cases were in the 25-34 age-group followed by the 35-44 (24.6%) and 15-24 (15.8%) age-groups respectively. Only 16.9% of HIV-infected cases were on antiretroviral therapy. Conclusions: The prevalence of HIV infection among suspected TB cases was 39.1%, which was relatively lower than 48%, 45% and 44% prevalence rates reported by Division of Leprosy Tuberculosis and Lung Disease (DLTLD) in the annual reports of 2007, 2008 and 2009, respectively. However, it was much higher the current national average HIV prevalence of 7.2%. Keywords: HIV prevalence; healthcare seekers; chest and paediatric clinics; suspected TB case

Endemicity and increasing incidence of leprosy in Kenya and other world epidemiologic regions: A review

Introduction: Leprosy ancient disease also called Hansen’s disease, is a chronic, progressive infectious disease caused by the bacterium Mycobacterium leprae. An obligate intracellular parasite, and a close relative of the Mycobacterium tuberculosis. It primarily affects the nerves of the extremities (peripheral nerves), the lining (mucous membranes) of the nose, eyes, and the upper respiratory tract. It produces skin sores, nerve damage, and muscle weakness leading to deformity and erosion. Aim: This review article was to theorize and hypothesize the recurrence of unique human, M. leprae or environmental characteristics that favour the endemicity, prolonged survival and Leprosy transmission in the affected epidemiologic regions, including parts of Kenya. Highlight the age old traditional line of perception about this disease Objective: Even though global efforts to control Leprosy by intensive multi-drug chemotherapy (MDT) since 1964 have led to a significant decrease in the number of reported new cases. The disease continues to be endemic in many epidemiologic regions. Some regions experiencing increasing incidence.  The disease has afflicted humankind throughout history leaving evidence in both early texts and archaeological record. Leprosy’s origins have reportedly existed as late as 3,500 BC. However, some of the earliest written records that accurately reflect leprosy appears to be from the 600 BC Sushruta Samhita text from India. The interplay of emotional and social factors modify or transform the life programme of persons afflicted with leprosy. Just like the current pandemic cancers, Leprosy is still a crucial global health concern. The MDT for leprosy was designed to prevent emergence and transmission of drug-resistant M. leprae strains. However, in the African epidemiologic regions, Peer reviewed articles on the Internet, Journals and Relevant topics in textbooks were reviewed. Methodology:  A literature review was done to up-date the socio-cultural perception of leprosy in Indian religions and ancient texts' references were obtained through examining relevant bibliographies and the views/suggestions of eminent scholars engaged in this field39 A Sociological study was carried out in respondents of a Lepers Colony (Gandhi Kusth Ashram), Jodhpur, India. An attempt was made to study the knowledge about causation of Leprosy, age at onset, and treatment. The reason for leaving their original place of origin (South India) was asked. A majority (95.2%) of patients were Hindus, had onset of leprosy in the age group of below 20 to 30 years (80.94%) they had a literacy rate of 6.3% only.  Leprosy is most challenging to behavioral scientists interested in the description and theory of medical sociology as a psychosocial phenomenon. However, the country is currently battling with resurgence of the disease, which is characterized with high numbers of relapses. Conclusion: The observed continued endemicity and increasing incidence of leprosy in some epidemiologic regions raised the assumption of the existence of unique human, M. laprae or environmental factors that favour prolonged survival and transmission of M. leprae. Unique strains of M. leprae with selective advantage to circumvent BCG induced immunity, or resistant to anti-leprotic drugs may also have emerged. Further interrogation of this assumption could generate valuable information for improved control of leprosy.  Key words: Mycobacterium leprae, leprosy, endemicity, incidence, re-emergence, contro

Patterns of risky sexual behavior and associated factors among undergraduates in the Coastal region of Kenya

Background: The majority of students in the institutions of higher learning are single, young adults who easily fall prey to exuberance coupled with adequate freedom in campus life that predisposes them to High Risky Sexual Behaviour. Effective response to the challenges of risky sexual behaviour and mitigation of its negative effects on youth relies mainly on accurate information from the extent of the problem among this age group. Introduction: The purpose of this study was to determine the pattern of Risky Sexual Behaviour and the associated factors among first year University students in the Coastal region, Kenya. Methodology: A cross-sectional study involving 473 first year undergraduate students was carried out in two public Universities in the coastal region in Kenya. Data was collected using self-administered questionnaire. Results: Majority of the students were within the age of 17-20 years and a mean age of 19.6 (SD+ 1.79 years). More than half of the respondents (59.4%), had once had sex before. Majority of the students, 195(41.2%) had their first sexual intercourse within the age of 15-19 years, while a total of 67(14%) had their sexual debut at the age of 7-14years. Only 32.5% had used condoms consistently in the last twelve months. The male gender was associated with the history of having had sex, early sexual debut, multiple sexual partners, inconsistent use of condoms and having sex under the influence of alcohol. Conclusion: The respondents were relatively young and had significant Risky sexual behavior exhibited by early sexual debut, multiple sexual partners and low prevalence of condom use. Those in authority need to have a fresh look into the issue of child sexual molestation  Key words: Risky Sexual Behaviour, University Students, Condom Use, Sexual Debu

A Qualitative Study on Alcohol and Drug Abuse among Undergraduate (University Students) in The Coastal Region of Kenya

