Community-based approaches to prevention of mother-to-child transmission of HIV: Findings from a low-income community in Kenya

The Horizons program, in partnership with International Medical Corps and Steadman Research Services International, conducted an intervention study in Kibera, an urban slum in Nairobi, Kenya to determine what effect three different community-based activities had on utilization of key prevention of mother-to-child transmission (PMTCT) services. The interventions included moving services closer to the population via mobile clinics, as well as increasing psychosocial support through the use of traditional birth attendants and peer counselors as PMTCT promoters. Data from the study showed that there were positive trends during the study period in most of the PMTCT indicators, including knowledge of MTCT, antenatal care utilization, and delivery in health facilities. However, it is not possible to attribute all these positive trends to the community-based interventions because similar positive trends were observed at the comparison site on most indicators. The report offers recommendations to other organizations exploring community-based PMTCT activities in a similar context

Structural, DNA/BSA binding interactions and cytotoxicity studies of carboxamide (pyridyl)pyrazine palladium(II) complexes

Reactions of ligands [N2, N3-bis(pyridin-2-yl)pyrazine-2,3-dicarboxamide] (L1), [N2, N3-bis(6-methylpyridin-2- yl)pyrazine-2,3-dicarboxamide] (L2), [N2,N3-bis(4-methylpyridin-2-yl)pyrazine-2,3-dicarboxamide] (L3) and [N2, N3-bis(quinoline-8-yl)pyrazine-2,3-dicarboxamide] (L4) with [PdCl2(NCMe)2] afforded the respective palladium(II) complexes: [Pd2(L1)2Cl2] (Pd1), [Pd2(L2)2Cl2] (Pd2), [Pd2(L3)2Cl2] (Pd3) and [Pd(L4)Cl] (Pd4). Molecular structures of complexes Pd1 and Pd3 are dinuclear containing two bridging bidentate ligand units. The interactions of the palladium complexes (Pd1-Pd4) with calf thymus DNA (CT-DNA) were monitored using UV–Vis and fluorescence spectroscopy and revealed intercalative binding modes, with intrinsic binding constants (Kb) in the order of 106 M1. Bovine serum albumin (BSA) interaction was evaluated using fluorescence techniques and displayed a static quenching mechanism. The cytotoxic effects of the complexes Pd1-Pd4 were examined against human breast cancer cell lines MCF-7 and MDA-MB-231, and human transformed lung cell line MRC5-SV2 (a model of lung cancer) and its parental normal lung fibroblast cell line MRC5. While the complexes Pd1 and Pd4 showed significant to moderate cytotoxicity against MCF-7 (IC50 of 11.2 µM and 61.5 µM, respectively), complexes Pd2 and Pd3 were inactive. All the complexes were inactive against the MDA-MB-231 cell line, and Pd2-Pd4 were inactive against the MRC5-SV2 cell line. Compounds Pd1 exhibited lower cytotoxicity against the normal cell line MRC5

Delivery effectiveness of and adherence to intermittent preventive treatment for malaria in pregnancy with dihydroartemisinin-piperaquine with or without targeted information transfer or sulfadoxine-pyrimethamine in western Kenya: a three-armed, pragmatic, open-label, cluster-randomised trial.

BACKGROUND: High-level resistance to sulfadoxine-pyrimethamine threatens the efficacy of WHO-recommended intermittent preventive treatment in pregnancy (IPTp) with single-dose sulfadoxine-pyrimethamine to prevent malaria. Monthly IPTp with dihydroartemisinin-piperaquine, a 3-day regimen, is an emerging alternative, but this regimen poses potential implementation and adherence challenges. We aimed to assess adherence to a multiday IPTp with dihydroartemisinin-piperaquine regimen and its delivery effectiveness in routine antenatal care settings in western Kenya. METHODS: We conducted a pragmatic, three-armed, open-label, cluster-randomised trial in antenatal clinics in 18 health-care facilities (six facilities per group) in Kisumu County and Homa Bay County in western Kenya. Clusters were facilities offering routine antenatal care services provided by trained Ministry of Health staff with 100 or more antenatal clinic attendances per month between July, 2018, and June, 2019. Private or mission hospitals, dispensaries, referral hospitals, and trial sites were excluded. Individuals in their first trimester, living with HIV, or who were not attending a scheduled antenatal clinic visit were excluded. The 18 antenatal clinics were grouped into matched triplets stratified by location and clinics in each matched triplet were randomly assigned to one of the three study groups (1:1:1). Masking was not possible. Two groups were given IPTp with dihydroartemisinin-piperaquine (one group with a targeted information transfer intervention and one group without any additional interventions) and one group was given the standard of care (ie, IPTp with sulfadoxine-pyrimethamine). The primary endpoint, adherence, was defined as the proportion of participants completing their most recent 3-day IPTp with dihydroartemisinin-piperaquine regimen. This completion was verified by pill counts during home visits no more than 2 days after participants' 3-day regimens ended. The secondary endpoint, delivery effectiveness, was defined as the proportion of participants who received the correct number of IPTp tablets and correctly repeated dosing instructions (ie, correctly recalled the instructions they received about self-administered dihydroartemisinin-piperaquine doses and the number of sulfadoxine-pyrimethamine tablets they had received) at their exit from the antenatal clinic. Individuals receiving treatment for malaria, visiting a clinic for registration only, or interviewed during IPTp drug stock-outs were excluded from analyses. We used generalised linear mixed models to compare endpoints among the IPTp with dihydroartemisinin-piperaquine groups. This trial was registered with ClinicalTrials.gov, NCT04160026, and is complete. FINDINGS: 15 facilities (five per group) completed the trial, with 1189 participants having exit interviews (377 in the IPTp with sulfadoxine-pyrimethamine group, 408 in the IPTp with dihydroartemisinin-piperaquine only group, and 404 in the IPTp with dihydroartemisinin-piperaquine plus targeted information transfer intervention group) and 586 participants having home visits (267 in the IPTp with dihydroartemisinin-piperaquine only group and 319 in the IPTp with dihydroartemisinin-piperaquine plus targeted information transfer intervention group) from Sept 8 to Dec 10, 2020. Relative to the IPTp with dihydroartemisinin-piperaquine only group, adherence was 16% higher in the IPTp with dihydroartemisinin-piperaquine plus targeted information transfer intervention group (266 [83%] of 319 participants vs 196 [73%] of 267 participants; adjusted relative risk [RR] 1·16, 95% CI 1·03-1·31; p=0·0140). Delivery effectiveness in the IPTp with dihydroartemisinin-piperaquine plus targeted information transfer intervention group was not significantly different from that in the IPTp with sulfadoxine-pyrimethamine group (352 [87%] of 403 participants vs 335 [89%] of 375 participants; adjusted RR 0·97, 95% CI 0·90-1·05; p=0·4810). However, delivery effectiveness in the IPTp with dihydroartemisinin-piperaquine only group was significantly lower than in the IPTp with sulfadoxine-pyrimethamine group (300 [74%] of 404 participants vs 335 [89%] of 375 participants; 0·84, 0·75-0·95; p=0·0030). INTERPRETATION: Targeted information transfer interventions to health-care providers and pregnant individuals boost antenatal care delivery adherence to a multiday regimen with dihydroartemisinin-piperaquine. FUNDING: European and Developing Countries Clinical Trials Partnership 2, UK Joint Global Health Trials Scheme of the Foreign, Commonwealth and Development Office, Medical Research Council, National Institute for Health and Care Research, and Wellcome Trust; and Swedish International Development Cooperation Agency

Language endangerment and language documentation in Africa

Non peer reviewe

Perennial transmission of malaria in the low altitude areas of Baringo County, Kenya

Abstract Background Malaria causes the greatest public health burden in sub-Saharan Africa where high mortality occurs mainly in children under 5 years of age. Traditionally, malaria has been reported mainly in the lowlands endemic regions of western Kenya, while the highlands of the Rift Valley have been relatively free except for the sporadic epidemics in some areas. Baringo County is located in the Kenyan highlands. The county generally experiences seasonal transmission of malaria. A few hotspots which experience continuous malaria transmission in the county do however exist. The objective of this study was to assess malaria infection status and identify areas with continuous transmissions with a view to mapping out probable transmission hot spots useful in mounting focused interventions within the county. Methods Systematic sampling was employed to identify 1668 primary school pupils from fifteen primary schools located in 4 ecological zones (lowland, midland, highland and riverine) of three sub-counties of Baringo. Finger prick blood sampling was done every 4 months (during the dry season in February/March, after the long rains in June/July and short rains in November 2015). Malaria occurrence was tested using rapid diagnostic test kit (CareStart HRP-2 Pf). Microscopic examination was done on all RDT positive and 10% of negative cases. Results A total of 268 (16.1%), out of 1668 pupils tested positive for Plasmodium falciparum by RDT; 78% had a single episode, 16.8% had 2 episodes, 4.9% had 3 episodes and 0.4% had 4 episodes. The riverine zone had the highest malaria cases (23.2%) followed by lowlands (0.9%). No malaria cases were detected in the midland zone while highland zone recorded only few cases during the third follow up. Up to 10.7% of malaria cases were reported in the dry season, 2.9% during the long rains and 5.7% in short rains season. Conclusions Malaria infection was prevalent in Baringo County and was mainly restricted to the riverine zone where transmission is continuous throughout the year. High malaria prevalence occurred in the dry season compared to the wet season. Even though malaria transmission is relatively low compared to endemic regions of Kenya, there is a need for continued monitoring of transmission dynamics under changing climatic conditions as well as establishing expanded malaria control strategies especially within the riverine zone which would include an integrated mosquito control and chemotherapy for infected individuals

Voices of Children in Schools and Institutions: Individual Questionnaires

The book illustrates an exploratory study to establish the magnitude, nature and intensity of the boy child sexual abuse in Kenya. The study was conducted between January and August 2007 on the streets, in slums, secondary schools and institutions that offer childcare, rehabilitation and medical interventions and reached 205 respondents. This exercise was conducted by a cross-national and interdisciplinary research team across the country

Voices of Professionals: Organizational Questionnaires Data Analysis

The book illustrates an exploratory study to establish the magnitude, nature and intensity of the boy child sexual abuse in the community at large. The study was conducted between January and August 2007 on the streets, in slums,secondary schools and institutions that offer childcare, rehabilitation and medical interventions and reached 205 respondents. This exercise was conducted by a cross-national and interdisciplinary research team across the country

Voices from the Street Population and the Slum Dwellers: Analysis of Interviews Realised in Riruta, Kawangware, Kibera and City Centre

The book illustrates an exploratory study to establish the magnitude, nature and intensity of the boy child sexual abuse in the community at large. The study was conducted between January and August 2007 on the streets, in slums, secondary schools and institutions that offer childcare, rehabilitation and medical interventions and it reached 205 respondents. This exercise was conducted by a cross-national and interdisciplinary research team across the country