BACKGROUND: Substance use poses a significant threat to the health, social and economic fabric of families, communities and nations. In Kenya, alcohol and drug abuse has been identified as a hindrance to education, development and by extension, to national development. Alcohol and drug abuse has been associated with crime and indiscipline e.g. poor class attendance, poor performance, school dropout and destructive strikes that lead to damage the institution property or even death. Alcohol and drug abusers are also likely to lower their morals and engage in risky sexual activities that can lead to sexually transmitted diseases including HIV infection and AIDS. OBJECTIVES: The aim of this study therefore was to explore on the perceptions and the magnitude of substance abuse among undergraduate (University students) in the two public Universities in the coastal region of Kenya. Also find amicable solutions to curb the menace that can destroy the future of a generation aged between 18–29 years at the peak of their life. METHODOLOGY: This was a qualitative study involving undergraduate (University students), dean of students and counsellors from Pwani University and Technical University of Mombasa. Focus Group Discussions(FGDs) and Key informant interviews were used to collect data. The number of KIIs was guided by data saturation. Thematic analysis was done by identifying, coding, and categorizing patterns or themes found in the data. RESULTS: The problem of alcohol and substance abuse among undergraduate students was a reality. The commonly abused substances were alcohol, miraa (khat), marijuana (cannabis) and cigarettes. Some of the factors predisposing students to abuse drugs were; easy accessibility to drugs, peer pressure, availability of funds, excess freedom, male gender, stress, not being active in religious activities, poor parenting and the African culture that uphold substances such as alcohol as an acceptable social drink. Participants noted that alcohol and drug abuse had led to various negative effects. The major ones affecting the students being poor performance, risky sexual behaviour, and mental disturbances. Participants suggested that Universities ought to intensify awareness campaigns to sensitize students against substance use. CONCLUSION: The commonly abused substances were alcohol, marijuana, miraa (Khat) and tobacco. Alcohol and drug abuse has left a negative impact among undergraduates (university students). The main consequences being; discontinuation of studies, mental disturbances and risky sexual activities. All stakeholders must take action creating awareness among students on the negative effects of substance abuse. Universities should set up programs with an aim to curb substance abuse in the institutions of higher learning. The government should reinforce the set laws and regulations and deal with trafficking of illicit substances into the country. Keywords: Alcohol and drug abuse, substance abuse, undergraduate students, qualitative study, Keny

Low anti tuberculosis drug resistance despite high rates of recurrent tuberculosis and HIV infection in western Kenya

Background: The high rates of recurrent tuberculosis and HIV in Kenya raised the assumption that anti -tuberculosis drug resistance may be an increasing problem. Objective: To determine whether HIV co infection and TB recurrence are associated with anti TB drug resistance. Methods: Cross sectional study in which sputa from 872 TB suspects underwent ZN smear microscopy and culture. Growth was identified using Hain molecular identification kits. Screening for HIV infection was done using Uni GoldTM rapid test and the positives confirmed with enzyme linked immunosorbent assay. Results: A total of 186 M. tuberculosis complex and 15 non tuberculous mycobacteria isolates were obtained. The tuberculosis recurrence and TB HIV co infection rates amounted to 44.8% and 41.8%, respectively. All the 186 M. tuberculosis isolates were susceptible to streptomycin and ethambutol. Only 12 (6.5%) of the isolates were mono drug resistant, nine to isoniazid and three to rifampicin. Only 3/27 isoniazid resistant isolates were from recurrent TB cases. Conclusion and recommendation: No MDR strains of M. tuberculosis were observed in the current study. However, the study suggests an association between HIV co-infection and anti TB mono drug resistance. High TB recurrence observed in the current study was not associated with anti TB drug resistance. What needs to be examined is the cause of this high TB recurrence rate in Western Kenya. Keywords: Recurrent TB; HIV co infection; antiTB drug resistance; prevalenc

A high rate of recurrent tuberculosis in western Kenya independent of human immunodeficiency virus infection

Background: Previous studies have shown that recurrent TB develops in about 2-5% of the patients after curative treatment with short-course anti-TB chemotherapy. With the advent of HIV/AIDS, the rate TB recurrence is anticipated to rise. Objectives: To determine whether HIV infection and TB recurrence are associated with anti-TB drug resistance and the rates of ZN microscopy and culture positivity among the recurrent TB cases in western Kenya. Design and methods: A cross-sectional study was carried out between 2007 and 2009. Sputa from 872 tuberculosis suspects underwent mycobacteriologic evaluation using Ziehl Neelsen smear microscopy, LowensteinJensen and BACTEC MGIT 960 culturing, and Hain’s GenoType® Mycobacterium CM and GenoType® Mycobacterium AS molecular identification tests. Consenting participants were screened for HIV infection using Uni-Gold TM test and positives were confirmed with the enzyme linked immunosorbent assay. Results: In total, 361/872 (41%) of the suspects mycobacterial disease (346 TB, 4.2% non-tuberculous mycobacterial disease). HIV testing was accepted by 695 (79.7%) and 39.1% of these (272/695) were found positive. Recurrence of TB constituted 44.8% (155/346) of the TB cases, with 41.9% (65/155) of them co-infected with HIV. There was nosignificant difference in TB recurrence rates with HIV status [OR = 0.57; 95% CI: 0.29-1.13; P = 0.10]. Conclusions and recommendations: This study reports a much higher (44.8%) rate of recurrent TB, compared to that of National TB control Programme of 5% in 2008 and a combined retreatment rate of 14% in 2009. The HIV co-infection and TB recurrence were not associated with anti-TB drug resistance. The majority of TB recurrent cases were ZN smear negative (67.7%) and culture negative (80%). The high TB recurrence observed in this study calls for studies to determine the proportions of the disease attributable to endogenous re-activation (relapse) and exogenous re-infection. Keywords: Recurrent tuberculosis; HIV co-infectio